May 22, 2018

Treating Chronic Pain Patients

By Michael J. Ingraham, MD

When most people hear the words “pain management,” they think of medications and procedures to fix existing problems. However, another important side to the field is preventive medicine – therapies that can guard against recurring pain or future injuries and improve overall health.

As an Interventional Pain Medicine physician, a major goal is to help patients avoid long-term reliance on narcotics and invasive surgeries whenever possible. We often can ease discomfort and restore function and range of motion with therapeutic injections, in-office physical therapy, at-home exercises and stretches, and structured medication regimens.

The bulk of our patients struggle with neck or lower back pain; some have suffered for years, if not decades. In many cases, non-surgical interventions can provide months and sometimes years of relief without significant side effects, lengthy recovery times or risk of painkiller addiction.

Once patients are feeling better and moving more, they also tend to improve on other important wellness indicators such as heart health, core strength and flexibility, mental outlook and sleep quality.

For chronic pain patients who don’t respond to conservative therapies or in some cases surgery, or who aren’t surgical candidates, we can try two other procedures: radiofrequency ablation, or RFA, and a spinal cord stimulator, or SCS.

RFA uses an electrical current to heat and destroy specific areas of nerve tissue, thereby reducing pain signals. The current is delivered via a small needle to a spot targeted by X-ray images, test blocks and patient feedback. The most common indications are neck, back or knee pain. The goal is at least six months of pain relief, but some patients feel better for as long as 18 months.

The SCS, a technology similar to a pacemaker or defibrillator, is a battery-powered device placed under the skin in an outpatient surgery. The stimulator delivers mild electrical currents to nerve fibers in the back, creating a tingling sensation and interrupting pain signals to the brain. Patients can turn the current on, off or up with a handheld remote control. This relatively minor surgery can provide incredible pain relief.

Before committing to any surgery, SCS patients first undergo a temporary trial to determine if a stimulator is a good option. Over a five-day period with trial leads – temporarily placed through hollow needles as an outpatient procedure with a local anesthetic – we can measure improvements in pain and the precise stimulation that was most effective. If a permanent SCS is implanted, batteries last about seven years and can be replaced easily.

With such a variety of treatment options, we are able to tackle complex chronic pain issues and prevent continuing health declines in more patients than ever. Watching people return to overall wellness is extremely rewarding.


Dr. Ingraham is a fellowship trained Interventional Spine Specialist and Board certified Physical Medicine & Rehabilitation physician based at SMOC’s Suffolk and North Suffolk locations. He completed a fellowship in Pain Medicine at the University of Virginia School of Medicine.