Pain Management

Treatment Philosophy

Almost a third of Americans suffer from chronic pain with a cost of at least $558 billion a year in medical bills, sick days and lost productivity. Chronic pain can have many origins such as arthritis, spine problems, cancer and digestive disorders.

Dr. Jerry Sobel, a leading pain management doctor in Phoenix, AZ, has been treating individuals with low back pain, neck pain and arthritis for over two decades. He understands that acute and chronic pain conditions are very different and therefore should be treated quite differently. In acute pain their is a specific tissue injury that occurs. Changing activity level, using ice and anti-inflammaories can be helpful. Acute injuries generally heal within a few months. When the pain from that injury does not resolve after the expected healing time, usually about three months, it becomes a chronic pain problem.

Chronic pain syndromes whether they involve the low back, neck or a joint, are influenced by many factors beyond the original tissue damage. After several months of pain, patients develop secondary problems that for many people become a bigger barrier to recovery than the original injury. Chronic pain sufferers develop significant loss of physical conditioning from a combination of reduced activity and fear of causing further harm to themselves. They can become quite anxious and/or depressed because they have not recovered, and if they have not been able to work, become financially distressed as well. Many of these individuals end up frustrated after seeing a series of doctors that are not able to help them. Eventually, the pain begins to take on a life of its own.

There are two basic pain management treatment approaches for chronic issues. The first is called the medical model of disease. In this model of pain management, the main focus of care is on finding the body part that is causing the pain and either through medication, injections, implantable stimulators or surgery, make it hurt less. This is by far the most common form of pain management. This can be an effective as long as one can find the pain generator. Unfortunately, this can be hard to do in many chronic pain sufferers. The second model of therapy, and the one practiced by Dr. Jerry Sobel at Sobel Spine and Sports, is known as the bio-psycho-sociamodel of illness. As the name implies, the focus is on multiple dimensions of the problem, the physical issues- bio, the mood changes that develop as a result of months of pain- psycho, and how the injury has resulted in a changed lifestyle as it relates to society, i.e. lost of work- social.

Treatment for chronic pain patients must focus on the multidimensional aspect of the “chronic pain” state and address all or most of these factors to achieve physical and functional improvements. In order to do this the loss of strength, flexibility, cardiovascular capacity and functional capacity must be addressed. One of the best ways of doing this is through a functionally restorative treatment program. These have been extensively studied and found to very effective in returning chronic pain sufferers to productive lives again.

In individuals with chronic pain, determining if the pain is “safe” or not is critical to treatment success. Safe pain means that if the person increases their activity and the pain increases, they are just having a flare up of pain and not causing further harm to themselves. This can only be determined through a comprehensive evaluation and review of all pertinent x-rays, MRI’s, CT scans and lab tests.

Dr. Jerry Sobel is a pain management doctor  that has years of experience in evaluating and rehabilitating patients with chronic pain and he is able to make this assessment as to whether or not a person’s pain is “safe” or not. This is very important because informing a patient to stop activities if they feel increased pain can significantly impact recovery. This fear of movement or kinesophobia (a pathological fear of motion) has been studied extensively and found that the greater the fear the worse the recovery rate from a low back injury. By avoiding activities that increase pain, even if that pain is not an indication that further damage to the injured body part is occurring, muscles get tight and weak, spasms intensify and constant guarding occurs. The patient lives in a state of fear, and before they do any activity it has to go through the “back filter” in their head. This reassurance can be invaluable for some and can be the impetus to get them moving again and start the recovery process.

Actually, the same principles about safe vs unsafe pain apply to acute low back pain. Ten countries since 1994 have published guidelines based on the best research in the field and all are in agreement that patients are to be advised to stay active and continue normal activities including work if possible, instead of bed rest. More than a few days of bed rest leads to slower recovery.

At Sobel Spine and Sports in Phoenix Arizona the goal of treatment is to improve the function and quality of life for our patients. Dr. Jerry Sobel believes in a comprehensive evaluation of a person’s spine pain to confirm or make a diagnosis, order or perform additional tests if necessary and developing a comprehensive pain management treatment plan. With respect to pain management, controlling pain with medications and injections is just one aspect of care. Correcting physical issues is paramount to controlling pain in the long run. This includes addressing muscle tightness, muscle weakness and lack of physical endurance. In the long-term, the medical research tells us that exercise is the best way to treat and control chronic back pain.