Electrical Stimulation

Neurostimulation delivers precisely controlled, mild electrical impulses to the spinal cord or to a peripheral nerve.

Neurostimulation is indicated as an aid for management of chronic, intractable pain of the neck, back, and limbs. Neurostimulation delivers precisely controlled, mild electrical impulses to the spinal cord or to a peripheral nerve. Neurostimulation is a proven effective alternative to repeated back surgery, medication, or other therapies. Neurostimulation uses a small system that is surgically placed under the skin to send mild electrical impulses to the spinal cord or to a peripheral nerve. The electrical impulses are delivered through a lead that is also surgically placed. These electrical impulses block the pain signal from reaching the brain.

Because Neurostimulation works in the area where pain signals travel, electrical impulses can be directed to cover specific sites where you are feeling pain. Neurostimulation can give effective pain relief and decrease the need for pain medications. In addition, this therapy is non-destructive. Typically, patients who have success with Neurostimulation experience a 50% greater reduction in their pain and improved ability to go about daily activities.

Injections

Injections of local anesthetic and steroid can be used to relieve back pain.

Epidural Injections
The epidural space is within the spinal canal and surrounds the spinal cord. Steroid injections into this space can help to decrease inflammation of nerves and other soft tissues in the problematic area. These injections are usually given in a set of three for a cumulative effect. They are used for problems such as: Herniated discs, Sciatica, Radiculopathy, Narrowing of the Spinal Canal (Spinal Stenosis), and occasionally for Discogenic Low Back Pain. They can be given in the neck (cervical spine), upper back (thoracic spine), lower back (lumbar spine), and from the level of the tailbone (caudal approach).

Facet Injections
Facet joints are the joints in the posterior portion of the spine. There is one set of two facet joints between each vertebra in the spine. These joints can commonly be affected by arthritis and can cause back pain. Injections of local anesthetic and steroid can be used to relieve this pain.

Selective Nerve Root Blocks/Transforaminal Epidural Injection
Nerve root blocks use medications such as local anesthetics or steroids to disable a specific nerve root that is causing pain. Nerve root injury can often be localized by electrodiagnostic testing, and can be caused by herniated discs, stenosis, facet cysts, whiplash, or hyperextension injuries.

Sympathetic Blocks
These blocks are used to disrupt an abnormal pain cycle that can be caused by an overactive sympathetic nervous system. This condition is commonly referred to as complex regional pain syndrome (CRPS). It is also known as reflex sympathetic dystrophy (RSD), causalgia, shoulder hand syndrome, or sympathetic pain syndrome.

Intrathecal Pain Pump (Morphine Pump)
Intrathecal drug delivery systems are indicated for chronic intractable pain, cancer pain, and for chronic spasticity. Intrathecal drug delivery has been shown to increase pain relief and comfort for people with severe pain. It may also cause fewer side effects than oral medications. These benefits may help people with chronic pain improve their quality of life and participate more fully in daily activities.

Delivery makes the difference with Intrathecal drug delivery. This therapy uses a small pump that is surgically placed under the skin of the abdomen to deliver medication directly in to the Intrathecal space (the area surrounding the spinal cord). The medication is delivered through a small, soft tube called a catheter that is also surgically placed.

The spinal cord is like a highway for pain signals on their way to the brain, where your body experiences the feeling of pain. Because the drug is delivered directly to where pain signals travel, Intrathecal drug delivery offers significant pain control, with a small fraction of the dose that would be required with pills. This helps minimize side effects. Clinical studies show that of 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 activities of daily living.

Psychology

Pain Contributors

Depression is a common finding in chronic back pain sufferers. There is some question as to which comes first, the back pain or the depression. Either way, the depression should be considered and treated in order to have the best possible results from all other treatments.

Stress related to work or other aspects of life will commonly exacerbate back and neck pain. It is important to identify these stressors, and deal with them in a way that does not adversely affect the pain.

Fear and Anxiety is often generated when a source of pain has been present past a normal period of recovery. Questions begin to develop regarding the cause of pain. Do I have cancer? Am I going to be paralyzed? Fear and anxiety that begins to develop can make the pain seem greater than it is.

Disrupted Sleep Cycle due to pain can cause agitation, fatigue, malaise, mood swings, and irritability. These can all cause the pain to intensify. Reestablishing proper sleep cycle is one of the first steps in treating chronic pain.

Treatment Options

Relaxation techniques are used to remind a patient to relax mentally and physically in order to decrease discomfort in an affected area of the spine. Mental and physical stress may sometimes contribute to neck or back pain and discomfort.

Distraction techniques are used to distract your mind away from the pain. These will sometimes include hobbies, which force the brain to focus on something other than the pain.

Pacing is very important in the recovery process. It is used to help control the amount of work a patient performs in a given amount of time, to avoid re-injury or fatigue that can cause rebound pain.

Biofeedback is a treatment, which uses electrodes to monitor muscular activity in the affected area of the spine, and displays it on a computer screen. This enables the patient to visualize the relaxation of muscles. This often times helps in decreasing the amount of "stress" that can settle in the back.