Introduction

Anatomy and Physiology of Pain Principles of Pain Spinal Cord Stimulation Intrathecal Drug Delivery Selective Spinal Cord Lesioning Neuroanesthesia

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Pain is a major public health problem. It is the most common symptom for which patients seek medical care and the primary complaint of approximately half of all patients who visit a doctor. Several surveys conducted in European countries have found that nearly 50% of adults suffer from one or more types of pain or discomfort at any given point in time.
Chronic pain is defined as pain that lasts for more than six months and does not respond to medical therapy. It may result from either a previous injury long since healed or it may have an on-going cause, such as nerve damage, cancer, chronic infection or failed back surgery syndrome (FBSS).
Chronic pain can have a drastic effect on a patientís quality of life. Severe chronic pain may weaken a patientís physical and psychological health far beyond that which might be expected for the patientís underlying disease.

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Physical problems
Patients who suffer from chronic pain are more likely to be in poor general health. This is the result of negative health consequences associated with
unrelieved pain, including:
● Increased stress, metabolic rate, blood clotting and water retention
● Delayed healing
● Hormonal imbalances
● Impaired immune system and gastrointestinal functioning
● Increased heart rate and blood pressure
● Increased blood sugar
● Decreased digestive activity
● Reduced blood flow
● Loss of function and atrophy

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Psychological problems
Chronic pain is often associated with a long history of psychological and social problems. Patients with chronic pain may lose their jobs and income. In addition, pain can lead to emotional distress and a deterioration in family and social life, while preoccupation with pain can lead to a downward
spiral of irritability and depression.

Advances of pain management


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For patients with chronic pain, pain management typically involves a combination of physical therapy, oral medication and other conservative therapies. Some patients will need surgical intervention to address the mechanical condition causing the pain, whereas others may require advanced interventions. Neurostimulation and intrathecal drug delivery (IDD) often offer alternatives to destructive procedures or sometimes more costly spinal surgeries in appropriately selected patients. Although pharmacotherapy pain treatment may reduce pain, it may also be associated with adverse effects that will impact on a patientís quality of life. Common adverse effects of pain management strategies include reduced alertness or mobility, dizziness or mental confusion, nausea, vomiting, constipation or urinary retention, and motor and sensory loss or weakness.

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Treatment of chronic pain typically involves a multidisciplinary approach. Management of chronic pain patients with neuromodulation or IDD requires the interaction of many specialists on a multidisciplinary team. The team draws on the expertise of these specialists with the goal of achieving an effective level of pain relief for the patient. The key members of the team are referring physicians, who typically are involved in all aspects of chronic pain treatment; implanting physicians (normally anesthesiologists, neurosurgeons, spine surgeons and general surgeons) and nurses with skills and training to implant products for neurostimulation and intrathecal drug delivery; and other personnel who work closely with patients, in particular, the patient management co-ordinator.


 

Whatís New
August/14/2007
Inomed ISIS Intraoperative neurophysiological monitoring started to function in all our related surgeries.
Oct /07/2009
The author celebrating 30 years experience in neurosurgery.
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