By Dr. John DeAngelis

While many of us may suffer occasional pain after a weekend in the garden or several games of tennis, millions of Americans suffer from serious chronic pain. Some of the most common types of chronic pain are arthritis, lower back, bone or joint pain, muscle pain and fibromyalgia. Suffering from chronic pain diminishes a person°¶s ability to concentrate, do their job, perform daily living activities, and sleep. Beyond that, the constant feeling of pain can lead to depression.

More than 50 million American men, women and children live with serious chronic pain that interferes with their personal, social and work lives. And according to the American Chronic Pain Association, 72 percent of people with chronic pain have lived with it for more than a decade.

Physicians trained to deal with patients suffering from severe pain must look at the whole person. Treating pain in patients requires taking into account their needs, beliefs and personality. Through the years, my patients have asked a wide range of questions on the subject of pain. Some of those questions and answers are shared here.

Q. I recently had a consultation by a spine surgeon for back pain. He discovered a ruptured disc and advised epidural blocks. Does the epidural injection make the pain and the ruptured disc go away?

A. A ruptured disc can cause nerve inflammation, nerve swelling and severe pain. Epidural injections counteract these effects and frequently, but not always, render the pain and disability inactive. The ruptured portion of the disc, however, remains the same, but without the pain and disability. Your surgeon is doing everything he can in an effort to avoid back surgery.

Q: I°¶ve suffered with low back pain for several years, and my doctor wants me to get an epidural steroid injection. How will this help?

A: Epidural steroid injections are a common treatment for low back pain so the patient can return to normal daily living activities. The injections are an anti-inflammatory corticosteroid drug placed in the epidural space of the back next to the spinal cord around the inflamed nerves. The drug injection is intended to decrease inflammation, and in turn reduce pain. Prior to the epidural steroid injection, the physician typically will first administer a numbing medication, such as lidocaine, to the site.

Q. My primary care physician has referred me to a pain doctor for three epidurals for my low back pain. What is magic about the number three or why do I need three injections?

A. One epidural injection is sometimes all a patient needs to relieve the majority of the pain. If this occurs, then a second and third is usually not necessary. If there is significant pain after three epidurals then other low back structures should be investigated as possible sources of pain, and if discovered, then treated.

Q. Why did my doctor put me on an antidepressant drug when my problem was a pain disorder?

A. Some antidepressants have pain relieving properties as well as antidepressant activity. Amitriptyline, commonly known as Elavil, is one of the oldest of the antidepressant agents used in the treatment of some types of pain. This category of drug can be used for pain without depression, depression without pain or in patients with a combination of pain with depression.