Acute Pain Management
The acute pain management program at Accurate Clinic has a multi-disciplinary, integrative approach to managing acute pain, or pain that is experienced for less than 3 months duration. Our focus is on the management of pain associated with recent injury such as occurs with motor vehicle accidents, falls and other trauma. Our multi-modal program includes the use of medications, nutriceuticals and natural supplements along with physical therapy including non-invasive physiotherapy treatments. We believe that it is important to address the psychological aspects of acute injury including the impact of anxiety, depression and post-traumatic stress as well as the impact on sleep. We also educate our patients regarding the role of diet and nutrition and the use of mind-based activities to reduce the impact of pain and facilitate the healing process.
There are four primary goals in the management of acute post-injury pain:
(1) Reduce the severity and duration of the acute post-injury pain
(2) Reduce the risk of the acute post-injury pain from becoming chronic
(3) Enhance the individual’s coping skills relative to living with pain
(4) Facilitate improved engagement in daily activities and reduce functional impairment.
We recognize that pain can be devastating to quality of life by impairing a person’s ability to enjoy many of the simple pleasures of life most people take for granted. We strive to restore our patients quality of life by reducing suffering and controlling pain adequately so our patients are able work, maintain their home and yard and get a good night’s sleep. To meet these goals we integrate many approaches to prevent and reduce pain, to improve skills for coping with pain and to address the complications of pain including anxiety and depression.
At Accurate Clinic we emphasize our role in educating our patients in every aspect of pain. This website offers an extensive education section dedicated to teaching our patients everything we would like them to know about understanding and treating pain. At the top of every page on this website is an “Education” link that directs the reader to the many sections that include not only in-depth discussion of the many topics but also down-loadable medical publication articles that provide the basis of our educational content.
For more information regarding our treatment of acute pain,
The following is a brief overview of some of the treatment options offered in our acute pain management program:
At Accurate Clinic every effort is made to provide medications to control pain that are the safest and offer the least side effects. The most effective approach to control pain is multi-modal, which combines various groups of medications for pain relief that target different pain pathways. This provides the most comprehensive targeting of the different elements of pain as well as allowing for lower doses needed of the individual medications. The most commonly combined medication groups include NSAIDs (non-steroid anti-inflammatory drugs such as ibuprofen and naproxen), acetaminophen (Tylenol), opioids, muscle relaxers and neuromodulators (medications directed at nerve pain). Recent reseach suggests additional classes of medications may offer benefit as well and these are explored in these education sections.
The term “opioid” refers to both the “natural” medications derived from the opium poppy (the “opiates” – morphine and codeine) and synthetic opiate-derived medications including hydrocodone, oxycodone, methadone and many others.
A significant concern in the context of today’s “opioid crisis” is the potential for patients treated with opioids for acute post-injury pain to progress to chronic use of opioids. For most, continued use of opioids is due to continued pain. In part, however, the concern lies in the potential for patients taking opioids for post-injury pain to develop an abusive or addictive relationship with their opioids. As a result of these concerns, it is recommended to minimize opioid use after injury. Emphasis is placed on non-opioid and behavioral approaches for managing pain whenever possible.
While opioids are not always necessary to control acute post-injury pain, for the many people who have failed to obtain adequate control of their pain with other measures, opioid medications can be the backbone of adequate pain management. With few exceptions, all opioids share the same benefits, the potential for abuse and addiction and the same side effects but they may differ significantly in potency. That being said, not all people respond equally to any particular opioid. With genetic testing provided at Accurate Clinic, it may be possible to identify specific opioids best suited for an individual for improved effectiveness and less likelihood of side effects.
Another characteristic of opioids is the potential for developing tolerance, in which the opioid becomes less effective over time. This process often becomes problematic for patients taking opioids for a long time. Understanding this, we offer means of potentially minimizing this problem by careful selection of which opioid to use, the practice of appropriate opioid rotation, and the use of supplements.
Recognizing that opioids are often the backbone of adequate pain control, we strive to seek the safest, most appropriate opioid for the patient at the lowest dose and shortest duration needed to provide adequate pain control while also seeking to avoid the development of tolerance.
Short-acting and Long-acting Opioids
Opioids can be “short-acting,” with a duration of effectiveness generally lasting from 4-6 hours, or “long-acting,” with an effective duration of 12 hours or even as long as one week. The long-acting opioids are for the most part avoided in acute pain management. Our physician will discuss the advantages and disadvantages of these different treatment options on an individual basis in order to devise the most appropriate approach to meet our patient’s needs.
In an effort to reduce reliance solely on opioids for pain control we often prescribe different classes of medications that reduce pain through mechanisms different from opioids, thus obtaining a synergistic effect for controlling pain. “Neuromodulator” medications are those that act directly or indirectly on nerves to reduce nerve pain such as sciatica, neuropathy or other nerve pains generally perceived as burning, electric, tingling or sharp pain.
Examples of neuromodulators include gabapentin (Neurontin), pregabalin (Lyrica), topiramate (Topamax), milnacaprin (Savella), duloxetine (Cymbalta), venlafaxine (Effexor) and others. These medications are usually tolerated well, especially when initially prescribed at low doses followed by slowly increasing the dose as tolerated. Because these medications reduce pain by different mechanisms than opioids, they can be very successful in reducing pain when used synergistically with opioids.
Topical medications are those athat are applied directly to the skin overlying the source of pain and include both commercial brand medications as well as unique blends formulated by our physician and provided by special “compounding” pharmacies. Topical medications offer the advantage of improved safety due to less systemic exposure So there are fewer side effects such as sedation. In many cases topical medications provide improved pain benefit due to enhanced access to the painful tissue. Topical medications can be very effective at safely reducing joint pains with minimal likelihood of side effects. They are frequently prescribed as a part of our multi-modal pain control regimen when appropriate.
Complementary & Alternative Medicine
Complementary & Alternative Medicine (CAM) treatment options are extraordinarily helpful in preventing and reducing many painful conditions and no pain management regimen is complete without considering their use. In our pain management programs, both acute and chronic, we place great emphasis on the use of nutriceuticals and natural supplements with evidence-based effectiveness in reducing the pain associated with such conditions as nerve pain, joint pain including arthritis, neck and back pain.
Evaluation by our licensed physical therapist is available as part of our pain management programs. Patients are assessed by our physical therapist with the goal of identifying how a person’s pain conditions have affected their strength, range of motion and balance in order to develop an individualized home exercise program to improve whatever problems are identified. Also included is assistance in the proper and most beneficial use of canes, braces and other orthotic devices. Our therapist is also available to assist patients in determining effective sleeping positions, pillow placement and mattresses to optimize sleep.
Non-invasive Physiotherapy Treatments
Non-invasive treatment modalities to reduce acute post-injury pain include transcutaneous electrical stimulation, therapeutic ultrasound, manual therapy including various massage techniques, heat and cold packs. Preferred invasive treatment methods include dry needling, local anesthetics, and botulinum injections (Botox).
The role of diet and nutrition is extremely important in the management of pain. All patients enrolled in our pain programs can be seen and evaluated by our registered dietitian including a body composition analysis of those patients who are overweight. Vitamin levels and other biomarkers are assessed routinely in an effort to optimize our patients nutritional status. Pain management patients are educated regarding the role of diet in pain and inflammation and are provided with the tools needed to navigate our modern food culture most effectively.
Of particular importance is the role of oxidative stress in obesity, metabolic syndrome and botha acute and chronic pain. Many pain patients are overweight and need help in successfully losing weight. Our pain management patients are strongly encouraged to enroll in our weight loss program and substantial discounts are provided to the patient and their family for enrollment.
Genetic testing is offered to all of our pain patients as a means of providing safer, more effective pain management. As identified in a study published by Dr. Ehlenberger in 2012, pain patients may have a substantial increased likelihood of having genetic variants in how they metabolize medications. Understanding these variants provides the advantage of safer prescribing by improving the ability to predict the effectiveness of certain medications, their potential for side effects and their potential for drug-drug interactions. As part of our coordinated care program, the impact of these genetic variants can be shared with the patient’s pharmacist and other prescribing clinicians to reduce the likelihood of potentially dangerous drug interactions, a signficant safety concern especially for those people taking multiple medications prescribed by multiple physicians.
Genetic testing also provides insights into a person’s sensitivity to pain and their response to opioids and other medications. Accurate Clinic is active in ongoing research investigating the role of genetics in predicting pain sensitivity, pain tolerance and opioid tolerance. Dr. Ehlenberger’s strong interest and participation in active medical research reflects the importance Accurate Clinic places on a practice based on evidence-based medicine.
Meditation and Mindful Exercises
The mind is an incredibly powerful tool when harnessed to help control pain and reduce suffering. The truth is, when properly trained, patients can gain a great deal of benefit towards living with pain by using their mind to apply simply-taught behaviors, including meditation and other “mindful exercises.” Mindful exercises are simple mind-based activities that allow a person to focus their minds in ways that allow for improved coping with pain and reducing pain’s negative impact on quality of life.
Through the use of medical hypnosis, our patients can learn self-hypnosis techniques that give them the power to use their minds effectively to improve their sense of well-being, their extent of pain and suffering and energy levels. These techniques can be learned quickly, by anyone, in only a few individual sessions and do not require susceptibility by being placed in a trance. Medical hypnosis is safe and contrary to common misconceptions, the participant does not ever lose control of their mind or their behavior and nearly everyone can benefit from learningnmedical hypnosis techniques.
CBT and Counseling
Treating pain is more than just providing medications and physical modalities of management. We believe that it is equally if not more important to address the individual’s psyche as a means of reducing pain and improving the coping skills needed to live with pain.
Cognitive Behavior Therapy (CBT) is a particularly effective tool for managing pain. CBT is a collection of techniques and education directed at improving a patient’s skills and ability to adapt to living with pain and improving sleep. CBT also aids in improving communication skills for interacting with both the medical community and family. CBT training is available to individuals interested or in need of help coping with their pain. In addition, a free computer-based CBT education program is provided.
Anxiety, stress and depression are significant and frequent complications of acute post-injury pain and must be addressed for successful pain management. Our licensed counselor is experienced in the problems faced by pain patients and is skilled at providing counseling to assist them. Individual counseling is available to those patients who need help with anxiety, stress or depression.