Pain Awareness and Management (cont.)

These may be specialists in:

  • Anesthesiology neurosurgery
  • Neurology
  • Physical medicine
  • Rehabilitation
  • Other specialties where physicians have developed an interest in interventional pain management.

What about pain from something like fibromyalgia, or headaches?

Traditionally we're talking about all kinds of pain, because almost all kinds of pain can be addressed with one or more of the interventional pain techniques.

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.

I have had 19 surgeries due to connective tissue disorders. Being allergic to all traditional pain medications, my surgeons are at a loss on how to help with post-op pain. Are there options to managing my case better?

These are particularly difficult problems but there are some new approaches to this. One particularly interesting approach is at the incision area where the surgery has been performed is to place a small catheter under the skin and then to use a small pump, which delivers local anesthetic directly to the incision area.

"For people who are very allergic to many of the pain-controlling medications, there are interventional techniques."

What is available to people who are highly allergic to pain medications?

For people that are very allergic to many of the pain-controlling medications, there are interventional techniques which can occasionally be applied to give relief.

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.

Can you explain what is involved in electrical stimulation?

In patients with nerve-related pain it was determined many years ago, in the 1960s and before, if an electrical signal could be applied in the area of pain on the nerves that go to the area of pain, that often there is a relief of the pain during the stimulation. There are numerous ways in which electrical stimulation is applied to give relief.

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.

"When might you use radio frequency lesion generation?"

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.

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