|
Narcotics (see Opioids, below).
Nerve blocks employ the use of drugs, chemical agents, or surgical techniques
to interrupt the relay of pain messages between specific areas of the body and
the brain. There are many different names for the procedure, depending on the
technique or agent used. Types of surgical nerve blocks include neurectomy;
spinal dorsal, cranial, and trigeminal rhizotomy; and sympathectomy, also called
sympathetic blockade.
Nonsteroidal anti-inflammatory drugs (NSAIDs) (including aspirin and
ibuprofen) are widely prescribed and sometimes called non-narcotic or non-opioid
analgesics. They work by reducing inflammatory responses in tissues. Many of
these drugs irritate the stomach and for that reason are usually taken with
food. Although acetaminophen may have some anti-inflammatory effects, it is
generally distinguished from the traditional NSAIDs.
Opioids are derived from the poppy plant and are among the oldest drugs
known to humankind. They include codeine and perhaps the most well-known narcotic
of all, morphine. Morphine can be administered in a variety of forms,
including a pump for patient self-administration. Opioids have a narcotic effect,
that is, they induce sedation as well as pain relief, and some patients may
become physically dependent upon them. For these reasons, patients given opioids
should be monitored carefully; in some cases stimulants may be prescribed to
counteract the sedative side effects. In addition to drowsiness, other common
side effects include constipation, nausea, and vomiting.
Physical therapy and rehabilitation date back to the ancient practice
of using physical techniques and methods, such as heat, cold, exercise, massage,
and manipulation, in the treatment of certain conditions. These may be applied
to increase function, control pain, and speed the patient toward full recovery.
Placebos offer some individuals pain relief although whether and how
they have an effect is mysterious and somewhat controversial. Placebos are inactive
substances, such as sugar pills, or harmless procedures, such as saline injections
or sham surgeries, generally used in clinical studies as control factors to
help determine the efficacy of active treatments. Although placebos have no
direct effect on the underlying causes of pain, evidence from clinical studies
suggests that many pain conditions such as migraine headache, back pain, post-surgical
pain, rheumatoid arthritis, angina, and depression sometimes respond well to
them. This positive response is known as the placebo effect, which is defined
as the observable or measurable change that can occur in patients after administration
of a placebo. Some experts believe the effect is psychological and that placebos
work because the patients believe or expect them to work. Others say placebos
relieve pain by stimulating the brain's own analgesics and setting the body's
self-healing forces in motion. A third theory suggests that the act of taking
placebos relieves stress and anxiety-which are known to aggravate some painful
conditions-and, thus, cause the patients to feel better. Still, placebos are
considered controversial because by definition they are inactive and have no
actual curative value.
R.I.C.E.-Rest, Ice, Compression, and Elevation-are four components prescribed
by many orthopedists, coaches, trainers, nurses, and other professionals for
temporary muscle or joint conditions, such as sprains or strains. While many
common orthopedic problems can be controlled with these four simple steps, especially
when combined with over-the-counter pain relievers, more serious conditions
may require surgery or physical therapy, including exercise, joint movement
or manipulation, and stimulation of muscles.
Surgery, although not always an option, may be required to relieve pain,
especially pain caused by back problems or serious musculoskeletal injuries.
Surgery may take the form of a nerve block or it may involve an operation to
relieve pain from a ruptured disc. Surgical procedures for back problems include
discectomy or, when microsurgical techniques are used, microdiscectomy,
in which the entire disc is removed; laminectomy, a procedure in which
a surgeon removes only a disc fragment, gaining access by entering through the
arched portion of a vertebra; and spinal fusion, a procedure where the entire
disc is removed and replaced with a bone graft. In a spinal fusion, the
two vertebrae are then fused together. Although the operation can cause the
spine to stiffen, resulting in lost flexibility, the procedure serves one critical
purpose: protection of the spinal cord. Other operations for pain include rhizotomy,
in which a nerve close to the spinal cord is cut, and cordotomy, where bundles
of nerves within the spinal cord are severed. Cordotomy is generally
used only for the pain of terminal cancer that does not respond to other therapies.
Another operation for pain is the dorsal root entry zone operation, or
DREZ, in which spinal neurons corresponding to the patient's pain are destroyed
surgically. Because surgery can result in scar tissue formation that may cause
additional problems, patients are well advised to seek a second opinion before
proceeding. Occasionally, surgery is carried out with electrodes that selectively
damage neurons in a targeted area of the brain. These procedures rarely result
in long-term pain relief, but both physician and patient may decide that the
surgical procedure will be effective enough that it justifies the expense and
risk. In some cases, the results of an operation are remarkable. For example,
many individuals suffering from trigeminal neuralgia who are not responsive
to drug treatment have had great success with a procedure called microvascular
decompression, in which tiny blood vessels are surgically separated from surrounding
nerves.
Prepared by: Office of Communications and Public Liaison
National Institute of Neurological Disorders and Stroke
National Institutes of Health
Bethesda, MD
Continue this article...
|
