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For more information about chiropractic treatment, contact: 

Catherine Duncan, DO

1031 West Williams St., #106
Apex, NC 27502
Telephone: (919) 439-7867

Many Tools to Manage Pain

“My fundamental goal for my patients is to improve and maintain physical function,” says Dr. Catherine Duncan. “Ultimately, what we do is all about achieving and maintaining good quality of life.”

Dr. Duncan treats her patient with viscosupplementation, which injects lubrication between bones and cartilage,
and frequently offers significant, long-term pain relief of osteoarthritis of the knee

Dr. Duncan, an interven-tional spine specialist, is an expert in the field of pain management. A graduate of Ohio University College of Osteo-pathic Medicine and owner of Atlantic Spine & Pain in Apex, she has been helping patients reduce pain and increase functionality for over 25 years.

“Approaching the treatment and management of pain can be a complex task,” Dr. Duncan observes. “Recent changes in CDC guidelines regarding opiate prescribing have further com-plicated an already complex, difficult issue. But it’s an issue we just have to navigate.

“Narcotic medications are an important tool, and when used appropriately, they are effective and often necessary. However, they are by no means the only or even the first option when it comes to dealing with pain—even chronic pain. I have many other tools, some quite newly developed over the last few years, that offer very effective pain management options for the right patients.”

Processing Pain

Unlike a primary care provider, Dr. Duncan is almost never the first to treat her patients or attempt to alleviate their pain. “Patients are referred to me when the most basic options used by their primary care provider have proven unsuccessful, and they clearly need a more precise level of evaluation or management. When they come to me, my process is to thoroughly evaluate their condition and develop a plan starting with the least invasive options.”

Providing options that avoid surgery or delay disease progression is one of Dr. Duncan’s primary goals. “Surgery often results in pain even as it engages in fixing a problem. From a pain management perspective, surgery should be a last resort,” she says.

The Role of Narcotics

An unfortunate outcome of the recent CDC guidelines on the use of opiate medications, observes Dr. Duncan, “is that it has made appropriate and reasonable use of these very important medications extremely difficult. The guidelines were intended for the primary care setting, not for specialists—which I am. However, as they have been interpreted by insurance providers, they have been evenly applied to all prescribers.

“I agree that non-opioid modalities should be the first line in the treatment of pain. Physical therapy, non-opioid analgesics, and epidural steroid injections are great adjuncts to medication. Unfortunately, not everyone can tolerate NSAIDs, anti-convulsants, and anti-depressants; not everyone can exercise; and most chronic pain patients have already exhausted treatments like physical therapy. For these patients, narcotic medications are all that remains if they are to maintain a reasonable level of function and quality of life. These people have become victims of misunderstand-ing and irresponsible prescribing. I will continue to advocate for these patients—now too often considered addicts and criminals—in a continued effort to decrease pain, increase function, and maintain a reasonable quality of life.”

Low-Back Pain

“Low-back pain is the most common diagnosis I see. For this, and for most things, I will get X-rays first, and probably try some physical therapy along with anti-inflammatory or other non-narcotic pain control options. If there isn’t satisfactory improvement, we will do an MRI and look deeper into the situation. If the clinical signs match up with the findings on the MRI, then spinal injections may be a good option. These would include steroid injections into the back, particularly into the sacroiliac joint—a frequent culprit of low-back pain. Epidural steroid injections to this area can also be quite effective.

“Radiofrequency ablation (RFA) is a great option for some causes of pain,” Dr. Duncan notes. “RFA treats the facet joints by heating up nerve tissue, thereby decreasing pain signals from that specific area. Pain relief using this technique can last six months to a year or longer.

Restoring Damaged Tissues

Two regenerative therapies offered at Atlantic Spine & Pain are important to note as they work towards restoring damaged tissues, thereby treating the actual cause of pain.

 “One such therapy in this category is prolotherapy. Prolotherapy is very effective in treating various causes of joint pain by injecting a solution into the joints, ligaments, or tendons, thereby signaling to the body this is an area that needs attention. The body responds by ramping up the immune system response in that area and initiating a healing process. Another treatment is PRP (Platelet Rich Plasma) injections, commonly used on athletes.”

One of the most difficult things about treating chronic pain, Dr. Duncan notes, “is the cyclical nature of the problems it creates. Our bodies are designed to heal themselves. But the body heals only through continued use. If you are hurt—and thus in pain—and your response is to become sedentary, what happens is further deterioration, ultimately causing more pain. The body needs movement to restore itself. Ideally, when an injury occurs, short-term use of pain medication will take the edge off enough to go to physical therapy, yoga, or Tai Chi. Healing takes place. The pain stops.”

Many Options for Pain Relief

When treating pain, Dr. Dun-can’s toolkit is extensive. “My goal is to find the optimal approach for each individual patient—from regenerative treatments to long-term pain management,” she says. Among these options:

  • Botox injections
  • EMG/Nerve Conduction Velocity Studies
  • Epidural Steroid Injections (Cervical, Thoracic, Lumbar)
  • Facet Joint Injections / Medial Branch Blocks
  • Medication Management
  • Occipital & Peripheral Nerve Blocks
  • Prolotherapy
  • Platelet Rich Plasma (PRP)
  • Radiofrequency Ablation
  • Selective nerve root blocks (Thoracic, Lumbar)
  • Suboxone (for chronic pain associated with opioid use disorder)
  • Spinal Cord Stimulation
  • Trigger point injection


“The reality, however,” she acknowledges, “is that the process doesn’t always work this way. My patients are often so deep into chronic pain, when I advise them to start getting some exercise to promote healing, they often look at me and say ‘Dr. Duncan, I can’t even make it to my mailbox.’ And, chronic pain often causes depression, and the combination of pain and depression lead to a lack of motivation; it’s a vicious cycle from there.”

Breaking that cycle, says Dr. Duncan is the challenge, and where medications can play a key role. “Non-narcotic medications such as Lyrica and Cymbalta can be helpful with neuropathic pain,” she says. “Anti-inflammatories help manage arthritis pain, along with joint injections, which can slow the joint deterioration and essentially buy some time.

“But sometimes narcotic medications are indicated, and in light of the recent spotlight on narcotic prescribing and government regulation, it’s really important not to demonize those people who truly do need this type of pain management. Chronic pain is a burden that is difficult to understand if you’ve not experienced it yourself. And while addiction is absolutely a risk when using opioids, and overuse/abuse of these medications a legitimate concern, part of my job is to find the balance between these risks and helping my patients be able to comfortably participate in their daily lives.

“From my perspective,” Dr. Duncan says, “no matter which modality is most appropriate for my patients—whether physical therapy, joint injections, meditation, or oxycodone—the whole point is to improve function and quality of life. That is the purpose of my practice and the work that I do.”