Your physician may refer you to the Pain Management Center for evaluation, for one or more specific procedures, or for ongoing treatment. We have prepared this information to provide an overview of services available at the Center and to explain what you may expect during your treatment.
What is Pain?
Because perception and tolerance of pain vary widely from individual to individual, pain is difficult to define and describe. Essentially, pain is the way your brain interprets information about a particular sensation that your body is experiencing. Information (or "signals") about this painful sensation are sent via nerve pathways to your brain. The way in which your brain interprets these signals as "pain" can be affected by many outside factors, some of which can be controlled by special techniques.
Acute pain is of short duration, usually the result of an injury, surgery or illness. This type of pain includes:
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acute injuries
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post-operative pain
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post-trauma pain
Chronic pain is an ongoing condition, such as
Your physician may refer you to the Pain Management Center because your chronic pain condition has not responded to conventional therapies.
Treatments
Treatments for acute and chronic pain are generally quite different.
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In some cases, pain can be stopped or alleviated by a single procedure or series of procedures.
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Sometimes, chronic pain is part of a widespread disease process, and the specific cause may be difficult to pinpoint.
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Once we have identified the specific factor causing the pain, we may be able to treat it so that the condition no longer occurs.
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In some patients, the specific factor causing the pain--such as cancer--cannot be changed, but we may be able to reduce the pain or help the patient to better cope with the pain through a combination of medical, psychological and rehabilitation techniques.
Multidisciplinary Team of Specialists
The Pain Management Center offers the benefit of a multidisciplinary team approach to the diagnosis and treatment of pain. The team includes
- highly experienced physicians (anesthesiologists specializing in pain management and other physician specialists)
- nurses
- psychologists
- rehabilitation specialists
- social workers
The Pain Management Center also has an active basic and clinical research program to ensure that the most advanced treatment options are available to our patients.
Comprehensive Evaluation
Unless your physician refers you to the Pain Management Center to undergo a specific procedure or series of procedures, you will be scheduled to undergo a comprehensive evaluation.
Members of the multidisciplinary team will conduct a full physical and psychological assessment of your condition, including a review of your medical records, and X-rays. In some cases, supplemental diagnostic tests may be necessary to further pinpoint the cause of your pain. (We will, however, avoid unnecessary duplication of tests wherever possible.) We usually ask that you bring a spouse, relative or close friend to the evaluation.
The Pain Management team will hold a multidisciplinary conference to determine whether or not treatment at Stanford holds potential benefits for you, and to develop and individualized treatment plan. Approximately two thirds of all patients are found to be appropriate candidates for treatment at Stanford. Your primary physician will be invited to attend this conference.
If you are a candidate, you will receive a letter from the Pain Management Center, outlining the recommended treatment plan and its approximate duration and cost.
Individualized Treatment Plan
The treatment plan developed by the Pain Management team will be specially tailored to your condition and degree of pain, your needs and your personal objectives. You treatment plan may included:
- a single approach
OR
- a combination of different types of therapies:
- medical therapies
- special procedures
- psychological therapies
- rehabilitation therapies
Medications
Your recommended medical therapy may include one or more medications (analgesics). Different medication are prescribed to treat different aspects of your pain. Your recommended treatment plan may also involve the use of investigational medications.
Medications used to treat pain fall into several major categories:
- Opiate "pain killers" are often used to treat acute pain or cancer-related pain, and sometimes prescribed for chronic pain.
- Anti-inflammatory drugs may be helpful in alleviating pain by reducing swelling and irritation.
- Anti-depressants may be helpful in reducing certain types of pain. They may also be used to help patients sleep at night.
- Membrane stabilizers are helpful for some patients in whom pain is caused by abnormal electrical discharges in damaged nerves.
Stanford offers a variety of procedures to treat pain, including various neural blocks and several innovative procedures available at only Stanford or a few institutions nationwide. Depending on your particular condition, you may be referred for single or ongoing procedural appointments. These procedures may also be used in combination with other therapies.
Some of the procedures available at the Pain Management Center include:
- Epidural Steroid Injection
- Hypogastric Plexus Block
- Intrathecal Programmable Pump/Spinal Cord Drug Delivery
- Intrathecal Catheter Placement
- Occipital Nerve Block
- Implanted Epidural Portal
- Temporary Epidural Catheter
- Brachial Plexus Block
- Peripheral Nerve Block
- Gasserian Ganglion Block
- Facet block
- Stellate ganglion block
- Celiac plexus block
- Lumbar sympathetic block
- Selective nerve block
- Spinal cord Stimulation
- Intravenous Lidocaine Infusion
- Intravenous Alfentanyl Infusion
Chronic pain can have profound psychological effects, including feelings of hopelessness, anger, sadness, and even despair. These feelings can interfere with your ability to perform your job or your normal daily activities.
Psychological therapy can help you to cope with the effects of pain on you and those around you. There are also specific psychological techniques that can actually help to reduce pain. Your treatment plan may include the following psychological therapies:
- Individual and group counseling
- Biofeedback
- Relaxation techniques
- Self-hypnosis
- Visual imaging
- Learning or conditioning techniques
The goal of rehabilitation therapy is to help you resume as active and healthy a lifestyle as possible. Rehabilitation therapies fall into two major categories:
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Physical therapy, which may include exercise, tissue manipulation, and other treatments focused on maximizing function in specific body parts
- Occupational therapy, which is focused on techniques that prepare you to work or your normal daily routine
- Other Therapies
- "Non-medical" techniques
- Physician-administered acupuncture
- Transcutaneous electrical nerve stimulation (TENS)
- Microelectrode nerve stimulation (MENS)
Your progress will be carefully monitored throughout the course of your treatment. Personal measurement goals will be set up at the outset of your treatment. An example of a personal measurement goal for a patient with migraine headaches would be to lower the number of work days missed due to pain. Goal attainment will be measured at regular intervals by your treatment team.
Duration of Care
The duration of the treatment plan will vary from patient to patient, depending on the particular complexity and combination of treatments prescribed. On average, most patients will be in treatment for a period of approximately three to six months. During this time, you may need to allocate approximately three hours per week for treatments at the Pain Management Center.
Throughout the duration of your treatment at the Pain Management Center, we will remain in contact with your primary physician to keep him/her apprised of your progress.
Pain Management Center
Phone: (650) 723-6238
For fellowship information, please contact:
Raymond Gaeta, MD
Email: gaeta@leland.stanford.edu
For clinical trials and research, please contact:
Sean Mackey, MD, PhD