When oral medications and/or nerve blocks do not sufficiently control the pain, advanced pain therapies or implantable systems may be effective for treating neuropathy. These systems are designed to interrupt transmission of pain signals from the spinal cord to the brain. If the neuropathic pain signals do not reach the brain, then the patient does not actually feel the pain.
Spinal cord stimulation (SCS) for pain control introduces low levels of electrical current to the dorsal portion of the spinal cord to block the sensation of pain. The device is implanted during a surgical procedure, and may include a fully implanted system or a system with an external power source.Spinal cord stimulators may be used to manage pain from failed back surgery syndrome or radiculopathy (sciatica or leg pain). Current medical literature indicates that 50 to 60 percent of patients will get a 50 percent or better pain relief with this procedure that has lasted up to 20 years post implant.
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Spinal pumps (or pain pump) delivers pain medication (typically morphine) directly to the intrathecal space around the spinal cord via an implanted pump. The pump is implanted during a surgical procedure, and medication in the pump is added periodically (e.g. monthly) by injecting medication through the skin into the pump reservoir.
Spinal pumps may be used to manage chronic pain from osteoporosis or axial somatic pain (nociceptive pain), and sometimes may by used to manage pain from failed back surgery syndrome (although the efficacy for this use is unclear). Spinal pumps are also used to treat painful spasticity as is seen in multiple sclerosis.
Often multiple medications are put into the pump to treat certain specific situations. That is, morphine to treat the nociceptive pain and local anesthetics (such as bipuvicaine) to treat a neuropathic pain component.
For each of the above procedures, a trial is first performed to see if it is effective and how the patient reacts before the surgery is performed. Both of the procedures are reversible and the implantable system can be removed.