A person with pain who is referred to our center will undergo an initial evaluation and consultation to review his or her health history and any diagnostic tests. This initial evaluation is designed to identify an overlooked biological condition that might explain the pain.
A brief psycho-social evaluation is also conducted to identify signs of depression, anxiety, stress or other mental states or major life events that can contribute to suffering. The psycho-social evaluation is also an opportunity to identify those with significant mental health issues that would be better addressed through our
psychiatric pain specialty program.
Because chronic pain often exists in the absence of any obvious root biological cause and because very few of our patients have significant mental health issues, the focus of our pain center is typically on identifying a constellation of modalities that can safely alleviate pain.
Options for Alleviating Pain
Patients are generally encouraged to start their pain rehabilitation conservatively beginning with an emphasis on healthy living.
We strongly encourage our patients to exercise regularly and will work with patients to find an exercise program they can be enjoyed without triggering pain. For many fibromyalgia patients, aerobic exercise is the cornerstone of our treatment approach. Education on diet, stress reduction and other aspects of healthy living are also emphasized to restore or maintain health and to position patients for success if a more invasive procedure such as surgery is eventually needed to control pain. Treatment plans may include:
Complementary or alternative medicine approaches
We offer in-house acupressure, in-house osteopathic manipulation and referrals to mindfulness training and stress reduction programs offered through UC San Diego Health’s integrative medicine center. These modalities have been shown to reduce pain in some people.
Anti-depressants, anti-anxiety and sleep medications may be prescribed, including medical marijuana. Opioid use is discouraged or minimized in most but not all situations. We offer an
opioid detoxification program as well.
Fluoroscopy and ultra-sound-guided injection therapies
These may include steroid injections, epidurals, nerve blocks and high-temperature or pulsed radio-frequency nerve ablations. For muscle pain, we also offer ultra-sound guided injections as well as Botulinum toxin injections. Joint and bursa pain is often treated with hyaluronic joint injections.
Devices may be implanted in individuals to deliver pain medications or stimulate nerves to reduce pain. Some implantable therapies include:
- Intrathecal “pain” pumps, in which medications are delivered directly to the spinal cord
- Spinal cord stimulation implants, which use electrical currents to control or relieve pain
- Intrathecal baclofen (a muscle relaxer) for severe spasticity
Candidates for these more invasive procedures are carefully screened.
As part of an academic medical center, our physicians design and run clinical trials and research studies to develop better strategies for dealing with chronic pain. These trials and studies may be particularly valuable for those who have not responded adequately to conventional treatments. Please contact our clinic or ask your pain doctor for information on whether you are a good candidate for a clinical trial or research study.