Chronic pain management discussed at 'Lunch and Learn'

Dr. Dennison Hamilton spoke Tuesday afternoon at the Mercy Lunch and Learn series on chronic pain management.

"I am primarily a musculoskeletal intervention pain physician," Hamilton said.

He treats people with spinal disorders, neck pain, low back pain, and some of the smaller joints such as hips, knees, elbows.

Hamilton said a common question asked by patients is, "Where is all the pain coming from?"

"Most of the time we can figure it out, but sometimes we can't," Hamilton said.

The pain can come from the skin, all the way down to the spinal column itself.

"Around this spinal column is all these little boney prominences," Hamilton said. "What attaches to those are muscles, ligaments, tendons... things like that. Any of those things can hurt a person. It's part of my job to figure out where the pain is coming from."

Anyone who can tell a patient they can get rid of all of back pain is probably lying, Hamilton said.

"The times of that happening are few and far between," he said.

Treatments

Treatment for pain is rest, over-the-counter medications and activity modification.

"If you do something that hurts your back, stop," he said. "Let your back heal."

A primary care physician may prescribe anti-inflammatory drugs, he said.

"They may give you cortizone either orally or in shots, and they may give you some pain medicine," Hamilton said. "Or you may be sent to the physical therapist. I am a strong believer in physical therapy, in strenghthening up your core which is a combination of your abdomen, your back and your legs. If those muscle groups are nice and strong, your spine is maximally supported."

Interventions

To help in the intervention of pain, epidural injections, medical branch blocks and discograms are used, he said.

Injecting medicines are used to reduce back pain and inflammation and ususally consist of a steroid and a numbing medicine, according to webmd.com

X-ray and dye are both used prior to injections to pinpoint where to make injections, Hamilton said.

Another treatment Hamilston spoke of is spinal cord stimulators, which send electrical pulses to the spinal cord to treat chronic pain.

"We put spinal cord stimulators in people who have intractable (hard to manage) pain," Hamilton said. "And they are not a candidate for surgery or they have had surgery and it didn't help them. Fifty-percent of all fusions, the patient still has back pain. So the spine surgeon will refer them to me for spinal cord stimulator."

Nerve stimulation is done in two steps. A doctor will first insert a temporary device through the skin to see if it will help with pain.

"It's an aide, not a cure all," Hamilton said. "If half or more of a person's pain is cured...two to three weeks later we put in a permanent one."

"Wires go along the spine and a power pack, about the size of a pacemaker, that we put in a person," Hamilton said."They turn that on or off through their skin."

"It causes a disruption of the nervous impulses coming up from your legs and your back," he said. "It replaces the pain with a sense of numbness and tingling."

There was question from one attendee at the luncheon of the device's cost.

"Medicare pays for this if you have a high-end plan," Hamilton said.

Dr. Hamilton specializes in interventional pain management and orthopedics. He holds a clinic at Mercy Medical Plaza in Fort Scott.