Pain Management Techniques to Help Conquer Back and Neck Pain
Procedures - Spinal Pumps and Stimulators
Radiofrequency Discal Procedures are newer procedures that involve inserting a needle into the disc. But instead of a heating wire (as was previously the case in a rarely-used procedure known as Intradiscal Electrothermoplasty, or IDET), a special radiofrequency probe is inserted through the needle into the disc instead. The probe generates a highly focused plasma field with enough energy to break up the molecular bonds of the gel in the nucleus essentially vaporizing some of the nucleus.
The result is that 10-20% of the nucleus is removed, which decompresses the disc and reduces the pressure both on the disc and the surrounding nerve roots. This technique may be more beneficial for sciatic-type pain, since nucleoplasty can actually reduce the disc bulge pressing on the nerve root. The high-energy plasma field is actually generated at relatively low temperatures minimizing the danger to surrounding tissues.
Although Intradiscal Biacuplasty (IDB) is currently the technique with the most interest—and recent support in the research literature—there is nevertheless concern about intradiscal procedures. Some research has shown that needle punctures of the disc can enhance and hasten disc degeneration however, the risk-benefit ratio for these procedures is still unclear.
Pumps and Stimulators
Spinal Pumps are called intrathecal (intra-thee-cal) spinal pumps. Intrathecal refers to the fluid containing space that surrounds the spinal cord. The benefit of administering pain relieving medication through a spinal pump is that medications taken orally are diffused throughout the entire body. A spinal pump delivers pain-relieving medication precisely where it is needed.
- Ziconotide is a non-opioid medication that can be used in spinal pumps, and can be effective for a wide variety of chronic pain conditions. It is not an addictive medication. This treatment is considered after standard conservative treatments have been ineffective or have caused intolerable side effects.
The pump is surgically implanted beneath the skin of the patient's abdomen. A catheter is run to the level of the spine from where pain is transmitted. Medication is pumped directly into the spinal fluid allowing for a much more potent effect on the spinal cord. This drastically cuts down on the amount of medication needed and provides better pain relief with fewer side effects.
The pump is refilled every 1-3 months by inserting a needle through the skin and into a diaphragm on the surface of the pump. Several different medications can be administered this way. Since the system is beneath the skin, the risk of infection is minimized and the patient can be fully mobile and active.
Spinal Stimulators. Instead of medication to relieve pain, spinal stimulators emit electrical pulses on the surface of the spinal cord to reduce pain. The stimulators are similar to pumps in that they are surgically implanted beneath the skin but differ in that electrical signals are used to ease pain.
Electrical signals are passed through the tip of the catheter at the precise location near the involved segment of the spinal cord. The result is a tingling sensation, which eases pain. Current theory is that the electrical current input alters the spine's processing of the pain so that the patient's pain is reduced. The patient is able to control the stimulator by holding a magnetic pulsing device over the skin on top of the implanted generator disk. The stimulator appears to be effective for patients with back and leg pain that spinal surgery did not relieve. There is data that shows that these patients will do better with the placement of a stimulator than they will with repeat surgery.
This approach is growing in use for chronic neck and back pain problems that have failed to respond to simpler treatments. New devices, such as the Nevro high frequency stimulator, are now available. These new devices may expand the utility and success of implanted stimulators for back pain.
As we learn about neuroplasticity, we have learned that good pain management starts with prevention. When possible, physicians should strive to reduce the intensity and duration of acute pain. When pain does persist, then a multidisciplinary approach is often most effective. In severe cases, when pain does not respond to usual treatments, then the more invasive techniques such as nerve blocks, spinal pumps, and spinal stimulators should be considered. It is not always possible to cure the cause of pain - but it is usually possible to reduce pain and suffering.
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