MODERATOR:
When might you use radio frequency lesion generation?

OAKLEY:
Radio frequency is used to shut down the nerves to joints in the back particularly, or the neck. So if a so-called facet joint, or a joint which joins two vertebrae together, can be determined to be the source of the pain, then using the radio frequency to heat the nerve or nerves to the joint can eliminate the pain coming to the joint.

This would be the most common application of radio frequency, although it can also be used in a special form called pulsed radio frequency, which can be used to pulse heat into a nerve, which causes the pained nerve fibers, or the portion of the nerve which signals pain, to be temporarily shut down.

The pulsed radio frequency techniques do not destroy the nerve but preserve the nerve. Later the pain nerves will start to function again, but one can expect anywhere from months to a year of relief with that type of a block, if it's very successful.

MODERATOR:
The third technique you mentioned was intrathecal medication pumps. Can you explain how they work and when they may be used?

OAKLEY:
The use of drug-administration pumps is based on an observation that ordinary pain medicine, such as morphine, can be placed directly into the spinal fluid that surrounds the spinal cord roots that go into the spinal cord; it markedly increases the potency of the drug to relieve pain.

The estimate is that a milligram of morphine applied to the spinal fluid with the use of a drug pump is about 300 times more potent in relieving pain than is oral morphine. 300 milligrams of oral morphine would be equal to 1 milligram given over 24 hours in the pump.

So given this observation, pumps have been developed that can be implanted in the body to relieve all types of pain. Morphine would be the standard used in the pump but there are other medications used, too. Some of these are called additive -- additional drugs added to the morphine; these would be local anesthetics, in one case a blood pressure medication.

These are primarily to relieve nerve-related pain where the morphine relieves pain from scarred bone and ligaments. That kind of pain is called "no susceptive pain" or "receptor mediative pain," as opposed to the nerve injury pain or neuropathic pain that we spoke of earlier.

The pumps often contain more than one medication for the reason of addressing both the receptor pain and the nerve-related pain; therefore the pumps can be used for a wide range of pain. The most common applications are, however, for patients with a multiple-operated spine that has been left with severe and intractable pain of a mixed variety, nerve and receptor-related and also as a very common application with cancer-related pain.

OAKLEY:
Yes, the person to contact regarding electrical stimulation would be an interventional pain management specialist in your community.

OAKLEY:
The characteristics of nerve-injury pain are a good place to start. Nerve-injury pain has some characteristic findings. It's usually associated with a feeling of:

• Burning
• Stinging
• Tingling

It may have an electrical shock like feel to it, and pressure along nerves going to this area can often produce a tingling or a burning sensation or a shooting pain in the area where the nerve goes. If there is an area of numbness on the skin or if there's an area where there's weakness in the movement of the muscles there may be nerve damage involved, particularly if these findings are in the area of the nerve.

MEMBER QUESTION:
I have degenerative disc disease and have had back problems for 30 years. I've had all the treatments you are talking about. I've been going to a pain clinic for 18 months, but my pain doctor said my treatments are done and has released me back to my family doctor who doesn't treat chronic pain. What can I do?

OAKLEY:
I would suggest you do a little of your own research. I would suggest you log on to the web site for the National Pain Foundation -- www.nationalpainfoundation.org or painconnection.org -- and you will find in this a tremendous variety of resources which the providers in your community may not have explored.

You can use the web resources from the National Pain Foundation to verify the various things available for your pain. You can chat with other people with the same pain and that can provide a tremendous support and resource for managing your pain, as well, and you may find there are things that the specialists you've seen have not offered or didn't think of, that could be available even in nearby communities.

MEMBER QUESTION:
What about pain relief associated with interstitial cystitis.