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Saturday, March 23, 2013

Spinal Cord Stimulation: Summary of Recent Lecture by Dr Tory McJunkin

Treating Neuropathic Pain, pain that feeds itself, pain that needs little to no stimulus to turn on, and can be difficult to turn off, can be very difficult to treat. I found in talking to my patients that I really had little knowledge of a wonderful new edition to this arena of pain management called spinal cord stimulators. I hope those who are suffering from severe pain, with no end in sight, will get themselves to a pain specialist skilled in this treatment to see if they are a candidate. I have listed under this lecture other links to my blog posts around complex regional pain syndrome, one of the types of neuropathic pain I see in practice. If you want to know if you have neuropathic pain, just answer this simple question: I am suffering with this pain? Neuropathic pain patients truly suffer. I have had severe back pain that I could manage and endure, but did not suffer. I have had back pain so bad that I have suffered, could not go to work, and was able to get relief with a sympathetic block (lucky me!!). This is one view, not complete by any means since it is through the eyes of one profession. But, it is an important understanding for patients suffering with neuropathic pain. I sure hope this helps. Dr Rich Blake

Algorithm for Treating Neuropathic Pain
                           by Dr Tory McJunkin

     Step 1: ID pain as neuropathic or mixed
                 Treat mixed if can

     Step 2: Initiate Tx Regimen for Neuropathic Pain
                     8 week Trial of one medication
                     If not completely responsive, add 4 week trial of 2nd medication

     Step 3: Week 12 Refer to Interventional Pain Specialist
                     Nerve Blocks (Sympathetic)
                     If not completely responsive, 3-5 day trial of Spinal Cord Stimulator
                                                        (Pacemakers for Pain)
                     If 50% pain relief or greater, Spinal Cord Stimulator 
                                  Level T12-L1 if foot pain

     Step 4: Referral back to Podiatrist for long term maintenance and mechanical/local treatments

     Step 5: When pain level and function still not optimal, consider the following:

                 Chronic Opiods (little effect overall)
                 Neurolytic or destructive procedures (chemical or surgical sympathetomies)
                 Intrathecal Pump Therapy (Ketamine)---very serious side-effects 
Other key points of lecture
  • Patient Care enhanced by Team Approach
  • Sympathetic Blocks (L2 to L4, sometimes L5, for foot problems) Overall 5-10% helpful
  • Peripheral Blocks (0-1% helpful)
  • Spinal Cord Stimulation 80% successful if done in first 2 years, earlier the better
  • 4 Tiers of Treatment
  1. Diagnosis
  2. First Tier Pain Therapies (cognitive and behavioral modulations, TENS, physical rehabilitation, exercise, and OTC pain meds)
  3. 2nd Tier Pain Therapies (thermal procedures, neurolysis, systemic opiods, nerve blocks)
  4. Advanced Pain Therapies (neuro ablation surgeries, spinal cord stimulators, implantable drug pumps)

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.