The Clinic
The Pain Team
Pain
Acute Pain
Chronic Pain
Pain diseases
The Therapy
Informations

1.

Nerve blocks

2.

Radio-frequency neurolyses

3.

Medication pumps

4.

Posterior funiculus stimulation

The therapy

The interventional pain therapy includes invasive measures to combat pain

1. Nerve blocks

By specific application of anti-inflammatory medications and local anesthetics to the nerves a soothing effect is frequently achieved on an irritated nerve. Although the effect of this measure is relatively short-lasting, it is often possible to achieve a sustained pain relief since the vicious circle of muscle tension – pain –muscle tension can be broken. The best success is obtained when other measures, such as physiotherapy, are carried out at the same time.

2. Radio-frequency neurolyses

In this method the pain-transmitting nerve is targeted with radio-frequency current. Basically, this involves microwaves that heat the nerve to a sufficient extent that it is no longer capable of conducting pain signals. Other qualities of the nerves, such as sensitivity and motor functions remain largely unaffected.

A special needle is guided directly to the nerves under X-ray monitoring. Usually a local anaesthetic is sufficient. When treating certain headache types, a short period of full anesthesia is necessary, however.

The success of the treatment generally appears within 6 weeks and lasts for between 6 and 18 months.

At the end of this time the treatment can easily be repeated.

Picture caption:
Medtronic’s programmable Synchromed analgesic pump

Picture caption:
Medtronic’s programmable Synchromed analgesic pump

3. Medication pumps

When administering medications by intrathecal means, a powerful analgesic, generally morphine, is passed directly to the spinal cord fluid. A so-called analgesic pump that is inserted under the abdominal skin in a short operation or is carried by the patient in a small bag serves as a medication reservoir.

The analgesic pump provides a continuous supply of painkiller to the spinal cord fluid. This affects the pain transmission to the brain (where the pain is felt).

As the painkillers can act directly on the spinal cord, the doses required are up to 300 times lower than oral administration in the form of tablets with a corresponding reduction in side effects.

This method is particularly effective with nociceptive pains. Also cancer patients whose pains cannot be brought under control by other means or who suffer severe side effects from the analgesic can benefit from this method.

Before insertion of the analgesic pump, a 3 – 4-week test phase with an external pump (i.e. situated outside the body) in order to test the effectiveness and determine the medication dosage. A spell of 4 – 5 days in hospital is required for this purpose. The patient spends the remainder of the test phase at home in his familiar environment whilst being checked regularly as an outpatient in our practice

Picture caption:
A probe sends weak electrical signals through the spinal cord to the brain.

The electrical signal generator with the electrical probes.

The control unit with which the patient can control the electrical signals for himself.

4. Posterior funiculus stimulatio

Posterior funiculus stimulation is particularly successful for dealing with neuropathic pains. A special probe is inserted under local anaesthetic. A generator sends weak electrical signals to the spinal cord which changes the perception of pain. The pain is replaced by a tingling sensation. The patient is able to control the electrical signals himself by means of a transmitter. This method frequently avoids the need for operations and drastically reduces the consumption of analgesics.

A test using a test stimulator is carried out before the actual implantation of the Posterior funiculus stimulator. Here, although the electrical probes are inserted, stimulation is carried out by means of a unit outside the body. In this way it is possible to find out whether the implantation of an actual stimulator would have the desired effect. A brief period in hospital is required for the test phase.



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