Chronic Pain Today

Wondering what medical specialist is right for your specific chronic pain condition? There are several choices, and one is right for you.

Family medicine doctor /General practitioner
These doctors specialize in the total health of the person and of family. They are able to diagnose and treat a wide variety of illnesses and conditions, or can refer you to a specialist should you need it. This is generally where most chronic pain sufferers begin their journey of healing and treatment.

Doctor of osteopathy (DO)
These doctors deal with the whole body and the interaction between the body’s systems. They are a primary care provider just like the family medicine doctor, and they are able to refer you to specialist should you need it. This is another choice for chronic pain sufferers to begin with in their treatment.

Chiropractor
These health professionals deal with the alignment of muscle and bone in the body. They are able to readjust and correct some forms of abnormality in the bone structure. They are also able to give patients massages, biofeedback, and other techniques for the session. This is a good start if your chronic pain is due to back injuries or other bone conditions.

Pain management specialist
These are doctors who have specialized their practice to those experiencing chronic pain issues. These can be other specialists, such as orthopedics or neurology, which have further honed their niche to include chronic pain.

Physical therapist
Health professionals that have used exercise, heat, electricity, and other methods to ease their patients pain issues. They can be working on extending range of motion, or the quality of life. They provide treatment to help in muscle and joint chronic pain issues.

A gallbladder scan is usually requested when the patient is showing signs and symptoms of having gallbladder dysfunction. It can be used to tell the cause of any jaundice the patient is exhibiting, to determine if there is a problem with the function of the gallbladder and the source of any right side pain, or to detect any blockage of the tubes.

During the test a radioactive tracer fluid will be injected into a vein, usually in the arm. This is so that the scanning pictures can show the path of the tracer going to the liver, the gallbladder, bile ducts, and the duodenum. This can show the radiologist if there is any dysfunction to the gallbladder itself in function or structure, and if there is a blockage in any of the bile duct tubes that lead from the liver to the gallbladder.

After the tracer has ran its course then the cholecystokinin (the substance that will make the gallbladder be stimulated, some say like after a particularly fatty meal) will be injected. Pictures will be taken to see how well the gallbladder is functioning. The results are generally given in a percentage, as in the percentage of solution that is released in the time given. Most doctors feel that anything below 35%-40% is a sign of gallbladder dysfunction, with 70%-75% being normal. If your scan comes back with these numbers, your doctor may be opting for a surgical removal of the gallbladder. They may take additional pictures later, or they may just go with the first set of data they collect. This is usually up to the doctor.

The test is a little time consuming, taking about two hours. And it’s restrictive. You will be lying on a table the entire time, and told not to move much during it. Much like a two hour MRI of sorts.

The test is generally pain free, although a bit uncomfortable. You may request a pillow or blanket if it will make you more comfortable. When the cholecystokinin (or CCK as it is known) is administered you may feel pain. Usually having pain with the CCK injection is a sign of gallbladder dysfunction and if you do hurt during this it is important to tell your radiologist.

If you are experiencing right side pain with nausea and diarrhea after fatty meals, your doctor may tell you to take this test. It is very useful in determining gallbladder function and shouldn’t be put off if you are experiencing any gastrointestinal issues. You can also see about a gallbladder ultrasound, if you would like to get a “second opinion” on whether you need the actual gallbladder scan or not.

You should go to your family doctor, or see a pain specialist, if you are experiencing any of the below items:

You feel that you have a chronic pain condition, or are experiencing symptoms of a chronic pain condition, but have never been treated for one.

You have new pain, or your pain has changed and worsened.

You increase the dosage of your pain medication to keep your pain away.

You find yourself more sedentary and less active than you were before your pain.

You are more anxious than you were before your pain.

You are more depressed than you were before your pain.

Although only one drug has been FDA approved specifically for interstitial cystitis, Elmiron, treating interstitial cystitis has always been a “brand off” approach. “Brand off” is where drugs not specifically designed for the illness or disease are used because of their side effects. For example, interstitial cystitis patients are given anti-anxiety drugs, antidepressants, antispasmodics, pain medication, and even some antiseizure medication.

Elavil is the brand name for the drug amitriptyline. The other brand name for the drug is Endep . It is given to mental health patients to elevate mood by increasing the neurotransmitters in the brain. Typically, this drug is prescribed for more than one reason to interstitial cystitis sufferers. It is available in tablet form in the dosages of 10mg, 25 mg, 50mg, 75mg, 100mg and in 150mg.

Sleep Effects
Elavil tends to make one drowsy after taking, and therefore is typically prescribed to be taken at night before bed. For this reason it is given to interstitial cystitis sufferers to help them sleep through the night without having to wake up to go to the bathroom multiple times. Also, even if one doesn’t typically get up at night, it will still give them a better night sleep and will help them feel better throughout the day because they were able to rest. According to Dr. Robert Moore (Director of Advanced Pelvic Surgery and Co-Director of Urogynecology at Atlanta Urogynecology Associates, a “low dose helps to elevate the patient’s pain threshold, i.e. the level that the pain fibers fire at in the spinal cord. These nerves are super sensitive and fire very easily at very low input levels; Elavil helps to elevate these levels so they don’t fire so easily at low levels.”

Pain Effects
Elavil will give a slight boost to treating and dealing with pain. It isn’t a pain medication, but it does “take an edge off”. This makes living with interstitial cystitis a bit easier. Its sedative effects help with the pain of the bladder. It raises your pain threshold so that lower level pain isn’t felt as much, and you are much more able to cope.

Warnings
There are many drug interactions with Elavil. If you are taking an MAOI (monoamine oxidase inhibiting drugs) you may get a high fever, convulse, or even die while on Elavil / Endep.

If you have seizures or are at risk for having a seizure, you should not take this drug.

You should not take Epinephrine (what is known as an Epipen, given to those with severe allergic reactions) while on this drug as it raises your chance of severe high blood pressure. If you have risk factors for allergies severe enough that you carry an Epipen you need to let your doctor know prior to filling this drug prescription.

Psychogenic pain is pain that has a mental or emotional cause rather than a bodily one. Typically those of any age can get develop it, with women having a slight higher percentage than men. Those that are at a higher risk are ones with a history of depression, alcohol or any other type of addiction, those with PTSD (Post traumatic stress disorder), or those with a relative with psychogenic pain. It typically is much harder to diagnose than other pain conditions because of the difficulty to find a reason. Many will be cast off as having hypochondria or Munchausen’s syndrome (where people make themselves sick so that they draw attention to themselves). Currently, there is no known way to prevent psychogenic pain from forming.

Psychogenic pain will typically develop as a reaction to a stress or a specific problem. The patient who is having social troubles with their mate will typically be seen for heart and chest related conditions while the patient with trouble at the office will typically be seen for back related conditions. It tends to be relative. In most cases, the pain will go away on its own after they have worked out their stress, or the reason for the pain. Others will have it manifest into a chronic condition.

To diagnose the condition a thorough medical history and exam will need to be done, with blood tests and other diagnostic tests to rule out any other reason for the pain. Then a thorough psychological exam will need to be done so that the patient can be properly diagnosed. Results though in eleven new studies have found that using antidepressants to treat patients with psychogenic illnesses may help relieve pain over a placebo. Other ways to help include hypnosis and biofeedback, as it will help with both the pain and the intensity of the pain.