Pain – we’ve all felt it. Chronic pain – that is a different story all together! One of AVALA’s Pain Management Physicians, Dr. Ronald Segura with Segura Neuroscience & Pain Center, shares his thoughts in the Healthcare Journal of New Orleans on how chronic pain patients can be helped. Many of these interventional pain procedures are performed at AVALA Hospital.
PAIN MANAGEMENT Q&A
How do you categorize pain, and which type of pain is most difficult to treat?
Pain is categorized by nociceptive, neuropathic, central pain syndrome, acute and chronic. By far, the most difficult pain in the world to treat is chronic central pain syndrome, meaning pain that originates from the brain and spinal cord.
Is being in more pain an inevitable part of aging? If so, what can be done about it?
Yes, pain is an inevitable part of becoming more mature. We can combat suffering pain as we age by exercise. Exercise has shown to be the fountain of youth. Patients who exercise every day or at least three to four days per week live happier, healthier lifestyles with little to no pain.
What are the challenges of treating pain in young individuals versus older?
Challenges of treating pain in young individuals arise when the plan of care for treatment is determined. In general, pain medication is relatively contraindicated in treatment of young patients due to higher prevalence of medication misuse, abuse and addiction. Interventional pain treatments are used with greater success. Challenges of treating pain in older individuals become complicated as older patients have more comorbid issues that prevent or postpone treatment. Also, the older population tends to be on fixed income, and financial hardship limits availability to certain treatment.
Much has been written about the mind-body connections of pain, where uncomfortable thoughts trigger pain in certain points of the body. What are your thoughts on this?
The mind-body connection to pain is a valid concept. I usually refer my patients to a pain psychologist for evaluation and treatment when my clinical suspicion is high that psychological factors are influencing pain.
Pain has been linked to the opioid crisis in the U.S. Do you think that is accurate? Do you think it is a crisis? And if so, what can be done to stop it?
Yes, pain is linked to the opioid crisis in the United States. Yes, there is a crisis, and I believe the current system is doing a good job to combat the crisis.
Because of the addictiveness of many pain killers, pain seems to be one of the few medical conditions where a patient’s motive is questioned. Do you think that is a reasonable thing for a practitioner to do, and how do you handle this?
Yes, treatment of pain using opioid medication is a critical topic in pain management. I screen all my patients for chronic medication misuse and abuse prior to engaging in treatment with opioid medication. The use of strict compliance and frequent urine drug screens aides my ability to determine if patients have developed medication misuse issues and addiction issues. Also, consultation with a pain psychologist is indicated to determine if patients have risk factors for treatment with opioid medication and help determine the best practice in treating these types of patients.
What treatments have you found most successful in targeting patients’ specific conditions?
My clinic is a full-service pain clinic. I use all the tools in my toolbox when treating patients. My tools consist of interventional pain procedures, medication management, physical therapy and chiropractic adjustment as well as psychological support.