Chronic pain can affect any part of the body. It occurs in a group of patients who present painful symptoms over a long period of time. It can appear in patients without an identified cause or in patients with persisting pain after treating the underlying cause. A typical example of the latter situation are those patients who have persistent low back pain after surgery on the lumbar spine (failed back surgery syndrome).
The most common types of chronic pain are: chronic low back pain, chronic neck pain, neuropathic pain in the lower limbs and facial or cranial pain.
The objective of the treatments applied for chronic pain is to modify the neuronal activity of the neural pathways that are responsible for carrying the painful sensation from the skin to the cerebral cortex.
Neurostimulation is one of the most advanced techniques in the treatment of refractory chronic pain. It is based on small electrical discharges released to the nervous system with implanted electrodes in order to modulate the activity of the neural circuits related with pain.
These electrodes have several active points called contacts. The electrodes are connected to a battery / generator that is implanted under the skin.
During the implantation process, a temporary implant allows the patient and the physician to assess whether neuromodulation is the right therapy for pain control. In general, the electrodes will be implanted and the therapy tested for approximately 15 days. In the case of an appropriate pain relief (about 50% usually), the final implantation will be performed. The already implanted electrodes will be connected to a internal pulse generator: a small battery that is implanted under the skin.
Spinal Cord Stimulation
Spinal Cord Stimulation (SCS) is designed to treat refractory chronic trunk and limb pain. The electrodes are implanted in the middle of the back for low back and leg pain or in the neck for arm pain. Its use is more common in post laminectomy syndrome, also known as failed back surgery syndrome, low back pain, radiculopathy and migraine or headache.
Dorsal Root Ganglion Stimulation (GRD o DRG)
Dorsal Root Ganglion (DRG) stimulation is a novel technique, ideal for focal refractory chronic pain i.e. in a very limited area such as the foot, the knee or the hand.
One of the most troublesome symptoms of chronic pain is allodynia, a feeling of pain stimulated by touching or rubbing. DRG stimulation is one of the best therapies to reduce chronic pain and allodynia.
The use of DRG stimulation is more common in complex regional pain syndrome -CRPS- (formerly called Sudeck’s atrophy, reflex sympathetic dystrophy or causalgia), post-herpetic neuralgia, chronic postsurgical or posttraumatic pain.
Neurocirugia Avanzada BCN has neurosurgeons and an anesthesiologist specialized in this field to guarantee an optimal treatment for these patients.
Treatments:
Lumbar and cervical facet joint infiltration
Epidural and foraminal infiltration
Radiofrequency rhizolysis
Spinal cord stimulation therapy for chronic pain
Ozone therapy
Cortical stimulation therapy for chronic pain
Deep brain stimulation (DBS) for Parkinson’s disease, movement disorders, obsessive-compulsive disorder and chronic pain
Intrathecal baclofen test
Intrathecal baclofen therapy for the treatment of spasticity