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
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
- Diagnosis
- First Tier Pain Therapies (cognitive and behavioral modulations, TENS, physical rehabilitation, exercise, and OTC pain meds)
- 2nd Tier Pain Therapies (thermal procedures, neurolysis, systemic opiods, nerve blocks)
- Advanced Pain Therapies (neuro ablation surgeries, spinal cord stimulators, implantable drug pumps)
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