Fletcher Allen, a Vermont university hospital and medical center, serves all of
Vermont and the northern New York region. Located in Burlington, Fletcher Allen is a regional, academic healthcare center and teaching hospital in alliance with the University of Vermont.
Pain Management FAQs
Frequently Asked Questions: Conditions
What is the difference between acute and chronic pain?
Acute pain is a normal sensation triggered in the nervous system to alert you to possible injury and the need to take care of yourself. Chronic pain is different in that it persists beyond the normal duration of an injury. Pain signals keep firing in the nervous system for weeks, months or years.
There may have been an initial event such as a sprained back or serious infection, or there may be an ongoing cause of pain such as arthritis or cancer – but some people suffer chronic pain in the absence of any past injury or evidence of body damage. Common chronic pain complaints include headache, low back pain, cancer pain, arthritis pain, or neuropathic pain.
What is neuropathic pain and how is it different from musculoskeletal pain, such as a muscle sprain ?
We usually think of pain in terms of an injury or inflammation. Pain can serve a useful purpose, because when we are hurt we also protect ourselves to allow healing and to prevent further injury. Neuropathic pain occurs as a result of an injury to a nerve or group of nerves.
It includes a wide variety of disorders affecting any part of the nervous system from the brain to the spinal cord to the smallest nerves in the toes. In some cases, pain sensation fibers send a signal even if there is no painful stimulus. In other cases, sensory signals get crossed and “misread” as pain.
How is cancer pain different from chronic pain ?
Pain associated with cancer can arise from many different causes. A tumor can be painful as it spreads or it can injure other tissues, causing increased pain. Bone pain in particular can be especially severe. Cancer can also affect nerves, resulting in the shooting, burning, or aching characteristics of neuropathic pain.
There can be pain associated with some cancer treatments such as chemotherapy, radiation, or surgery. Complications from cancer such as infection or bone fractures can cause additional pain. In addition, weakness and fatigue (which may occur with chemotherapy) may make any type of pain worse.
Frequently Asked Questions: Treatment
What are some of the main treatments for pain ?
There are a wide variety of treatments for pain. Your doctor will discuss the best treatment for you. Below are explanations of some of the major procedures and therapies available.
Injections and Nerve Blocks
What is an epidural steroid injection ?
A common type of injection given to provide relief from certain types of low back and neck pain. Steroids – potent anti-inflammatory medications -- are injected into the epidural space around spinal nerve roots to relieve pain associated with irritated spinal nerves. The steroid used in the epidural steroid injection reduces the inflammation of those nerves, which is often the source of the pain.
Are there different types of epidural steroid injections ?
Yes. A translaminar epidural steroid injection takes place when the needle is placed between two vertebrae from the back. Also called interlaminar, this method accesses the large epidural space overlying the spinal cord. Medication is delivered to the nerve roots on both the right and left sides of the inflamed area at the same time.
A transforaminal epidural steroid injection is a very selective injection around a specific nerve root. X-ray fluoroscopy is used to guide the needle directly to the neural foramen, the point where the affected spinal nerve root exits the spine. This method treats one side at a time and is used most often for diagnostic purposes or pain limited to one nerve root.
A third type of epidural steroid injection is known as a caudal block, which is placed through the sacral gap (a space below the lumbar spine near the sacrum). The injection is placed into the epidural space. This type of block usually affects the spinal nerves at the end of the spinal canal near the sacrum.
What is a large joint injection ?
A procedure used in the treatment of inflammatory joint conditions such as arthritis. An injection is made into the joint to determine the source of pain or provide pain relief. Injections in the sacroiliac joint, a joint located between the sacrum and pelvic bones, are commonly used to determine what is causing back pain. These injections eliminate pain temporarily by filling the SI joint with an anesthetic medication that numbs the joint, the ligaments, and joint capsule around the SI joint.
If the SI joint is injected and your pain goes away for several hours, then it is very likely that the joint is causing your pain. In addition, cortisone may be injected into the joint to reduce any presumed inflammation, which can provide long-term pain relief.
What is a nerve block ?
Blocks are injections of medication onto or near nerves. The medications that are injected can include local anesthetics or steroids. They are usually performed for diagnostic purposes.
What is a peripheral nerve block ?
The peripheral nerves, nerves located outside the brain and spinal cord, transmit sensation and motor control. They can be damaged by trauma, surgery, scar tissue or illness. Examples of peripheral nerves include the occipital nerves that travel from the cervical spine in the neck to the back of the head and scalp; and intercostal nerves in the chest that can trigger chronic chest wall pain and the ilioinguinal nerve that wraps around the rim of the pelvis and travels to the inguinal (groin) and pubic areas. With a peripheral nerve block, local anesthetic is injected close to the nerve to relieve pain.
Is a trigger point injection the same thing as a nerve block?
Trigger point injections are not truly nerve blocks, but rather injections of local anesthetic into a muscle. Muscles that are chronically tense or in spasm become tender and painful. The pain then triggers more spasm and a vicious cycle develops. When trigger point pain is severe, these areas can be injected with local anesthetics or steroids using tiny needles of variable lengths, to relieve pain.
What is radiofrequency ablation?
A procedure used to control chronic pain that works by destroying nerve tissue, thereby stopping pain signals. Radiofrequency ablation uses an electrode to conduct current that destroys tissue with high temperatures or charged particles. The success of this therapy depends on meticulous placement of the needles. Another type of radiofrequency therapy called pulse radiofrequency exposes the nerve to intermittent low temperature electric currents. The concept of this pulse therapy is to block pain without destroying or damaging nerve tissue.
What are some of the treatments available for disc problems? Are minimally invasive therapies available ?
Doctors will first perform a diagnostic test called a discogram to determine if your pain is caused by a disc. A dye is injected into the disc under pressure and the reproduction of your symptoms is documented. Once the disc is determined to be the source of the problem, your doctor will discuss treatment options with you.
IDET, or IntraDiscal Electrothermal Therapy, and Coblation Nucleoplasty are relatively new, minimally invasive therapies for the treatment of chronic low back pain and sciatica caused by disc problems or degenerative disc disease. With IDET, a needle is inserted into the affected disc with the guidance of an x-ray machine. Doctors carefully position a wire in the injured disc and send heat through the wire. The heat destroys the small nerve fibers that have grown into the cracks and invaded the degenerating disc, producing pain.
Nucleoplasty also involves inserting a needle into the disc. Instead of sending heat through a wire, a special radiofrequency probe is inserted through the needle into the disc. Electrical energy from the probe dissolves tissue in the disc -- decompressing the disc and reducing the pressure both inside the disc and on nerve roots.