What is Pain?

Pain is an unpleasant sensory perception

What is Chronic Pain?

It is pain that is persistent even after the stimulus that causes pain has stopped

Examples of Chronic Pain :

Failed Back Surgery Syndrome

Pain in the low back and legs even after spinal surgery. The MRI scans will not reveal any ongoing compression of the nerves and therefore further spinal surgery is not an option.

Failed Neck Surgery Syndrome

Pain in the neck and arms that persists even after surgery to the cervical spine. Again, MRI scanning does not reveal any ongoing compressive pathology and further corrective surgery is not an option.

Chronic Regional Pain Syndrome

An extremely painful condition that was previously called Reflex Sympathetic Dystrophy. This occurs typically in the hands at or around the wrists and fingers or in the legs at or around the ankle and toes. There is a history of trauma to that part which may have been a fracture. The affected part is swollen, red, painful, tender to touch and the skin is stretches, shiny and devoid of hair.

Neuropathic Pain

Pain occurring in any part of the body due to injury to the nerves

Chronic Facial Pain

Here the patient complains of chronic pain involving the face that is again longstanding and where all medicines and surgeries have failed.

Chronic headaches:

Conditions like Cluster headaches, Occipital Neuralgia, Chronic migraine which are not responsive to the first or second line medical treatments

Is there a treatment option for these patients?

Though CURE is not possible in such debilitating conditions, there is a potential for offering a meaningful relief of the patient’s suffering.

As always, the first option is to manage with neuromodulatory drugs. Medicines like Gabapentin, Pregabalin, Duloxetine, Carbamazepine etc are tried. However, the result is usually not satisfactory.

Surgical Options

Spinal Cord Stimulation:

This is an operation where an electrode is implanted over the area of spinal cord relevant to the patient’s pain and electrical current is sent through that. The aim is to cheat the brain and block the painful impulses reaching the brain. The end result is that the patient feels warmth or mild tingling instead of pain.

Intrathecal drug delivery:

Delivery of painkillers directly to the spinal cord using an implanted pump and a catheter into the spinal fluid is a viable option in such conditions

Deep Brain Stimulation:

Various targets exist in the brain which are responsible for the transmission/modulation of the pain. Implanting an electrode into areas such as the thalamus/ Peri-aqueductal gray/ peri-ventricular gray etc  and connecting it to a pacemaker is an option in managing chronic neuropathic pain

Motor Cortex stimulation:

Implanting an electrode on the motor cortex and sending electrical stimulation through it has been useful in conditions like chronic facial pain.

Occipital Nerve stimulation

For patients with Occipital Neuralgia and Chronic Headaches which are not responsive to medicines, implanting an electrode over the Occipital Nerve which runs in the back of the head and connecting it to a pacemaker can significantly reduce the severity of the headaches.

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