Non-Opiate Pain Management
Our non-opiate (non-opioid) chronic pain management program is a multi-disciplinary, integrative approach to managing pain without the use of opioid analgesics or other potentially addictive, habit forming medications likely to be associated with withdrawal symptoms when discontinued.
We engage a Bio-Pscyho-Social model of pain management, meaning that our approach to managing pain includes not only a biological approach with the use of medications and supplements, but also addresses the psychological side of pain in which a person is taught methods of using their mind to improve their experience of pain and enhance coping skill relative to living with chronic pain. We also engage the social side of pain by working with our patient and our patient’s family and significant others, when indicated, to facilitate improved engagement in activities and reduce functional impairment.
We recognize that severe chronic pain can be devastating to quality of life by impairing a person’s ability to enjoy many of the simple joys of life most people take for granted. Our primary goal of managing pain is to restore quality of life by reducing suffering and improving the ability to engage in work-related, domestic and social activities.
As the measure of successful pain management, our goals are to control pain adequately so that our patients are able meet the activity needs of their employment, maintaining their home and yard and getting 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 chronic pain including anxiety and depression.
“Neuromodulator” medications are those that act directly or indirectly on nerves to reduce nerve pain such as sciatica, neuropathy or other nerve pain, 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 even when opioids have previously been ineffective.
Topical medications, or those applied directly to the skin overlying the source of pain, 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 and in many cases improved pain benefit due to enhanced access to the painful tissue. Topical medications can be very effective at safely reducing neck, back and joint pains with minimal likelihood of side effects and are frequently prescribed as a part of the 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 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 chronic headaches, fibromyalgia, arthritis, and chronic neck and back pain.
Evaluation by our physical therapist is included as part of our pain management programs. Patients are assessed by our licensed physical therapist with the goal of identifying how a person’s chronic 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. Included also 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.
Our certified personal trainer provides instruction in safe and effective aerobic and resistance exercise as part of a complete exercise program directed at reducing pain and preventing further injury. We also offer genetic testing to help identify an individualized exercise program genetically based to provide the most efficient exercise program for each patient.
The role of diet and nutrition is extremely important in the management of chronic pain. All patients enrolled in our pain programs are seen and evaluated by a 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 chronic pain. The majority of chronic 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 pain patients as a means of providing safer, more effective pain management. As identified in a study published by Dr. Ehlenberger in 2012, our pain patients 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, Mindful Exercises and Medical Hypnosis
At Accurate Clinic we recognize that “the mind is a powerful thing.” The truth is, when properly trained, patients can harness a great deal of benefit in living with chronic pain by using their mind to apply simply-taught behaviors, including meditation and other “mindful exercises,” simple mind-based activities that allow a person to focus their minds in ways that allow for improved coping with pain and reduced negative impact on quality of life.
Related to meditation and mindful exercises is medical hypnosis, in which a person teams with our hypnotist in guided sessions that can facilitate changes in pain perception and pain coping skills and improved quality of life. After only a few individual sessions with our hypnotist, a patient can acquire the skills needed to successfully perform their own self-guided, self-hypnosis sessions. Contrary to common misconceptions, the participant does not ever lose control of their mind or their behavior and everyone can benefit from medical hypnosis.
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 psyche as a means of reducing pain and improving pain tolerance.
A particularly effective tool for managing pain is to incorporate Cognitive Behavior Therapy (CBT), a collection of techniques and education directed at improving a patient’s skills and ability to adapt to living with chronic pain and improving sleep. CBT also aids in improving communication skill for interacting with both the medical community and family.CBT training is provided in individual and group sessions for those interested or in need of help coping with a life of chronic pain. In addition, a free computer-based CBT education program is provided.
Anxiety and depression are significant and frequent complications of chronic pain and must be addressed for successful pain management. Our licensed counselor is experienced in the problems faced by chronic pain patients and is skilled at providing counseling to assist them. Individual counseling is provided for those patients who need help with anxiety or depression.