New Horizons in Pain Management

Minimally Invasive Spine Surgery. Every year, more tools and techniques are being developed in order to advance the art to that of the level of laparoscopic gall bladder surgery or endoscopic knee surgery.  It appears fusion surgery is already possible with MISS and hopefully endoscopic artificial disc surgery will occur in the future.  Cartilage research and inducing disc growth appears to be possible at this point.

Medication Management There are new methods of blocking the NMDA receptor, including oral magnesium, memantadine, and hopefully S(+) ketamine which should help with chronic pain.  The serotonergic drugs continue to improve and new antidepressants are showing promise in treatment of various conditions associated with pain.  Opiate therapy combined with a better understanding of tolerance and receptor interactions may make it possible to tailor make specific drugs.  The tachykinins and their receptors hold promise since at least one (substance P) already has a blocker.  There are many areas of receptor blockade that havenít been addressed at all with respect to pain management.

Diagnostic Advances By using fat supressed MRI images of ligaments, we are now able to examine the possibilities of ligament tears in the spine.  Spec imaging of the cervical spine was recently demonstrated to show significant pathology when MRI images were negative.  Standing MRIs should begin producing enough data to determine whether or not the technique bears widespread adoptance. The ISIS demonstration of the accuracy of discography should bring assurance the technique will be used with more rigorous standards.  The combined use of selective endoscopic discectomy with spinal probing may enhance our understanding of spinal pathologies.

Pain Management Interventional Therapies This year we hope to see additional uses of the Holmium YAG laser to tissue modulate cartilage in facet joints and to shrink the capsule over facets, treat ligament tears, etc.  Also, the nucleoplasty probe should yield published results this year.  Spinal cord and peripheral nerve stimulation uses continue to abound.  The first DRG stimulators were placed this year and some deep peripheral nerve stimulators were placed.  Foraminal probing for scar tissue and transforaminal Racz procedures continue to advance our therapies.  New needles which are blunt have been developed to avoid accidental penetration of nerve roots.


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