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Other Methods: Minimally Invasive Techniques in Pain Clinic

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Chronic Pain Management in General and Hospital Practice

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Abstract

There are several methods for treating chronic pain in conjunction with nerve blocks: multimodal rehabilitation, cognitive behavioral therapy, administration of analgesic drugs, brain stimulation, spinal cord stimulation, peripheral nerve stimulation, acupuncture, radiofrequency denervation, physical intervention, physical exercise, relaxation, biofeedback, massage, manipulation, physical therapy and active orthosis, supervised exercise.

Brain stimulation represents one of the earliest uses to treat chronic pain that is refractory to medical therapy. Pain relief is most frequently achieved by stimulating the motor cortex, the thalamus, or the periaqueductal and periventricular gray matter.

Spinal cord stimulation (SCS) or dorsal column stimulation (DCS) is a type of technique that is used to send electrical signals to selected areas of the dorsal spinal cord for the treatment of certain pain conditions which hardly respond to the analgesics or other measures.

Percutaneous electric nerve stimulation (PENS) by a needle electrode or transcutaneous electrical nerve stimulation (TENS) by a surface electrode may provide a safe and simple alternative to narcotics and anti-inflammatory analgesics utilized in chronic pain.

Electrotherapy of pain by neurostimulation including spinal cord and peripheral nerve stimulations are based on the gate control theory proposed by Melzack and Wall in 1965.

Acupuncture is believed to be devised before 2500 BC in China and widely introduced in the late twentieth century in many other areas of the world. Acupuncture consists of the insertion of one or several small metal needles into the skin and underlying tissues at meridian points on the body. Mechanism of its action has been hypothesized variously, including meridians and acupoints theory.

Vagal nerve stimulation, recently developed, provides growing evidence that it has also analgesic effects besides therapeutic efficacy in the treatment of refractory epilepsy and depression. The proposed mechanism of its action is alteration of epinephrine release by projections of solitary tract to locus coeruleus in the medulla, and elevation of gamma aminobutyric acid (GABA) levels in the brain stem.

Percutaneous disc coagulation therapy (PDCT) can deliver stable thermal damage to the center of nucleus pulposus and annulus part as well with ball shaped plasma light, and several similar methods have been developed.

MRI-guided focused ultrasound (MRgFUS) surgery is a minimally invasive thermal ablation method that uses magnetic resonance imaging (MRI) for target definition without damaging normal structures.

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Notes

  1. 1.

    Acupuncture in the narrower sense of using metal needles to treat illnesses by stimulating specific points along circulation channels (meridians) in accordance with theories related to the circulation of qi [91, 92].

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Authors and Affiliations

  1. Niigata University Graduate School of Medicine, Niigata, Japan

    Koki Shimoji

  2. Pain Control Institute, Tokyo, Japan

    Koki Shimoji

  3. Kurume University Medical School, Kurume, Japan

    Tatsuhiko Kano

Authors
  1. Koki Shimoji
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  2. Tatsuhiko Kano
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Correspondence to Koki Shimoji .

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Editors and Affiliations

  1. Pain Control Institute, Shinjyuku, Tokyo, Japan

    Koki Shimoji

  2. Feinberg School of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Antoun Nader

  3. Guy’s and St Thomas’ Hospital, Pain Management Centre, London, UK

    Wolfgang Hamann

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Shimoji, K., Kano, T. (2021). Other Methods: Minimally Invasive Techniques in Pain Clinic. In: Shimoji, K., Nader, A., Hamann, W. (eds) Chronic Pain Management in General and Hospital Practice. Springer, Singapore. https://doi.org/10.1007/978-981-15-2933-7_9

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