What is pain?
Pain is the 2nd most common reason for medical consults in the United States, only behind the common cold. It is a common symptom of many medical conditions, and the control and management of the pain can be as important as the treatment of the underlying cause in the restoration of the quality of life and activities of daily living.
Pain is defined as an unpleasant feeling that is correlated with injury or damage to the body. The International Association for the Society of Pain states that: “Pain is an unpleasant sensory a
nd emotional experience associated with actual or potential tissue damage, or described in terms of such damage”. The is based on the Old French word “peine” and the Latin word “poena”, which means “punishment or penalty”.
Despite the unpleasantness, pain is an important survival mechanism. It provides self-protection by causing withdrawal and/or avoidance of harmful situations. Pain will typically resolve soon after the negative stimulus is ceased, or once the injury/damage is healed, however, persistent pain despite resolution of the underlying condition is not uncommon. In some cases, pain occurs even without damage or disease that is detectable.
Various treatment modalities exist for pain, ranging from conservative, medical treatments to surgical options.
How is pain diagnosed?
Appropriate treatment of pain will depend on an accurate diagnosis of the underlying condition. The pain management doctor in Boulder will conduct a complete medical history and physical examination to elicit information relevant to the diagnosis, such as location of the pain, triggers and aggravating circumstances, the quality or description of the pain, among others. Ancillary examinations such as imaging studies (X-rays, CT scans, MRIs, laboratory exams) may be requested as necessary.
How is pain assessed?
Rating scales are used to assess the severity of pain. A number scale from 0 to 10 is usually used (0 is used for complete absence of pain, while 10 is for the most severe, intolerable pain/worst pain imaginable by the patient, such as in labor), however a faces scale with corresponding numerical values can also be used for children and patients unable to use the number scale.
How is pain managed?
While the definitive resolution of pain requires treatment of the underlying cause, symptomatic treatment and pain management remains essential in any planned intervention. Pain management typically follows the “pain ladder” of the World Health Organization: medications are delivered in a progressive and stepwise manner. The medications used can range from over-the-counter drugs (acetaminophen/paracetamol, mefenamic acid, celecoxib, etc.) to the more powerful opioid analgesics (morphine, fentanyl, diamorphine, etc.).
If conservative and non-surgical treatments are unsuccessful, then more invasive options can be considered. Techniques such as neurolytic blocks, radioablative therapy, and spinal cord stimulation have been used with good rates of success. However, the appropriate method of treatment should be discussed with the attending physician.
What is a pain pump?
Intrathecal drug delivery, more commonly known by the colloquial name “pain pump”, is a method of pain management that involves direct injection of medications into the spinal cord. The sub-arachnoid or intrathecal space refers to the space around the spinal cord that contains the cerebrospinal fluid (CSF) – bypassing the oral route with direct injection into this area gives a more powerful effect. The side effects associated with the medication are also reduced.
The pain pump consists of a round metal device (the “pump”) that is surgically implanted underneath the abdominal skin. The pump serves as a reservoir for the medications, which is released in controlled doses. The pump is connected to the spinal cord via small tubes called catheters.
What are the risks/outcomes of having a pain pump?
Majority of patients who undergo implantation of a pain pump report significant improvement and pain relief. Pain pumps have been shown to lessen chronic pain from:
- Complex Regional Pain Syndrome/Reflex Sympathetic Dystrophy
- Failed back surgery syndrome
- Chronic pancreatitis
- Post-operative pain
Pain pumps have also been shown to reduce the spasticity caused by conditions such as cerebral palsy, stroke, brain and spinal cord injury, and multiple sclerosis.
There are risks associated with the procedure. As with any surgical procedure, the patient is at risk for infection of the surgical site, intraoperative damage to nerves, muscles and other tissues, as well as pain and bleeding in the surgical site. The pain pump is also at risk of getting dislodged.