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Pain is our body's way of telling us there’s something wrong. If it’s long lasting, it can have a profound impact on an individual’s quality of life.
“If pain is affecting your everyday activities, your personal life, or your ability to work, you should seek help from a specialist,” says Rajat Mathur, MD, a MedStar National Rehabilitation Network physiatrist and pain management specialist who sees patients at MedStar Good Samaritan Hospital. “Understanding the pain—how and when it started, where it occurs, what makes it better or worse, and whether it’s constant or occasional—is key to determining the most effective treatment. There are so many ways to treat pain that there is no reason for anyone to live with it.”
With every new patient Dr. Mathur performs a thorough physical exam and may order x-rays, an MRI, a CT scan, or other tests to check for nerve damage. Depending on the diagnosis, the source of pain, and its severity, treatments are customized for each patient.
This approach to pain management is why 69-year-old Joyceann Wright-El is now pain free. “I had lower back pain that was so bad I could barely stand,” she says. “Physical therapy wasn’t helping, and I couldn’t take pain medication because of other health issues. Surgery wasn’t an option either.” Wright-El’s doctor referred her to Dr. Mathur, who recommended electrodiagnostic testing, which measures the electrical activity of muscles and nerves to determine if there is nerve injury or damage.
“She had what is called low back radicular pain, a type of pain that is caused by compression, inflammation, or injury to a spinal nerve root. She had experienced a lot of trauma over the years and had severe arthritis of the spine, all contributing to her condition,” Dr. Mathur explains. “This led to a series of spinal interventions to try to control, and hopefully, eliminate the pain.”
The first step was an epidural injection to decrease the swelling in her lower back and the pain associated with it. This was followed by a medial branch nerve block, a primarily diagnostic procedure in which an anesthetic is injected into the spine to identify the specific nerve involved.
“Based on this, we determined she was a candidate for a procedure for longer term pain relief called radiofrequency rhizotomy or ablation,” says Dr. Mathur. “This involves destroying the nerves causing the pain with highly localized heat generated with radiofrequency. By destroying these nerves, pain signals are prevented from being transmitted from the spine to the brain. A successful procedure reduces pain without reducing nerve function.”
Today, Wright-El is pain free. She is extremely happy with the care she received and the outcome. "Dr. Mathur really took the time to talk to me and was able to keep me focused. His team worked so well together and made me feel so comfortable," she says. "They straightened me up!"
“Pain can be very complex and may require a combination of therapies,” Dr. Mathur notes. “Building rapport with a patient is essential to understanding the pain so that the best treatment plan can be developed for that individual."
Speaking of Pain
Improving communication about pain between caregivers and patients is the focus of a new initiative of MedStar Good Samaritan Hospital and MedStar Union Memorial Hospital. Led by Karen Droter, MSN, RN, performance improvement manager at MedStar Good Samaritan, the Patient Experience Pain Management Team is working to ensure that the needs of every patient are anticipated and addressed when dealing with pain. The ultimate goal is increased patient satisfaction.
To that end, the team, representing a cross section of employees and caregivers, meets monthly to review what is currently being done to promote effective communication about pain and identify ways to augment and enhance those efforts. Their work to date has resulted in:
- The use of a pain tool guide to assist providers in better assessing pain
- The increased use of white boards in patient rooms to post pain scores and inform patients about daily pain control plans
- The adoption of a comfort brochure to educate patients and families about non-pharmacological therapies for treating pain and improving comfort
- More frequent use of the C.A.R.E. (Continuous Ambient Relaxation Environment) Channel in patient rooms to create a relaxing environment that reduces anxiety and alleviates pain
- Pain champions are also being identified, who will be trained in pain management to serve as resources to patients, family members, and providers.
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This article appeared in the summer 2018 issue of Destination: Good Health. Read more articles from this issue.
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