Pain control has become a complex science, and new treatments and technologies are rapidly being developed. It was amazing to see the new scientific leaps that are being made in our knowledge of pain during my visit to the annual pain conference this year. The mechanisms of pain generation, transmission, and perception are all being intensely studied. New chemicals and methods to interfere with the eventual delivery of signals to the brain are being discovered. It is still several years until most of these research findings become part of our practical treatment of pain, but the future looks encouraging for those battling chronic pain.
As I mentioned above, pain management is a complex science. There is usually not a magic solution to control symptoms. Most treatments incorporate tools to help better control pain and optimize a patient’s ability to function. Treatments are to diminish the intensity of pain, not to eliminate all pain. Often a patient has multiple generators of pain signals and a combination of interventions is necessary to best control symptoms. Unlike a simple cut where a Band-Aid or stitches will cure the problem, pain often requires the skills of a Pain Management Specialist to develop an individualized strategy to control symptoms and maximize function.
The Role of IPCDs
Implantable pain control devices (IPCD) are tools employed when simpler strategies are not working. These are tools to use in combination with other treatments to maximize function. They do not totally eliminate pain. Two high technology devices have been developed to be implanted into the body: a spinal cord stimulator, and an implantable intrathecal medication delivery pump.
A spinal cord stimulator is the basic IPCD used to control pain. The spinal cord stimulation acts as a pacemaker that paces out the delivery of sensory signals at the spinal level that prevents pain signals from being delivered to the brain. These devices have been available for over 20 years, and three different companies make competing similar units. Over the last ten years, as technology has improved, so have these stimulators. They are programmed to deliver an electrical signal to the spine from a position in the epidural space. For the right patient, they can be a life saver, as they dramatically increase pain control and often reduce the need for medications.
An intrathecal implantable medication pump is more complex. These pumps deliver medication directly into the spinal fluid. The drugs need to be specially compounded by a pharmacy, and only a limited number of drugs have been used in this fashion. Pumps can deliver medications to receptors that are only accessible by being present in the spinal fluid, and often these same medications do not transfer from the blood to the spine or brain. A lot can go seriously wrong with medication delivery directly to the spine. These are also only effective in highly selective and very motivated patients. Once implanted, the patient is married to the pain clinic and there may be significant additional limitations especially on travel and freedom to be away from the clinic that fills the pump.
Pain is a very complex problem. If your pain is not well controlled, working with an experienced pain physician to develop the correct strategy is necessary. Implantable devices are tools to help control symptoms, but they are complex and not magical solutions. There are new developments in pain control being researched now. A good pain specialist will help find a pathway to a better solution.