New Ways to Treat Chronic Pain

According to an article in the Wall Street Journal, some 76.5 million Americans, or about 26% of all adults, suffer from chronic pain, generally defined as any pain that lasts more than six months. Medical experts say the condition can be as debilitating as many severe diseases, leaving the patient exhausted and unable to carry on with many everyday activities.   People over 65 are the least likely to report chronic pain, while those aged 45 to 64 are the most likely.  More women than men, and more whites than blacks, report suffering from chronic pain.Lower-back pain is the most common affliction, followed by severe headache and migraine, and neck pain.
Chronic pain is estimated to cost about $100 billion a year in treatment costs, lost income and reduced productivity.  Source: American Pain Foundation.

…  Leah Weinberg recently tried a radical new treatment: Her doctor implanted a small battery-operated generator in her lower back that sends a weak electrical current to the nerves near her spine. It tricks the brain, replacing her pain signals with what she describes as a tingling sensation.

“Unless you live with chronic pain, you can’t imagine how it feels,” Ms. Weinberg says. “I will always be living with some pain, but now at least I feel I can control it.” When she has pain, she says, she uses a remote device to control the current from the implanted generator.

“Without adequate treatment, this pain and suffering can be expected to continue throughout life, preventing the patient from working or performing many activities of daily living,” says neurosurgeon Christopher Winfree, the head of the pain medicine center at Columbia University Medical Center who implanted Ms. Weinberg’s device.

The new therapies, some of which have been borrowed from the field of anesthesiology, mostly share a goal of preventing pain signals from reaching the brain. Implantable devices, such as the one Ms. Weinberg received, are intended to stimulate nerves to mask pain. Nerve stimulation also can be achieved by attaching electrodes on the outside of the skin, for instance at the knee, to deliver a low-voltage electrical current. Another technique, known as facet joint denervation involves inactivating nerves in the joints that enable the spine to bend and twist, such as in the neck, by passing radio waves via needles inserted through the skin to heat the tissue at the tip of a joint. Other devices and procedures deliver drugs directly to the site of pain, such as nerve blocks, which use injections to numb nerves including in a shoulder or arm.

The expansion of the procedures in recent years prompted the American Society of Anesthesiologists in April to publish the first new set of guidelines for chronic pain management in more than 15 years to help lead doctors and patients through the variety of options. They are meant “to give some guidance in an area of medicine that is growing like crazy, with new treatments coming out faster than the research can be published,” says Richard Rosenquist, lead author of the guidelines and director of the pain medicine division at the University of Iowa.

Many of the so-called interventional pain management procedures are controversial because they can be expensive and there is not enough research in some cases to support their effectiveness. Also, many of the new techniques require invasive procedures or surgical implants that carry risks of infection, bleeding or nerve damage.

Costs range from $15,000 to $50,000 for such procedures, including equipment, surgery and anesthesia. But in the case of nerve stimulation, for example, “in two years you break even because you have fewer doctors’ visits, lower medication costs and lower use of medical resources in general,” Dr. Winfree says. Many interventional pain management procedures are covered under Medicare and many private insurance plans.

The new therapies have been shown to reduce the use in some patients of narcotic drugs known as opioids, the most commonly prescribed therapy for pain. The Centers for Disease Control and Prevention estimates that more than eight million patients in the U.S. use the drugs to manage pain, a number that has increased tenfold in the last 15 years. While the drugs can be effective in many patients, such as those suffering from pain due to cancer or severe injuries, opioids can lead to addiction among long-term users and have strong side effects in some people, including depression, constipation, nausea, drowsiness and breathing problems. Public health officials also are concerned about a growing problem of unintentional drug overdosing from painkillers. In 2006, the latest data available, the drugs caused more overdose deaths than heroin and cocaine combined.

For pain patients, drugs may also stop working when used over a long time, says James P. Rathmell, chief of the division of pain medicine at Massachusetts General Hospital. “The pendulum is swinging from aggressive use [of painkiller drugs] toward more measured use,” he says.

The new guidelines are based on both research studies and medical consensus about what has worked best to treat different kinds of pain, and make it clear that in some cases there is not enough evidence to show if a particular treatment is effective in dealing with specific types of pain. Dr. Rathmell of Massachusetts General, a co-author of the guidelines, says too many treatments are used for chronic pain with little evidence to support their use. For example, he says, while epidural injections of steroids can effectively speed resolution of acute leg pain after a herniated disc, there is no evidence that they are helpful for chronic low back pain.

According to Laxmaiah Manchikanti, chief executive of the American Society of Interventional Pain Management, close to 4.8 million interventional pain management procedures were performed in 2008, up from 1.4 million in 1998.

Among the most widely used techniques is spinal cord stimulation, which uses a small device surgically implanted in the lower back to deliver electrical signals to the brain that reduce the sensation of pain. First introduced 40 years ago, the technique is still being refined and tested against conventional approaches such as repeat surgery for patients who still have pain after back surgery.

A technique pain specialists have borrowed from anesthesiology involves injecting an anesthetic drug into a trigger point in one part of the body to reduce pain that radiates elsewhere.

One therapy that wasn’t discussed in the Wall Street Journal article is the Neurologic Relief Centers Technique (TM) also referred to as the NRC Technique(TM).  It is a natural, noninvasive, painless therapy that relieves stimulation of the sympathetic nervous system that sends pain signals to the brain.  With a simple 8-10 minute therapy session, patients report immediate relief of pain and other symptoms that can last for minutes to days without any negative side effects.  There are about 200 NRC trained doctors in the US who can provide an alternative to narcotic drugs and invasive procedures. 

Not all chronic pain patients are good candidates for the NRC Technique (TM), and an ethical NRC doctor will offer a complimentary test to determine whether the patient is a good candidate for the NRC Technique (TM).  What is important to understand is that there are many, many pain management options and when ever possible, narcotic drugs and surgeries should be last resort options. 

Pain experts caution that there is no magic bullet or cure for most chronic pain, but several therapies used in combination may provide long-term relief.

B. Todd Sitzman, director of the Advanced Pain Therapy clinic in Hattiesburg, Miss., and past president of the American Academy of Pain Medicine, advises seeking treatment at a comprehensive pain center “where there are multiple therapeutic options to manage your condition and where they are willing to follow you over the long term.”

Dr. Remmel, D.C. is an awarding winning NRC doctor who is also a Regional Director for the Neurologic Relief Centers.  Dr. Remmel offers a complimentary consultation, exam and testing for chronic pain patients.  To schedule your appointment, please call 727-525-1141. 

Posted by Laurie Puckett, Remmel Wellness Center – a full service chiropractic and wellness facility in St. Petersburg, Florida.