A Note on Pain
Pain takes the joy out of living. It makes getting through each day a real challenge. The goal of the physicians and staff at Advanced Pain Centers of Alaska is to improve the quality of your life by helping you, our patients, restore function, manage pain, and return to the activities you love. We accomplish this by addressing the medical, physical, and psychological aspects of your pain. Using the latest research and advances in technology and treatment, our multidisciplinary team works together to coordinate a treatment plan custom designed for you. We then assemble a winning team of physicians and practitioners who will most effectively address your pain needs, while considering a full spectrum of treatment options available. At Advanced Pain Centers of Alaska, we take pride in our comprehensive approach to pain management and are highly committed to serving you in a manner that strengthens our reputation as Alaska’s premier provider of pain management care!

Neck and Back Pain  
The back and neck are intricate structures of bones, ligaments, muscles, nerves, and tendons, and are divided into 3 general areas of the spine: cervical (neck), thoracic (middle back), and lumbar (lower back). Most everyone at one time or another develops pain in the neck or back. Usually, an activity brings on the pain, and the pain typically improves with rest. There are a few important signs that indicate when pain is more than a simple strain. Chronic pain usually gets worse despite rest, wakes you in the middle of the night, interferes with daily activities, and progresses despite medication. Neck and back pain come in all degrees; from a brief, mild ache after a day of painting the ceiling to a crippling year-long misery that defies potent pain-relievers and intense physical therapy. Most neck and back pain is easily recognized as the result of overdoing some activity. It is amazing what the human body can be trained to do, but it’s equally amazing how incapable it is of doing something it is not accustomed to. Risk factors for neck or back injury include aging, poor posture, joint or bone disease, infectious disease, sports involving twisting of the back (i.e. golf), being overweight, and physically demanding occupations. In the United States, back pain is reported to occur in 85% of adults below the age of 50, and nearly all of them will have at least one recurrence. It is the second most common illness-related reason given for missed work, and the most common disability. Work-related neck and/or back injury is the number one occupational hazard today.

Musculoskeletal Pain  
This is a non-diagnostic term referring to any general painful condition involving the muscles or skeleton. Pain that originates in the muscles or bones and can include sore muscles, broken bones, torn ligaments and tendons, or conditions such as arthritis are examples of this type of pain. The causes of musculoskeletal pain are varied. Muscle tissue can be damaged with the wear and tear of daily activities; or, trauma such as accidents, falls, fractures, sprains and dislocations can lead to this type of pain. Other causes include repetitive movements, overuse, stress, and prolonged immobilization. Changes in posture or poor body mechanics may bring about spinal alignment problems and muscle shortening, thereby causing other muscles to be misused and become painful. People with musculoskeletal pain sometimes complain that their entire bodies ache. Their muscles may feel like they have been pulled or overworked. Sometimes the muscles twitch or burn. Symptoms vary from person to person; but, some of the more common complaints are pain (neck, limb, back), fatigue, and sleep disturbances. Treatments can include injections around the painful site, physical or occupational therapy, relaxation techniques, biofeedback, and even acupuncture.

Joint Pain  
Pain, swelling, stiffness, and/or warmth in one or more joints is known as joint pain. An inflammation of the joints is commonly called arthritis; and, although it is not always the cause of joint pain, it can be very bothersome. Live long enough and you can pretty much count on developing arthritis, or a touch of osteoarthritis at the very least. Arthritis consists of more than 100 different conditions ranging from mild forms of tendonitis (i.e. tennis elbow) to crippling rheumatoid arthritis. The common denominator for all these conditions is joint and musculoskeletal pain, often a result of inflammation of the joint lining. Other common causes of joint pain include injury or fracture, tendonitis, bursitis, unusual exertion or overuse, autoimmune disease, gout, or hepatitis. Because joint pain can vary drastically in its cause and location, treatments also vary depending on the affected joint(s), the severity of the pain, and the symptoms presented by the patient.

Discogenic Pain  
Discogenic pain is pain from an invertebral disc. After an injury, patients can have fairly severe nagging pain that gets worse with sitting, standing, or staying too long in the same position. The pain is usually across the back if a lumbar disc is injured. In the neck, the discs can cause neck pain and sometimes nagging pain in the head, shoulder, or arm. Many patients worry that the onset of discogenic pain is simply the beginning of endless back pain, which is usually not the case. Most patients with this type of pain will improve with time and some simple treatments.

Complex Regional Pain Syndrome (CRPS)  
This is a chronic pain condition usually involving the arms or legs, but not always. A patient with Complex Regional Pain Syndrome experiences pain as well as changes in blood flow, sweating, and swelling in the painful area. Patients typically complain of a burning feeling, which usually develops after an injury. However, the condition can sometimes appear without obvious injury to the affected limb, or can occur after heart attacks and strokes. It can be progressive or even improve on its own. The cause of CRPS is thought to result from damage to the nervous system, including the nerves that control the blood vessels and sweat glands.

Causalgia  
Another name for Complex Regional Pain Syndrome, Causalgia is named after its most common symptom – a burning pain referred to a particular body region appearing spontaneously following injury to a major nerve. It occurs especially after injuries from high-velocity impacts but may occur without apparent injury at all. The pain is present in a limb along the course of a peripheral nerve (most often in the arms or legs), and is usually associated with skin changes. It is a major cause of disability, and the earlier a diagnosis is made and treatment is commenced the better the prognosis.

Reflex Sympathetic Dystrophy (RSD)  
A type of Complex Regional Pain Syndrome, RSD usually results from an injury to the skin, bone, joints, or tissue. A burning sensation is a common complaint from patients, as well as extreme sensitivity to the touch in the injured area. It is also characterized by pathological changes in bone and skin, excessive sweating, tissue swelling, muscle spasms, restricted movement, and sometimes changes in the nails and skin. One visible sign of Reflex Sympathetic Dystrophy is warm, shiny skin near the site of the injury which later becomes cool and bluish. The pain that patients report is often out of proportion to the severity of the injury and gets worse, rather than better over time. It may initially be localized to the site of the injury or the area covered by an injured nerve, but often spreads to include an entire limb. The pain is continuous and may be heightened by emotional stress.

Post Laminectomy Syndrome  
Sometimes known as “Failed Back Syndrome”, Post Laminectomy Syndrome is used as a catch-all expression to cover the various causes of pain and disability after disc surgery for nerve compression. The cause can be multifaceted, but there is strong evidence that scar tissue proliferation after back surgery can cause irritation around the nerve root making the pain reappear. The main feature of this syndrome is continuing post-operative pain even though the leg pain caused by nerve pressure prior to surgery may have been significantly relieved. Disc surgery for nerve compression can only be expected to relieve sciatic leg pain caused by that compression, although back pain present prior to surgery is sometimes relieved as well. About one in three patients who have had a surgical procedure performed on their spine will experience Post Laminectomy Syndrome after the surgery is complete. Epidural Lysis of Adhesion (RACZ procedure) is a common treatment for this syndrome.

Spinal Stenosis  
Spinal Stenosis is a narrowing of spaces in the spine that results in pressure on the spinal cord and/or nerve roots. The spinal canal, which contains and protects the spinal cord and nerve roots, narrows and pinches the spinal cord and nerves resulting in low back and/or leg pain. This disorder usually involves the narrowing of one or more of the three areas of the spine (cervical, thoracic, lumbar), and may cause numbness of the legs if the pressure is lower or numbness of the shoulders if the pressure is higher. Potential causes include aging, heredity, and changes in blood flow to the lumbar spine. Symptoms of Spinal Stenosis can include pain and difficulty walking, numbness, tingling, or a tired feeling in the legs, clumsiness, frequent falling, or a foot-slapping gate. People over the age of 50 are the most likely candidates for this disorder, although it may occur in younger people who are born with a narrowing of the spinal canal or who suffer an injury to the spine.

Facet Pain  
Facet joints are small stabilizing joints located between and behind adjacent vertebrae, and are found at every spinal level except the top level. They provide about 20% of the twisting stability in the neck and lower back, yet prevent excessive motion or over-twisting that could lead to spinal cord or nerve damage. Pain from facet joints may arise from several causes. An acute episode of back pain may be due to sudden excessive movement that traumatizes the joint. More commonly however, facet pain is chronic in nature, with the underlying cause due to long-term changes in the joint, meaning the pain does not go away in a few days. In most cases there is degeneration within the joint, causing an arthritic-type problem. This may be a long-term consequence of a seemingly minor trauma in the past. Typically, there is back pain just to one side of the spine which is made worse by side bending or backward bending toward the affected side. The back will generally feel stiff in the morning. In some cases there may be involvement of the nerve roots which emerge from the spinal cord at the level of the problem, causing pain to refer to the buttock, groin, or hamstring region. Often this problem is made worse by prolonged standing or sitting in one position.

Myofacial Pain  
Myofacial Pain Syndrome is a painful condition characterized by the development of myofacial trigger points that are tender when active and refer pain to other areas of the body through specific patterns. These trigger points are a localized area starving for oxygen which create an increased local energy demand. This energy crisis releases biochemicals which sensitize nearby nerves. The sensitized nerves initiate the motor, sensory, and autonomic effects of myofacial trigger points by acting on the central nervous system. Trigger points are usually associated with a taut band (a ropey thickening of the muscle tissue) and when pressed upon, will cause the pain to be felt elsewhere. This is considered referred pain.

Sacroiliac Joint Pain  
The sacroiliac joint is the area where the sacral bone in the center of the upper buttocks connects to the pelvic bone on both sides. This joint is like no other in that it’s actually fused together by ligaments and does not pivot or move. One reason the sacroiliac joints can become irritated is through abnormal movement occurring on a repeated basis. Examples of this are sport-related activities where heavy impact occurs through excessive jumping and/or twisting, characterized by discomfort in the lower back in the area where the base of the spine meets the pelvis. This is especially likely to cause irritation if the joints are compressed for a prolonged period by sitting, resulting in microscopic damage to the surrounding muscle tissue. Scar tissue formation occurs to help aid the healing of the sacroiliac joint by acting like glue to bond the tissue back together. Once the scar tissue begins to accumulate, procedures are necessary to help break down the tissue in order to let the muscle regain its normal flexibility and lessen the chance of re-injury.

Radicular Pain  
This type of pain is deep, steady, and reproducible with activities such as sitting and walking, and follows the involved dermatome (the area of distribution of the leg covered by a specific nerve). Radicular pain radiates into the lower extremity (thigh, calf, and sometimes foot) directly along the course of a specific nerve root, and can cause numbness, tingling, muscle weakness, and loss of specific reflexes. When the nerve root is irritated pain can be experienced at any point along the course of the nerve or throughout the entire nerve. The most common example of this is “Sciatica”, an irritation of one of the nerve roots that comprise the Sciatic nerve in the lumbar spine. When one of these roots is irritated, pain travels down the back of the thigh, calf, and into the foot. In corresponding cervical conditions, pain will travel down the shoulders, arms, and into the hands.

Chronic Pelvic Pain Syndrome  
Chronic Pelvic Pain is one of the most common medical problems affecting women today, and is defined as any pelvic pain that lasts for more than six months. Although acute pain may indicate specific active injury to some part of the body, chronic pain is very different. Often in chronic pelvic pain, the initial physical problem has lessened or even disappeared, but the pain continues because of the changes in the nervous system, muscles, or other tissues. As this long-term, unrelenting pain process continues, even the strongest person’s defenses may break down. This can result in associated emotional and behavioral changes, an expected evolution of chronic pelvic pain syndrome. Therefore, contrary to misguided beliefs, chronic pelvic pain is not “all in your head”, but rather a dynamic interaction of the combined influences of the mind, nervous system, and the body. Studies such as blood tests, x-rays, and ultrasound examinations may be necessary for diagnosis, and occasionally more sophisticated imaging techniques such as MRI’s may be required. As far as treatment is concerned; because multiple interactive problems are likely here rather than a singular problem, the question is usually not what treatment is recommended, but what treatments.

Sports & Work Injuries  
The grocery store checker who must compensate for carpal tunnel syndrome, the teenager who must regain strength following a hockey injury, the construction worker who hurt his back in a nasty fall. Whether you are a young baseball player, oil-slope worker, college athlete or weekend jogger, injuries can occur. Our role in the recovery process is to help patients relieve the pain, regain their strength, and return them to their normal, active schedule of work and play as quickly and effectively as possible. In addition to facilitating recovery, emphasis is also placed on prevention of re-injury so patients can continue the activities they love. We thoroughly assess the injury and consult with other members of our physician team (pain management physicians, physical therapists, health psychologists, and advanced nurse practitioners) before developing a comprehensive rehabilitation plan with your individual needs in mind. Our goal is to help patients achieve their maximum level of function and regain their independence through a multidisciplinary approach to treatment and rehabilitation.

Headaches  
While the experience of an occasional headache may be universal and is typically tolerable, chronic headaches are an important cause of distress and even disability. The vast majority of people who suffer from headaches have either tension-type or migraine headaches. Although drugs have helped change the lives of some of these people, they do not work for many patients and can result in unpleasant side effects. In addition, because these patients are ‘chronic’ headache sufferers, the long-term use of such drugs can be serious. These concerns encourage many patients who have tried conventional therapies to explore complementary, more holistic alternatives such as mind-body techniques, biofeedback, stress management, and relaxation therapy. The essence of biofeedback is to teach a patient how to encounter stress without adverse physiological effects. Learning to control body functions such as temperature can be achieved only by first learning to relax the skeletal muscles. This is achieved through progressive relaxation, visualization, and breathing techniques. A conscious effort is required in the first few weeks of training, but gradually self-monitoring and brief relaxation techniques become a subconscious habit. This allows patients to lower tension throughout the day and results in fewer, less intense headaches.

Psychological Aspects of Pain  
Treating chronic pain takes a three-pronged approach which includes Pain Management Physicians, Physical Medicine and Rehabilitation Specialists, and Pain Psychologists. Pain is not just a physical condition. A patient with chronic pain is ruled by their pain. They no longer live their lives in terms of their hopes and dreams. Instead, they are so overwhelmed by the failure of their pain to improve, that they are swept away by depression, anxiety, anger, fear, hopelessness, and frustration. Their sense of loss is justified as they usually have lost a lot of what makes up a life. They may no longer feel they can work to support their family, and their family may no longer give them the emotional support they need. These psychological aspects of pain are successfully addressed by a Pain Psychologist, who will help find ways to decrease the pain and increase functional levels. The focus of treatment is the development of specific skills that help patient’s self-manage pain and increase their quality of life. The interventions used at Advanced Pain Centers of Alaska are based on extensive research consistently found to improve function, and may include biofeedback testing, relaxation techniques, and stress management exercises.