Chronic pain develops when a body’s usual response to injury lasts longer than required. This pain becomes harmful instead of protecting. This type of chronic pain can lead to problems eating, exercising, working, or pursuing other activities of daily life. This condition and its effects can wear a person down leading to other chronic health problems, such as depression, weight gain, along with issues related to medication overuse in an attempt to manage the pain.
Nerve signals are constantly relayed from the body to the brain. This activity assists in preventing injury by making someone aware that something is wrong. However, if nerves are damaged, they may send pain signals to the brain, even if an injury is not present. A good solution to preventing the brain from receiving these signals is spinal cord stimulation.
CAUSES
Chronic pain may develop for a variety of reasons. Almost any injury to a nerve holds the ability to develop into a chronic problem. Depending on the nerve injury’s location, this pain may feel different per case. Trauma to the body, along with other medications or medical conditions, may injure the nerves. For example, a pinched back nerve, uncontrolled diabetes, or a medical procedure may result in chronic pain. A person’s mental health may also play a role in their perception of pain, as well as their ability to manage it. With this large number of potential chronic pain causes, the treatment and evaluation for one chronic pain patient may be very different from another similar patient.
It is essential to know and understand that a person may experience periods of nearly constant, acute pain, often related to joint or muscle injury, arthritis, and numerous other medical conditions. Chronic pain occurs when the pain continues even after the initial cause is no longer present. The most useful procedure for injury to the nerve is spinal cord stimulation, as injury to the nerves often causes this type of pain.
SYMPTOMS
The symptoms of pain vary largely per case. Chronic nerve pain may range from burning, throbbing pain to sharp, shooting pain. This pain lasts longer than it should. It also is usually out of proportion, causing a light touch or rub to hurt when it shouldn’t. This condition can lead to people feeling exhaustion, a decrease in energy, difficulty sleeping, and a depressed mood. Chronic pain can make it difficult to work, play, or simply manage normal activities of daily life.
WHEN AND HOW TO SEEK MEDICAL CARE
Pain can have a negative impact on a patient’s overall health. Medical care is recommended when the pain interrupts someone’s usual activities and does not improve with rest. Primary care providers are the best option to initially evaluate ongoing pain. If pain lasts for over 6 months, it can be seen as chronic, and a referral to a pain specialist may be essential.
TESTING AND DIAGNOSIS
Certain causes of pain are easily identifiable while others may be more difficult. A good documentation of someone’s pain and a physical exam is needed to begin the evaluation. Combining this approach with imaging studies, laboratory testing, alongside some minor procedures will identify most of the common causes of chronic pain. The ability to locate the origin of pain and the original cause of the injury happened are important for treating the pain.
TREATMENT
Searching for the most effective pain treatment type for a patient requires understanding the place where pain is originating from and the kind of injury that has occurred. The origin of the pain can be specific to one area or it may be widely distributed. The most effective treatment is found by understanding the cause of the nerve injury and utilizing therapy to correct the problem or lessen its effect. No single treatment plan works for all patients, and most patients require numerous different approaches.
Non-Surgical Treatments
Generally, non-surgical treatments should be used as a first option for the evaluation and treatment of chronic pain. Improving lifestyle factors (good mental and emotional health, appropriate weight management, proper nutrition, regular physical activity, and healthy sleep habits) are often useful in promoting recovery. The repercussions of chronic pain will usually make a healthy lifestyle more challenging and can lead to a variety of the previously mentioned negative effects. Physical therapy is typically utilized as a first line treatment for pain conditions. This type of therapy promotes many of the beneficial lifestyle factors listed above and does not carry the risks that are associated with medication and surgery.
Various medications are available with multiple ways of relieving pain. Anti-inflammatory drugs, such as ibuprofen, are typically used as the initial choice. If pain worsens, prescription pain medication, including opioids like oxycodone, can be utilized to manage pain. Although used in treating acute pain, these medications are less useful for chronic pain. Additionally, these types of prescription pain medications can lend way to abuse, addiction, and potential harm. The risks of these issues increase if the medications are taken over a long period of time. Certain medications are increasingly or decreasingly effective for particular types of pain, so it is essential to talk with your medical provider about any medications before use.
Surgery
Multiple procedures are utilized to manage chronic pain. Certain procedures will be used to assist with identifying the cause and origin of the pain, while others assist in controlling the pain. Nerve blocks or injections are often used during this procedure and may utilize numbing medication and/or steroid medication to block inflammation to a certain area. Pain specialists can use procedures like this to manage pain without the need for larger surgical procedures.
When there is a problem with the body, surgery can be completed to correct it. A surgeon will use x-rays, CT scans, or MRIs to view the areas where the pain is located and identify problems. When a problem can be identified and surgery can be done to correct it, surgery will often be the best option. In neurosurgery, this will most commonly include removing bone from the spine or fusing sections of the spine together. If no defect can be found to explain why the patient experiences pain or correcting it is not likely to improve the pain, surgery to do so is not a good option.
Spinal cord stimulation (SCS) is a relatively new technology that can assist in managing chronic pain when the cause cannot be removed or the injury cannot be repaired. The device consists of a stimulating wire (“electrode”) connected to a control unit (“generator.”) By setting a stimulating electrode over one’s spinal cord, the pain signal is blocked from being sent up from the spine to the brain. Following the evaluation of and non-surgical treatment of a patient, spinal cord stimulation is considered to help manage chronic pain. A patient will commonly undergo mental health testing and counseling so they understand how an implanted device will be managed. A trial is done by placing one or two wires into the space outside the spinal cord, controlling them from a unit located on the outside of the patient’s body. This is usually maintained in place for about a week, and the patient is able to test how well stimulation through the wire assists their pain. The stimulation is a very mild electrical pulse that the patient typically does not feel. These electrical pulses mask the pain signal and may be adjusted over the course of the trial to receive the greatest improvement in pain. Trials are considered successful if they can remove half of a patient’s pain.
A successful trial is eventually followed by surgery to place a permanent stimulator. This is typically completed by making a small cut in the back and another near the waist. A small, flat electrode or wire is placed through the incision located on the back to the space behind the spinal cord. Next, the wire is tunneled under the skin to the incision near the waist where it is connected to a small battery powered generator. The generator is then placed under the skin at the waist incision. The system is tested. Iif all is working properly, the incisions are closed and the surgery is completed. The stimulator is controlled with a small hand-held remote, which can be utilized to make adjustments as needed. Some generators’ batteries must be recharged every few days, while some don’t need to be recharged at all. Non-rechargeable units usually need to be replaced about every 3-5 years, while rechargeable batteries can last for over 10-15 years.
FOLLOW-UP
The surgeon will typically see the patient within a month after surgery to ensure that the incisions are healing well and to remove sutures if applicable. Management or adjustment of the stimulator is typically completed by a pain specialist or a representative from the medical device company. No further surgical intervention is required until the battery must be replaced.
