Pain Management Complementary to Rehabilitation

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The most remarkable difference between a living being and a machine is the ability to heal. The steps necessary for efficient healing from a sports injury, however, are not always intuitive. Physical therapy and rehabilitation can help guide the body toward recovery, but it often requires stressing the injury, which in turn causes pain. While this pain serves a function by relaying feedback about an injury, it can become a limitation to rehabilitation. No one likes to intentionally hurt, and when the recovery exercises are coupled with discomfort, the motivation for getting better can be lost.

Acute pain management, however, can play an instrumental role in facilitating recovery from a sports injury. By controlling the pain, the therapies that guide functional restoration become less burdensome and therefore easier to maintain. Whereas, pain medications have historically been the default treatment to ease rehabilitation, they are also associated with side-effects including nausea, disorientation, constipation, and opiate tolerance. Furthermore, the effects are diluted across the entire body rather than focusing at the point of injury.

Modern pain management techniques employ more than just medication management. The introduction of ultrasound-guided injections has enabled a wide variety of pain control modalities that were previously much more challenging. Focal injections, nerve blocks, and even stem cell therapy help control the pain and facilitate recovery. Moreover, healing in certain conditions may even be accelerated through injections.

Trigger point injections and tendon sheath injections are local injections of numbing medicine with or without steroids. Traditionally they have been done without any image-guidance, but more recently, ultrasound guidance helps to both diagnose the specific cause of the injury in real-time and localize the distribution of medication to the primary source. Conditions treated with such injections include acute injuries such as tendon injury or muscle strains, but also more chronic conditions such as fibromyalgia and myofascial pain.

Peripheral nerve blocks are injections targeting nerves that carry pain signals from the injured site. When an injury takes place, the body responds by ramping up an inflammatory response often resulting in swelling. This inflammation also sensitizes peripheral nerves to respond more intensely and with a greater perception of pain. It is a defensive mechanism to protect the injured site. Peripheral nerve blocks are similar to a reset button and diminish the over-burdening sensitivity. These injections can last from hours to weeks depending on the condition and medications used. Ultrasound guidance is again very helpful in isolating the nerve to avoid affecting any other nerves or causing motor weakness. There are innumerable conditions treated with peripheral nerve blocks, and they include such conditions as post-operative joint pain, arthritis, or nerve injuries coincident with a sports injury.

Platelet-rich Protein (PRP) & Stem-cell therapy is a new arena in sports injury pain management. When an injury takes place, certain blood cells that come into contact with the injured site act as the alarm and recruit other cells to help repair the damage. Because of their versatility and ability to adapt to any tissue type, they are called stem cells. These cells are always present in the bloodstream and can be isolated by using a special centrifuge to concentrate them. The solution of stem cells are then injected at the site of injury using ultrasound guidance to ensure the valuable concentration is directed into the injury. PRP can help accelerate healing of injured tendons and ligaments as well as chronic arthritis. Since it is a newer modality, however, insurance coverage of the procedure can be a barrier.

Dr. Danesh Mazloomdoost is a pain management specialist with Pain Management Medicine in Lexington, Corbin, and Winchester. He can be reached at (859) 275-4878 or via his website, painmm.com.