Dr. Cope Interviewed for PA Medical Society Feature Story
Dr. Doris Cope was recently interviewed by the PA Medical Society for a feature story on the different types of pain and various treatments for pain. As a result of this interview, she was later interviewed by Cathy Clark of Radio PA State Network. Below is the full feature story, and more information can be found at www.myfamilywellness.org.
Understanding pain and treatment options
PA Medical Society member offers insight for pain sufferers
Here’s good news and bad news: many of us have the ability to live a long life, but we’ll probably have pain as we age.
“Our bones wear out over time,” notes Pittsburgh-area anesthesiologist and pain medicine specialist Doris K. Cope, MD. “The bones in our back become gnarly, like knotty old trees. And our discs are flattened like a pillow that’s been slept on for 60 years.”
No wonder we have pain. And it’s a big issue.
The chart below depicts the number of pain sufferers compared to other major health conditions:
Number of Sufferers
76.2 million people
National Centers for Health Statistics
23.6 million people
(diagnosed and estimated
American Diabetes Association
Coronary Heart Disease*
*heart attack and chest pain
23.3 million people
American Heart Association
11 million people
American Cancer Society
The most common complaints include headache, low back pain, cancer pain, arthritis pain, and pain resulting from nerve damage.
“We’re now able to treat so many diseases better than ever before, but it means that, rather than dying of infection or complications, people will live longer,” says Dr. Cope, a Pennsylvania Medical Society member. “Their bodies are slowly wearing out. In the long run, this means arthritis. And pain.” She also notes that almost half of her patients suffer from arthritis pain.
Many Pennsylvania adults – 49.8 percent – suffer from arthritis or a chronic joint symptom.
According to Dr. Cope, there are several types of general pain:
Acute pain typically results from an injury, surgery or illness. It’s often sudden and improves as healing occurs.
Chronic pain is pain you’ve had for three months or more that impacts your lifestyle. Chronic pain means pain signals keep firing in the nervous system for weeks, months, even years. Causes can include an incident – a sprained back, serious infection, or some other trauma to the body -- or there may be an ongoing cause of pain like arthritis, cancer, or infection. And some people suffer chronic pain for unknown reasons.
Cancer pain is a different type of chronic pain. Cancer pain requires dramatic quick action. It’s chronic pain in an acute setting.
Dr. Cope started treating pain in the mid-80s and says that, back then, most treatment was medication based. “We have new technologies and new ways to help people deal with their pain while avoiding drugs, if possible. But patients should know that pain medicine is not a quick fix.”
The first step in treatment is to diagnose the specific kind pain. Is it nerve pain, sympathetic pain, muscle pain, cancer pain? Pain specialists conduct a physical examination and review medical records in addition to analyzing the description of a patient’s pain. “We look at the whole patient.” Since the degree of pain varies from person to person, treatment plans vary and may include a single approach or a combination of medications, therapies and procedures.
Some of the available treatments being used successfully to treat pain patients:
Injection treatments - Local anesthetics can be injected around nerve roots and into muscles or joints. These medicines reduce swelling, irritation, muscle spasms and abnormal nerve activity that can cause pain.
Nerve blocks - Often a group of nerves that causes pain to a specific organ or body region can be blocked, at least temporarily, with local anesthetics. When the pain transmitting nerves are blocked, hypersensitivity and chronic pain syndrome can be prevented. Some patients may benefit from a single nerve block, while others with more complex pain conditions may require several blocks.
Physical and aquatic therapy – An exercise program may be recommended to help increase daily functioning and decrease pain. Other treatments may include whirlpool therapy, ultrasound, and deep-muscle massage.
Electrical stimulation - Transcutaneous electrical nerve stimulation (TENS) is the most common form of electrical stimulation used in treating pain. It is not painful and does not require needles or medicine. TENS consists of a small, battery-operated device that can diminish pain by stimulating nerve fibers through the skin.
Local anesthetics, with or without cortisone-like medicines, can be injected around nerves or into joints. These may act to reduce swelling, irritation, muscle spasms, or abnormal nerve transmissions that can cause pain.
Neuroablation. When other treatments fail, doctors may use heat or chemicals to sever the nerves that serve as pathways for the pain. Neuroablation is the destruction of these nerves. Neuroablation may be permanent, or the nerves may grow back in time. Doctors usually use neuroablation only as a last resort.
Dr. Cope cites the successful use of a surgically-placed intrathecal pump which can deliver less than one-hundredth of a standard opioid dose, but goes directly to the spinal pain receptors. The medication travels through a catheter that is also surgically placed.
Pulsed radio frequency is another form of treatment that can bring relief for some of the most common causes of back pain. Cope targets the area in the sacroiliac joint and pulses heat to ablate the nerve and stop the pain. The procedure takes less than an hour. "It's like resetting your computer. We basically stun the tiny pain fibers that enervate these arthritic joints," she adds. The solution is only temporary, but it can offer a year of relief. In addition to arthritis, the procedure can treat whiplash, degenerative disc disease and other common problems that can't be helped with many other treatments.
Cope notes that maintaining a healthy weight and working on good abdominal tone and aerobic fitness can improve circulation and significantly reduce the stress on your joints. "People feel like pain is something that you should just take. Chronic pain is like torture – no one should suffer."
Dr. Cope encourages people with pain to seek help. “There are so many options these days that fall somewhere between Tylenol and surgery. It’s definitely worth a discussion with your doctor.”
“Pain affects everyone, not just the patient. Once your pain is lessened, you and everyone around you can enjoy life that much more.”
For more information, visit www.myfamilywellness.org
The patient-doctor relationship has been the priority of the Pennsylvania Medical Society since its founding in 1848. While there are many issues being debated about health system reform, the physician members will continue to focus on better health for all Pennsylvanians. To learn more about the Pennsylvania Medical Society, visit the web site at www.pamedsoc.org.
Organizations That Can Help
American Society of Anesthesiologists
American Pain Foundation
National Pain Foundation
American Cancer Society
American Chronic Pain Association
A Patient Story:
Vandergrift resident Frank Gatto has a congenital, unfixable problem with his back – scoliosis and 3 herniated disks. Over the years, his pain has worsened, making it nearly impossible to sleep or stand upright. Slowly, Frank was losing his ability to function, but fortunately, a neurosurgeon’s recommendation that he see a pain medicine specialist changed his life.
“I didn’t want to rely on pain pills,” notes Frank. “And I wanted to be able to work if possible,” he adds. “So I went to see Dr. Cope and life got better.”
Initially, Dr. Cope injected medication into the painful areas in Frank’s back, which helped for a while. She then suggested the Racz procedure which releases some of the scar tissue from around entrapped nerves in the epidural space of the spine, so that medications can reach the affected areas.
Frank receives 3 consecutive treatments, one month apart. Then he waits 6 months until treatment can resume.
“Being able to talk with your doctor makes such a difference. Explaining pain is hard, but a pain medicine specialist understands. I would never have been able to do half of what I do now without treatment.”
Pennsylvania Department of Health, 2004 State of Arthritis Report http://www.portal.state.pa.us/portal/server.pt?open=512&objID=11200&mode=2&PageID=560279