Pain Management Techniques inclusive of Orthobiologics and Regenerative Medicine Techniques
Clinical research is being continually conducted to help determine which pain management therapies are the most effective in treating neuromusculoskeletal and in particular spine, large joint and extremity pain. Most of the clinically substantiated practices that have evolved in the conservative treatment of chronic pain are now incorporated in pain management protocols designed to address pain in a systematic approach. In addition, there are many methods of pain management that were not developed or had not gained wide acceptance until recently. Some of these more invasive methods may not stand the test of time.
There is currently no universally accepted standard for injection therapeutics or other interventional techniques for chronic pain management. The many colleges, societies and academies engaged in the education and organization of pain medicine physicians and non-physicians have varying protocols and standards. Thus pain medicine remains a non-standardized field as there are many correct methods to treat and control chronic pain. Pain practitioners come from many ranks in the physician populations ( e.g. anesthesiologists, physiatrists, neurologists, rheumatologists, internists, etc) and their techniques – particularly interventional techniques – vary considerably. In general, pain management techniques can be grouped in terms of their invasiveness. Some, such as physical therapy, are not invasive at all and do not inherently involve the use of medications. Oral or topical pain medications are time-honored methods and pharmacologic in their effect. Many different types of substances are given by injections to control regional chronic pain and to improve tissue recovery: local anesthetics ( e.g. lidocaine, bupivacaine, etc.), saline, corticosteroids, different concentrations of dextrose, Sarapin, BoTox, homeopathic compounds, hyaluronic acid derivatives, etc. More recently autologous blood products ( products from a patient’s own blood e.g. platelet rich plasma, bone marrow aspirate concentrate, etc.) are also being used. Orthobiologics / Regenerative Medicine is a term commonly applied to these autologous ( i.e. patient’s own blood) derivatives. Injections may be in the soft tissues ( e.g. around tendons and ligaments), near nerves and the spinal column, in joints, etc. Lastly, some interventional pain medicine specialists implant spinal stimulators, lesion the nerves with radiofrequency methods or inject special glue in vertebral bodies ( vertebroplasty / kyphoplasty) to address chronic pain spinal and extremity pain. As orthobiologics / regenerative medicine continue to advance in their efficacy and become more popular these latter more invasive techniques which historically were neuroablative ( would destroy tissues such as nerves) or tissue destructive are becoming less necessary and eventually will be rendered obsolete.
Thus in determining the efficacy of treatment one needs to refer to a practitioner’s clinical outcomes, the scientific and experiential validity of the applications and the referring physicians reliance on the skills of a given pain medical practitioner.
Dr. Massumi has been in the specialty practice of Physiatry (Physical Medicine and Rehabilitation) with particular interest in orthopedic medicine and the management of chronic pain for twenty-nine years and has treated over 14,000 patients. He is referred patients from community and hospital based physicians as well as nurses, physical therapists, pharmacists and other allied healthcare providers. Many patients of his have already been to other pain medicine practitioners and have not realized the benefits they expected. The tenure of our patients at our clinic and their testimonials are indicative of their sense of recovery and satisfaction with our services.