Weill Medical College of Cornell University

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Pain Treatment

Pain Surgery

Weill Cornell offers advanced neurosurgery techniques for the treatment of pain. Clinicians treating pain include those practicing neurology, neurological surgery, neurological oncology, radiation oncology, anesthesiology, and neuroradiology. This multi-disciplinary team works together to achieve the best treatment for patients.

The use of electrical stimulation of the nervous system to relieve debilitating chronic pain may be able to provide considerable relief in properly selected patients who are not responding adequately to conventional medical therapy. For some patients, a better option is to implant a pump that continuously provides pain medication directly to the spinal cord without spreading through the entire body. The patient should first investigate alternative treatment modalities such as medications and physical therapy because of the level of involvement and patient motivation required.

Spinal Stimulation

Spinal cord stimulators are implantable devices used to treat pain arising from a range of conditions such as nerve injury or scarring, reflex sympathetic dystrophy (RSD), amputated limbs, herpes, and spinal cord injury. Thanks to advances in technology, degree of effectiveness, and greater education of both patients and physicians, use of these procedures is increasing. When successful, patients usually feel a buzzing sensation in the area of their pain that is pleasurable and eliminates the pain. A test is performed prior to permanent implantation to determine if patients will respond to this therapy.

Modern spinal cord stimulators are programmable. Once implanted, signal delivery can be adjusted for optimal pain relief. Weill Cornell is researching enhanced efficacy of spinal cord stimulators. There has also been development of new minimally-invasive methods for implanting these devices with less pain and shorter hospital stays. Using local anesthesia, clinicians will implant electrodes and a generator in the patient. Electrode activity stimulates spinal pain pathways, thus producing relief. Patients are educated on the use and programming of the device.

Intraspinal Pumps

Intrspinal pumps (also called intrathecal pumps) deliver drugs directly to the spinal cord to treat a variety of painful conditions, including:

• Severe low back pain which cannot be improved with spine surgery or further medication
• Failed back syndrome (severe, chronic aching back pain following spine surgery)
• Spasticity

Typically, intraspinal pump surgery involves the placement of a pump with a drug reservoir under the skin in the abdomen. At the same time a catheter is placed into the spine in the back and is connected under the skin to the reservoir. Thus the contents of the reservoir, typically morphine (to treat pain) or baclofen (for spasticity), can be delivered in a controlled manner directly to the spinal cord, which is where the drugs are most needed. This permits delivery of a much higher dose of drug to the spinal cord because it is not spreading through the entire body, thereby limiting adverse effects of high systemic doses of drugs. The reservoirs can be refilled as necessary, and the pumps are programmable so that the amount of drug delivered can be changed as needed in the doctor's office with a painless programmer that works in a few seconds.

An initial test is necessary to determine patient candidacy for an intraspinal pump. Those patients whose pain or spasticity is relieved during the initial test are considered for placement of a pump.

Deep Brain Stimulation

Deep brain stimulation has been successfully utilized in the management of patients with pain arising from a range of conditions. It is rarely used today since most patients who would be candidates for deep brain stimulation respond well to spinal cord stimulation. However, for certain patients in whom spinal stimulation would not be effective (such as patients with pain following a stroke, or patients with pain from injuries high in the neck), deep brain stimulation can still be a useful technique.

The surgical procedure is performed under local anesthesia. Computer-assisted imaging techniques are employed to identify the targets of stimulation. One end of an electrode is carefully guided to the specific brain area(s) responsible for sensation of pain. The other end of the stimulating electrode is connected to a battery-powered programmable device implanted in the chest like a pacemaker. As with spinal stimulation, patients usually feel a pleasurable buzzing sensation, which can eliminate the painful sensation when effective. Because it is programmable, deep brain stimulation can be individualized to the patient.