other treatments

Final Options for Treating Chronic Pain

Christina Lasich, MD Health Pro December 31, 2012
  • What’s next? If this question is on your mind, you have likely seen many doctors, tried many different drugs, maybe had a surgery or two, or are just at your wits end. Before you let despair and helplessness answer your question about what life will offer next, look at some of these final options for treating chronic pain. When you are reading through the options, ask some other questions pertaining to reversibility, probability, and accessibility. The answers will help you to decide which option is right for you.

     

    Is the option reversible? If things don’t turn out very well, can you go back to the original starting point? What is the probability that the option will be successful for you? What is the probability that the option will make matters worse? And finally, do you have access financially or otherwise to the option in the initial stages and for follow-up care?

     

    Long-term Opioid Use:

     

    You are likely already using opioids for the management of chronic pain. Long-term use does have its advantages in regards to effectiveness for a vast number of people with various types of pain. Cost can sometimes be an issue for the newer types of medications. And finding a doctor willing to prescribe opioid medications is becoming increasingly difficult. But if the potential consequences of long-term opioid use outweigh the risks in your situation, then this might be a good option to stick with or consider. Another good point about this option is that taking medications is reversible when side effects or harmful effects are encountered.

     

    Spinal Cord Stimulator:

     

    Another reversible option is the spinal cord stimulator which utilizes leads that are placed near the spinal cord to deliver an energy field in order to block pain signals. The probability of success is very high for some types of nerve pain like lumbar or cervical radicular pain, complex regional pain syndrome, or peripheral mononeuropathies. However, success is less likely in post-stroke pain, phantom pain, postherpetic neuralgia, and low back pain. When it does work, the results are really miraculous. One community member writes about her experience saying, “For all of you that are deciding on a spinal cord stimulator implant, go for it. To tell the truth it really is the most positive thing I could have done with my pain even though it has not took away it all, I am thankful for what it has helped.”

     

    Once the initial trial and implant is in place, you might need a couple of adjustments, but then the spinal cord stimulator is relatively easy to maintain and troubleshoot without multiple trips to the doctor.

     

    Intrathecal Opioid Pumps:

     

    Although reversible, this implant is not as easy to maintain and troubleshoot as the spinal cord stimulator. The implanted pump delivers medication directly to the spinal cord. Refilling the pump with medications requires specialty care on a regular basis and really keeps users of the pump tethered to a major city to find such specialty care. The probability of success depends on your expectations because, as one community member wrote, “This is not a magic wand and you need a good support system around you to get through the surgeries and days you are down.”. Other people describe complete nightmare-like experiences with their newly implanted or aging pump due to complications like catheter tip blockage or pump break-downs. Because of the inherent risks of complications, some doctors only recommend the opioid pump to those who are in a terminal situation and are looking for some better, final days.

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    Surgery:

     

    This option has a probability of not only making matters worse, but also has an added downside because surgery is not reversible. Accessibility doesn’t seem to be an issue because you’ll always be able to find a surgeon willing to operate if you look under enough rocks. The probability of surgery successfully treating your pain seems to diminish with the more surgeries and problems you have. You probably already know someone who has had a similar situation to this community member who wrote: “I HAD A SECOND SURGERY IN 2007 TO REPAIR PART OF THE FUSION THAT DIDN'T HEAL AND TO REMOVE SOME SCAR TISSUE.  THIS DID NOT WORK.  IT MADE THINGS WORSE.” Because of the probability of experiencing a failed surgery, you should only opt for this option if you are willing to risk things getting worse and have reasonable expectations.

     

    Overall Health:

     

    Health really should be your first treatment options. However, your health might have been overlooked until after the medications, injections and surgeries have failed. Eliminate smoking, depression, anxiety and sugar from your life; add exercise, meditation and whole, unprocessed foods to your life really can help to relieve pain. Plus, good health also improves the probability that the above options will work for you. Your health is reversible. Your health is readily under your control. And whether this is your first or final option, health always matters for the treatment of chronic pain.

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