Stimulators and Implants
In situations where pain originating from the facet joint is isolated via medial branch blocks, these specific nerves can be destroyed selectively with thermal energy. This technology can also be used in sympathetic-mediated pain. This procedure involves the precise placement of radiofrequency needles along the appropriate nerves confirming location with motor and sensory stimulation followed by the delivery of thermal energy.
Spinal Cord Stimulation
This procedure places two electrodes into the epidural space at appropriate levels to electrically stimulate the spinal cord to block the transmission of pain. This technique is effective for persistent extremity pain (arm, leg), nerve-related pain, certain types of low back pain, specific cases of abdominal pain and other resistant cases of pain of multifactorial etiology. Patients can adjust the stimulation, allowing them to customize treatment.
Before permanent implantation, the patient undergoes a three- to seven-day trial in which the electrodes are placed without an incision and attached to an external power source. This period is a "test-drive" to determine the effectiveness of this device. Electrodes are permanently placed surgically in an outpatient procedure.
Intrathecal Drug Delivery
Initially developed to deliver medications directly into the spincal canal of cancer patients, intrathecal catheters provide a system to deliver analgesia with much lower doses than required orally or intravenously. Medications including narcotics and other agents are often delivered this way. Before implantation of a permanent system, a trial procedure determines the effectiveness of this delivery method.
Infusion Therapy (Ketamine, Lidocaine)
Intravenous delivery of local anesthetics and other medications can be helpful in treating neuropathic pain. Recent studies have clarified the role of these medications, particularly for patients who have not had success with other treatment modalities. This therapy typically is performed over the course of several days under a monitored setting.