The center, which treats patients who do not require or cannot have surgery to correct their pain problem, is located at the Allegheny General Back Institute. The center's staff offers multiple approaches to the control and management of chronic pain resulting from both injury and disease (such as cancer and arthritis). Treatment approaches include the use of anti-inflammatory drugs, anti-depressants, anti-seizure medication, injection and infusion therapy, electrical stimulation, physical therapy and if needed, surgery. In addition, the center's psychological service adds an important dimension to pain management by helping patients learn to cope with issues that often accompany chronic pain.

What is pain chronic?
Pain exhibits itself in many ways. Sometimes, there are no clear-cut reasons or identifiable causes. Pain is considered chronic when it lasts for an extended period of time -- often long after its cause has been repaired or healed. The severity of the pain often has no relationship to the seriousness of the condition that caused it. For example, minor diseases may cause a great deal of pain, yet life-threatening illnesses sometimes result in little pain. Unrelenting pain is often associated with low back, neck, abdominal and postoperative pain, as well as headaches and pain resulting from cancer.

What are the goals of pain treatment?
Untreated chronic pain impairs the quality of life for pain suffered and their families. It can affect every aspect of a person's life, both personal and professional. The key to relieving chronic pain lies in more than just treating the painful areas of the body; it also requires a person to regain control of his life by learning methods to cope with remaining pain or discomfort.

Although each person's treatment is different, there are common goals in all programs, including:

• Using all available and appropriate non-surgical methods of reducing chronic pain

• Decreasing the use of medication

• Increasing physical activity

• Educating patients about the causes of their discomfort

• Reducing stress

• Encouraging patients to be responsible about maintaining their own good health

• Improving communication between patients and their families, friends and co-workers

• Encouraging a return to everyday activities, including work

Who makes up the treatment team?
Clinicians at the Center for Pain Medicine offer a range of care and include:

• Anesthesiologists -- These physicians are board-certified anesthesiologists and consultants in pain medicine. They evaluate a pain issue and the most appropriate methods of treating it. Treatments may include the use of nerve blocks, muscle or joint injections, or infusion therapy. The physicians also treat any medically related problems that may be associated with pain, organize referrals to other healthcare professionals when appropriate, evaluate patient progress and maintain contact with referring physicians.

• Clinical psychologist -- Because pain problems often bring about psychological or psychiatric problems, the Center for Pain Medicine provides care from a doctorally trained clinical psychologist who helps identify the problems and devise a strategy for their treatment. He provides psychological testing when appropriate and offers psychologically oriented, non-pharmacological treatment methods for pain management.

• Clinical nurse specialists -- Clinical nurse specialists are master's degree level nurses with training in pain management. Their primary responsibility is to coordinate patient follow-up and quality assurance. They also focus on patient education and consultation, and work in the community to increase awareness about pain and its management.

• Registered nurse algologists -- These nurses coordinate the activities of the Center for Pain Medicine, assist physicians with procedures and monitor the patients' progress.

• Consultants -- In addition to its own staff members, the center has access to all the other services at  Allegheny General, including: general surgery, internal medicine, neurosurgery, obstetrics and gynecology, oncology, orthopaedic surgery, oral and maxillofacial surgery, occupational and physical therapy, psychiatry and psychology, physiatry and radiology.

How does the Center for Pain Medicine staff approach treatment?
The Center for Pain Medicine staff tries not only to treat pain, but also to diagnose its source. They conduct physical examinations, review available medical records and analyze the patient's description of pain. Sometimes supplemental diagnostic studies such as detailed questionnaires, special X-rays and nerve blocks are helpful to pinpoint the source of the pain.

Because the degree of pain varies from person to person, a treatment plan will be shaped to the patient's special needs. Such treatment may include a single approach or a combination of the following medication, therapies and procedures:

• Anti-inflammatory drugs -- These drugs help reduce swelling and relieve pain.

• Anti-depressants -- Originally used to treat depression, these drugs also may alleviate pain and, as a result, help a patient to sleep.

• Anti-seizure medication -- Such drugs help to relieve certain types of pain by reducing the electrical discharges that transmit pain from the damaged nerves to the brain.

• Injection and infusion therapy -- Local anesthetics, with or without cortisone-like medication, can be injected around nerves or into joints to relieve pain. These injections act to decrease swelling, irritation, muscle spasms and abnormal nerve transmissions. Infusion of analgesic medications, either through spinal or intravenous methods, may be used as a treatment in certain chronic pain conditions. This can be accomplished with external or implanted systems.

• Electrical stimulation -- Transcutaneous electric nerve stimulation (TENS) units are small, battery-powered devices that stimulate nerve fibers through the skin to diminish pain. Spinal catheters that work by electrical stimulation also can be inserted to treat certain types of chronic pain.

• Physical therapy -- Exercise, massage, ultrasound, manipulation and stretching techniques, including the use of biofeedback, often is useful in relieving pain and diminishing stress. Individual and group psychotherapy methods also are used.

• Surgery -- When necessary, surgery may be advised to alleviate chronic pain. Surgery also may be recommended if injections or other treatments provide only temporary relief.

For more information
If you are interested in more information on the Center for Pain Medicine of Allegheny General Hospital, call (412) 359-3005.

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