The University of Maryland Pain Management Center (PMC), located at Kernan Hospital, offers a multidisciplinary approach to pain management. Our team includes board certified anesthesiologists who specialize in pain medicine, licensed clinical psychologists, physical therapists, nurses, and radiographers who work together to treat the whole patient. The Center treats patients from all over Maryland, as well as surrounding states such as Delaware, Pennsylvania, and Virginia.
Treatment options for chronic pain at Kernan Hospital include optimal medication management, physical therapy to improve function and strength, and psychological support. Treatment programs that include psychological support teach coping skills and other strategies to better manage pain and the depression that often accompanies it. Interventional pain management is another method of treatment that can be used both diagnostically and therapeutically to treat a variety of pain conditions.
At the PMC we perform over 2,000 procedures each year. Many patients who come to us have pain as a result of a traumatic injury or disease, and have previously seen a variety of medical specialists in their search for pain relief. Often, these patients have dealt with pain for months or even years; as a result, the prospect of having an interventional pain procedure may be very anxiety provoking for them. Our staff works together to create an atmosphere that helps to allay the fears patients have regarding these procedures. At the PMC, patients are cared for with sensitivity and compassion.
What exactly is an interventional pain procedure and when is it beneficial? The goal of interventional procedures is to diagnose the site of pain, to decrease inflammation and provide pain relief, to reset the nervous system so that it stops abnormal painful stimuli in disease processes such as Complex Regional Pain Syndrome (CRPS), and to help patients improve the quality of their lives. Pain that comes from injured or inflamed nerves can often be improved through the use of certain medications delivered specifically to the area of injury.
Patients who may benefit the most from an interventional pain procedure are those who have symptoms of radiculopathy (pain from nerves being compressed near the spine) or other types of nerve injuries. For these patients, an interventional procedure such as an epidural steroid injection or a selective nerve root block can target the nerve causing the pain. Injecting a mixture of a steroid medication and local anesthetic often gives patients immediate pain relief, and the steroids start working to decrease the inflammation around the nerves in approximately 2-3 days. These nerve blocks also allow patients to work effectively with physical therapists or start personal exercise programs to regain strength and function with less pain. Our Center has the expertise to perform a variety of nerve blocks which deliver both temporary and permanent pain relief.
Implantable pain therapies such as spinal cord stimulators and intrathecal pumps are utilized when more conservative therapies have failed. Spinal cord stimulators deliver an electric current directly to the spine, which masks the pain patients normally feel. Instead, the patients experience a pleasant tingling or numbing sensation over the area of pain. Patients have a remote control device which allows them to control the amount of electricity delivered.
Intrathecal pumps relieve pain by delivering medication directly to the spine. This delivery method uses less medication to achieve pain relief and therefore patients experience less side effects. Our most successful cases for intrathecal therapy have been used in patients with cancer pain at the end of life. Pain relief achieved by this method dramatically improves the quality of life, and patients are able to interact with their family members in a more meaningful way.
Patients who are scheduled in the PMC for a procedure can expect a letter in the mail that includes special pre-procedure instructions. In addition, they are called by our nursing staff the day before the procedure. This gives the nurses the opportunity to make sure that the patients understand the pre-procedure instructions and to answer any questions that the patients may have.
On the day of the procedure, patients meet with the nurses, physicians, and the radiographer responsible for their care during and after their procedure. A nursing assessment is completed, while the physician completes a brief history and physical exam. The physician reviews the procedure with the patient, obtains informed consent and answers any of the patients' remaining questions.
Although the nature of our procedures makes it imperative for patients to be awake, patients are offered the option of having IV sedation during the procedure, as light sedation can make patients more comfortable and less anxious. Patients are monitored throughout the procedure and during the recovery period by specialized nurses who are trained in Advanced Cardiac Life Support (ACLS) and the administration of conscious moderate sedation.
Our fluoroscopic procedures are performed in a special procedure room in which patients are given a choice of musical options to be played during their procedure. Patients are positioned on our procedure table with pillows, and care is taken to make them as comfortable as possible. The lights are dimmed and patients are supported by our staff with hand holding, if needed, and a lot of personal attention. This atmosphere, in conjunction with IV sedation, helps to calm patients during the procedure.
The patient's skin is numbed with a local anesthetic, and the patient's comfort and sedation level are continuously monitored. Once the site for the injection is located using fluoroscopy, a mixture of local anesthetic and steroid, if appropriate, is injected around the nerves that are causing pain. The actual procedure time varies depending on the procedure, but most are completed in 20-40 minutes.
At the end of the procedure, patients are taken to the recovery area and monitored for an additional 30-40 minutes. Here, patients are given something to drink and a snack, along with an X-ray image of their procedure. Patients generally experience pain relief immediately after their procedure. This initial pain relief is related to the local anesthetic or numbing medication used. The pain relief from this medication lasts for a few hours to a few days. Most patients experience a prolonged benefit, which occurs within 48 hours from the steroid medication. Patients may return to work and/or normal activity the day after their procedure. The PMC nurses follow up with patients the next day to assess their response to the procedure.
The excellent care received by our patients is greatly appreciated. After their first procedure at the PMC, many are surprised and relieved that the procedure was not what they had expected.
“To say your staff is magnificent is an understatement. The atmosphere in the procedure room is always very upbeat. The personal care they give to each patient is wonderful. By the time the procedure starts, I feel relaxed and cared about. During the procedure, I feel the same. The doctors and nurses told me exactly what to expect and when. They take the time and make the effort to keep me relaxed throughout the procedure ... the amount of energy each person on the staff puts into each patient's feelings is phenomenal...all of you should be proud of the excellent care you provide."
Delivering compassionate care to patients is what we do best. Alleviating patient fears and providing pain relief not only for the pain condition, but also during the interventional procedure, is the goal of interventional pain management. Patients should not have to endure more pain to get the pain relief they deserve.