Category Archives: Therapy

Psychotherapy: The Quintessential Placebo

Of all the alternatives to antidepressant medication, psychotherapy is the most thoroughly researched. It has been the subject of hundreds of studies, which have been summarized in scores of meta-analyses. Indeed, there have been so many meta-analyses of the psychotherapy outcome research that there are even systematic reviews of the meta-analyses ― that is, reviews… Read More »

Spinal-Cord And Brain Stimulation

The recent use of electrical stimulation to relieve pain dates back to 1967, when spinal cord stimulation was first attempted by Shealy and co-workers, the logic for this following on from Melzack and Wall’s gate control theory for pain published in 1965. Methods and sites The commonest site for stimulation is the spinal cord. Stimulation… Read More »

Spinal Cord

Physiology of Spinal Cord The mechanism of spinal cord stimulation is unknown. Three possible mechanisms have been suggested. Stimulation using currents, voltages and frequencies typically in use is shown to activate the dorsal column fibres. Larger fibres are preferentially activated, though the spinal sympathetic pathways are also activated. • In the first of these mechanisms… Read More »

Opioids In Chronic Pain

The use of opioids in pain of non-malignant origin is controversial and depends on a proper understanding of the nature of chronic pain, and the strategy of its management. Patients with chronic pain who take opioids must understand the rationale for the use and be prepared to be an active partner in the management of… Read More »

Neurosurgical Techniques

This post is not intended as a comprehensive account of all the neurosurgical procedures for pain; rather it is intended to explain the rationale of neurosurgery for pain, and illustrate some of its potential. One of the most important roles of a neurosurgeon involved in surgery for pain is to be certain that surgically remediable… Read More »

Cordotomy

Indications This procedure is performed almost exclusively for malignant pain. The ideal candidate has pain around the torso or into the lower limbs on one side. Bilateral cases can be considered, but significant side-effects then accepted. Methods It can be performed either percutaneously or at open operation. The aim is to cut the anterior spinothalamic… Read More »

Intrathecal drug delivery systems

There is increasing use of such systems. Indications These may be divided into two and it is convenient to consider them separately. 1. Baclofen for the management of spasticity. The indication is provoked by pain from the continuing muscle spasm; additional benefits are improvement in function and for disabled bed-bound patients ease of nursing care.… Read More »

Nerve Blocks: Somatic And Lesion Techniques

Sensory nerve blocks are widely used in chronic pain management for diagnostic and therapeutic purposes. Local anaesthetic agents and neurolytic substances such as phenol, alcohol, or glycerol can be used, depending on the indication. Radiofrequency (heating) or cryotherapy (freezing) probes can be used to cause a lesion in a nerve after precise localization with X-ray… Read More »

Nerve Blocks: Autonomic

Nerve blocks of the sympathetic nervous system are indicated for the control of pain where nociceptive afferents travel with the nerves of the autonomic system, or where an effect of blockade of the efferent autonomic nervous system is required. Efferent autonomic blockade has two major effects: • removal of the influence of catecholamines from nociceptors;… Read More »

Ketamine And Other NMDA Antagonists

Ketamine is an anaesthetic drug with a few notable features which have resulted in its introduction to pain clinic practice. The rationale for its use is supported by animal studies which allow tentative conclusions to be drawn about a mechanism of action. However, the extrapolation of animal data, based on electrophysiological and behavioural studies, to… Read More »