What is pain? It is the nerves, or cells, in the body that send messages to your brain to warn something is wrong. The brain processes these warnings and makes you feel pain. Usually, pain medication can mask the pain until the injury heals but there are incidences when drugs are not enough. When this occurs, other methods are used to interrupt these warnings the brain is sending out. This is the time to reassess your options. The severity of the pain and its causes will determine the type of options necessary for the proper treatment. Common treatments for pain not responding to drugs are injections, nerve blocks, electrical stimulation, IDET, laser decompression, and radiofrequency discal nucleoplasty.
Injections and nerve blocks are local anesthetics which are substances such as alcohol or phenol that induce insensitivity to pain and are injected into the region of pain. Spinal injections are this form of treatment. A local anesthetic is injected into the base of the spine to reduce the inflammation causing the pain. There are various kinds of such nerve blocks that are available to minimize or eliminate pain in the face, neck, shoulder, arm, hand, elbow, wrist, abdomen and pelvis. Nerve blocks work for six to twelve months. They can be repeated if needed. But they are not risk free. Complications can develop such as soreness at the site of injection, elevated blood sugars, bleeding, and in rare cases, death.
Another common management for pain when drugs no longer work is electrical stimulation known as TENS therapy. Developed in the late 1960s, TENS, short for transcutaneous electrical nerve stimulation, uses electricity to eliminate pain. Small devices called electrodes that conduct electricity are taped on to the part of the body that is experiencing pain. These electrodes are then attached to a machine that releases minuscule electrical impulses to the body through the electrodes. The electrical waves interrupt the pain messages the brain had been sending. Since the electrical currents are very low the body only feels slight warmth at the connection. Each session takes about fifteen minutes and may be repeated.
IDET also uses electrical currents to minimize pain. It was developed in the late 1990s to relieve back pain. An electrical current passes through a wire heating it slightly. A fluoroscopic, or x-ray, guide an electrothermal catheter through a needle into the spine where the heated wire is inserted into an incision made into a disc. The catheter heats the disc for fifteen to twenty minutes. Pain relief can last six months or longer.
Laser decompression uses a catheter to insert an optical fiber that transmits laser energy to the area of pain. Success is reported from seventy to one hundred percent. However, there may greater risks than with IDET since the laser decompression is a newer procedure with unknown risk factors as yet.
Radiofrequency discal nucleoplasty is a newer procedure than IDET. It uses a radio frequency probe instead of heating a wire with electrical currents like the IDET does. A radiofrequency probe is inserted into the disc. The probe creates energy that reduces the pressure surrounding the disc that is causing the pain.