Pain Treatments

Pain and Chronic Pain Resources

How Is Non-Malignant Chronic Pain Treated?

Treatment begins with non-surgical techniques including pain medication, physical therapy, and pain management therapy. The four main elements of most pain management programs include drugs, injection therapies (nerve blocks like epidurals); physical therapy and exercise; and behavioral techniques that include relaxation training, biofeedback and psychotherapy.

Most patients will respond to a combination of physical therapy, oral medication and other conservative therapies.

Medications prescribed depend on the nature and underlying source of the pain. Medications may range from basic acetaminophen (Tylenol) or non steroidal anti-inflammatory drugs , triptans such as sumaptriptan (Imitrex) , anticonvulsant drugs like Neurontin, tricyclic antidepressants such as Elavil, lidocaine patches or opioids, among others.

Some patients require surgery to treat the underlying mechanical condition that causes the pain. Some patients may require more advanced surgical interventions to treat their chronic pain. (See below, section on surgical techniques)

How Can Cancer Pain Be Treated?

Though cancer pain can be treated effectively in the majority of patients with a regimen of drugs and anti-cancer therapies, it is estimated that 15% of cancer patients cannot be successfully treated with such programs.

For these patients, more aggressive forms of pain treatments exist, including intra-spinal drug delivery systems. (See section below on intrathecal drug delivery systems)

What Are Some Of The Surgical Procedures Used For Treating Chronic Pain?

I ntrathecal drug delivery

Intrathecal involves the delivery of pain medication directly to the patient's spinal cord. Small doses of medication bind directly to pain receptors in the spinal cord thereby blocking the path of pain impulses to patient's brain. This technique has been successfully employed to treat chronic pain since the early 1980's. The surgical technique involves the implantation of a small programmable drug pump and a narrow catheter (tube). The pump releases prescribed amounts of pain medication through the catheter that has been implanted in the area that surrounds the spinal cord. The programmable pump allows the patient to control his own pain relief by controlling the amount of medication release. Larger doses can be delivered when the patient experiences the most pain.

Intrathecal drug delivery systems are most often recommended for patients with non-neuropathic pain such as cancer pain, pain originating in multiple regions, or with pain that has fluctuating patterns. (Though occasionally it may prove helpful in non-neuropathic pain as well.)

The use of intrathecal Baclofen has been recently found to decrease dysesthtic pain in some patients with spinal cord injury, transverse myelitis, multiple scleroses, or spasm-related pain.

It has been reported that cancer patients can achieve good to 80% pain relief with use of the morphine pump.

To have a patient considered a candidate for a pump implantation, there should be evidence of disease, a failure of conservative treatment, analgesia induced by a pre-operative trial with morphine,
neuropsychological clearance, no morphine allergy, and an expected remaining life expectancy of more that three months. A complete neurological work-up is an absolute requirement.

Spinal Cord Stimulation

Spinal cord stimulation involves the implantation of a pacemaker like device that delivers tiny electrical impulses to small electrodes implanted directly into the spinal cord. The neuro-stimulation blocks the transmission of pain impulses to the brain.

This technique has been available since 1967 for patients suffering from chronic, intractable pain of the trunk or limbs. Sometimes it helps back pain. Spinal cord stimulation is most often recommended for patients who suffer from neuropathic pain, pain mainly in the arms, legs, and trunk caused by injury to nerve tissue.

Spinal cord stimulation is reversible. It can be turned off or removed entirely.

Deep Brain Stimulation

Deep brain stimulation involves the implantation of an insulated wire electrode into the thalamus of the brain. The electrode is connected to a pacemaker like device that delivers tiny electrical impulses directly to the brain. A complex pain relief mechanism results from brain stimulation therapy, including the release of endorphins (the body's natural pain relief substance) as well as interference in the pain pathways to the brain.

For years, deep brain stimulation had been used successfully as a treatment for chronic pain, when all else failed. Currently, deep brain stimulation is only approved as a treatment for Tremor control though it is a viable treatment for chronic intractable pain.. Patients with tremor, who also suffer from chronic pain, and, who have undergone deep brain stimulation surgery, have gotten relief from both their tremor and
their pain. ( SEE Commonly asked questions)

Thalamotomy is an ablative technique. It involves the placement of a surgical lesion within the thalamus region of the brain. It can provide excellent pain control in properly selected patients.

Other Ablative techniques for pain control include rhizotomies,
cordotomies, tractotomies, and dorsal root entry zone.

All ablative techniques are irreversible.

How Do You Choose Which Techniques To Use?

Pain is caused by complex mechanisms. It is one of the most difficult things to treat because the symptoms are so subjective.

Managing intractable chronic pain through surgery is considered an option for patients whose pain is interfering with the normal function of everyday life, and who have undergone conservative pain therapy regimens but have not achieved relief.

Conservative methods of treatment are exhausted before considering any surgical treatment.

Some types of pain such as post herpetic neuralgia, thalamic syndrome, anesthesia dolorosa, and post spinal cord injury pain, do not respond well to conservative pain treatments. In these cases, patients should be made aware of the neurosurgical alternatives before undergoing useless treatment regimens, often resulting in unecessary, prolonged suffering.

Candidates are evaluated on a case by cases basis. Treatment must be designed to meet a patient's individual needs. Careful screening and selection of surgical candidates, as well as careful procedure selection, is crucial to achieving good pain relief results.

Chronic Pain Disorders That Can Be Commonly Treated Include:

Low back pain
Facial pain, neuralgia
Burning pain as RSD
Herpetic neuralgia, shingles
Cancer pain
Head pain
Post surgical spine pain
Extremity pain
Phantom pain post amputation
Pain after stroke
Pain after nerve injury
Diabetic neuropathies and other peripheral neuropathies
Multiple sclerosis with pain
Painful paralysis
Painful numbness(anesthesia dolorosa)
Rare conditions
Visceral pain