Neuropathy and Nerve Injury Pain:
Nerve injury and associated (“neuropathic”) pain is very common. Nerves are in contact with the outside world, and subject to trauma and/or injury by a wide variety of insults. Thermal burns, traumatic injury, surgery, broken bones, and exposure to drugs, chemicals, and therapeutic agents (i.e. radiation therapy for cancer) may all result in painful nerve injury. Many common diseases such as diabetes, HIV disease, vitamin deficiencies, and malnutrition may also result in injury to nerves and nerve pain as a prominent symptom. Nerve injury pain is most often described as “burning” in nature, and frequently associated with tingling, and numbness in the affected area. Appropriate therapy begins with the accurate identification of the nerve or nerves involved, which may require the use of ‘EMG’ or ‘electrod
iagnostic’, and/or other special tests, followed by establishment of the correct diagnosis of the disease process responsible for the nerve injury. Often, correction or treatment of the primary underlying disease, such as treatment of diabetes or correction of nutritional deficiency is all that is needed. At other times, the pain specialist may be consulted to help with the management of intractable pain from nerve injury. Medications may be used, from many broad classes of drugs also used for the treatment of other unrelated diseases. These include, anticonvulsants, antidepressants, and drugs also used for treatment or irregular heartbeats. When a physician uses a medication to treat any condition other than its “FDA approved” use, it is considered an “off label” use of the medication. Pain specialists use many medications in an “off label” manner to safely and effectively relieve pain symptoms in individual patients. Other proven techniques for the treatment of nerve injury pain include nerve blocks, either at the location of the damaged nerve itself, or at the “dorsal root ganglion” near the spinal cord. In the case of dorsal root ganglion block, Foothills Regional Pain Center is pleased to announce the recent availability of non-destructive pulsed radiofrequency technology to treat severe neuropathic pain without the risk of permanent nerve damage sometimes seen with older heat radiofrequency methods. In other cases of severe pain unrelieved by less invasive methods, the pain specialist may offer a trial of spinal cord or peripheral neurostimulation, or intraspinal drug therapy. If either of these advanced treatment methods is found to be effective, the patient may then undergo implantation procedures in which the neurostimulator or pain pump is surgically implanted within the body for the long-term effective management of the pain problem. After implantation, implant coordinators and physician specialists at the Foothills Regional Pain Center will adjust and “fine tune” these devices to ensure that patients receive optimum benefit from their use.
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