The process of treating chronic pain is difficult because pain can change over time and patients may no longer respond to their current treatments either because of tolerance or increased pain. There are other treatment options that may help chronic pain instead of or combined with oral medications.
Joint and Bursae Injections
Injections in joints or bursae are not the initial approach to managing chronic pain since long-term use of steroids can weaken the bones. When other, less invasive, methods do not provide adequate relief, injections can give some people months of benefits. Injections are most appropriate when pain affects a single joint or the nearby bursae. During the injection, steroids are administered to reduce inflammation at the site of pain. The benefits of injected steroids are often far superior to oral steroids and have fewer side effects. Depending on the severity of the underlying problem, your doctor may eventually recommend surgical procedures to address the issue, such as joint repair or replacement or removal of the bursae.
You can think of neuromodulation as a more sophisticated and targeted version of a transcutaneous electrical nerve stimulation (TENS) unit. With neuromodulation, electrical impulses are sent to a nerve or the spinal cord with the goal of disrupting the signals that induce pain. Both TENS units and neuromodulation are based on the gate control theory, which states that whatever signal reaches the brain first is the one you feel. The goal is to send a signal that is not painful in an attempt to close the "gate" before painful signals reach the brain. If neuromodulation is helpful in drastically reducing or eliminating pain, some people may have a permanent device implanted for ongoing pain management.
An intrathecal pump is a device surgically implanted in the body. It contains a catheter that is placed at a specific area in the spinal column and a pump that is located in the abdomen. The catheter dispenses pain medication in preprogrammed amounts and intervals throughout the day. One of the benefits of an intrathecal pump is it is not controlled by the patient, so it cannot be abused. Since the medication goes directly to the site of pain or the nerves responsible for causing pain, intrathecal pumps are more effective at a lower dose than oral pain medications. Before a pump can be inserted, doctors will do preliminary testing to determine the right medications and their effectiveness. This trial helps them determine if a long-term pump would be appropriate, which medications they should use, and what the correct dosage is.
Controlling chronic pain often requires using a combination of approaches. In many instances, treatments that specifically target the site of pain can have profound benefits. For more information, reach out to a chronic pain treatment service.