Comprehensive Center for Pain Management
The Comprehensive Center for Pain Management specializes in the treatment
and reduction of pain with a focus on improving function and quality of
life. Our highly skilled team of board-certified specialists includes
anesthesiologists, and psychologists. Working together with nurses, radiology
technicians and therapists, our professional staff is committed to providing
a comprehensive multi-disciplinary, individualized, plan of care for each patient.
Our hospital-based outpatient center for the management of chronic and
cancer pain offers state of the art spine injections, pharmacologic management
and cognitive-behavioral therapy. This dedicated facility includes a specialized
procedure suite with state of the art monitoring and sophisticated imaging
equipment that enables precise placement of injections. We offer procedures
such as nerve blocks, neurolysis, trigger point infiltrations, epidural
steroid injections, facet joint injections, sympathetic ganglion blocks
and radiofrequency ablation.
Our psychologist provides assessment and support on-site. The multidisciplinary
treatment approach, which includes psychological interventions, has positive
long-term effects in controlling chronic pain. The goal is to help patients
develop strategies for relaxation, managing stress and coping with pain.
Our pain management staff also provides inpatient consultations for complex
pain problems. Patients may be referred by their physician or may call
the Comprehensive Center for Pain Management directly at 561.955.PAIN (7246).
Back pain is very prevalent - affecting over 80% of all adults at some
time during their lives. In fact, back pain is second only to headaches
as the most frequent cause of pain. Back pain may come on suddenly or
gradually. It may be short-term - lasting a few days to several weeks.
Pain that persists longer than three months is chronic. Even though back
pain is rarely life-threatening, it costs an estimated $40 billion dollars
a year in medical bills, lost wages and insurance claims in the United
States. Since we use our backs for nearly all of our activities, there
is a high probability that we will injure or stress this area of our bodies
and develop pain.
What makes up the spine?
The spine is a delicately balanced structure made up of two dozen vertebrae
(bones) stacked on top of each other, cushioned individually by discs
(filled with a jelly-like material), held together by a network of ligaments
and strengthened by overlying muscles. The spinal cord runs along the
vertebra in a long hollow canal. Nerves exit the spinal cord and branch
out through spaces between the vertebra. This presents a challenge to
both patient and doctor in determining which one of these structures is
the source of the pain.
What are the potential causes of back pain?
Back pain can occur for no apparent reason at any point in your spine.
The lower back bears the majority of your body's weight and is therefore
at highest risk for damage. The most common cause of low back pain is
using your back muscles to perform activities to which you are not accustomed.
Poor muscle tone/physical condition and excess weight can cause and exacerbate
back pain. Any imbalance, like poor posture can stretch muscles and joints
causing injury. Daily activities like playing tennis, lifting heavy objects,
or weeding your flower beds may strain the lower back. Emotional stress
may also cause back pain to increase. Below are a list of common sources
of back pain:
Osteoarthritis -- Associated with the aging process, this problem occurs
with wear and tear of the spinal column protective tissues and joints.
The discs which act as 'shock absorbers' start to thin out. With advancing
age the spine loses its flexibility. Sciatica -- This term refers to pain
radiating from the buttocks to the lower leg. It may be related to inflammation
of one of the nerve roots that make up the large sciatic nerve. This pain
may increase with bending or even with coughing or sneezing.
Osteoporosis -- As you age, the calcium in your bones decreases -- weakening
the bony structure. This may cause the bones in the spine to collapse
and result in compression fractures. This condition is most noticeable
in women who have suffered a progressive loss in height.
Herniated Disc -- The fibrous capsule surrounding the disc develops a
weakness causing the jelly-like material inside to protrude against a
Spinal Stenosis -- Common among men and women 50-70 years old, this condition
is characterized by a narrowing of the spinal canal. This means less room
for the nerves to move freely.
How can a doctor determine the cause of the pain?
Even with today's sophisticated diagnostic equipment, the exact cause
of low back problems can be found in very few people. In most cases, the
symptoms are related to muscle spasm, tears in ligaments, joint problems,
or disintegration of the shock absorbers in the back. Other causes are
related to irritated nerves.
A physical exam and patient description of the pain may be all that is
required. If further diagnostic tests are necessary, any combination of
the following can help determine the cause of the pain: blood work, urinalysis,
X-rays, CT scans (computerized tomography), MRI (magnetic resonance imaging),
myelogram (injection of dye into the spine to study nerves) and bone scans
(injection of minute radioactive tracers into a vein).
How to Manage the Pain?
The source of the pain will determine the treatment. The latest guidelines
for treating most back problems include non-prescription pain relievers,
rest and mild exercise. More than 80% of patients will have symptoms diminish
within weeks. With strained ligaments or muscles, recovery may take longer.
For acute low back pain, short periods of bed rest for no more than two
to three days, ice and anti-inflammatory medications are recommended during
the first 48 hours. If the pain persists, your doctor may suggest physical
therapy and oral drugs for six weeks. Persistent pain may require the
injection of local anesthetics, anti- inflammatory medications and nerve
blocks. Surgery is only recommended for a small percentage of patients.
Suggestions for Home Treatment of Back Pain
Apply cold and heat. Immediately after injury, apply ice (wrapped in a
cloth or towel) several times a day for up to twenty minute intervals.
After the acute pain subsides, within the first 24-48 hours, apply a heating
pad (low setting) for up to 20 minute intervals.
Use over-the-counter medications such as Tylenol, non-steroidal anti-inflammatories
like aspirin and ibuprofen to reduce inflammation of muscles and joints.
However, if you are taking medications for other health problems, check
with your doctor before taking any additional medications.
When should I see a doctor? Most people with back pain or discomfort may
not need to see a health provider immediately. However, you should call
your doctor right away if:
- Your symptoms are severe, constant, or not alleviated with over-the-counter
- Your pain is the result of a direct injury such as a fall or hit to the
- You feel weakness or numbness in your legs.
- You have any changes in bladder or bowel habits.
- The pain is preventing you from your regular activities.
- The problem does not go away within a few days.
If you have any doubt about your condition, contact your doctor.
Tips for Preventing Back Pain
- Exercise regularly. Walking, cycling and swimming will help prevent back
problems. Ask your doctor about specific exercises to improve your muscle strength.
- Lose weight if you are overweight.
- Maintain good posture while standing, sitting and sleeping.
- Wear flat or low heels.
- Make sure your work surfaces are a comfortable height.
- Avoid lifting heavy objects. When you do lift something, do not bend over,
twist, or reach.
- Keep your back straight and keep objects close to your body. Push rather
than pull, if possible.
- If you must sit at your desk or in the car for long periods, take breaks
- Plan ahead and reorganize your work or leisure activities to eliminate
high risk movements.
What is shingles?
Shingles (herpes zoster) usually begins as an inflammation of nerve roots
where they exit the central nervous system at your spinal cord.?Some people
mistake the initial pain caused by shingles as back pain. The painful
inflammation moves outward from the spinal cord along the sensory nerves
and usually results in painful blisters and a rash on the skin over the
affected nerve fibers. This can occur anywhere on the body but is most
commonly found on the chest.
What causes it?
The same virus that causes chicken pox causes shingles. Following an occurrence
of chickenpox, the virus lies dormant in certain nerve cells near your
spinal cord throughout your life, or can reactivate years, even decades
later, resulting in shingles. Approximately 20% of the population, mostly
over the age of 50 is affected at sometime during their lives.
A shingles infection usually occurs when your immune system becomes weak.
This may be due to advancing age, cortisone-type drugs, cancer or cancer
treatment such as chemotherapy or radiation therapy. Patients who have
had organ transplants and are taking anti-rejection drugs, and people
with diseases that affect the immune system such as AIDS, are also more
susceptible. Also, trauma or stress may also trigger an attack.
What are the symptoms?
Burning pain and extreme sensitivity in one area of the skin (typically
on one side of the body) for one to three days are the fist symptoms of
Then a rash develops and turns into groups of painful blisters that resemble
chickenpox. The blisters typically last for two to three weeks before
crusting over then disappearing. The pain may last for months or even years.
Can shingles be treated?
Pain relievers and cool compresses to dry the blisters are helpful. New,
antiviral drugs are prescribed to shorten the time period of the discomfort
and to decrease the pain.
Is there pain after shingles?
Post-herpetic neuralgia (PHN) is a condition in which either constant
pain or periods of pain can continue after the skin has healed. It can
last for a long time--occasionally for years. PHN may cause a variety
of types of pain including skin hypersensitivity to touch and temperature.
How to Manage the Pain
Treatment for PHN includes the use of anti-inflammatory drugs and oral
pain relievers. For severe cases, a combination of an anesthetic and an
anti-inflammatory steroid may be injected near the nerve roots as a nerve
block. An ointment containing capsaicin is also helpful for some people.
The ointment is applied to painful areas of the skin three to four times a day.
Ask your doctor for a referral to the Pain Management Services of Boca
Raton Regional Hospital for help in managing your pain from shingles or
any other condition. Pain Management Services utilizes a variety of approaches
including highly effective oral medicines, and the latest high-tech therapies
including intraspinal infusion pumps and nerve blocks.
Pain Management Services Boca Raton Regional Hospital, Sandler Medical Plaza
650 Glades Road, Boca Raton, FL 33431
Carmen L. Dominguez M.D. is Medical Director of the Pain Management Service
of Boca Raton Regional Hospital.
Fall Prevention and Balance Improvement
Falls and balance dysfunction are two of the greatest problems that can
impact aging individuals. One fall is one fall too many. Gloria Drummond
Physical Rehabilitation Institute offers a thorough balance intervention
program specific to each client's needs. People may develop balance problems
rather suddenly. Difficulties can develop after a long hospital stay or
when patients have developed muscular weakness from another cause of lengthy
immobility. They may find that their balance has been progressively deteriorating
over sometime and it is finally threatening their safety and independent
Balance problems may be the result of tight muscles, muscle weakness,
postural problems that offset a person's center of gravity, delayed balance
reflexes and reactions, subjective fear of falling, to name a few contributing factors.
One of the most common questions that we hear from clients is “Can
I get any better, or how much improvement can be expected?” There
is hope! Prognosis is dependent on many factors, including the number
of systems involved in the problem and patient compliance with their home program.
Your therapist will explain his or her findings and expectations at the
evaluation. The good news is that “yes,” most clients do show
significant functional improvement. One of the greatest goals that we
can help person achieve is to reduce his or her fear of falling and increase
confidence with balance to minimize the risk for falls.
For information on how to schedule an appointment, please click on the
Gloria Drummond Physical Rehabilitation Institute offers a program of therapy
services for individuals with vestibular and balance dysfunction. Common
diagnoses related to balance and vestibular problems that we see include:
- PPV (benign paroxysmal positional vertigo)
- Vestibular dysfunction
- Gait Dysfunction
- Imbalance and fear of falling
- Balance problems secondary to muscle weakness and hospitalization
- Balance problems secondary to peripheral neuropathy
- Balance problems secondary to functional decline
Each client is thoroughly evaluated to determine the root cause of the
problem. Physical problems are identified and goals are established to
help each client achieve his or her maximum functional improvement and
safe independence. Each client's program of treatment is unique to his
or her needs. Therapy intervention may range from three treatment sessions
up to two months, depending on nature of the injury, compliance with home
program, and individual progression. People with acute vestibular dysfunction
can often expect improvement in as little as three treatment sessions.
People with balance related problems usually require four weeks of therapeutic
intervention to see significant results.
The following are useful links and resources:
Massage is considered to be one of the oldest forms of health care in the
world. Egyptian tomb paintings depict people receiving massage, ancient
Chinese and Indian texts refer to it as treatment for disease and injury,
and Greek and Roman physicians relied on it as one of their primary therapies.
Massage is a noninvasive form of integrative therapy used to complement
traditional medical care. Scientific research has indicated that massage
therapy is helpful in reducing pain and relieving stress. It is aimed
at achieving or increasing the health and well-being of an individual
by affecting the musculoskeletal, circulatory, lymphatic, and nervous
system as well as the mental and emotional state.
Effects On Skeletal System
- Pain or tingling in arms or legs: Muscles can become so contracted that
they press on the nerves to the arms, hands and legs causing pain or tingling.
If this occurs, a massage can help to alleviate muscle spasms in the shoulder or hip.
- Injuries: Massage can help heal injuries such as tendonitis that develop
over time, as well as ligament sprains or muscle strains caused by an
accident. Massage benefits the skeletal system by increasing joint mobility,
range of motion and flexibility. It can also help to restore tone to flaccid
muscles and partially compensate for the lack of exercise and inactivity.
- Scaring: Certain massage techniques can limit scar formation in new injuries
and can reduce, or make more pliable, scar tissue around old injuries.
- Secondary pain: Headaches can be a result from eye strain, a low backache
can be due to pregnancy, or the protective tensing of healthy muscles
around an injury.
Effects On The Relaxation Response
- Prevention of new injuries: By relieving chronic tension, massage can help
prevent injuries that might be caused by stressing unbalanced muscle groups,
or by favoring or forcing a painful, restricted area.
- Pain or restriction in joints: Massage works directly on the joints to
improve circulation, stimulate production of natural lubrication, and
relieve pain from conditions such as osteoarthritis.
- Posture: Releasing the restrictions in the muscles, joints, and surrounding
fascia, the body is able to return to its natural posture. Massage can
also relieve the contracted muscles and pain caused by abnormal spinal
curvatures such as scoliosis.
A soothing massage can help to reduce anxiety, muscle tension, stress,
and improve the quality of sleep and mood state.
Effects On Immune System
The immune system may be affected by massage due to the increased flow
of the lymphatic system which is influences the immune function. Chronic
stress can influence susceptibility to infections, slow wound healing,
and exacerbation of certain autoimmune diseases.
Effects On Nervous System
Massage stimulates the parasympathetic nervous system, which helps to
reduce pain and muscles to relax. Stress can influence certain conditions
aggravated by anxiety such as asthma or insomnia.
Massage Will Help With:
- Back Pain
- Chronic Fatigue Syndrome
- Circulatory Problems
- Effects of Chemotherapy
- Myofascial Pain
- Post Surgical Recovery
- Shoulder Pain
The Gloria Drummond Physical Rehabilitation Institute provide patients
a healing environment using massage therapy to compliment traditional
medical care. The Center’s teams of caring professionals work hand-in-hand,
to assist their patients to feel their best and live life to the fullest.
Massage stimulates the sensory receptors in the skin thereby increasing
superficial circulation. It also affects the connective tissues (the fascia)
by separating the tissues and increasing pliability. The relaxation of
the muscles reduces the sensitivity of the myofascial trigger points thereby
releasing metabolic wastes into the venous and lymph channels and increases
Massage can aid in the recovery of acute inflammation caused by muscle
trauma by increasing circulation and oxygenation of the injured tissues.