The Pain Institute

Q What does it mean to be an anesthesiologist?

Q What does it mean when you say "fellowship-trained in pain management"?

Q I'm having so much trouble with back pain. I teach music at a grammar school and sometimes my back hurts so much I can't even sit down when I'm teaching. I want relief, but without surgery or drugs. What can be done for me?

Q Helping a friend move, I grabbed a box and tried to bring it into her house. The box was so heavy that I could hardly get halfway upstairs before I had to set it down. While I was setting it down I felt something go out in my back. It didn't hurt as much then as it does now. What can be done for me?

Q I've had arthritis in my knees for years. Every day I take aspirin to help stop the pain. Lately the pain has been increasing. Do I have other alternatives besides aspirin?

Q I love to play golf, but I keep experiencing sharp pains and spasms in my shoulder and lower back. Often my golfing partner has to carry my golf clubs back to my car. He told me that the problem may lie within my trigger points in my shoulder and back. What is a trigger point and how would I go about treating it?

Q Two months ago, I was diagnosed with shingles on the right side of my abdomen and chest. Since then, I have continued to have pain even though the blisters are gone. My doctor has diagnosed my condition as post-herpetic neuralgia. What is this and what can be done to treat the pain?

Q Will insurance pay for treatment at The Pain Institute?

Q What does it mean to be an anesthesiologist?

A Anesthesiology is a medical specialty focusing on relief of pain. After receiving an M.D. or D.O. degree and serving an internship, the physician receives specialized training in anesthesiology during an intensive residency period. By passing a rigorous professional examination, the physican may then qualify for board certification in this specialty.

QWhat does it mean when you say "fellowship-trained in pain management"?

A A fellowship is an additional term of training in the subspecialty of pain management, taken after the medical residency. A physician may be board certified in pain management after receiving this special training and passing a professional examination.

QI'm having so much trouble with back pain. I teach music at a grammar school and sometimes my back hurts so much I can't even sit down when I'm teaching. I want relief, but without surgery or drugs. What can be done for me?

AThe Pain Institute utilizes a variety of treatment technologies to help patients return to pain-free, normal, productive lives. Some of the treatments they perform include epidural blocks, medicine management, physical therapy, behavioral therapy, stress management and a host of other interdisciplinary options. If these less-invasive procedures fail, a new medical treatment performed at The Pain Institute could help you. It's called SpineCATH™ IDET. For many chronic pain sufferers, this may be the alternative of choice. SpineCATH™ IDET is a non-surgical, therapeutic procedure that was developed specifically for patients with back pain related to abnormalities of the disc. After the comprehensive treatment, SpineCATH™IDET not only stops the pain associated with degenerative discs but can also significantly improve the mobility of your back. While surgery is the only option for some patients, SpineCATH™ IDET is a viable alternative for many of those suffering from back pain.

QHelping a friend move, I grabbed a box and tried to bring it into her house. The box was so heavy that I could hardly get halfway upstairs before I had to set it down. While I was setting it down I felt something go out in my back. It didn't hurt as much then as it does now. What can be done for me?

A Any forceful accident can injure small joints, stretch and tear ligaments, muscles or nerves in your body. Some injuries can cause a unique problem in that the injury may not create any symptoms for days or weeks following the accident. Generally, these symptoms do not resolve on their own, and can get worse with time. Percutaneous Radio-Frequency Neurotomy, called "Radio Frequency" for short, is a method of alleviating the pain. Basically, Radio Frequency interrupts pain signals by focusing a small amount of radio energy on the nerve tissues sending pain signals to the brain. Larry Zhou, M.D. performs the Radio Frequency procedure under the guidance of x-ray photography. A microelectrode is used to begin the stimulation process. During this process, a patient is asked simple questions. This feedback helps Dr. Zhou focus on and eliminate the pain pathways. This method provides a safe means of relieving back pain. Clinical data shows that Radio Frequency can play a part in long-lasting results for those who suffer from pain.

Q I've had arthritis in my knees for years. Every day I take aspirin to help stop the pain. Lately the pain has been increasing. Do I have other alternatives besides aspirin?

A Many arthritis patients take medication to alleviate pain, but now there are new alternatives that will help alleviate some of the pain. The Pain Institute uses a professional staff of fellowship-trained Board-certified anesthesiologists who are experts in the field of pain management. Michael C. Cronen, D.O., medical director of The Pain Institute, works in conjunction with other specialists, including physicians, nurses, physical therapists and psychologists, to develop personalized treatment plans for patients who suffer from arthritic pain. Very often, Dr. Cronen will administer injections of synvisc or epidural blocks, which are effective because he is able to place a small amount of medicine right at the site of the problem. This has the advantage over ingesting a drug orally because it does not have to be absorbed and carried through the blood stream, which dilutes its effects. These injections offer a new option for those suffering from leg, neck, shoulder and lower back pain.

QI love to play golf, but I keep experiencing sharp pains and spasms in my shoulder and lower back. Often my golfing partner has to carry my golf clubs back to my car. He told me that the problem may lie within my trigger points in my shoulder and back. What is a trigger point and how would I go about treating it?

A In most instances, a trigger point is a focal point of pain. It is an area of irritation in the vicinity of a joint and may include the joint. The irritation is usually caused by a strain, fibromyositis (inflammation of muscle or tendon), or in association with arthritis. In many cases, the pain is very intense and can be associated with muscle spasm. The area is aggravated by movement and can cause severe disability. The most common areas of involvement are the lower back, the hips and the shoulders. However, any area in and around a joint may be involved. The usual treatment, ASA (asprin) and Tylenol, may not relieve the pain and spasm quickly and may take considerable time to achieve significant relief. A quick and effective method to overcome the problem is to pinpoint the area and inject it with a local anesthetic and a small amount of steroid. The anesthetic provides immediate relief and the steroid provides more lasting relief. The shots may have to be repeated, but many patients experience long-term relief with this treatment.

A The same virus that causes chickenpox in a child, is the cause of shingles in an adult. The virus can lie dormant in the nervous system and spinal cord for long periods of time before symptoms are triggered. A variety of things can trigger the activation of this virus, such as u.v. light, stress, or other illnesses. The symptoms tend to occur on only one side of the body. The pain may be present 10-14 days prior to the start of the rash and it may mimic other illnesses, such as heart attacks, peptic ulcer disease and pneumonia. The symptoms associated with an acute outbreak of shingles may consist of red blisters, which will eventually turn into scabbing lesions, associated with itching, or sharp, shooting pain. The pain, which is associated with the nerve endings, can linger up to a month or as long as a year after the rash is gone. This is referred to as post-herpetic neuralgia. A physician may prescribe topical ointments or pain relievers as well as anti-viral medications, electrical stimulation and a new advancement referred to as Lidoderm patches. Lidoderm patches are topical applications of a local anesthetic. This allows relief of the pain due to a numbing effect. If these treatments fail, a series of epidural nerve blocks may be effective to relieve the pain. The procedure involves placing a very small amount of an anti-inflammatory substance (steroid) mixed with a local anesthetic agent into the epidural space. This works better than ingesting a drug orally because that has to be absorbed and carried throughout the bloodstream, which dilutes its effect. The epidural nerve block offers an additional treatment option for patients suffering from shingle or post-herpetic pain.

Q Will insurance pay for treatment at The Pain Institute?

A Treatment at The Pain Institute is covered by most insurance plans. Depending upon the individual plan, a referral from a primary care physician, or specialty care physician such as an orthopaedic surgeon or neurosurgeon, may be necessary. Treating persons in chronic pain and getting them back to their normal lives is the top priority at The Pain Institute. Payment plans are available for people who are uninsured.