Padda Institute Center for Interventional Pain Management

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Interventional pain treatments aim to directly address the source of pain, often by blocking the pain signals from the affected area to the brain. Common interventional pain treatments include epidural steroid injections, nerve blocks, radiofrequency ablation, spinal cord stimulation, and intrathecal pump implants. Physical therapy can also be considered an interventional treatment as it helps improve function and reduce pain. The type of treatment recommended will depend on the cause and location of your pain, your overall health, and how you’ve responded to previous treatments. I encourage a multidisciplinary approach, including psychological support, nutritional advice, and lifestyle modifications along with the interventional procedures to manage the pain effectively.

Opioids can be an effective tool for managing certain types of pain, particularly acute pain such as that experienced after surgery. However, for chronic pain, the picture is more complicated. While opioids can provide short-term relief, they do not treat the underlying cause of the pain. Additionally, long-term use of opioids can lead to tolerance (needing more of the drug to achieve the same effect), dependence, and even addiction. There are also other potential side effects, such as constipation, drowsiness, and suppressed breathing. Therefore, I generally consider opioids as a last resort and focus primarily on other pain management strategies such as interventional procedures, physical therapy, and lifestyle modifications. However, in cases where these strategies are not effective, and the pain is severe, opioids may be considered under careful monitoring.

Lifestyle changes can play a crucial role in managing pain and inflammation. Regular physical activity can strengthen muscles, reduce joint pain, improve flexibility and boost mood, all of which can help manage pain. Diet also plays a key role in inflammation; certain foods can promote inflammation while others can reduce it. For instance, foods rich in omega-3 fatty acids, like fish, and those high in antioxidants, like fruits and vegetables, can help reduce inflammation. In contrast, processed foods and those high in sugar and unhealthy fats can promote inflammation. Maintaining a healthy weight can also reduce pressure on joints and decrease pain. Lastly, smoking and excessive alcohol can exacerbate pain and should be avoided. Sleep and stress management are also vital; both poor sleep and high stress can worsen pain and inflammation.

Metabolic inflammation, also known as metaflammation, is a chronic, low-grade inflammation that can occur in response to excess nutrients and energy. It is commonly associated with obesity and sedentary lifestyle, and it’s thought to contribute to the development of metabolic syndrome, type 2 diabetes, and cardiovascular disease. Research has also shown a link between metabolic inflammation and pain. This may be due to pro-inflammatory molecules, called cytokines, which can be produced in excess in conditions of metabolic inflammation and can trigger pain signaling pathways. Chronic pain conditions, such as fibromyalgia and osteoarthritis, have also been linked with metabolic inflammation. Management of metabolic inflammation involves lifestyle modifications, such as diet changes, increased physical activity, weight loss if overweight, and stress management. Anti-inflammatory medications and certain dietary supplements, such as omega-3 fatty acids, may also be used.

Physical therapy is a crucial component of the multidisciplinary approach to pain management. It aims to improve mobility, restore function, decrease pain, and prevent further injury, which in turn helps enhance overall health. Physical therapy might include exercises to strengthen muscles and improve flexibility, posture corrections, manual therapy techniques, and modalities like heat, cold, and electrical stimulation. It can help patients manage conditions like back pain, arthritis, fibromyalgia, and neuropathy effectively. Physical therapists can also educate patients about the biomechanics of their bodies, helping them to minimize or avoid activities that might exacerbate pain.