Pain specialist with acute pain…

Acute pain 4

Dr. Michael J. O’Connell, PainCare, New Hampshire, noted that having been a pain specialist for over 30 years, I always deeply respected how devastating chronic pain can be.  When I had a fall recently while rock climbing and was yanked, twisted only to be saved by a skinny tattered rope, I felt that tell tale tweak in my right lower back and leg.  I was pretty certain I would be unhappy the next day, but what I REALLY feared was a chronic condition.  Despite being able to complete my climb, and experiencing no discomfort beyond that mild quick lightening-like flash, the following morning I could barely get out of bed.  Lifting the right leg sent jolts of electrical pain from my right butt into my second, third and forth toes, and burning on the dorsum of the foot.  I knew what it was of course, an L5 radiculopathy that is a specific type of sciatica.  I also knew that at the age of sixty, this was not good news, with a significant likelihood of becoming a life long condition.

Furthermore, an MRI showed, in addition to the expected wear and tear of an active 60 year old, more importantly, a tight canal stenosis at L4-5.  Because I had marked tenderness over the right sacroiliac joint, I had that injected at my pain center.  It resulted in almost total relief of the back pain.  Then I had a lumbar translaminar epidural steroid injection, which eliminated my thigh pain, and a week later an L4-5 and L5-S1 TFB (transforaminal block).  This reduced my remaining radicular pain to intermittent mild levels and was liveable.  I returned to climbing, indoor gym only for awhile, with no exacerbation, and then on real rock again with impunity.
I make the following observations based on my experience and diagnosis:

1.   The cause of my acute pain was not and is not entirely clear.  The severe stenosis at L4-5 is so glaring, it is most assuredly involved even though the MRI appearance is one of old pathologic changes and not new ones.  Spinal nerve roots are designed to slide to accommodate our routine physical activities, especially leg and back motion.  But when held snugly in a very tight spinal canal, the ‘right’ movement can pull so suddenly as to chafe that root since it cannot slide freely. Swelling of the chafed area then ensues, in a region where there is no room to accommodate. This sets up a vicious cycle whereby further movement during ADLs causes more swelling and pain.  Only a strong anti inflammatory injected directly onto this nerve is conceivably of real value to reverse this cycle (aside from total inactivity of course).

2.   Note that despite my agony, I did NOT consult a spine surgeon.  With my pathology, severe canal stenosis, I would have been considered a “prime candidate” by most spine surgeons for a so called “decompression,” in which the major portion of vertebral lamina is chiseled out, to create more room posteriorly for the spinal roots in the canal.  Sounds like a perfect solution doesn’t it?  Just what I needed!  Not so fast.  This surgical concept is incredibly naïve.  What do you think happens in the area of the removed bone (lamina)?  The bone is replaced by fibrous tissue, otherwise known as firm scar.  And scars tighten with time.  So there is great potential that not only will my symptoms not be relieved by this major surgery, but gradually grow worse over time.  Poor success of spine surgery for stenosis is validated in the literature, even articles written by the surgeons themselves, they have to admit that much of what they do is useless when evaluated a year after an operative procedure.  So I was armed with this “insider knowledge,” and never considered surgery.

3.   While severe acute pain indicates injury, it does not mean life is put on hold.  Getting back in the game is important for functional restoration and physical rehab, but also for mental rehab.  For me, the steroid spinal injections were essential in the process, and I believe essential in avoiding chronic pain.

What if the steroid spinal injections did not help the acute pain I was experiencing?  Guess surgery would be the answer then.  No, wait again!  There are various treatments available at pain management practices and partnering practices throughout the country.  However, if in New Hampshire, there are twelve PainCare locations throughout the state.  What options can be offered to alleviate the acute?

  1. Continue with a series of injections over a period of time
  2. Spinal cord stimulator implant if a patient has a successful trial with it
  3. Physical therapy – land and water
  4. Acupuncture
  5. Chiropractic
  6. Yoga
  7. Oral medication in addition to the above

In most cases, surgery should be avoided because it only allows for short-term relief.  In a year or two, a patient is right back where they started if not worse off.  These are not only my words or opinions, but there is published documentation out there from various trials.

About Dr. Michael J. O'Connell, New Hampshire
Dr. Michael J. O'Connell of Barrington, New Hampshire, has forged a distinguished career spanning over three decades, as entrepreneur, physician, businessman, philanthropist and healthcare consultant. As former owner, administrator and CEO of a 225+ employee multi-specialty medical practice, Dr. O'Connell has dedicated his entire professional life to helping patients with family medicine and especially those experiencing chronic pain and all aspects of addiction. Since selling his family of healthcare businesses, he has never once contemplated retirement despite his rich and fulfilling journey, but instead has turned his focus to consulting in an industry starved for courage and creativity. Having weathered many political, technological and legal challenges, there is hardly a storm he has not confronted, a tempest he has not quelled, an urgent need he has not met. While the talking heads and self-proclaimed experts in the field have assumed the conventions and standards of the times, Dr. O'Connell does not believe in merely reflecting the herd mentality, but rather in leading the charge. Eschewing political correctness, Dr. O'Connell says and does what needs saying and doing, and not what the mindless masses expect. In addition to the continual education afforded by his variegated life experiences, Dr O'Connell earned his BS in Biochemistry at the University of NH in 1975, his Medical Degree from Dartmouth College in 1981, interned at Walter Reed Medical Center in 1982, Residency/Fellowship at UCSF in1986, and finished his Masters in Healthcare Administration at UNH in 1995. Dr. O’Connell enjoys many outdoor activities, including rock climbing, snowboarding, hiking, and golf. Through the decades Dr. O'Connell has supported many non-profit charities to include the St. Charles Home in Rochester NH, the Tri City VNA and Hospice, Hyder House, and Cocheco Valley Humane Society. To the latter organization alone Dr. O'Connell has donated over $180,000 and pledged another $250,000 in the “Bring-Us-Home” campaign for a new building. His “Matching Donations Christmas drive” has generated over $175,000 in charitable giving from the community. In addition Dr. O'Connell has participated in many dozens of other volunteer and donation efforts locally as well as in Africa and the Dominican Republic. For a listing of how I gave back to the community during my career and continue to do see:

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