New technologies can help short circuit chronic pain

As part of a comprehensive treatment plan, a variety of technologies offer new hope to people living with chronic pain.

Used by physician anesthesiologists who specialize in pain management, these techniques ease pain in various ways -- using radio waves, electrical pulses, image-guided injections and special pumps to deliver pain medication. Pain medicine specialists have extensive training and expertise in finding the cause of pain and working in partnership with patients to create a plan for managing pain and improving function.

"Pain is one of the most challenging things to treat because its source can be elusive," said Richard Rosenquist, M.D., chair of the American Society of Anesthesiologists® (ASA®) Committee on Pain Medicine and chairman of the department of pain management at the Anesthesiology Institute at the Cleveland Clinic. "That's why it's vital to see a physician specializing in pain medicine who can help identify the source of the pain and suggest which pain method might work best, including the more recent technical advances."

Pain Relief Techniques

Here are some of the latest high-tech methods for relieving chronic pain:

Radio Waves - Radiofrequency (RF) ablation involves heating a tiny area of nerve tissue, which short circuits pain signals. Using CT imaging as a guide, the pain medicine specialist inserts a needle into the nerve responsible for the pain and zaps it using an electric current created by radio waves. The relief can last for up to a year.

Blocking the Pain - Under X-ray guidance, pain medicine physicians can inject numbing medication that blocks or dampens pain, and might even stop chronic pain from developing. The location of the injection depends on the source and type of pain. For example, pain in the arm or face can be relieved by blocking nerves in the neck. Chronic abdominal pain or pain from cancers such as pancreatic cancer can be relieved by an injection into nerves supplying the abdomen. Relief may require a series of injections and may need to be repeated.

Electric Signals -- Transcutaneous electrical nerve stimulation (TENS) can provide short-term pain relief, especially for various types of muscle pain, by sending low voltage electric signals from a small device to the painful area through pads attached to the skin. The patient will feel little pulses when it's on. While researchers aren't sure why it works, they think it may either interrupt the nerve signals to the brain, or stimulate the production of "feel good" endorphins, the body's natural painkillers.

Spinal Cord Stimulation -- When other methods fail, a pain medicine specialist might recommend spinal cord stimulation (SCS), which uses a pacemaker-like device that replaces the pain with a more tolerable sensation, typically tingling or a massage-like feeling. The physician implants the device in the lower back, attaching it to tiny wires that are located in the spinal canal. When the patient feels pain, he or she can use a remote control device to send signals to the painful area. This technique can help with back pain as well as neuropathy -- nerve damage in the legs that causes numbness and pain. Neuropathy is common in people with diabetes.

High Frequency Spinal Cord Stimulation -- A recent study published in Anesthesiology, the medical journal of the ASA, showed that a special high frequency form of SCS provided significantly greater long-term relief for both chronic back and leg pain, compared to traditional low frequency SCS. The high frequency SCS also relieved pain without introducing the tingling or other stimulation-induced sensation that some patients find distracting.

Pumping the Pain Away -- Special pumps can be implanted that allow the patient to push a button and deliver local anesthetics, narcotics and other pain medications to the spinal cord. This can bring relief while avoiding the side effects that often come with taking these drugs by mouth. Patients also get a psychological boost by having direct control over their pain. These spinal drug pumps are most often used by people with cancer pain, but also by patients with other types of pain who had side effects when taking medication.

On the Horizon: Using Our Cells to Fight Pain -- One of the most promising research areas involves harvesting stem cells from a patient's bone marrow and injecting them into an area, such as the lower back, that has become painful because tissue has deteriorated. The hope is that the stem cells will build new, healthy tissue and relieve pain for good.