Nicole Brand, MD, board-certified physiatrist and interventional pain management specialist, discusses the many positive treatments she and her colleagues can offer to help safely manage chronic pain.
Chronic pain is no stranger to a large percentage of our friends and family. The Centers for Disease Control and Prevention (CDC) estimates that 20% of adults in the U.S. —50 million Americans — struggle with chronic pain. The most common sources of chronic pain are the back, hip(s), knee(s) and feet, and can lead to such negative outcomes as missed workdays and limitations in social/recreational activities and activities of daily living, according to The National Institutes of Health. Beyond the physical pain, the effects of chronic pain can have far-reaching impacts, as a Harvard Medical School study recently revealed that individuals with chronic pain have three times the average risk of developing depression, anxiety or another mood disorder.
Given chronic pain’s prevalence and challenges, the field of pain management has become more essential in delivering relief, enabling the healing process and helping people return to functionality. Nicole Brand, MD, board-certified physiatrist and interventional pain management specialist at Bergen Medical Associates, with six offices throughout Bergen County, discusses common causes of and treatments for chronic pain and how proactive pain management can help patients regain control of their lives.
What are some of the most common causes of chronic pain?
Dr. Brand: Some chronic pain has a direct cause, such as an accident, injury or trauma, while other cases are the result of natural degenerative processes such as arthritis. Some of the most common conditions we treat are neck and mid- or low-back pain caused by muscle strains or spasms, arthritic changes involving joints in the spine, irritation of nerves in the spine causing radicular pain in the arms and legs, and stenosis, which refers to a narrowing around the nerves centrally in the spine. Relative to the joints, we see a range of shoulder, arm, elbow, hip, knee and leg pain, which can be caused by arthritis or conditions of the muscles and tendons.
Why are so many people in chronic pain today?
Dr. Brand: In general, our society is living longer and many people are trying to remain as active as possible into their later years. We’re happy to see that trend, though it can be difficult to balance the desire to remain active with physical issues that arise as a function of the aging process. That being said, our patients range in age from people in their 20s and 30s to those in their 80s and 90s, and some of our younger patients confirm that they’ve struggled with back pain since their teens.
What does a pain management doctor focus on?
Dr. Brand: Pain management is a broad field, but in our practice, we’re focused on diagnosing and treating both acute and chronic pain caused by a combination of tissue and nerve damage involving the spine or the joints — conditions for which a patient would normally see an orthopedist, neurosurgeon or neurologist.
How do you begin working with a patient?
Dr. Brand: We start by listening to the patient’s history and collecting information about their pain, such as whether a specific incident triggered it, where it’s located, and anything they do that makes it better or worse. We’ll conduct a physical exam to try to reproduce their pain through certain movements, then decide what treatments to offer or any other diagnostic procedures that could be helpful (such as X-rays, MRIs, or possibly ultrasound).
What types of treatments do you provide within the pain management arena?
Dr. Brand: Physical and occupational therapy are among the first-line treatments we recommend because they can be very effective in alleviating pain and organically correcting the imbalances that lead to the pain. Our hope is that PT/OT can be the starting point of an exercise program that helps patients remain active and prevents recurrences. Other conservative treatments include non-opioid medications such as anti-inflammatories and muscle relaxants.
Next on the pain management spectrum — and appropriate for patients who are in severe pain and can’t tolerate or have failed more conservative treatments — are image-guided injections. In the office, we offer ultrasound-guided injections in the joint, around the tendon, or in the fluid-filled ‘bursa’ sacs that support joints and tendons, and we also offer trigger point injections in muscles as well as nerve blocks, which involve the use of ultrasound to place medicine around the nerve causing pain. Steroids calm inflammation and nerve blocks administered in addition to steroids can further alleviate compression around the nerve. For spine-related pain, I also do injections using the X-ray machine (fluoroscopy), epidural injections (for nerve irritation related to stenosis) and radio frequency ablations (for pain related to arthritis).
Describe Bergen Medical Associates’ approach to and success with pain management?
Dr. Brand: I’m part of Bergen Medical Associates’ Sports Medicine department. In addition to myself, our team includes a podiatrist, rheumatologists and an experienced medical and nursing staff, and we can also mobilize involvement by an orthopedist, neurosurgeon or neurologist as necessary. Our group collaborates on many patients by discussing the source of their pain and their best course of treatment. Having the ability to call on these specialists under one roof is beneficial to the patient, as they often have multiple issues going on, and our collaboration is a benefit and help to us as medical professionals as well. There’s a big focus on patient well-being at Bergen Medical Associates and we always try to help our patients in a way that’s most effective and fits their needs. At the same time, working with colleagues whom we trust provides such confidence that our patients are in great hands and will get a sound opinion and the best possible results.
What final message can you share with people struggling with chronic pain?
Dr. Brand: I try to be someone who truly listens to what patients are experiencing so that I can best help them. They’ve been through a lot and may feel hopeless, but I let them know that there are many pain management techniques they can try alone or in a step-wise, multi-modal fashion. We can even take a fresh look at a technique that may not have been successful for them in the past. Ultimately, if you’re in pain, it’s worthwhile to have this conversation and be open to the possibilities because there are many effective tools in our toolbox that we can try.
For More Information
With offices in Emerson, Paramus (2), Ridgewood, Northvale and Montvale, Bergen Medical Associates offers primary care and 12 areas of specialized care. Patients enjoy the “one-stop shopping” approach where so many medical services are provided under one umbrella. The multi-specialty group fosters an environment of collaboration among the physicians, which results in a seamless continuum of care for patients. For more information, contact us today or call 201-967-8221.
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