Dr. Vajira Gunawardane explains a procedure to patient Anthony Vitale.

Written By David Greisman

She is 71 years old, lying face down with a needle in her back. Soon, the anesthetist will thread a catheter up her spine to a spot near the bottom of her skull, just between the C2 and C3 vertebrae, a pinpointed location for anesthetics and, most importantly, anti-inflammatory steroids.

She has had debilitating headaches and neck pain for two decades. This injection, the third in a series, will give her relief.

“She’s very comfortable,” Dr. Vajira Gunawardane said afterward. “It’s almost gotten rid of her headaches. For her to have 20 years of headaches and be without them for two weeks is a big deal.”

Gunawardane is president of the Maryland Pain and Spine Center, which has offices in Fulton (in Howard County) and in Westminster. For 17 years, he has worked in a specialty that uses innovative approaches to chronic pain.

Among them: steroid injections; cementing spinal fractures; sucking out material to take pressure off spinal discs; using radio frequencies that heat up needles, interrupting nerves so they won’t transmit pain; and implanting electronic devices, controlled by hand, that override pain signals.

“People are more knowledgeable because of the Internet,” said Gunawardane. “They’re getting to know more and more about pain; that there’s a way to deal with it, and not just by popping pills. There’s much more they can do.”

There are three types of pain management, according to Dr. Alva Baker, director of McDaniel College’s Center for the Study of Aging. Baker specializes in geriatrics, hospice and palliative medicine. They are:

(1) The management of acute pain in a hospital setting: anything from pain caused by surgical procedures to broken bones, lacerations or severe bruising.

(2) Management of the pain people feel at the end of their lives.

“People who suffer at the end of life usually have severe pain,” said Baker. “It is sometimes incredibly difficult to control. It requires, in most cases, the use of very large amounts of narcotics and other medicines that can help the narcotics work better or impact the pain itself.”

(3) Management of chronic pain, which can be a long, arduous process, but one many patients ultimately feel is worthwhile.

“Pain can be such an overwhelming issue,” said Baker. “The folks who get that type of procedure are those who have chronic pain and are not being helped by more standard measures. They are looking for solutions.

“I would have to be pretty desperate to have somebody sticking needles into me,” he said. “People having chronic pain get desperate because they’re not getting relief. I’m talking about people whose pain isn’t relieved by narcotics or physical therapy. To think about moving to the level of having a procedure like that done is pretty drastic.”

The field of chronic pain management grew out of anesthesiologists who were already versed in the techniques of dealing with the spine because of their experience with epidural needles, according to Gunawardane. Baker said that pain management clinics became much more common as various outpatient procedures moved out of hospital settings.

“The increasing availability of these outpatient pain centers, and the ease with which a physician can refer a patient to them for diagnosis and treatment, is keeping them all busy,” said Baker. “Second, like a lot of other things in medicine, there’s a better understanding of the kinds of things that are available.”

Between 80 and 100 patients come to the two Maryland Pain and Spine Center locations each week, according to Gunawardane. They can be aging people dealing with arthritic conditions or younger patients living with chronic pain caused by their jobs.

Anthony Vitale, a 67-year-old from Waynesboro, Pa., had a degenerative spine condition and had undergone two back surgeries. He had osteoarthritis and fibromyalgia: pain in his back, arms, and neck. His legs hurt, too.

“I was experiencing a lot of pain,” said Vitale. “I was on a lot of medicine, which I didn’t like taking. I tried physical therapy on three occasions, and that didn’t work.”

Then he made his way to Westminster.

Shots meant to make his pain subside for months did not. And then Gunawardane recommended implanting devices that Vitale could control by hand that would make the pain disappear.

Years and years of pain – and it was gone, just like that.

“It has been very successful in ridding me of pain and limitations I would’ve had,” said Vitale. “Now I’m able to be more active. It’s really proven to be a big help to me.”

Of course, there are other, non-surgical approaches to pain management, such as those offered in places such as Therapeutic Kneads in Sykesville and The Center for Healing Arts in Westminster.

“We have always offered acupuncture, massage therapy and counseling,” said Vickii Engel Thomas, a massage therapist, co-founder and coordinator of The Center for Healing Arts. “Acupuncture certainly has been very successful in various kinds of pain management. “It can be very helpful for pain from overuse or repeated use of the muscles or the soft tissues, and even from lack of use from being seated at computers or a desk for long hours.”

Massage can even take care of headaches, she said, through techniques focusing on the soft tissues, scalp, forehead, jaw and the back of the head to help ease muscle tension and stress. And counseling can help relieve the psychological contributions to stress.

“Most people who come are looking for gentle or natural ways of tending to the body,” said Thomas. “If they’ve seen a physician and there’s no medical concerns, then having a massage to see if it can be helpful is an option. I also ask what else they’ve done in terms of physical therapy.

“One of the most important things we can learn from our body is how to take better care of it,” she said. “If pain is the voice of the body, then it’s speaking up to get your body to make some type of change.”


  • Carroll Hospital Center Outpatient Advanced Pain Management Center Richard N. Dixon Building, 291 Stoner Avenue, Westminster, MD 21157; 410-871-6191;
  • Maryland Pain and Spine Center Richard N. Dixon Building, 291 Stoner Avenue, Westminster, MD 21157; 410-871-6191;
  • Spine Medicine and Rehabilitation Therapy 826 Washington Road, Suite 210, Westminster, MD 21157; 443-605-0500;



  • Palamone Chiropractic 6220 Georgetown Blvd., Eldersburg, MD 21784; 410-795-7766;
  • Ritchie Chiropractic Route 26 & 32, Eldersburg, MD 21784; 410-795-7200;
  • Carroll Chiropractic & Sports Injury Center Ste 9A, 330 140 Village Road, Westminster, MD 21157; 410-876-8881;
  • Lewis Family Chiropractic and Wellness Center P.A. 403 Malcolm Drive, Westminster, MD 21157; 410-876-8885;
  • Total Health Chiropractic Center Ste 12, 250 Englar Road, Westminster, MD 21157; 410-848-3355
  • Chiropractic First 603 Ridgeville Rd., Mt. Airy, MD 21771; 301-829-4040;
  • Mellon Chiropractic 13002 Penn Shop Rd., Mt. Airy, MD 21771; 301-831-5444;
  • Winebrenner Spine & Wellness 4510 Lower Beckleysville Rd., Hampstead, MD 21074; 410-239-4000
  • Taneytown Chiropractic and Wellness 4 York Street, Taneytown, MD 21787; 410-756-9355;