MORE FROM THE CONFERENCE
Neurostimulation for the Treatment of Facial Pain and Headache – Presenter: Dr. Richard Osenbach
Neuroaugmentation is the use of electrical stimulation of deep brain structures and the spinal cord to relieve debilitating
chronic pain. This treatment modality may be able to provide considerable pain relief (though not necessarily complete),
but alternative treatment modalities such as medications and physical therapy should first be attempted because of the
level of involvement and patient motivation required.
This does not work for people with Anesthesia Dolorosa. It is used in the study of Occipital neuralgia, trauma, cervical
strain and other pains.
If someone wanted more information on this I have it in my notes.
Pain Management for TN in the Emergency Room – Presenter Dr. Jeffrey Cohen
“This is from the Conference”
Avoid the Emergency Room unless there is no other choice. Take medications as prescribed and do NOT self
medicate. Strongly consider having that procedure so that maybe you won’t have that crisis. There may be a special
medication for a situation.
Have documentation from your doctor that is treating your pain on letterhead what the condition is. Have the doctor call
the ER ahead of time so that he can let them know everything.
I have on my notes that, “Propylene glycol is what is put into anti-freeze”. Fosphenytion is better-tolerated and best to
use. It is a prodrug that is metabolized to phenytoin and administered parenterally for the treatment of seizures.
IV Keppra is for people who are allergic to Dilantin and is not metabolized in the liver.
Sumatripitan is used to treat migraine headaches.
Have a plan. Use eye drops like what the eye doctor uses “tetracaine”. This is white, water, soluble, crystalline solid
used mostly as an anesthetic.
I asked if the medical department looks at the Medical Alert Bracelet or am I just wasting my money? Yes, and you
MUST keep it up to date. You can call or go on-line to keep.
Deep Brain Stimulation
Deep brain stimulation has been successfully utilized in the management of patients with several different kinds of pain,
including pain associated with spinal cord injury, nerve injury, stroke, herpes, and cancer. Substances known as beta-
endorphins, which are produced by certain brain cells, mediate the body’s pain mechanisms. These beta-endorphins act
to inhibit pain by their influence on two areas of the brain called the periventricular gray matter and the periaqueductal
gray matter.
The surgical procedure is performed under local anesthesia in the operating room. Computer assisted imaging
techniques known as sterotaxy (Stereotactic neurosurgery) has become an indispensable portion of the neurosurgeon's
repertoire, a method allowing three dimensional localization of specific sites within the complex and compact human
nervous system) are employed to identify the targets of stimulation. An electrode is carefully guided through a small hole
made in the skull and passed to specific brain areas, which may be the periventricular or periaqueductal gray matter or
brain regions known as the thalamic sensory nuclei. The other end of the stimulating electrode is connected to a battery-
powered programmable device that is implanted under the skin below the clavicle. One potential drawback to this
treatment modality is the development of tolerance, or diminished effectiveness over time. This possibility is diminished
with the use of certain drugs and the avoidance of using continuous stimulation.
Spinal Stimulation
Spinal stimulation has provided pain relief in people suffering from multiple sclerosis, low back pain, amputated limbs,
herpes, and spinal cord injury. Candidates for spinal stimulation may undergo a period of trial stimulation before
conversion to an implanted stimulator. The placement of the electrode is performed under local anesthesia and allows
testing of its effectiveness during the procedure. Electrodes are placed over the back of the spinal cord and connected
to a battery-powered pulse generator device that is placed under the skin. Recipients of spinal cord stimulators are
educated on the use and programming of their device.
Stimulation is used for trigeminal neuropathic pain (unintentional damage to trigeminal system, facial fracture, dental
procedures, etc. RF lesion, glycerol injection, radiosurgery, etc.). Post-herpetic trigeminal pain and atypical facial pain
– Somatiform pain disorder. Not all pains are the same.
Electroanalgesia is an analgesia that is induced by the passage of an electric current. This was the best website that I
could find that explains more about this. There could be more but there is a LOT to write about from the conference.
http://health.enotes.com/nursing-encyclopedia/electroanalgesia
We have already had a speaker on Motor Cortex Stimulation so I won’t go into that. But this one is being studied for
people with AD.
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