Pain Awareness and Management (cont.)
These may be specialists in:
There are a lot of pain diagnoses that are considered to be more traditionally and perhaps optimally treated with noninterventional treatments; one of those would be fibromyalgia, which is better treated perhaps with medicines and behavioral management and physical therapy techniques.
This would be totally dependent on the type of pain and how the pain is mediated. For example, pain which is related to nerve injury (we call that neuropathic pain), can often be treated with techniques of electrical stimulation, and with a substantially high success rate. Seven times out of 10 patients with neuropathic pain can have good control of the pain using a type of electrical stimulation.
There can be techniques that use heating of the nerve structure, such as what's called radiofrequency lesion generation, where the heat shuts down the nerve. The nerves can be heated to the point where they are completely ablated or destroyed. But there are techniques that preserve the nerve as well and these can occasionally be applied to patients with allergies.
Probably the most common and one of the oldest is stimulation of the spinal cord, a technique which goes back to the 1960s. In these cases, patients with nerve-related pain in the legs, for example (perhaps they have had prior back surgery and have persisting leg pain), an electrode can be placed into the epidural space -- the space between the covering over the spinal cord and the bone -- and the electrode can be activated to produce a tingling sensation in the lower extremity in the area where the pain is located.
The patient can then experience a control of the pain. You should notice I'm not saying a cure of the pain, because these techniques give, in general, relief of the symptom pain; when the stimulator is turned off the pain will recur, so they need to use the stimulator to control the pain and improve the quality of their life and ability of function and it can allow for a decrease in pain medication, as well.
The electrical stimulators can be used for pain of nerve origin almost anywhere in the body. Perhaps the most exotic pain stimulator is called motor cortex stimulator in which an electrode is placed on the motor part of the brain itself and relieves nerve-related pain of the face and upper extremities.
Electrical stimulation has also been applied in structures within the brain itself with some success at relieving some kinds of pain and has certainly been applied in what is known as peripheral nerves for relief of pain.
A newer application of electrical stimulation is the placement of electrodes underneath the skin in the distribution of a peripheral nerve that has been injured.
An example would be a bone graft donor site over the hip area that has been used to do a fusion. This is where the bone would be harvested or taken for a spinal fusion; the pain that can be seen due to injuries to small nerves there can be controlled by a stimulator placed under the skin where the skin was taken. This is called a subcutaneous stimulator.