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Pain medicine is a multi-disciplinary approach that incorporates modalities from various specialties to ensure a comprehensive evaluation and treatment of the pain patient. Pain can be very challenging to treat. Our Pain Management Specialists at Virginia Spine Institute have sophisticated new treatments to provide pain relief. Advances continue to emerge as researchers and clinicians gain a greater understanding about the origin, mechanism, and perception of pain.

Our pain specialists have a growing understanding of how the sensation of pain occurs within the human body. Insights into how painful stimuli are interpreted and passed in the body allow for different strategies to disrupt painful messages to the brain. There are a wide range of innovative medications and drug delivery systems to provide adequate pain relief. Medications are usually the first line of treatment for both acute and chronic pain. All pain is not equal. There are different types of pain; some examples include somatic or neuropathic pain and central or peripheral pain. These types of pain can respond to different medications. Finding the most effective medications for your specific pain may be a trial and error process due to individual sensitivities and life exposures. There is no one best drug for everyone. Different drugs and drug combinations will be tried until you achieve effective pain relief with minimal side effects.

Watch Dr. Nguyen describe our unique approach to pain management.


When treating pain, medical providers will typically start with oral non-steroidal anti-inflammatory drugs (NSAID) to address pain from acute or chronic inflammation. There are numerous traditional NSAIDs which most commonly can have associated side effects of gastrointestinal discomfort, especially with long term use. If one NSAID causes GI upset, it does not mean that all medications in this class of drugs will. There are newer, more selective NSAIDs known as COX-II inhibitors that are more tolerable and decrease the chance of GI irritation. Other medications are formulated as a combination of a NSAID and a GI “protective” medication to combat the common stomach adverse effects. These newer NSAIDs still have potential to cause harm if not carefully monitored.

Opiate Analgesics

When pain is severe, pain specialists may opt to try stronger pain medications. Opiate pain medications have been used since the beginning of human history. Narcotic pain medications bind to central pain receptors and are very effective in controlling severe pain. Advances in opiate medication include extended release preparations for long term relief, ranging from a twenty-four hour extended release to a seven day extended release. Innovations in immediate release preparations include transmucosal lozenges, sublingual sprays and sublingual tablets; all of which are indicated for breakthrough cancer pain.


Low doses of common antidepressants are prescribed for many chronic pain problems, regardless of whether the person is depressed or not. These drugs adjust levels of neurochemicals and are the likely mechanism behind why they help control pain. Antidepressants are often used as analgesic adjuvants when patients don’t get complete chronic pain relief from other treatments. Doses needed to treat pain are usually lower than doses used to treat depression.

Tricyclic antidepressants (TCAs) have long been the mainstay antidepressants prescribed to help treat neuropathic pain. These drugs affect the brain’s concentrations of norepinephrine and serotonin. The main disadvantage which limited their use was strong side effects including sedation, dry mouth, and low blood pressure upon standing. More recently, new antidepressants have been developed with better side effect profiles and specific indications for certain chronic pain syndromes. SNRIs (Serotonin and Norepinephrine Reuptake Inhibitors) increase the availability of these chemicals in the brain. Cymbalta is FDA-approved for the treatment of diabetic neuropathy, fibromyalgia, and musculoskeletal pain like that of osteoporosis and chronic low back pain. Savella is FDA-approved for the treatment of fibromyalgia.

Topical Medications

Pain relief creams are increasingly popular to treat certain types of pain. Some topical pain killers contain capsaicin, an ingredient found in hot peppers, which works by reducing transmission of a pain-relaying chemical called Substance P to the brain. Other products have ingredients like salicylate which decreases inflammation and relieves pain. Counter-irritants like camphor, eucalyptus oil and menthol relieve pain by causing either coolness or heat at the painful region. Topical NSAIDs are now available in gel and liquid form to address arthritic conditions.

There are also new types of transdermal patches that act to relieve pain. Transdermal patches are a medicated adhesive patch placed on the skin to deliver a specific dose of medication through the skin and into the bloodstream. Transdermal delivery systems must use medications whose molecules are small enough to penetrate the skin as the skin is designed to be a very effective barrier. A wide variety of pharmaceuticals are now available in transdermal patch form.


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