FRANKFORT One of the latest trends in pain management has made its way to the Bluegrass. Ultrasound, long used in diagnostic medicine, is one of the latest technologies to be deployed in the battle against pain.
In the Central Kentucky clinics of Richard Lingreen, MD, therapeutic injections to treat acute and chronic pain are now made under the guidance of ultrasound imaging. Traditionally, image-guided injections exposed patients to harmful radiation, but today Lingreen’s patients are spared the dangerous side effects of fluoroscopy or x-ray while they reap the benefits and improved performance of the ultrasound-guided approach.
According to Lingreen, ultrasound is a versatile tool that gives the pain medicine practitioner many new ways to address chronic pain. “It helps increase accuracy,” he says, “because I know the depth of injection, and I can actually see the medicine go into the proper area or the proper layers.” In both large and small joint applications, where blind techniques are 65–75% accurate, ultrasound-guided techniques increase Lingreen’s accuracy to almost 90%.
In the case of abdominal pain, where the pain is diffuse, ultrasound plays both a diagnostic and therapeutic role in the performance of diagnostic blocks called TAP, or transabdominal peritoneal injection. While providing some short term pain relief, TAP allows Lingreen to analyze the nuances of abdominal pain and determine which modalities to use to treat it.
“The problem with abdominal pain is that you can actually have one organ causing pain that is felt in a different area. That means you may treat that pain without identifying what the pain generator actually is,” he explains. “One way to approach abdominal pain is from the spinal cord level, with spinal cord stimulation and blocking.
“Alternately, you can approach it from an ultrasound level and block the abdominal musculature to see whether the pain is actually manifested by the muscles or whether it is generated from an internal organ.” With a more accurate diagnosis, Lingreen is better able to determine which treatment modality to use to block the pain.
The net result, for Lingreen, is a new freedom to approach an old problem. “All these many patients who have abdominal pain for whatever reason – pancreatitis, metastases from cancer, spinal cord problems, bladder and pelvic pain problems for both males and females – at least now they have a hope that there is something else out there that can help them out.”
Ultimately, Lingreen may choose to address the pain at the spinal cord level either chemically, with intrathecal pumps, or stimulatory with spinal cord stimulation and blockade devises. Either way, ultrasound provides an opportunity to improve upon medical management of complex abdominal pain.
Professionalism in Pain Management
“There is a need for this technology,” says Lingreen, “and it helps the primary care doctors across the state by providing an avenue for patients that they didn’t know what to do with before.”
Lingreen’s practice, Commonwealth Specialists of Kentucky, Pain Management, works in tandem with referring physicians to help manage pain in a more conductive way and to help patients attain improved functionality. With satellite clinics in Shelbyville, Dry Ridge, Versailles, and Mount Sterling, Lingreen aims to bring advanced pain management tools to underserved areas.
The portability of the ultrasound technology provides a freedom to this purpose. “We can take the ultrasound machine to any clinic and provide accurate diagnostic and therapeutic techniques. There is no need for expensive x-ray or fluoroscopy capacity,” he says, “so we can take our goal comprehensive pain management across the state, even in underserved areas.”
Ultrasound is a versatile tool that gives the pain medicine practitioner many new ways to address chronic pain.
FOR REFERRALS ► Dr. Richard Lingreen at Commonwealth Pain Specialists, PLLC 279 Kings Daughters Dr STE 100 Frankfort KY 40601 (502) 352-2530, Fax (502) 353-2534 www.cwpain.com