Question 1

1. Why treat pain?  Why not just live with it?

Accepted Answer

Untreated pain slows us down and keeps us from being active.  The human body was not designed to sit still and do nothing.  Doing nothing makes us less healthy.  The heart, lungs, muscles, joints, bones are healthier with activity.  Pain itself has also been shown to decrease life span, so relieving pain is not only humane, it keeps us alive!

Question 2

2. Why not just take pills?

Accepted Answer

Taking analgesic pills to relieve pain makes sense in certain circumstances, for instance if there is an acute injury, very recent surgery, certain types of nerve damage, migraines, or a painful cancer.  For chronic non-cancer pain, these types of medication are known for developing tolerance, dependence, constipation.  Additionally, there is the risk of misuse, abuse, diversion, and addiction.

Question 3

3. Why are injections a good idea?  Aren’t they risky?

Accepted Answer

In many instances, particularly with spine pain, X-ray guided injections allow us to safely target specific pain generating structures to diagnose and treat the pain.  While no course of action is completely without risk (including doing nothing---see #1 above), the risk of injury from injection, or from any other interventional pain management technique, is very small.

Question 4

4. I want relief, but I am afraid of needles.  Can I be asleep for the procedure?"

Accepted Answer

The most important piece of safety equipment in the procedure room is the patient.  It is essential that during a procedure, the patient is able to communicate with the physician if he/she is feeling something that should not be felt.   This would be impossible if the patient was “asleep” or deeply sedated.

Question 5

5. Why do we do the procedures in a hospital and the benefits?

Accepted Answer

Two reasons.  First, in a hospital setting, we can safely offer light intravenous sedation for our anxious patients.  Second, this allows us to offer our specialized service in or near your community in order to minimize travel distance.

Question 6

6. How can I get an appointment?

Accepted Answer

Appointments are by referral only.  There is a lot of preparation ahead of time.  First, you and your primary physician (or other specialist) decide that your pain is consistent and persistent, and has not responded to conservative care, such as physical therapy or chiropractic.  Then, appropriate images (usually MRI) of the pain location (usually a portion of the spine) are obtained.  Your referring physician will then contact the nearest of our offices to set up an appointment.  There will be paperwork.  The most important piece of paper is our intake form, on which you will be asked to draw the location of your pain and describe it for us.

Question 7

7. What can I expect when I am evaluated?

Accepted Answer

The appointment will be 30 to 60 minutes.  The evaluator will review the notes from your physician and especially the intake form that you have previously completed.  A thorough and targeted physical exam will follow.  The evaluator will then explain the most likely reason or reasons why you are hurting and develop a plan of care designed to specifically diagnose and treat your pain.  If appropriate, you will be booked for x-ray guided injection with Dr. Herland

Question 8

8. What can I expect on procedure day?

Accepted Answer

At most locations: There will be paperwork.  The procedure will be done in a hospital operating room, which will require changing to a hospital gown and having a small i.v. started.  You will be placed on an operating table and monitored.  Together, you and Dr. Herland will locate the painful location(s) and mark the skin.  Dr. Herland will prepare the skin with an antiseptic and place a drape over the target area.  He will then numb the area before placing the needle(s).  After the needle is placed and injected, it will be removed.  Frequently, we will have you wait several minutes to evaluate the immediate effect of the injection.  If you receive intravenous sedation, you cannot drive a vehicle until the following day.  Additionally, you will be asked not to eat for 6 hours prior to the procedure and not to drink for 2 hours prior to the procedure.  With the exception of diabetic medication, do NOT skip your usual medications. If you take blood thinning medication, our office will contact your primary physician in order to safely manage this. At A.R. Gould: Procedures are usually done in the radiology department.  If we choose to use sedation, a small i.v. will be started.  You will be placed on a procedure table and monitored.  Together, you and Dr. Herland will locate the painful location(s) and mark the skin.  Dr. Herland will prepare the skin with an antiseptic and place a drape over the target area.  He will then numb the area before placing the needle(s).  After each needle is placed and injected, it will be removed.  Frequently, we will have you wait several minutes to evaluate the immediate effect of the injection.  If you receive intravenous sedation, you cannot drive a vehicle until the following day.  Additionally, you will be asked not to eat for 4 hours prior to the procedure and not to drink for 2 hours prior to the procedure.  With the exception of diabetic medication, do NOT skip your usual medications. If you take blood thinning medication, our office will contact your primary physician in order to safely manage this.

Question 9

9. Will it hurt?

Accepted Answer

Keep in mind that in most cases, the needle is aimed directly for the location we believe is the source of your pain.  It can therefore be expected that the needle placement my stir up the pain for a day or two.

Question 10

10. How long is recovery?

Accepted Answer

Recovery from injection is expected to be between 2 days and 1 week for the discomfort to return to its baseline.  Recovery from RF denervation takes 3 to 6 weeks.  If there is soreness, ice, not heat, should be applied for 10 to 12 minutes every 4 to 6 hours.  If there is NEW ONSET of weakness, problems of bladder or bowel control, or persistent headache CALL the hospital where the procedure was done.

Question 11

11. How long should relief last?

Accepted Answer

This is the least predictable aspect of this targeted approach to diagnose and treat chronic non-cancer pain.  Relief can last from just a few hours (diagnostic response only) to several years (a remarkably good therapeutic response).

Question 12

12. Will I need more than one injection?

Accepted Answer

This will vary a lot from one person to another.  If pain relief from a procedure is significant, and then returns, it may be worthwhile to repeat.  If one or two attempts fail to provide relief, then a re-evaluation should be done.

Question 13

13. Will insurance pay for interventional pain management?

Accepted Answer

Almost all insurances do.  Although there are a lot of similarities, each payer has slightly different rules and protocols that must be followed in order that they cover the costs.  With many of the private payers, there is a prior authorization process for the procedures.

Question 14

14. What is an interventional pain management physician?

Accepted Answer

This is a physician whose interest, training, and experience is focused on the diagnosis of specific localized pain and upon customized, targeted treatment.  The physician has earned at least a bachelor’s degree prior to medical school.  After earning a four-year medical degree, internship and residency must be completed.  The majority of pain physicians’ residency was in anesthesiology.  The final stage of training is a one-year pain management fellowship in an accredited program.  Career long maintenance and growth of expertise usually consists of reading journals, attending conferences and training courses, on line lectures, maintenance of certification, examinations.

Question 15

15. What are Dr. Herland’s credentials?

Accepted Answer

Bachelor of Science, Biology, Massachusetts Institute of Technology Doctor of Science, Applied Anatomy and Physiology, Boston University Research Fellowship, Muscle Physiology, Harvard Medical School Doctor of Medicine, University of Massachusetts Medical School Medical Internship, Saint Vincent Hospital, Worcester, Massachusetts Anesthesiology Residency, Massachusetts General Hospital, Boston, Massachusetts Pain Management Fellowship, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire National Board of Medical Examiners, Certified American Board of Anesthesiology, Board Certified in Anesthesiology American Board of Anesthesiology, Added Qualifications in Pain Management

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