Friday, September 16, 2011

The Five Big Trends in Pain Management

By David Greene


Pain management as a field is evolving continuously. In certain respects the treatments are getting better, and every once in a while a trailblazing new therapy presents itself. One of the most prominent advancements, though, has been a more appropriate recognition of treating an individual's pain better rather than ignoring it (or undertreating).

Here are 5 of the most impressive evolutions (or regressions) in pain management that are currently happening:

1. Improvement in pain management interventions. Over the last few years, there have been some improvements in pain procedure technology that have allowed physicians to get better results. One of these is transforaminal epidural shots. The initial type of epidural injection that was invented was called intra-laminar shots. Now pain docs are able to pinpoint place their needles into the location where the nerve root exits the back, getting the cortisone more accurately where it is needed. Another improvement in pain treatments is with radiofrequency thermal ablation machines. When they were first put on the market, they were only able to treat two areas simultaneously. Now they can do four, reducing the overall procedure time.

2. Biologic solutions. Regenerative medicine is not just on the horizon, but is rounding the corner of reality. There are now injection substances that contain numerous regenerative components, including specific cytokines, hyaluronic acid, and stem cells. This will hopefully prove to be instrumental in disc problems, arthritis, and soft tissue and cartilage injuries.

3. Disc treatments have decreased in popularity. As the studies have come out showing that percutaneous diskectomies and intradiskal electrothermy and have marginal outcomes, their use is going down. In addition, there is some initial data showing that diskography may start some degeneration of the disk. So its use is going down too. The disc is such a difficult problem with how to treat it. Surgery can sometimes be a 50/50 proposition, and interventional nonsurgical pain therapies are a question mark as well. If there is one area that could use a better option, it is degenerative disk disease.

4. Performing kyphoplasty and vertebroplasty for spine fractures. These treatments are done as an outpatient, and do not involve surgery. They take less than an hour, and can provide quick pain relief for those with compression fractures. More doctors are learning how to do them in the pain management field.

5. Comprehensive spine care centers. As more research comes out showing the benefits of multiple specialists participating in a patient's care, comprehensive centers are becoming more common. This has benefitted patients tremendously by having more providers with varied backgrounds coming together for the benefit of the patient. Patients can end up needing less narcotics and becoming much more functional.




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