Level Three Pain Therapies

Relieving stubborn pain takes time and patience, and some trial and error. Certain chronic pain conditions can be very resistant to first- or second-step pain therapies. If this is the case, your physician may consider more advanced treatments to relieve your pain.

• Surgery. Surgery may be performed to repair or correct an anatomical defect or a defect due to an illness or injury. Surgery may also be performed on a nerve to interrupt the transmission of pain signals. Surgery carries a greater risk than noninvasive procedures.
  
  
• Spinal Cord Stimulation. Spinal cord stimulation (SCS) is used to treat certain types of chronic neuropathic pain in the body (trunk) and/or arms and legs (limbs). Spinal cord stimulation uses low-level electrical impulses to interfere with or to block pain signals from reaching the brain. This therapy replaces painful sensations in the affected areas with a more pleasant sensation. Spinal cord stimulation is part of a broader category of therapies called neurostimulation. 
  
  
• Implantable Drug Pumps. For certain types of pain, including persistent nociceptive pain and cancer pain, an implantable drug pump (also known as a pain pump or an intrathecal drug pump) can be an appropriate therapy. Pain pumps deliver pain medications directly to the fluid (cerebrospinal fluid) in the space (intrathecal space) surrounding the spinal cord. This direct approach allows powerful pain medications, such as opioids, to be used in much smaller doses than are needed with pills or skin patches, reducing the likelihood of unpleasant side effects.
  
  
• Neuroablation. Neuroablation is a surgical technique that permanently blocks nerve pathways to the brain by destroying the nerves and tissue causing the chronic pain. Several procedures are used. Cordotomy is the surgical cutting (division) of a tract of the spinal cord. Rhizotomy involves selective destruction of a nerve close to the spinal cord. Thalamotomy and pallidotomy use radio frequency to heat and destroy specific cells deep in the brain. In addition to the risk of causing unplanned motor or sensory dysfunction in an area other than the affected area, neuroablative procedures are sometimes only temporarily successful because pain can redevelop in a nearby or different nerve pathway.

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