Advanced Therapies Can Relieve Chronic Pain
Chronic pain can lead to a drastic change in a person's quality of life, and at the Neuroscience Institute at Scott & White, our physicians and healthcare professionals offer many options for advanced pain therapy, in addition to the surgical treatment of pain.
For more information, or to schedule an appointment, call 254-724-2475.
Two methods of advanced pain therapy, intrathecal drug delivery therapy and neurostimulation (described below), are restoring quality of life to chronic pain sufferers. The following questions, and their answers, will give you a better understanding of who is eligible for these surgical treatments for pain, what they are and how they work.
Intrathecal Drug Delivery Therapy
What is Intrathecal Drug Delivery Therapy?
Intrathecal drug delivery is a pain management therapy that delivers medication directly to the fluid-filled (intrathecal) area surrounding the spinal cord.
How does it work?
Simply, a small pump is surgically inserted under the abdominal skin to drive pain-relieving medication into the intrathecal space, thus blocking pain signals traveling from the spinal cord to the brain-where pain sensation is experienced by the body. The medication is delivered (pumped) through a thin, flexible,surgically placed tube called a catheter.
Why take a screening test?
A screening test lets your doctor decide how well long-term drug delivery therapy may work for you. Your doctor administers small doses of medication into the fluid surrounding your spinal cord, then assesses your level of functional improvement and pain relief. If improvements are significant, you may be a candidate for the therapy.
How is the screening done?
There are two types of tests: injection and continuous infusion. Both are done with local anesthesia. Injection involves putting a small amount of medication into your spinal area. That's followed by several hours of in-hospital monitoring to measure pain reduction. You can then return home.
Continuous infusion requires a few days and more closely resembles therapy delivered by the fully implantable infusion system. A continuous flow of medication is delivered to the spinal area through a temporary catheter. One end of the catheter is placed in your back; the other end is attached to an external pump. You can usually resume normal daily activities (within guidelines) during test days. Again, by measuring your pain before and during screening, your doctor will be able to evaluate the medication's pain-controlling effectiveness.
Are there any side effects to screening?
Sleepiness, nausea/vomiting, headache and/or dizziness may occur during screening. Be sure to tell your doctor if you experience any of these. If you go on to receive long-term intrathecal drug therapy, you and your physician will work together to adjust the pump to deliver the dose of pain-relieving medication that's right for you. Intrathecal drug therapy is a process requiring teamwork between you and your doctor.
Is intrathecal drug delivery superior to oral medication for chronic pain?
Clinical studies show that for people who did not experience enough pain relief with high doses of oral medication, most achieved significant pain control with intrathecal drug delivery and were able to improve their quality of life.
What is neurostimulation, and how does it work?
Neurostimulation refers to a system that is surgically placed under the skin to send mild electrical impulses to the epidural space near the spinal cord or to a peripheral nerve. Tiny electrical impulses, delivered through a “lead” (special medical wire), block the pain signal from reaching the brain, where pain sensation is experienced.
Is a screening test necessary?
There is a screening period prior to implantation, which gives you an opportunity to experience the system-and enables your doctor to assess your battery requirements. During the evaluation period, which can last several days, your doctor determines your response to neurostimulation and your level of pain relief.
Once I pass the screening, what is involved in the implantation procedure?
The surgical procedure to implant the neurostimulation system may require a brief hospital stay. Prior to surgery, you and your doctor will decide where to position the neurostimulator (the device that generates electrical impulses) for maximum comfort. Following sedation and during surgery, an incision is made over the spine so that your doctor can place the “lead” (the pain-blocking medical wire) and connect it to an extension. The extension is tunneled under the skin and connected to the neurostimulator. Once this final connection is made, incisions are closed and surgery is complete. The procedure takes one or two hours.
What are the benefits of neurostimulation?
With neurostimulation, electrical impulses can be directed to specific pain sites. The system gives effective pain relief reduction of 50 percent or more, allowing recipients improved ability to perform daily activities.
What does neurostimulation feel like?
The sensation felt with neurostimulation varies from person to person; most report a tingling sensation in the pain area.