The availability of high-quality evidence to recommend treatment strategies for Chronic Pain Disorders is limited (World Health Organisation, 2008).
Each patient should have an individualised multi-modal therapeutic regime that concentrates on treating the underlying cause of pain, using appropriate medication as part of a pain management plan, provide regular analgesia (by the clock) titrated to achieve best affect & improve quality of life. Therapeutic regimes need to be individualised and combined with psychological support (i.e. cognitive behaviour techniques) and identify the importance of evaluation and monitoring for any unwanted effects.
Technologies that help?
There are many areas of neurotechnology in the treatment of pain. Below is a description of three basic areas of treatment that are currently available; transcutaneous electrical nerve stimulation (TENS), intrathecal pump and spinal cord stimulators (SCS).
- TENS units (transcutaneous electrical nerve stimulation) and Percutaneous Neuromodulation Units (PENS) work by delivering low level electrical stimulation through electrodes placed directly on the skin of the affected area. The electrical stimulation delivered through the skin may help alleviate pain by blocking pain messages being sent to the brain. Both systems require a physician prescription but this therapy can provide a convenient means of treating some forms of pain. Both are non-invasive and can be an economical solution.
- Intrathecal Pump, refers to the administration of medicine, by a medication delivery pump. The pump has a chamber or reservoir for the drug that delivers the medication through a catheter directly into the spinal canal. The pump needs to be refilled, usually once every few months, by placing a needle through the skin. Generally, a person first undergoes a trial of the medication by an intrathecal injection. If successful, a pump system can be implanted permanently through a surgical procedure. The intrathecal pump reduce the need for oral medications, can be more effective and is now a mainstay of therapy for intractable pain including neuropathic pain and spasticity.
- Spinal Cord Stimulation (SCS) system is a hybrid system comprised of implanted electrodes in the spine and an external control unit. It uses electrical stimulation to block the pain pathways to the brain that travel through the spinal cord. SCS has also been known to decrease spasticity. An initial trial is needed to see if effective results can be achieved. If the trial is successful, a permanent system may be implanted. The patient has the ability to keep the system on permanently or as needed.
These above options should be discussed with a pain consultant. Deep brain stimulation, transcranial magnetic stimulation and the use of very high frequency alternating currents as a method for blocking nerve conduction in peripheral nerves is currently under investigation. These methods might be able to provide an improved alternative for blocking pain and controlling muscle spasms.