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1.) Injection Treatments/Nerve Blocks
These procedures are performed either to diagnose the cause of a complicated pain problem or to treat the pain by repetitively blocking the pain pathway. Local anesthetics, with or without cortisone can be injected around nerves, joints or muscles to reduce swelling, irritation, muscle spasms or abnormal nerve transmissions that cause pain.
2.) Appropriate Analgesic Tailoring For some patients, use of appropriate pain medications can make the difference in the quality of their life. If the use of pain medication results in increased function, adjustment of pain medications according to the patient's individual need can be done. This method is chosen if adequate trial of other options have failed and opiate maintenance remains the only option. Patients also have the unique opportunity to participate in clinical research of novel pain medications.
3.) Psychological Services
Persistent pain often affects a person's mood and ability to cope with everyday living. Studies demonstrate that reactive depression is common with constant intractable pain from whatever cause. Depression, in turn, affects pain perception by lowering the pain threshold. Therefore, evaluating and treatment depression is an important adjunct to the physical treatment of intractable pain.
4.) Physical Rehabilitation
Pain tends to prevent individual from engaging in their usual physical activity resulting rapidly in dysfunctional muscles and joints. Once they start responding to pain relieving techniques such as nerve blocks, patients are immediately referred to a physical therapy program to improve their physical condition.
5.) Implantable Devices
The most advanced treatment for intractable pain are two types of implantable devices that have been recently developed.
(a) Intrathecal Opioid Pump
This device consists of a small tube implanted into the spinal canal and connected to a pump device. The whole unit is implanted in the body and allows slow injection of minute amounts of narcotic into the spinal canal 24 hours a day. This is particularly useful for patients with pain on both lower extremities due to multiple back surgeries or escalating cancer pain.
(b) Spinal Cord Stimulator (SCS)
This device consists of an implantable electrode inserted in the epidural space in the back and connected to an implantable transmitter. This device works by "short-circuiting" the pain pathway in the spinal cord level. This method works well for patients with intractable pain on one extremity (examples: post laminectomy with persistent unilateral radiculopathy, intractable reflex sympathetic dystrophy (RSD) and phantom pain).