Research At Pain Management Institute
Spinal Cord Stimulation
Recent advances in spinal cord stimulation (SCS) technology have allowed for neuromodulation to be thought of as a viable alternative to opioids.1,2
Stimulation of dorsal root ganglion (DRG) implicated in the development of chronic pain, has been shown to be particularly effective in treating focal pain.2,6
Although traditional SCS devices may cause uncomfortable paresthesias in some patients, high-frequency SCS (HF10, 10 kHz) achieved pain relief without paresthesias.2 HF10 has demonstrated efficacy in clinical trials and is approved for chronic intractable pain of the trunk or limbs.2,7,8
Closed-loop SCS offers another promising technology currently evaluated in clinical trials.1,9 The device detects real-time changes in nociceptive signals from the target nerve and adjusts its stimulation to maintain a therapeutic dose.
“Psychotherapy has been shown to play a major role in treating chronic pain,” said Joel Katz, PhD of York University in Canada, in an interview with Clinical Pain Advisor.
Several forms of psychotherapy have been shown to be effective: Cognitive Behavior Therapy (CBT), Mindfulness-based Stress Reduction (MBSR), and Acceptance and Commitment Therapy (ACT). “Even though the main objective of these forms of psychotherapy is not to reduce the intensity of pain but to improve quality-of-life, coping, and in general to contribute to a more meaningful life, pain intensity may also improve,” he added.
Treating acute pain before it develops into chronic pain may be the key to preventing chronic pain from arising in the first place.10 “Self-rated health, anxiety, expectations of recovery, depression, and resilience appear to be important predictors for chronic pain. Some of these may be changeable with targeted education and psychological input,” Marc Russo, MD of Hunter Pain Clinic in Australia, told Clinical Pain Advisor.
Patients who have depression, pre-existing pain, or severe acute pain are at risk for chronic pain due to nervous system sensitization.1,11,12
Psychotherapy may also play an important role in chronic pain prevention. Toronto General Hospital in Canada was the first medical center to use targeted psychotherapy in postsurgical patients at risk for chronic pain.1 Although published data are not available at this time, Dr Katz and researchers at the hospital report promising results.