The management of moderate to severe chronic pain encompasses various modalities, including innovative drug therapy, targeted procedures, medication pumps and infusion systems. Many physicians choose medication as the first option for chronic pain management. Although morphine has been considered the medication of choice among patients suffering from debilitating pain, adverse side effects and drug dependency are serious considerations. One of the newest pain medications, Duragesic, provides a continuous delivery of the narcotic fentanyl through the application of transdermal patches. Fentanyl provides pain control similar to morphine with fewer side effects and longer lasting relief.
Anticonvulsants, commonly used to treat seizure disorders, are effective for the treatment of certain types of pain, and have fewer side effects than opoids. Medications in this class include Lyrica, Neurontin and Tegretol. Antidepressants, prescribed in low doses, have proven effective for chronic pain management. Medications in this class act by adjusting pain receptor chemicals in the brain. Tricyclic antidepressants such as Elavil, Pamelor and Norpramin are often prescribed in combination with non-narcotic drugs such as Tramadol or Neurontin.
Sophisticated pain management technology and interventional techniques are being developed to manage chronic pain. The effectiveness of interventional techniques varies according to type, location and severity of the pain. Spinal cord stimulation can provide ongoing pain relief by preventing pain signals from reaching the brain. The procedure involves the surgical implantation of a device through which electrical signals are delivered directly to target areas such as the spinal cord. Improvements are ongoing in the design of spinal cord stimulation devices to reduce potential nervous system complications. These devices are typically used on a trial basis. If optimal pain control is achieved, permanent implantation may be recommended.
Spinal drug pumps, known as intrathecal pumps, are surgically implanted under the skin to deliver medications directly to the spinal cord. Intraspinal infusion therapies include medications such as clonidine, gabapentin and midazolam. Neuromodulation techniques involve the electrical stimulation of certain areas of the nervous system and may include the administration of medications or steroid solutions directly into the central nervous system.
Nerve blocks can be used to treat severe spinal pain. The injection of local anesthetic agents into specific pain-generating nerves is usually effective for a short time. It has been widely reported that repeat nerve blocks can cause permanent nerve damage or paralysis. Radiofrequency ablation, an alternative pain control method, is recommended for severe pain in localized areas. The procedure, performed on an outpatient basis under CT imaging guidance, involves the insertion of a needle into the targeted nerve site. Electrical currents generated by radio frequency waves produce heat directed to small areas of nerve tissue.
In addition to medication and interventional modalities, alternative treatment options include acupuncture, biofeedback, relaxation techniques and psychological counseling. Interdisciplinary pain management clinics have been established nationwide to provide optimal pain control, as well as counseling assistance to patients suffering from chronic, debilitating pain.