A Multimodal Approach to Pain Therapy

By: Lance E. Reinsmith, MD
Monday, March 3, 2014

Pain is such a common manifestation of various medical conditions that it has been described as the “fifth vital sign.”* Despite this pervasiveness, there is a wide variance in the ways individuals experience pain.

Pain was once thought to be merely a response to some type of physiologic insult or anatomic injury, but we now know that many physical, metabolic, psychological and environmental factors play a role in how people feel pain. Just as our understanding of pain has evolved over time, the treatment of pain has changed over the course of recent medical innovation.

At South Texas Radiology Imaging Centers (STRIC), we understand the complexity of pain and draw from many resources when providing therapy. STRIC offers nonsurgical, image-guided pain relief services for spine and extremity discomfort at its Orthopedic Imaging Center and Hardy Oak Imaging and Interventional Center.

Pain management physicians at STRIC work with patients’ physicians to determine the best therapy, with the goal of restoring quality of life. Therapy is often multimodal and requires communication among physicians in different disciplines, frequently coordinated by the pain relief specialist.

All of the pain management physicians at STRIC are board-certified by the American Board of Radiology and performed fellowship training in musculoskeletal or neuroradiology with a focus in pain alleviation practices. As trained diagnosticians, STRIC radiologists are skilled in using imaging modalities, such as MRI, computed tomography (CT), ultrasound, nuclear medicine and radiography to help diagnose a painful condition.

In a single physician/patient encounter, the treating physician at STRIC reviews a patient’s subjective description of the location and characteristics of the pain, performs a focused medical history and exam, and reviews pertinent diagnostic imaging studies. Therapy is usually performed in the same session, eliminating prolonged waiting between diagnosis and treatment.

STRIC pain physicians utilize state-of-the-art imaging modalities, such as CT, ultrasound and fluoroscopy to guide procedures. These directed techniques offer supplemental information regarding the cause of the patient’s pain. By precise localization of an injection or other therapy, we acquire the most accurate diagnostic information and ensure optimal treatment efficacy.

An innovative area of pain diagnosis and therapy is peripheral nerve pain syndromes. While all pain is transmitted by nerves, some characteristic types of pain are mediated by localized peripheral nerves with little or no motor function. Examples include intractable groin pain following hernia or prostate surgery, knee pain due to osteoarthritis or prior knee replacement surgery, meralgia paresthetica, phantom pain following limb amputation, and nonradiating back pain from facet (zygapophyseal) joint osteoarthritis. If necessary, MRI sequences tailored for neurography can diagnose impingement of these nerves and help direct therapy.

Radiologists at STRIC use ultrasound and fluoroscopic guidance to place radiofrequency ablation probes next to these nerves before ablating them, destroying their ability to transmit pain impulses and providing up to a year or more of pain relief.

Lance E. Reinsmith, MD

Dr. Reinsmith received his MD from Baylor College of Medicine. He subsequently completed residency training in diagnostic radiology at the Mallinckrodt Institute of Radiology, affiliated with the Washington University in St. Louis School of Medicine. He stayed at Mallinckrodt to subspecialty train in musculoskeletal radiology and interventional spine procedures. Dr. Reinsmith has presented research at meetings of the Radiological Society of North America and the American Society of Neuroradiology. He has coauthored research accepted for publication in the peer-reviewed journals, Radiology and Radiographics. He is a board-certified radiologist with specialized training in orthopedic radiology and interventional pain management.

For more information or to schedule an appointment, please contact South Texas Radiology Imaging Centers at 210-617-9000 or visit www.stric.com. Follow STRIC on Twitter @STRICImaging and on Facebook.