Neurosurgery Dr. Stoforou

CHRONIC PAIN AND SURGICAL TECHNIQUES FOR CHRONIC PAIN RELIEF

CHRONIC PAIN AND SURGICAL TECHNIQUES FOR CHRONIC PAIN RELIEF

Pain is an unpleasant aesthetic and emotional experience that is accompanied by actual or potential harm or described as such (Definition of International Pain Study Association – IASP).

WHAT IS ACUTE PAIN VS CHRONIC PAIN?

Acute pain is a sensation triggered by the nervous system when an injury, trauma or disease occurs in the body and serves as a warning signal for the timely removal of the damaging agent and the investigation of the pain cause.

Chronic pain can be a constant sense of discomfort which can last for weeks, months or even years and can persist beyond the time frame it takes to treat a disease. Chronic pain is now considered a disease itself that needs treatment, either causality treatment by investigating the cause and applying directed treatment or symptomatic treatment in case the cause is not detected even after thorough examination.

 

Common causes of chronic pain are back painsciatica, neck pain, bruxia, trigeminal neuralgia, neuropathic pain, diabetic pain and cancer pain.

CHRONIC PAIN AND SURGICAL TECHNIQUES FOR CHRONIC PAIN RELIEF

The treatment of chronic pain is based on therapeutic algorithms, but the following chronic pain and surgical techniques for chronic pain relief related to Neurosurgery are applied when less invasive methods have failed (medication, local infusions, physiotherapy, etc.):

  •  Radio Frequency (RF) Application. It aims at modifying the transmission of the pain signals from the spinal cord to the brain, in order to modify the perception of the painful stimulus. This technique is applied to patients with chronic lumbago or autoimmune discomfort due to degenerative or other spinal disorders, peripheral neuropathies, atypical facials, and lastly drug-resistant migraines with interesting results. It is performed under local anesthesia and with the aid of a radioscopy. With a needle, such as the one used in epidural anesthesia, the epidural space is catheterized and the catheter is directed into, according to the damage of the lesion, on which a radio frequency is applied. The application lasts for about two minutes and can be applied on multiple pain frequency levels so as to treat pain at diverse locations. The patient remains in the hospital for 2-3 hours and then returns home. Radio frequency application lasts from a few months to two years and can be repeated without affecting the patient by causing a permanent anatomical damage. The technique alters the perception of the pain stimulus transmitted and hence is perceived differently from the brain.
  • Needle RF Radiofrequency Application. This technique is used in cases of “aponeurosis” of the trigeminal nerve when we deal with a drug-resistant trigeminal neuralgia or for the “aponeurosis” of painful visceral organs of the abdomen and pelvis to treat cancer pain.
  • Stimulation of the spinal cord by placing an epidural electrode attached to an implantable electric field generating device.
  • Deep brain stimulation by placing electrodes in the brain connected to an implantable electric field generating device. The two abovementioned techniques apply in cases of intense, non-manageable otherwise neuropathic pain, with the implantation of permanent electrodes, either epidural or intracerebral, and the continuous stimulation of the central nervous system with an electric field generating device that functions as a “pacemaker” of the nervous system.
  • Placement of pump for a continuous subarachnoid-infusion or the implantation of a pump for continuous drug administration in the subarachnoid space for continuous subarachnoid infusion of drugs (morphine). The implantation of a continuous subarachnoid drug injection is usually recommended for the treatment of cancer pain in patients with bone metastases but with a satisfactory survival prognosis. By placing a continuous subarachnoidal drug injection pump or implanting a pump for continuous drug delivery in the subarachnoid space, a 24-hour amount of morphine is injected directly into the nervous system, thereby avoiding systemic dosing of sufficient doses that usually cause intense and unpleasant systemic side effects. In this way the daily pain suffering is eliminated, the patient is relieved not only physically but also mentally, thus improving his quality of life dramatically. The procedure of installing the pump is performed either with general or regional anesthesia, depending on the individual patient’s indications. The patient remains in the hospital for one to two hours. The pump is controlled depending on its setting and is “recharged” with a drug solution, according to each individual patient’s needs.

 

 

The chronic pain and surgical techniques for chronic pain relief are ideal for suitably selected patients with chronic neuropathic and / or physical pain, provided that all other less invasive methods of pain management (medication, local infusions, physiotherapy, etc.) have been exhausted.

 

The chronic pain and surgical techniques for chronic pain relief are ideal for patients with chronic lumbago or autoimmune disorder due to degenerative or other spinal disorders, peripheral neuropathies, atypical facial pain, and lately in drug-resistant migraines with interesting results.

 

Examples of such painful conditions where chronic pain and surgical techniques for chronic pain relief are suitable for, is the failed back syndrome, the ischemic peripheral angiopathy limb pain, the neuropathic limb pain after amputation or traumatic nerve damage or migraine, the cancer pain, the post-herpetic neuralgia, the diabetic peripheral neuropathy, etc.