Chronic Pain

What is chronic pain? Sharp and acute pain is a normal reaction triggered by your nervous system to let you know of a danger to your body. When you touch a hot pan, for example, the pain is immediate and you jerk your hand away from the danger. Chronic pain is different. It persists for a long period of time, sometimes even when the original cause of the pain no longer exists. Pain signals keep firing to the nervous system for weeks, months, and even years. Sometimes these signals are a response to an ongoing medical problem like arthritis, cancer or an ear infection. At other times, there may have been an initial injury, to the back for example, that has been remedied, but the pain persists in spite of the cure. And in some instances, there is no discernible cause for the pain: it simply happens and endures for long periods of time. Common chronic pain conditions include headaches, arthritis pain, low back pain, pain caused by cancer, pain resulting from damage to the central or peripheral nervous system, or psychogenic pain – pain not associated with any past disease or injury. Chronic pain can affect the quality of your life both physically and mentally and can take a toll not only on you, but on loved ones around you. In many instances, however, with proper medical care it can be alleviated or eliminated altogether.

Treatment for chronic pain. Alleviating, controlling and eliminating chronic pain takes many forms and depends upon the cause or type of chronic pain involved. In all instances, it involves diagnosis and consultations with specialists so that a plan for managing the pain can be devised. Chronic pain treatment is often multi faceted and frequently involves pharmacological, physical and psychological treatments as well as counseling for the patient and family involved. The goal is to eliminate the pain, or, if this isn’t possible, to help the patient manage the pain so that he or she can live the most enjoyable and productive life possible.

Headaches. There are several different categories of headache. They include tension headaches caused by muscle contractions; sinus headaches that are often related to infections; cluster headaches, a severe throbbing headache often located behind an eye; acute headaches, a severe headache sometimes afflicting children; hormone headaches suffered by women during menstruation and menopause; and migraines, a severe and chronic condition still not properly understood. Treatment for headaches varies considerably, depending upon the type of headache. Treatment for tension headaches, for example, often involves relaxation exercises and changes in lifestyle. Headache pain is often treated with pain relievers like acetaminophen (paracetamol) and nonsterodial anti-inflammatory (NSAIDs) drugs like aspirin or ibuprofen. Changes in diet, including the inclusion of adequate amounts of Vitamin D, often helps provide relief. For some, simply getting adequate exercise helps relieve headache pain. Increasingly popular are complementary therapies like acupuncture and meditation.

Neck and lower back pain. Many people suffer from chronic neck and lower back pain, and a wide variety of treatment options has arisen over the years. Some, such as physical therapy, are non-invasive and don’t even involve the use of medications. Others are purely pharmacologic in nature and involve the use of analgesic drugs that work on the peripheral and central nervous system. Treatment often consists of a combination of physical therapy and the administration of drugs. Other treatments involve invasive techniques ranging from simple injections and the implantation of devices to deaden nerves, to complex surgery designed to eliminate the causes of the pain.

Pain from underlying physical disorders. Controlling pain from an underlying physical disorder often involves treating the physical disorder causing the pain. If the disorder at the root of the problem can be diagnosed and eliminated, the accompanying pain will usually cease to exist. Many instances of chronic pain, however, involve underlying causes like arthritis or cancer and cannot be cured. In these instances, controlling pain usually involves administering drugs. In the case of arthritis, the drugs are usually NSAIDs. Although not narcotic in nature, these drugs must be taken under a physician’s supervision as prolonged use can have harmful side effects. Cancer patients are often administered morphine and other drugs with narcotic properties to help eliminate the intense pain involved. These drugs are always administered under the supervision of the attending medical staff.

Treatment of chronic pain by physical intervention. Several chronic pain syndromes can be benefited, sometimes dramatically, by physical intervention or surgery. The Bangkok Neuroscience Center has the trained personnel and modern technology necessary to provide many of these state-of-the-art treatments. They include:

• Injection of alcohol, phenol and glycerol (Nerve blocks). Injecting substances like alcohol or phenol into nerves or the spine can deaden nerves and interrupt how pain signals are sent to the brain. This treatment is often used with cancer patients, especially those with pancreatic cancer. Facial pain, or trigerminal neuralgia, can often be reduced by glycerol injection to the cheek and into the area around the trigerminal nerve.
• Cryoablation and radiofrequency lesioning. Rather than using chemicals, extreme cold or extreme heat is sometimes used to treat chronic pain. In cryoablation, extreme cold is used to destroy the nerves causing pain. With radiofrequency lesioning, an intense beam generates heat that destroys the nerve cells causing the problem. Both of these treatments require counseling as they are ‘end of the line’ modalities that result in the destruction of nerves; a procedure that must not be undertaken lightly.
• Epidural catheters. Injecting medication, like analgesics and steroids, into the spinal canal area known as epidural space, can deaden nerves and relieve chronic pain. It is especially helpful for treating pain in the legs, pelvis, abdomen and some forms of back pain.
• Intrathecal Pump Therapy. When other methods have failed, some types of chronic pain can be reduced by using an intrathecal pump to deliver medication directly into the spinal fluid. The tiny pump is implanted under the skin in the side of the abdomen. The pump can be refilled with medication through a syringe every four to 12 weeks and is programmed to deliver specific amounts of medication throughout the day. Neurosurgeons can reprogram the amount of medication that flows through the catheter.
• Spinal chord stimulation. A pain management strategy, pain messages are blocked by sending an electrical impulse to selected nerves in the spinal cord. Small electrodes are implanted in the spine and a generator is placed just under the patient's skin. A programmable transmitter is worn by the patient and communicates with the receiver via radio waves. The generator is programmed to allow a certain number, type and pattern of electrical impulses to be fired by the electrodes within a specific time frame. Patients can turn off the system throughout the day by turning off the power source and a neurosurgeon can adjust the amount, type and pattern of impulses by adjusting the generator.

For more information, please contactt
Bangkok Neuroscience Center
Tel. (662) 310 3011, (662) 755 1011
Email : info@bangkokhospital.com