“They can send a man to the moon, but they can’t……”
The boomer equivalent aphorism for today’s younger generations refrains of “there’s got to be a hack for this!”
Unfortunately, most chronic pain problems are not “curable.” For that matter, most medical ailments humans suffer from are rarely “curable.” The good news is that most of them are treatable. Rarely is there an endpoint or “touchdown.” However, when treating chronic pain itself, my approach is to identify what the patient feels is a reasonable pain level that would allow them to achieve meaningful ability to perform activities of daily living. “ADLs .” This can be as simple, but vital as living independently without the need for assistance for the necessities of life, or it can be as lofty as trying to maintain your ability to beat your next 10k running race record.
While the majority of patients that are referred to me have (unfortunately) “been there, and done that” as far as reasonable, conservative therapies (Physiotherapy, stretching, exercise, anti-inflammatories, pain, tablets, surgery and other modalities, etc.) go, they still continue to have pain that is unacceptably elevated on a chronic basis, which unfortunately reduces quality of life to a degree that is hard to witness, let along try to live with.
Many are familiar with the majority of treatments that are performed when traditional more conservative, therapies fail. Techniques such as targeted nerve block therapy for chronically, irritated nerves of all sorts, targeted rhizotomy treatments, which in effect takes specific pain nerves “off-line” for many months or longer at a time, specific targeting of both spinal and non-spinal structures to reduce chronic inflammation or degenerative age related structural abnormalities without the use of anatomy, altering surgeries, etc. “Denervation” procedures are similar to turning the pain switch to the “off” position for several months or more at a time by selectively stunning those specific nerves that carry pain information. But there are other pain carrying nerves that carry more than just pain signals, and those we can’t just “turn off”, without turning off other vital functions. For these situations, thank goodness for advances in technology!
Today’s article is about the melding of our computer age to the treatment of chronic pain. When both conservative and perhaps even other advanced targeted non-surgical techniques fail, or not indicated, what then?
It’s important to understand that all pain, no matter what the source, is transmitted through our neurologic system, up our spinal cord into the deep portions of our brain, where it is recognized as pain. The advanced techniques that my specialty offers typically address the cause of the actual pain problem. However, sometimes that doesn’t work well enough. Pain can be treated at the neurologic, or brain level with both psychological approaches, which can be helpful but not for many people. Pharmacological approaches can also help, but that too has its negatives such as sedation, concentration, problems, cognitive, side effects, constipation, and addictions/dependency.
However, when conservative as well as advanced treatments mentioned above are not indicated and/or fail, and if the actual source of the pain isn’t amenable to treatment, this is where 21st century technological medical advances are revolutionizing the treatment of chronic pain. These types of techniques are known as “neuromodulation” treatments for chronic pain. The term “neuromodulation” literally means to change nerve functioning.
As I stated, nerve functioning, is how all pain transmission occurs, no matter the source. Some types of nerves should not alter their functioning. For instance, motor nerves are needed to move our bodies to be able to function. With the use of neuromodulation technology, we are able to quite literally change the transmission of pain signals to non-pain signals.
I often use analogies with patients to try to communicate their diagnosis as well as my proposed treatment plan. If neuromodulation treatments are indicated, I sometimes have been known to use a biblical analogy of “changing water to wine”. In a sense, the transmission of pain information from an anatomic area of our bodies is transmitted up the nerves, to the spinal cord, and to the thalamus of the brain, which is the receiving area of our brain. Neuromodulation changes these pain signals to where that sensation no longer is transmitted as a pain sensation but is transmitted as a non-pain sensation! Pain relief! Changing pain signals to non-pain signals. Not numbing them, not stunning them, not distracting the nerves, but literally changing the signal itself. These digital devices which are minimally invasive, non-surgical, micro computers that can fit on the end of a pinhead, are placed on top of those specific spinal pathways that only transmit chronic pain, and instead of blocking signals, or numbing pain signals… which would block all signals, including the ones we need to function. These micro medical wonders selective only change chronic pain signals, and don’t have any effect on other normal signals nor any effect on acute pain. So if you stub you toe, it will hurt the same. Instead, the chronic pain signals are “modulated” – changed from a pain signal to a normal non-pain signal.
The beauty of these digital medical marvels is that they can be tested without exposing the patient to any surgeries, or even a scalpel! In fact, these techniques can be utilized for any type of pain throughout the body since all chronic pain, no matter what the source, still must travel through the spinal cord and to the brain. If indicated, these digital transformers of pain are first tested to confirm that the patient will respond well enough to consider this technology or not. The best part is that no incision, no cutting of flesh, not even a suture is necessary for this 3-7 day test to determine if these super micro computers are effective for the patient tested. If during that 3–7 day test the patient experiences a significant positive response that improves both pain as well as function to a good or an excellent degree, then this tiny little temporary microcomputer tethered to a hair, thin “fishing line” which was placed literally just threw a very small needle under local anesthesia and if necessary, mild sedation is then removed after the patient confirms that they’ve had wonderful improvement in their pain and function over those preceding 3–7 days. Then at a time of the patients/physicians choosing, the patient can schedule “implantation” where a brand new set of these tiny digital pain modulators are placed inside the body. Yes, all on its own with no input necessary from the patient, this minuscule medical device automatically (24×7) changes pain signals to non-pain signals. With the very distinct advantage, that nothing is tethered to the patient, and in fact, I often encourage patients after a period of a few weeks after this minor outpatient procedure is performed to re-engaging most, if not all their normal activities, if possible. They are completely invisible to anyone else, as well as the patient. Nothing is seen, even if you happen to be only wearing your “birthday suit”.
While these techniques are not first line techniques to treat chronic pain, they are (increasingly) being successfully utilized for all sorts of patients whether they suffer from chronic spinal pain, nerve pain, pelvic pain, headache, pain, facial pain, neck, and/or arm pain, etc. Since all pain must be transmitted from its source through the specific pathways in the spinal cord to be received in the brain, again this “modulation” or changing of pain signals to non-pain signals can be performed.
So, yeah, “there’s a hack for that!”
Dr. Keith Javery