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All Posts in Category: Chronic Pain

Drug-resistant Epilepsy / Parkinson’s disease / Motor disorders

 

Many patients with epilepsy, Parkinson’s disease, tremor, dystonia, and other movement disorders may not respond to medication, even with the most modern drug combinations. Their quality of life can be significantly affected. Many of these patients are young, otherwise healthy individuals, and they need to work and, above all, live a normal life. There are now special surgeries for these patients, such as Deep Brain Stimulation (DBS). These surgeries belong to the category of the so-called Functional Neurosurgery, and are based on the theory of Neuromodulation.

Neuromodulation

This means that with an external intervention, we affect a known circuit of the brain functioning in a way that causes some of the symptoms of the disease that we wish to treat. Thus, by disrupting this circuit in a controlled way, the brain re-programs itself and the symptoms subside. This is the general principle, but of course there are cases where we are even obliged to remove nerve tissue to control the symptoms, especially in some cases of epilepsy. In this case the so-called “epileptogenic tissue” is removed.

Deep Brain Stimulation (DBS)

In general, Deep Brain Stimulation is a relatively mildly invasive procedure, in which an electrode is inserted into the area of the brain that we want to “re-program”. There are extremely accurate that are used for this purpose and allow for the safe achievement of the goal. The implant is carried out via a very small hole in the skull. Local anesthesia is mainly used; usually the patient can have an immediate improvement in their symptoms, even during the operation, as soon as the electrode is activated. This is stimulated in a specific way by a special pacemaker, similar to the one used in the heart, which is also implanted in the patient’s body. The desired result is achived depending on the type, degree and area of stimulation. Stimulation systems (or even permanent micro-destruction of a specific area) are now used for certain psychiatric diseases, such as severe drug-resistant depression and obsessive-compulsive disorder.

It should be made clear that not all patients are suitable for this type of surgery. A thorough preoperative examination, and special imaging and electrophysiological examinations are required. In addition to the neurosurgeon, the team of physicians also includes a neurologist, a psychologist, a psychiatrist, a neurophysiologist and, as the case may be, other specialties such as speech therapists, physiotherapists, occupational therapists, etc.

 

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Postherpetic Neuralgia

 

 

Following a nerve infection with the herpes virus (we are not talking about cold sores), severe pain in the trunk or limbs that does not respond to medication may linger. In such a case, a test electrode can be implanted under the skin or in the back and low-intensity electrical stimulation can be injected. This way, 50-60% of the pain will be eliminated. If the test is successful, the electrode can be permanently implanted in the patient’s body, by means of a simple surgery.

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Postoperative chronic pain

 

 

This category includes a number of conditions such as the so-called failed back / failed neck pain syndrome. Many of these patients continue to suffer from pain, although clinical and imaging tests (X-rays, MRI scans, etc.) do not identify any cause of their pain.

Implantation of spinal cord stimulators in the spine

Postoperative chronic painIn selected cases , implantation of spinal cord stimulators in the spine may help.The correct diagnosis of the syndrome made by specialized doctors (anesthesiologists, neurologists, or neurosurgeons) and the correct choice of patients who may benefit from it is a prerequisite. The stimulator is implanted in the patient’s body, usually in the abdomen. After a short period of training it can be used by the patients themselves through a simple remote control, depending on the intensity and location of their symptoms. It significantly improves symptoms by controlling pain in the exact area where it occurs. The implant operation is relatively simple. The surgery lasts 30-45 minutes, under general anesthesia, and the duration of postoperative treatment is 2-3 days. The use of the system can start during the hospitalization of the patient and its beneficial effects are immediately felt. About 2 in 3 patients in this category are relieved of their symptoms and no longer need to take chronic medication with all its possible side effects.

 

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Post-traumatic pain

 

 

This describes the type of pain that persists after an injury, and is usually identified with neuropathic pain, i.e. pain that is not due to the injury itself, but to the chronic irritation of a nerve or nerves, and that lasts after the patient’s injuries have healed. Modern neurosurgery can help in the cases when chronic post-traumatic pain is diagnosed and medication is not enough.

Implantation of spinal cord stimulators in the spine

The implantation of spinal cord stimulators in the spine offers significant relief to most of these patients (approximately 60%). A prerequisite is the correct diagnosis of the syndrome, made by specialized doctors (anesthesiologists, neurologists, or neurosurgeons) and the correct choice of patients who may benefit from it. The stimulator is implanted in the patient’s body, usually in the abdomen, and after a short period of training it is used by the patient themselves, through a simple remote control, depending on the intensity and location of the patient’s symptoms. It significantly improves symptoms by controlling pain in the exact area where it occurs. The implant operation is relatively simple. The surgery lasts 30-45 minutes, under general anesthesia, and the duration of postoperative treatment is 2-3 days. The use of the system can start during the hospitalization of the patient and its beneficial effects are immediately felt.

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Ghost member pain

 

 

This is a relatively rare disorder, attested in patients who have had a limb amputated, and after a period of time they start feeling pain in the missing limb. The mechanism of this disorder is not very well known, but it seems that it involves centers of the spinal cord and possibly the brain. There are special surgeries placing electrodes in areas of the brain that can treat the problem in selected patients. Selective spinal cord areas may also be selectively destroyed (DREZ lesion – destruction of the posterior spinal cord entry zone), and results have been promising.

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Complex Regional Pain Syndrome

 

 

This is the name given to the syndrome that used to be called reflex sympathetic dystrophy and heartburn. There are 2 distinct types of this syndrome. In type I no nerve injury can be found, while in type II the nerve injury is given. It can occur in patients who have undergone an injury or surgery at the upper or lower limbs. The onset of the syndrome is thought to be related to some form of inflammation in the affected nerve; unfortunately often it does not respond to the usual analgesic treatment. It is often accompanied by redness of the limb and reaction even to non-painful stimuli. Sometimes even a simple touch on the affected area can cause pain.

Modern treatments

Contemporary neurosurgery can suggest a modern treatment to these patients who continue to suffer despite taking medication, or if medication cause serious side effects. The implantation of spinal cord stimulators in the spine offers significant relief to 60-80% of these patients. The correct diagnosis of the syndrome made by specialized doctors (anesthesiologists, neurologists, or neurosurgeons) and the correct choice of patients who may benefit from it is a prerequisite. The stimulator is implanted in the patient’s body, usually in the abdomen. After a short period of training it can be used by the patients themselves through a simple remote control, depending on the intensity and location of their symptoms. It significantly improves symptoms by controlling pain in the exact area where it occurs. The implant operation is relatively simple. The surgery lasts 30-45 minutes, under general anesthesia, and the duration of postoperative treatment is 2-3 days. The use of the system can start during the hospitalization of the patient and its beneficial effects are immediately felt.

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