Friday, April 20, 2012
Stand up to Pain
Pasquale Ventrone loves going on vacation, although just a few years ago he cringed at the thought. One time he stood at the boarding gate and decided at the last minute that he wasn’t getting on the plane. His back pain was so bad he couldn’t even sit for the few hours it would take to get from New York to Puerto Rico to see his college buddies.
Now 60, Ventrone has had chronic back pain for much of his adult life, stemming from scoliosis (curvature of the spine), spinal stenosis (pressure on nerves) and degenerative disc disease related to arthritis. Pain forced him into early retirement; he couldn’t sit at his workstation without writhing in agony. He had tried just about every therapy imaginable near his home in White Plains, but it wasn’t until he heard someone talk about their success at Greenwich Hospital that he shifted course in search of relief.
Totally frustrated and almost in tears when he arrived, Ventrone met Christian Whitney, DO, a board-certified anesthesiologist who specializes in pain management at Greenwich Hospital’s Sackler Center for Pain Management. Dr. Whitney started with new diagnostic tests and imaging to “map” Ventrone’s back.
“He gave me an injection, and the way he handled it was different than anything I had experienced before,” said Ventrone. “I didn’t feel any pain from the injection itself, and for the first time in about three years I felt like there was a light at the end of the tunnel.”
Dr. Whitney explained, “For all of our interventional pain procedures, we use state-of-the-art imaging guidance such as fluoroscopy, CT scanning, and ultrasound to increase accuracy and safety. We also use conscious sedation.” This was new for Ventrone. Because he was sedated, he stayed comfortable and didn’t move. And that, noted Dr. Whitney, allows the doctor to direct the injection more precisely and with greater ease.
Pain interventions offered at Greenwich Hospital range from routine epidural steroid injections to complex procedures such as spinal cord stimulation. All are performed using the most advanced technology available today.
One procedure that has helped Ventrone is radiofrequency ablation (RFA). This technology uses energy generated by radio waves to block the ability of targeted nerves to transmit pain signals to the brain. For Ventrone, RFA provided relief for about eight months. “Total pain elimination may not be a realistic expectation for all patients, but we do our best to manage the pain, increase functional abilities, and improve the quality of a person’s life,” explained Dr. Whitney.
Greenwich Hospital uses a multidisciplinary team approach to treatment, depending on the patient’s needs. Team members may include interventional and medication pain management specialists, a pharmacist, psychiatrist or psychologist, surgeon, oncologist, physiatrist, physical and occupational therapists, as well as the patient’s primary care physician. The hospital also hosts a bimonthly forum for Chronic Pain Education and a Chronic Pain Support Group where patients and families learn coping techniques. (Search for these programs in our Calendar >>.)
The Pain Team at Greenwich Hospital
Pain specialist Steven Bennett, DO, works with the medication aspect of treatment. He says some patients prefer to manage their pain with medicine because they are frightened by the thought of surgery, or want to put it off as long as possible. As part of the multidisciplinary team, he appreciates the high level of expertise and communication among the staff. “We’re small enough that we work in close proximity, so we can easily confer with each other. That’s a huge advantage.”
“Dr. Bennett asks about your world,” said Ventrone. “He listened to me. He actually got what I was saying when I told him ‘I’m in pain here!’ He’s a very caring man.” Ventrone knows that he may never get rid of his pain for good, but he’s grateful to get it down to a level where he can function socially – to sit through a movie or dinner with friends at a restaurant. The medication prescribed by Dr. Bennett alleviates the shooting pains down his leg and he’s able to sleep through the night.
Nurse practitioner Doreen Chimblo, APRN, another member of the pain team, sensed the anxiety that was digging a hole into Ventrone’s life. “Anxiety and depression are very common among people who suffer from chronic pain,” she noted, adding that they are a main reason why patients see psychologist Jeffrey Lerner, PhD, as part of the multi-pronged pain management approach.
“Being anxious or depressed will amplify the experience of pain,” explained Dr. Lerner. “If I can get a person to feel more comfortable in his life, I can help lessen the anxiety. With less depression and less anger, a patient doesn’t experience pain quite as easily. And it helps to recognize the triggers that make your pain worse.” Lerner teaches cognitive behavioral techniques such as visual imagery and distraction. A positive attitude, he says, can significantly raise a person’s threshold for pain.
Good news for joint replacement patients
Greenwich Hospital has recently made great strides in reducing acute post-surgical pain and medication side effects for patients undergoing knee and hip replacement surgery, thanks to new protocols guided by anesthesiologist Mark Chrostowski, MD.
Before and after surgery, patients receive a nerve block catheter and pump, which administers numbing medication to the area of the affected joint. Ultrasound technology allows the doctor to see the nerves, surrounding muscles and the medication as it spreads around the nerve.
Patients also receive pain medications that include non-opiates, instead of opioids exclusively. The combination of the nerve block catheter/pump and the new medication regimen has had a dramatic effect, according to Dr. Chrostowski. “Joint replacement patients used 32 percent less opioids during their entire hospital stay, and patients who were not given a bedside morphine pump used 53 percent less opioids.”
The new protocols help prevent nausea and other uncomfortable side effects for patients not used to taking opioids on a regular basis. Patients also report a more comfortable recuperation period and require less pain medication as
their healing progresses. “By controlling the pain initially, rehabilitation is easier and more effective,” explained Dr. Chrostowski. “The goal is to get patients discharged faster with a better range of motion.”
Acute pain, chronic pain and opiates
Acute pain is associated with injury, surgery or illness, and usually goes away on its own as the body heals. Short-term opiates are sometimes prescribed to effectively relieve pain in these instances.
Chronic pain may be caused by an ongoing condition such as arthritis, and may not resolve itself. Strong medications classified as opioids are known to
effectively relieve high levels of pain for patients with advanced conditions. Yet, some of these medications are abused as street drugs and may cause dependency under some circumstances. Dr. Bennett stressed the importance of working with a pain management specialist who understands the social as well as medical implications of pain.
”Pain is intangible and not always apparent on scans and other tests,” he explained. “Many doctors are suspicious when a patient comes looking for medication to provide relief. As part of a continuum of care to manage pain, opioid medications have a valued place to improve a person’s quality of life.”
As Ventrone puts it, “When you’re in constant pain, you’re miserable. You make the people around you miserable. People stop inviting you places because you always leave early because it hurts too much to sit.”
Sackler Center for Pain Management
Whether pain is the result of trauma or accident, sports injury, or a medical condition such as diabetic neuropathy, arthritis or shingles, Greenwich Hospital’s Sackler Center for Pain Management offers highly individualized outpatient care. The newest equipment is used to both diagnose and treat a wide variety of pain problems. In addition, the staff works closely with the hospital’s oncology specialists to help manage pain for people undergoing cancer treatment or receiving end-of-life palliative care.
When chronic pain is caused by a complicated interaction involving poor posture, muscle knots, hormones, infection, inflammation, toxin exposure or other lifestyle factors, integrative medicine therapies can be a welcome option for many patients.
“Mind/body approaches are among the essential components of any integrative treatment strategy for those suffering from chronic pain of any sort,” said Henri Roca, MD, medical director of Greenwich Hospital’s Integrative Medicine Program. Services include hypnotherapy, biofeedback, acupuncture, massage
therapy, music therapy, nutritional intervention, supplements and botanicals.
Whether caused by a lifestyle habit that can be corrected, a genetic condition, or an injury, debilitating pain day after day is not something to ignore. For Pasquale Ventrone, getting proper help to manage pain is the difference between feeling isolated and being able to drive someplace that’s more than an hour away. “It means not spending every waking moment in a bad mood,” he said.
Dr. Lerner, the psychologist, says one of the most common things he hears from pain patients is, “I’m not the same person I used to be.” To which he replies, “What is the core of a person? Is it what you think? What you feel? How you are perceived? Remember, you ARE that core person. You need to find that person again. And, with the right help, you can.”
A Pain Procedure Primer
Nerve block – a pain medication, often a steroid and local anesthetic, injected directly around the source of pain
Implanted infusion pump – continuous medication delivered precisely to the source of the pain
Spinal cord stimulator – electrical current delivered to the spinal cord, which interrupts the transmission of pain and causes the release of the body’s natural pain-relieving hormones
Radiofrequency ablation – radio wave energy that selectively disrupts nerve function
Discography – a diagnostic procedure that uses dye injections to determine the exact location of disc pain
Interventional Pain Management
Wednesday, June 6
Noble Conference Center
Christian J. Whitney, DO, Anesthesiologist and Pain Management Specialist
Dr. Whitney will talk about the advanced techniques at Greenwich Hospital for the treatment of acute and chronic pain.
To register, call 203-863-4277 or 888-305-9253 or register online. (This will link you to a separate calendar. We apologize for the inconvenience while we merge our two calendars into one.)