Pain Therapy

Development

Chronic pain always starts as an acute pain, but after a while there is often no connection to the original trigger. Only the chronic pain continues to exist. This phenomenon is most clearly demonstrated in phantom pain, when a patient continues to experience excruciating pain in an amputated limb. We now know from recent studies that the pain producing areas in the brain and spinal cord become "sensitized" during amputation, and these areas continue to produce painful sensations.

Treatment

Underlying the development of chronic pain is a process of the brain developing "pain pathways" through memory and learnt behavior. The central nervous system responds to repeated stimuli with a sensitized reflex pain pathway. To prevent this chronic development two methods are available: one is to keep pain to an absolute minimum during the acute event by keeping tissue damage minimal, the other is to treat the patient with adequate analgesia, so no "pain memory" develops within the central nervous system.

Helping through minimally invasive techniques

These principles of reducing chronic pain are realized using minimally invasive surgery in combination with specialized anaesthetics. The "pain-stimulus-sensitization" cascade, essentially determined by the degree of intra-operative tissue damage, is extremely minimal, and is further measurably reduced using our special anaesthetic procedures here at the MIC. In addition, our anaesthetic department has years of experience treating chronic pain, which has led us to our specialized treatment strategies.


These are minimally invasive pain therapy procedures:

1. Port implantation
A port is a synthetic or metal capsule with a silicone membrane that is inserted or implanted just under the skin. The port is then connected to a thin tube that is either inserted into a large vein, the epidural space of the spinal column, or another affected area of the body. Medication can then be injected directly into the port through the skin. Port systems are used if venous access is poor in, for example, chemotherapy, or if a patient requires regular pain relief for chronic pain. The medication can be directly injected into the space around the spinal cord, thus reducing drug side-effects.

Hospital duration is usually one day


2. Catheter implantation
If medication is required regularly for a defined period of time ( eg myofascial trigger points or nerve plexus pain), a catheter can be inserted directly to the site under radiological guidance and treatment continued on an outpatient basis.

Hospital duration is usually one day.


3. Pump implantation ( pump syringe driver)
In some special cases, if other methods of pain relief are unsuccessful or if there are unwanted side-effects, it can be necessary to inject pain medication (usually opioid analgesia) directly to the central nervous system via fine catheters placed within the epidural space. Should this be necessary for a long time, a permanent pump is inserted. Depending on the pump size and delivery rate, the medication is topped up regularly, usually monthly. This must be performed by a specially trained doctor under sterile conditions.

Hospital duration is usually up to 7 days.