Pain is an extremely common problem that most people experience at some point in their life. The Denver Spine & Pain Institute has the diagnostic and therapeutic tools to address your pain and help you return to the activities that you enjoy. Pain can arise from:
Most painful episodes are easily treated and go on to heal. We can assist you in this process. When pain becomes chronic and disabling, we can also help you reduce your pain and help get you back to activities you enjoy and a quality of life that you desire.
Pain – Why, How, and Where?
Pain normally serves the purpose of warning us of actual or nearing damage to our bodies. Stepping on a tack, touching a hot pan or excess strain on a joint send warning signals to your brain, and you respond in a way to protect yourself. When you do experience an injury or infection, nerve and chemical signals are sent to both the injured area as well as the spinal cord and brain (central nervous system). Inflammation sets in, causing swelling, redness, and local pain. The nervous system also becomes inflamed (neuroinflammation), causing you to be even more sensitive at the injury site and to feel “down”, so that you are less active – preventing further injury and allowing for healing. When the brain and the nerves at the injury site do not return to normal as you heal, chronic pain may result. Another term for these brain and injury site nerve changes is “neuropathic pain”. Even more complicated are the changes to your behavior and mood that chronic pain may bring. You may avoid activities, worry about the functional and financial “fall-out” of your pain, have trouble sleeping or exercising, or notice stress on your relationships. All aspects of pain should be addressed so that you can experience the best treatment outcome possible.
Inflammation and Pain
Inflammation at the site of injury and persistent inflammation of the glial cells and other cells within the spinal cord and brain is a very important mechanism for the set up of chronic pain. It also presents with a treatment target for pain. This may mean reducing inflammation to restore things back to their normal or homeostatic state in the treatment of acute pain. With chronic pain, it is important to reduce the level of inflammation and return the abnormal pro-inflammatory nerve cell function back to its normal anti-inflammatory status. This can be done through the use of medications, corticosteroid injections, diet and supplements, and influenced with adequate exercise and sleep.
Diet and Inflammation
Diet changes can have a significant impact on our bodies’ general inflammatory state, both at the site of injury and within the brain and is an easy way to start implementing an inflammation control strategy from the time of onset of pain or injury. Dietary choices that cause increased inflammation include sugary or starchy foods, such as sweets, potatoes, and refined flours. Positive anti-inflammatory choices of carbohydrates include whole grains, non-starchy vegetables such as leafy greens, broccoli, and asparagus. The advantage of these types of food are several-fold and include:
Slower release of sugars, reducing your body’s release of insulin.
High levels of fiber, which is good for the gut microbiome and thus anti-inflammatory.
High in other vital nutrients.
Saturated fats such as those found in many processed or fast foods, and meat fats can also cause increased inflammation and thus increased pain, as well as other health problems. Better choices are foods high in omega 3 fatty acids such as certain fish including salmon, walnuts, and flaxseeds. Extra virgin olive oil contains polyphenols which have an anti-inflammatory effect. In general, colorful foods such as berries, peppers and other choices are very nourishing and effective at reducing inflammation.
Some commonly used supplements with anti-inflammatory effects include omega 3 fatty acids, vitamin D3, turmeric and others. There are anti-inflammatory diets of that name, the Mediterranean diet and intermittent fasting which are dietary strategies used to reduce inflammation and benefit you in additional ways.
Conservative Treatment of Pain
We will design a treatment plan that takes your individual needs and preferences into consideration. We believe in a conservative approach whenever possible, so this plan will often contain multiple approaches to provide pain relief and improve your quality of life and may include:
Non-opioid pain medication and topical pain relievers
Safe use of opioids when indicated
Lifestyle guidance for pain management
Pain psychology services to address mindfulness and other pain control options
Trigger point and other office-based injections
Sleep and Pain
We know that getting enough sleep is very important to general overall physical and mental health. It is also very important component of your pain management. Sleep is interrupted by pain, which lessens the quality of your sleep and its ability to help restore you to better health. We know that interrupted sleep also makes you more sensitive to pain and lowers your pain threshold on a neurological level. Our team of providers will discuss important sleep topics, including sleep hygiene, relaxation strategies, home remedies and medications when necessary. With your input, we will design a specific sleep treatment plan for you. You may also want to learn skills such as calming the mind, learning how to break worry loops and other cognitive behavioral and mindfulness strategies to assist with improving the quality and restorative power of your sleep.
Exercise can improve your overall physical health, reduce anxiety and depression, reduce inflammation, and improve sleep quality, and as a result be a good stress and pain management tool. Our team of providers will work to utilize physical therapies, medication management when needed, diet and supplements, and other means to assist you in achieving the highest level of exercise possible. Even low-level stretching, walking or stationary cycling and minimal core exercise can have a very positive effect on your sense of well being and management of pain. There should ideally be a balance of strength, endurance and flexibility.
There are many components to physical therapy and other therapies that employ some of these strategies such as chiropractic, osteopathic manual therapy, massage, Rolfing, and other therapeutic arts. Manual therapy consists of the use of maneuvers to free up joint motion or expand the range of motion through tight and painful tendons, muscles, or joints. Soft tissue massage, cupping, dry needling, and other techniques are useful in working on relaxing, lengthening or freeing movement up in muscle, tendon and joint capsules. It is then also very important to rebalance the muscles in terms of strength, flexibility, and the proper timing of the muscle firing for joint and spine protection and the normalization of function. This muscle retraining is one specialty of physical therapists. The physical therapists at the Denver Spine and Pain Institute are experts in providing all levels of restoration of joint mobility, muscle function and helping you get back to the activities you enjoy.
The injuries and inflammation that cause pain also cause changes in the brain, called neuroinflammation. Neuroinflammation not only makes pain worse, but worsens or even causes symptoms of anxiety, depression, PTSD and lessons your quality of life. We also know that certain thought patterns, social stressors, as well as lack of sleep and exercise worsen these brain, neuroinflammation, and behavioral problems which leads to a worsening of pain. Science has also learned about the ability of our brains to adapt and change in response to good or bad stimuli. The brain is adaptable and is called neuroplasticity. This adaptation can be a negative one in response to chronic pain and poor behavioral responses to pain. One advantage of working with a pain psychologist is that your work with them helps to change these negative neural circuits back towards more positive and normal neural circuits, or wiring. They may use strategies such as:
Instructing you in proper relaxation techniques
Cognitive behavioral therapy
All of these modalities can help reduce your pain and move you towards restoring normal function and mood. This ultimately leads to a better quality of life. Speaking with a pain psychologist about these and many other pain treatment options can be an important component of your pain management plan. We work closely with Joy Simpson, LPC of MindYourPain, who is a member of our Connected Care Approach™ team, as well as other psychologists in the community and are happy to work with your psychological care provider, if you already have one. We believe that this is an important component of a well-rounded, holistic care approach.
Medications can be very helpful in the management of pain, if chosen and used wisely. There is a wide range of medications to choose from, and through discussion of the pros, cons, and reasoning for certain choices, as well as your needs and input, your provider will work with you to choose the medication regimen. Through mutual decision making, medications can be trialed, and a specific regimen can be dialed in to assist with your pain management. There is an art to choosing the right pain medication or medications to best assist you with your pain management strategy.
Antidepressant medications – Certain antidepressant medications are very helpful for pain management and may be chosen if you have developed some degree of depression along with your pain. These medications can be used even without the presence of depression, however, and can also be used to assist in improving the quality of your sleep.
Antiseizure medications – Certain antiseizure medications have been found to be helpful in the treatment of pain. These tend to have a positive effect on reducing anxiety, hyperactivity, and some can also help with sleep.
Muscle relaxants – Likewise certain muscle relaxants can be used on an as needed basis during the day for pain management and reduction of muscle spasms, but may also be useful very helpful in getting to or staying asleep.
Anti-inflammatory medications – Control of inflammation is important, and you may be prescribed a few day course of corticosteroid to address a very acute and severe flare up in symptoms, or you may be prescribed nonsteroidal anti-inflammatory medications (NSAIDs) on a short or intermediate-duration basis to assist in reducing both pain and inflammation. Certain supplements and diets may enhance the effect of these anti-inflammatory medications.
Other analgesics – Analgesics such as acetaminophen (Tylenol) and others can be very beneficial for some people and can augment the effect of anti-inflammatory or other medications.
Topical medications – Topical medications can also be helpful and take the form of lidocaine, mentholated products, topical anti-inflammatory medications, or capsaicin-containing products. These are very helpful and tend to minimize (but not eliminate) the systemic effects of these medications, while delivering them where they are needed.
Opioids – Opioid medications can play a role in maximizing function, sleep, and ability to exercise. There are downsides to the use of opioids, including constipation, endocrine effects, slowing of mental processes, contribution towards depression, and the possibility of misuse of the medications. There are safety concerns as well. Your provider at The Denver Spine and Pain Institute will discuss and weigh the pros and cons of opioid use before prescribing them. Opioids are prescribed with certain precautions, such as avoiding all use of alcohol, not starting any new sedation medications from outside providers, such as benzodiazepines (valium), sleeping medications or sedating muscle relaxants without discussing these first with your pain provider. We have you sign a drug agreement which outlines these safety measures and ensures that you agree with adhering to these precautions when using opioids or other controlled substances. An initial and periodic urine toxicology screen will be utilized, as is now standard of care for pain practices, including ours. We can also help you to reduce or eliminate opioid medication use if that is desired or required.
Diagnosing Your Pain
The Denver Spine and Pain Institute care providers will listen carefully to your history and perform a detailed, hands-on physical exam to begin the diagnostic process. Other pain diagnostics include:
This is a complex sequence of diagnostic decisions and treatment choices that the diagnostic experts at the Denver Spine and Pain Institute can work through with you. You will be educated as to the purpose and potential value of any diagnostic injections that might be carried out to help with your diagnosis.
Interventional Treatment of Pain
The medical providers at The Denver Spine and Pain Institute perform therapeutic injections. This may take the form of corticosteroid injections around inflamed or pinched nerves (epidural injections), into joints or around tendons. This can include trigger point injections into painful bands of muscle, called trigger points.
Joints of the spine, called facet joints, as well as certain other joints including the knees, have nerve branches that conduct pain signals from the joints to the brain. These nerve branches can be numbed, and if numbing these takes away the pain temporarily, we can also apply heat to those nerves and destroy them to help eliminate pain from those joints. This procedure is called radiofrequency ablation (RFA) and generally lasts about 10-12 months and can be repeated when the nerves grow back.
Spinal cord stimulation has evolved, and the technology is excellent at this point. Dr. Trainor is highly trained and skilled in performing spinal cord stimulation trials and permanent implantation of the devices used. These are programable so that different signals can be applied to the spinal cord to cover up the original pain signals.
Regenerative medicine involves the injection of platelet rich plasma (PRP), stem cells derived from your bone marrow, or stem cells, growth factors or other chemicals and matrix from umbilical cord sources into disc, joints or around tendons. This is done using guidance for accurate needle placement through fluoroscopic (x-ray) or ultrasound imaging.
Drs. Bainbridge and Trainor also perform a number of specialized procedures, including the basivertebral nerve ablation, with Relievant’s Intracept device procedure, to treat chronic low back pain associated with abnormal findings on MRI, called Modic changes. These indicate endplate microfracture and swelling that is commonly associated with low back pain. If you experience lumbar spinal stenosis (tightness around the nerves due to degenerative bone spurs, disc bulge, or both), you may be a candidate for a decompressive procedure through the placement of a device to open up the spine. This is done when surgery is not the best option or is not desired. There are newer procedures being used for a minimally invasive distraction/fusion of the sacroiliac joint as well.
Research Trials at The Denver Spine & Pain Institute
The Denver Spine and Pain Institute is now carrying out research trials that include cutting edge treatments for back and leg pain due to spinal nerve irritation and pain. This includes two spinal cord stimulation trials, the SOLIS and FAST studies, a study where an enzyme is placed into a herniated disc to help soften and retract the herniation, relieving pressure on the painful nerve root (DISCovery study), and a study of a drug which contains a natural anti-inflammatory in our brains. This last study makes use of an oral medication to decrease the pain of a pinched nerve in the low back. Click on the links below to learn more about these studies.
Exceptional Pain Management
At the Denver Spine and Pain Institute, we know how debilitating pain can upend your quality of life. Our team is committed to offering you with the relief vital to enjoying your favorite activities once again. Our goal is to help you get back to living your best life.
We have designed our exclusive Connected Care Approach™ with your needs in mind, and it will get you back to enjoying life faster and easier, without the challenges that often come along with chronic pain. As part of this approach, you’ll receive:
A full spectrum of care options, including physician treatments, physical therapy, massage, diet and lifestyle coaching, behavioral health services and other state-of-the-art treatments
Individualized care plans to address your specific pain needs
Caring and therapeutic relationships with our team to ensure the best possible treatment
A detailed discussion of all your treatment options so that you can make an informed decision
We’ll work closely with you to identify and deliver the treatments necessary to achieve the pain relief you’re seeking.
Schedule an Appointment
Please contact us today to schedule an appointment. The Denver Spine and Pain Institute serves patients in Denver and the surrounding areas of Colorado.