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+++++++++++++++++++++++++ +++ + +++ PAiN MANAgEMENT+ +++++++++++++++++++++++++ stages of pain management: treatment continuum for chronic Pain By Vivek Mahendru, M.D. A ccording to the National Center for Health Statistics, more t ha n 76.5 m illion Americans suffer from chronic pain. Those affected have many therapeutic options to discuss with physicians to try to relieve their pain. But what is the best approach? When should one treatment be tried over another? This article presents a tiered, industry-accepted approach to managing pain. a tiered approach Physicians generally treat chronic pain patients using an algorithmic care paradigm known as the pain treatment continuum. According to the pain treatment continuum, physicians start with the least expensive and least invasive treatments. If the patient doesn't respond well to the therapy or has become unresponsive to it over time, physicians prescribe a more expensive or invasive option on progressing tiers of the continuum until a therapy or combination of therapies works.1 Treatment options for patients fall under two main categories: conservative therapies and interventional therapies. conservative therapies Conservative therapies are predominantly noninvasive treatments and appear on the lower tiers of the pain treatment continuum. Conservative treatments range from minimally intensive options such as exercise programs, physical and psychological therapies, over-the-counter medications, and transcutaneous electrical stimulation (TENS) to moderately intensive options such as nerve bl ock procedures and opioid medications. interventional therapies As a patient's pain resists conservative treatments or as the patient becomes refractory to them, interventional procedures may be able to relieve the pain. Interventional therapies include surgery, neurostimulation, an intrathecal pump and neuroablation. Of the aforementioned options, surgery and neuroablation are irreversible procedures. the Best Medical Management Various pain etiologies and each patient's unique physiology and psychological disposition toward pain complicate how physicians implement the best care. As such, pain patients may benefit by consulting a pain management physician who specializes in diagnosing and treating conditions like chronic pain. Regardless of when a treatment is used, the most important factor is to provide patients the best medical management of their pain. Vivek "Vic" Mahendru, M.D., is founder of Pain Specialists of Austin, Medical Director of The Pain Relief Surgicenter, diplomate of the American Board of Anesthesiology, and he was fellowship-trained at Harvard Medical School. To refer a patient to his care, call (512) 485-7200 or (855) 876-PAIN (7246), or visit www.painspecialistsofaustin.com. ■ references 1. Krames E. Spinal cord stimulation: indications, mechanism of action, and efficacy. Curr Rev Pain. 1999;3(6):419-426. MdnewS.coM ■ MD News Austin | 13