Medical service provided by
Pain Care Physicians, PLLC
206-538-6300 | Fax: 206-538-6301 | Email:
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Pain Conditions We Can Treat

Arthritis and Joints

Painful joints can develop in one or multiple sites depending on the condition. The hip, knee and shoulder are large joints which are subject to degeneration or damage to soft tissues causing pain. As with most musculoskeletal conditions, treatment begins with physical therapy to correct mechanical conditions that predispose the joint(s) to ongoing damage. Anti-inflammatories and supplements such as glucosamine-chondroitin can be useful, as well as topical medications and bracing. Direct injection of a cortisone medication or a cartilage supplement into the joint can sometimes benefit the patient’s pain. Some forms of joint damage can benefit from orthopedic surgery. For knee pain associated with nerve damage to the knee, often after a replacement, numbing of three sensory nerves surrounding the knee using electrical energy generated at a needle tip can effectively provide long-term relief.
Some forms of widespread arthritis are the result of autoimmune disease and are best diagnosed and treated by a rheumatologist. Widespread joint pains can be the result of amplified processing of sensory information in the nervous system called central sensitization, which is thought to be associated with fibromyalgia.  This and its associated conditions are handled under a separate header.

The Spine

One of the most common chronic painful conditions that people suffer from is pain of the neck or back. Musculoskeletal pain of the neck can also cause referred pain to areas of the head or shoulder. Back pain frequently refers to the flank, buttock or thigh. If a nerve root is involved, the pain may radiate all the way to the hand or foot. Sometimes, low back pain may originate in the sacroiliac joint. This is a large joint between the tail bone (sacrum) and hip bone (ilium) bound by a very thick ligament that may become strained or inflamed. Sacroiliac injury can mimic sciatica in its radiation to the leg.

Image result for spine painThe treatment of musculoskeletal pain of the neck and back begins with physical therapy to correct the mechanical problems that initially caused the pain. This may be supplemented with anti-inflammatories, topical medications, chiropractic, massage, acupuncture and other alternative therapies. Some prescription medications in the class of antiepileptic or antidepressant drugs may be useful for nerve pain. Behavioral therapies may also be recommended for helping patients cope with the psychosocial burdens of chronic pain.

For persistent pain of the spine there are interventional therapies which may be useful. An epidural injection of steroid can calm an inflamed nerve root and accelerate healing of a compressed nerve. The sensory nerves of the spinal joints themselves can be numbed on a long-lasting basis using electrical energy, provided a patient obtains temporary relief from a local anesthetic on those nerves. There are some individuals with extensive disease or significant disc herniations who could require surgery. There are highly effective therapies for pain of the spine, with or without nerve root injury, that block pain signals from getting to the brain by creating an electrical field in the epidural space with an implanted electrode and battery system.

Please use one of the options to the right to learn more about these modalities.

The Nerves

Many types of injury to peripheral nerves or the central nervous system may result in chronic pain called neuropathic pain. Traumatic injuries, including surgery, or a case of shingles can cause neuropathic pain which begins suddenly and persists. Chronic diseases like diabetes can cause progressive neuropathic pain with a more insidious onset. Physical therapy may be appropriate for certain types of neuropathic pain, but typically anticonvulsants, certain types of antidepressants, and topical medications are used to control symptoms. Certain neuropathies may benefit from therapeutic nerve blocks or even implantable devices. In the case of neuropathy due to chronic disease, control of the underlying disease is crucial to help prevent worsening of symptoms.

Fibromayalgia and Associated Conditions

Fibromyalgia is a disorder characterized by widespread pains and other associated symptoms of fatigue, headache, and disturbed sleep. The biological basis of the disorder is poorly understood; the immune system and nutritional factors may play a role, but the most recent evidence suggests that fibromyalgia is a dysfunction in the sensory and regulatory processes of the central nervous system (brain and spinal cord). Brain imaging studies suggest that people with fibromyalgia have amplification of background sensory information from the small nerve endings which exist throughout the body, including the musculoskeletal system. Most individuals are not aware of this surveillance activity of the nervous system, but if the signal is turned up, like white noise on a radio, it can be distracting and uncomfortable. Enhanced sensory input and disrupted regulation of other routine bodily functions having to do with sleep, digestion and urination can cause symptoms like insomnia, headache, irritable bowel symptoms and pelvic pain.

The term that has been coined for this set of conditions is “central sensitization syndromes”. We administer a questionnaire to all of our new patients to help detect these syndromes. If this survey along with other clinical information support this diagnosis, we have various strategies to offer help.


Chronic headache is common disorder. Migraine and tension headaches are the most common types, but there are a host of diagnoses associated with headaches. Chronic opioids, benzodiazepines, and barbiturates such as Fioricet may transform occasional headaches into chronic daily headaches, and should be avoided. Headaches may also originate from the upper cervical spine. In these cases, physical therapy and/or interventional pain therapies are likely to benefit. Patients with chronic headaches who have not had prior consultation with a neurologist would benefit from their expertise.

Abdominal Pain

Abdominal pain has many potential causes, and should always be addressed by appropriate specialties such as gastroenterology, urology, and or gynecology prior to referral for pain management. Irritable bowel syndrome (IBS) is often a source of difficult to diagnose abdominal pain. In some cases, abdominal pain is a result of surgery and can be treated as neuropathic pain. Chronic inflammation of the pancreas, or difficult to treat cases of inflammatory bowel disease (IBD) such as Crohn’s or Ulcerative Colitis may also be a source of abdominal pain. Usually, pain from these diseases are more appropriately managed by a gastroenterologist, however there are some interventional therapies that may be appropriate.