Simple analgesics like Aspirin, paracetamol, Diclophenac etc. are very useful in controlling mild pain, however, their prolonged unsupervised use for months together may cause harmful effects on the stomach, liver and kidney.
Opioids are very useful in controlling severe cancer and other chronic painful conditions. However, they are frequently denied to patients or prescribed in inadequate doses. This is partly due to fear of addiction and respiratory depression. However, it has been proved that their supervised prolonged use for months together is safe.
Oral morphine tablets or liquid is available for such patients. To prevent its misuse by drug addicts it is not available across the counter, and pain relief clinic gets special license for its stock and use for patients. When the patient cannot take oral medicines, the pain consultant may advice and arranges for other routes like subcutaneous, epidural, spinal etc.
TENS is one of the simple, safe, non–invasive methods used for controlling mild acute and chronic painful conditions. Special equipment is used to provide this therapy. It is very useful for patients with neck, back, shoulder, phantom and neuralgic pain. Pocket sized battery operated portable equipment is also available for home use.
Interventional pain management procedures/nerve blocks are very useful in controlling severe, acute, chronic and cancer pain conditions. These are performed by anesthesiologists with a special skill and extensive experience in pain management. Nerve block is an injection of local anesthetic drug similar to that used for numbing the mouth in preparation for dental work. Longer lasting. steroids, opioids, phenol, alcohol etc. are the other drugs used. The drug may be injected near very small nerves, groups of nerves (plexus), close to the spinal cord or in the joint, depending on the underlying cause of pain.
Sometimes, x–ray assistance is used as a tool for these procedures. Most procedures are performed in a well equipped operation theatre and most patients require hospitalization for a period of a day or two.
These blocks allow the patients to stop or lower drug doses and thereby reduce their side–effects, or to experience better pain relief from current doses in order to improve their quality of life. The duration of effect of these blocks depends on the type of medicine used. It may last about 30 to 60 minutes as and when used for local anesthesia or it could last as long as four to 24 hours as and when used for post–operative and other acute pain relief. When neurolytics are used for chronic and cancer pain, the relief lasts for several months or years.
As with other medical procedures, there may be undesired effects or complications arising from nerve block. Allergic response to drugs used, infection at the site of injection, weakness in muscles supplied by target nerve etc are the unusual complications. There is the theoretical risk of puncture of vital body organs, threatening life. In special circumstances involving phenol block in the area of nerve roots near the spinal column, if phenol is accidentally injected in the space containing spinal fluid, it might then affect the nerves that control portions of bowel, bladder, or sexual function. Special precautions are taken to avoid such complications when this type of block is performed.
Few Interventional Pain Management Procedures/Nerve blocks are:
- Epidural block – (Lumber, thoracic, caudal, cervical) are very useful for patients with neck, low back pain, spondylosis, sciatica etc.
- Coeliac block is extremely useful for patients with abdominal pain due to cancer pancreas, stomach, liver, gall bladder, intestine etc. It is also useful for patients with chronic pancreatitis.
- Hypogastric plexus block is advised for patients with pain associated with pelvic organ malignancy.
- Sympathetic nerve blocks – Stellate, lumber are useful for patients with peripheral vascular diseases like TAO, gangrene, RSD, phantom, and cancer pain.
- Cranial nerve block – Maxillary, mandibular, glossopharyngeal etc are useful for patients with neuralgia and cancer pain in the head and neck region. These are a few examples, many nerve blocks are available for different types of pains.