Pain is an endemic problem in our society. We treat some chronic pain with nerve blocks, implantable morphine pump, implantable spinal cord stimulator…..

 

 

Pain

 

What is Pain?

Pain is a sensation of discomfort or unpleasant emotional experience.  It usually occurs from tissue damage.  Most acute pain goes away after the tissue has healed.  Pain is considered to be chronic when it continues after the tissue has healed and persists for more than 6 months.  Inadequate treatment of pain can cause unnecessary suffering, disruption of life style, loss of income, and loss of self-esteem.

Pain can be divided into two categories:

Neuropathic pain.

Nociceptive pain.

Neuropathic pain is pain that is caused by damage to nerve tissue.  It is often described as tingling, burning, shooting, electric-shock, and stabbing.  Examples include “pinched nerve”, carpal tunnel syndrome, and peripheral neuropathy.

Nociceptive pain arises from an injury or disorder outside the nervous system that results in activation of specialized pain receptors called nociceptors.  These receptors are present in skin, muscles, bone, joints, bowel, and other tissues.  The pain is described as aching, throbbing, less often, sharp.  This type of pain can occur from arthritis, osteoporosis, and ischemic limb pain.

Mixed pain consists of a combination of neuropathic and nociceptive pain.  This may be seen in migraine or cancer.  About 70% of patients with advanced cancer have pain and about 25% die without adequate relief.

 

What is the standard treatment for Pain?

The World Health Organization’s (WHO) 3-step “analgesic ladder” is an excellent guide for appropriate treatment of pain based on its intensity.

 

 

STEP 1

  • Mild Pain: Nonopioid analgesics
  • Recommended drugs: Aspirin (ASA), Acetaminophen (Acet), and NSAIDs.
  • +- Adjuvants

STEP 2

  • Moderate Pain: Mild opioids used in combination with ASA, Acet, or NSAIDs
  • Recommended: Codeine, Hydrocodone, Oxycodone
  • +- Adjuvants

STEP 3

  • Severe Pain: Strong opioids
  • Recommended: Morphine, Hydromorphone, Oxydocone, Methadone, Fentanyl
  • +- Nonopioid analgesics
  • +- Adjuvants

 

 


Most nociceptive pain is opioid-responsive, but effective doses may produce intolerable side effects.   Neuropathic pain is usually opioid-resistant.  Many patients require the addition of adjuvant analgesics like antidepressants and anticonvulsants.

Patients who do not respond to the 3-step analgesic ladder should be considered for treatment in a comprehensive multi-disciplinary pain clinic.  Transcutaneous electrical nerve stimulation (TENS), nerve blocks, epidural steroid injections, are commonly used, depending on the cause of the pain.

We offer a variety of treatments to patients who have failed standard medical pain management.

 

Nerve Block

Joint injection

Implantable Spinal infusion pump (Morphine pump)

Spinal Cord Stimulation