Treatment options for chronic pain

A wide range of treatment options and therapies are available to manage and treat chronic pain. A multidisciplinary approach that supports the individual needs of each patient will achieve the best possible outcome in relieving and managing chronic pain.

Medication

Non-opioids

These include commonly used over-the-counter pain killers such as paracetamol and anti-inflammatory drugs. A wide range of brands and types are available.

Opioids

Opioids are medications belonging to the morphine family of drugs. They vary in strength and can offer powerful pain relief. Due to potential side-effects and the risk of addiction opioids must only be used under a doctor’s guidance.

Adjunctive therapy

Some anti-epileptic/anti-seizure drugs and some anti-depressant drugs can be useful in the treatment of chronic pain. These drugs work to control pain by reducing abnormal activation of the nerve cells.

Minimally Invasive Interventions

Epidural steroid injection

Epidural steroid injections are used to treat chronic pain associated with inflammation of nerves. It allows a targeted delivery of steroids, which works as placement of anti-inflammatory agents directly into the spinal canal, near the inflamed nerves. Epidural steroid injections work by effectively by blocking pain signals in the inflamed nerve. The duration of nerve block is variable and depends upon patient individual condition.

Rhizolysis

It is performed to block pain signals at the spine level which includes  

1) Median branch blocks (MBB) and

2) Selective Nerve root blocks (SNRB).

Rhizolysis is a useful diagnostic intervention to map the pain triggers as well as a therapeutic option to reduce inflammation in the targeted area.

Heat lesioning rhizotomy

Heat lesioning rhizotomy is a minimally invasive procedure used to treat pain caused by arthritis, injury or damage to the facet joints. It is suitable for treating pain originating from the spine and may also benefit pain referring to various parts of the body. Heat lesioning ablation works by the application of heat using electrical energy to the small medial branches of dorsal spinal nerve roots which also supply the facet joints. This effectively interrupts the pain pathway triggered by facet joints. Typically, heat lesioning rhizotomy eliminates or significantly reduces chronic pain for six to twelve months.  The procedure is performed in an operation theatre, under X-ray guidance and requires the insertion of radiofrequency needles with electrodes connected to the source of electrical energy.

Pulsed radiofrequency treatment (PRF)

Pulsed radiofrequency treatment controls pain by applying an electric field (radiofrequency) to the nerves responsible for sending pain signals. This has the effect to alter the nerve functions, suppressing the abnormal activity of pain in the nerves. It is applied in short bursts to preserve the nerve. It can also be applied to the Dorsal Root Ganglion (DRG) which is a cluster of nerve cells at the root of the spine and has an important role in the function of the nerves. This procedure can also be used on the peripheral nerves. The procedure is performed in an operation theatre, under X-ray guidance and requires the insertion of radiofrequency needles with electrodes connected to the source of electrical energy. Pulses of electrical currents are then sent through the needles to create the necessary changes.

Vertebroplasty

It is a minimally invasive treatment used to treat pain caused by uncomplicated spinal fractures. This procedure provides an instant fix by injecting special bone cement into the broken vertebrae through a small hole in the skin. The most usual indication for this procedure is fragile bones secondary to osteoporosis.

Implantable Neurostimulators

Neuromodulation: Spinal Cord Stimulation (SCS) and Dorsal Root Ganglion (DRG) Stimulation

Neuromodulation is the alteration of nerve activity using targeted stimulus. It is usually only considered as a treatment option after a trial stimulation period to assess how effective the system would be for an individual patient. Both SCS and DRG stimulation is used for patients with chronic pain who are resistant to conventional treatment. The best results are seen in patients who have nerve damage pain or chronic diseases of the nervous system. Neuromodulation works by applying a mild electrical current to the nerves in different patterns to change the way that the nervous system is functioning. The stimulation triggers an internal system of pain suppression, naturally blocking and diminishing the intensity of the pain message being transmitted to the brain.

Physiotherapy and rehabilitation

Physiotherapy

Physiotherapy plays an important role as an essential ingredient of multidisciplinary pain management. It is a significant part in the rehabilitation of patients with chronic pain to improve quality of life. Cardiovascular fitness, muscle endurance, control, balance, and flexibility are assessed for each patient and an individualized plan is devised to help move forward in a safe and effective way.

Psychology-led techniques

Psychology

Living with chronic pain can be very distressing and can reduce a patient’s quality of life. A multidisciplinary approach to pain management must, therefore, include psychologically-based treatments that teach skills to cope with the disabling effects of chronic pain. Pacing, mindfulness techniques, relaxation therapy, and other strategies can offer a sense of self-management and improve the quality of life.

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