Taking Pains with Pain

More than 100 million Americans suffer from some type of chronic pain, a condition that disables more people than cancer or heart disease.  OU's pain medicine specialists offer a wide variety of treatments to make life more tolerable for their patients.

 
Gretchen Wienecke, M.D., and
Badie S. Mansour, M.D., discuss a case.
 

The other physicians in town laughed when Badie S. Mansour, M.D., opened a pain medicine clinic in Wichita, Kan., in the late 1970s.  It simply wasn't a service they were familiar with, Mansour recalled, and very few programs were providing the special training he'd received at the Cleveland Clinic.

Gradually, however, attitudes changed as Mansour and a growing number of pain management specialists demonstrated that their interventional procedures could successfully treat many types of chronic and intractable pain and give patients the relief they had longed for.

Mansour is the Section Chief of OU Pain Medicine of the Department of Anesthesiology, which has its own year-long fellowship program for physicians who have completed anesthesiology, neurology or psychiatry residencies.

Each year the program’s four faculty members, a pain medicine fellow and anesthesiology residents record over 6,500 patient visits. "We see a lot of patients with bad backs -- disk problems and a lot of arthritis," said Gretchen Wienecke, M.D., Associate Professor of Anesthesiology, Clinical Directory of Pain Medicine and Pain Fellowship Director. Several physicians in our group specialize in injection therapy, with options including:

  • Three types of epidural steroid injections that offer relief for patients with back or leg pain associated with disk and pinched nerve (sciatica) problems.
  • Radio-frequency nerve ablation that deactivates minor nerves around the spine and is an effective treatment for patients with spinal arthritis pain.
  • Spinal cord stimulation that delivers low levels of electrical energy directly to nerve fibers via an implanted electrode and successfully treats chronic neuropathic pain. 

The goal of each of these techniques is to decrease the pain sufficiently so that the patient can function as normally as possible.

Of the 100 million Americans with chronic pain, a quarter of them have one or more chronic disorders of the musculoskeletal system.  Myofascial pain syndrome, a common yet often disregarded muscle disorder, is caused by hyperirritable spots called "trigger points."  When these trigger points flare up and spasm, pain can radiate away from the site, even to another muscle, disguising its origin.

"It's very common," Mansour said. "About half of visitors to pain management have myofascial pain even if they think they are coming for another reason.  For example, I had a patient who had two surgeries for carpel tunnel syndrome, but they didn't help.  I treated the trigger point for the pain, and it went away."

Mansour's specialty is in locating the precise location of the trigger point, and "he's the best," said Wienecke.  Mansour credits his years of experience for the skills required to find the trigger point and injecting it properly.  He said that putting a needle in the precise spot can inactivate the trigger point, allowing the muscle to relax, even if all he injects is saline solution. "It's mechanical," he said of the response.  "If I get in that spot, it destroys the source of the pain and the muscle relaxes and the pain goes away."

Mansour said chronic tension headaches, the kind that last for months, can be treated by finding and injecting the trigger point.

In addition to treating their patients’ existing pain, Mansour, Wienecke and their pain medicine colleagues, Doctors Alexander Bautista and Saima Kamal, can also help prevent one type of dreaded pain -- the devastating post-herpetic neuralgia that older patients often experience for months and even years following bouts with herpes zoster or shingles.

On average, one in every five patients with shingles gets post-herpetic neuralgia.  However, the risk of developing this debilitating condition increases with the age of the patient.  Mansour said use of sympathetic nerve blocks early in their disease can significantly reduce the chance that older shingles patients, who are at higher risk for post-herpetic neuralgia, will develop it.

"We advise family physicians to give their older patients the antiviral, and then get them quickly to us for a sympathetic nerve block," Mansour said.  "When we get them early, there's less incidence of post-herpetic pain." 

Reducing patients' pain is the program's overarching goal.

"We aren't to the point yet that we can get rid of all pain, but we should be able to make it tolerable," said Wienecke.  With the addition of physical therapy, medication and coping skills taught by a psychologist, "patients can reduce pain to a tolerable level where they can enjoy life."