Chronic Back Pain: When Surgery is Not the Answer

For patients suffering from chronic back pain, surgery isn't always an option because of other health problems, previous surgery or a specific characteristic of their pain. However, neurosurgeons have other solutions besides surgery for eliminating chronic pain from everyday life.

Low back and related leg pain are the most common manifestations of chronic pain seen by neurosurgeons, who can also provide relief to patients suffering from cancer pain, phantom limb pain, complex regional pain syndromes, vascular pain in the arms and legs, pain caused by nerve damage as a result of trauma, and more. The feeling of pain is transferred throughout the body by nerves and the pain message originates in the spinal cord and the brain.

"Patients suffering from chronic pain often have damage to a nerve and that nerve is in a constant state of aggravation sending pain messages up and down its entire length," said Kim J. Burchiel, MD, an Oregon neurosurgeon who specializes in pain management. "Many times, the sciatic nerve in the lower back is damaged and causes chronic pain in the legs because that's where the nerve travels. Nerves can be damaged by injury, cancer treatment or a circulatory problem."

In some cases, painful nerve damage cannot be repaired. However, neurosurgeons currently have two techniques available to stop the pain message before it even leaves the spinal cord.

Spinal Cord Stimulation

Spinal cord stimulation is a pain management strategy that blocks pain messages by sending an electrical impulse to selected nerves in the spinal cord. Small electrodes are implanted in the spine and a generator is placed just under the patient's skin. A programmable transmitter is worn by the patient and communicates with the receiver via radio waves. The generator is programmed to allow a certain number, type and pattern of electrical impulses to be fired by the electrodes within a specific time frame. Patients can turn off the system throughout the day by turning off the power source and a neurosurgeon can adjust the amount, type and pattern of impulses by adjusting the generator.

Pain relief with a spinal cord stimulation system is almost instantaneous and patients normally experience a 50 to 70 percent reduction in pain. This often allows patients to significantly reduce the amount of pain medication they take, reducing side effects. The system can be removed if needed.

Intrathecal Pump Therapy

If pain is limited to the spine, an intrathecal pump can be used to deliver medication directly into the spinal fluid. Normally, for pain medication to reach the spinal fluid, it must be given in great quantities, causing significant side effects. An intrathecal pump, can be implanted under the skin in the side of the abdomen. The medication is delivered directly to the site of the pain and in much larger quantities than would be tolerated if taken orally.

The pump is refilled with medication through a syringe every four to 12 weeks and is programmed to deliver specific amounts of medication throughout the day. Neurosurgeons can reprogram the amount of medication that flows through the catheter using radio telemetry from a computer and electronic wand.

Approximately 65 percent of patients experience significant pain relief with intrathecal pumps. The pump can also be easily removed.

"These two techniques are not the first option for patients suffering from back pain because we are not 'fixing' the problem, just stopping the feeling of pain. A neurosurgeon needs to determine which option is best for each individual patient," said Kenneth A. Follett, MD, a neurosurgeon in Iowa and a specialist in pain management. "The advantage is that they can be tested in a trial mode, they are non-destructive to the tissue and they are reversible."