Advanced Innovations for Pain

Abstract

Chronic pain represents one of the most important public health problems in terms of both the number of patients afflicted and health care costs. Most patients with chronic pain are treated with medications as the mainstay of therapy, and yet most medically treated patients continue to report ongoing pain. Additionally, adverse effects from pain medications represent a major challenge for clinicians and patients. Spinal cord stimulation and intrathecal drug delivery systems are well-established techniques that have been utilized for over 25 years. Intrathecal drug delivery systems have proven efficacy for a wide variety of intractable pain conditions and fewer adverse effects than systemic medical therapy in patients with refractory cancer-related pain. Spinal cord stimulation is cost-effective and provides improved pain control compared with medical therapy in patients with a variety of refractory pain conditions including complex regional pain syndrome, painful diabetic neuropathy, and chronic radiculopathy. Patients who have intractable pain that has not responded to reasonable attempts at conservative pain care measures should be referred to a qualified interventional pain specialist to determine candidacy for the procedures discussed in this article.

Spinal cord stimulation in treatment of patients with critical lower limb ischemia

“…Первое описание эффективного применения спи-нальной нейростимуляции не только при нейропати-ческом, но и ишемическом генезе болевого синдрома нижних конечностей опубликовано более 40 лет назад [15], однако общепринятой теории, объясняющей кли-нические эффекты SCS при КИНК, не создано [27]. В первую очередь это относится к улучшению показате-лей транскутанной оксигенации и скорости перифери-ческого кровотока в нижних конечностях у большинс-тва пациентов, для объяснения которого предложено несколько возможных механизмов.…”

Spinal Cord Stimulation for Treatment of Neuropathic Pain Associated With Erythromelalgia

“…9 Further, spinal cord stimulation can be cost effective compared with conventional medical therapy for a number of painful conditions. 10 Our patient had a truly refractory neuropathic pain condition.…”

Recent advances in understanding and managing cancer pain

“…SCS, also known as dorsal column stimulation, is a minimally invasive, outpatient technique that involves placement of electrodes in the dorsal epidural space 69, 70 . The electrodes are connected to a pulse generator that is implanted under the skin, typically in the buttock area.…”

“…Before implantation of the device, a patient undergoes typically a week-long trial to evaluate the effectiveness of the treatment. The purported mechanism of action is based on electrical stimulation of the dorsal horn, which most likely through several mechanisms suppresses the transmission of noxious stimuli from the peripheral nerves 64, 69, 71 . More research is needed to better define the population of cancer patients who may benefit from the therapy.…”

“…Implantable IT pumps have been in use since 1982. However, this method remains underutilized in the treatment of intractable cancer-related pain despite a significant body of evidence documenting its effectiveness 69, 83 . Multiple barriers, including high price, make wider utilization of IT pumps difficult.…”