Basis, indications and risk: Basis, indications and risk
Surgery for pain and pain clinics
Objetive
To decrease patients' pain.
Theoretical base
In the past, in order to stop the perception of
pain, nerves transmitting pain to the brain were cut. Nevertheless,
this type of surgery was aggressive and had a high failure rate.
At the present time, stimulating nerve cells that
impede pain transmission has proven to be more effective. Such a
stimulation is achieved by implantation of electrodes or pumps that
release pharmaceutical drugs.
As an alternative to surgery, other techniques are used in pain
clinics. Their application becomes increasingly agressive depending
on patients' response. Psychological support is sought if patients
need to learn how to cope with pain.
Evidence of efficacy
There are studies showing that in those patients whose prior spinal
surgery has failed, pain surgery is more efficient than further
surgery on the spinal column.
Risks and contraindications
The inherent risks in all types of surgery.
Indications
The existing recommendations
based on scientific evidence do not include it in their guidelines,
probably because pain surgery is understood to be a very sophisticated
high technology procedure which is not specific for back pain, but
common to all untreatable pain, beyond the scope of the key areas
analyzed by those guidelines.
Pain surgery should be considered for patients
with severe pain resistant to all other treatments.
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