hkcs at socal.rr.com
Sun Feb 6 11:17:45 PST 2000
For those who know me, please forgive the repetition...this is for those
new subscribers who don't.... I hope it will help clarify some recent posts
on the subject of phantom pains, when all else has failed...
Hello, My name is Christina, I've been a hemipelvectomy amputee (entire
leg, hip and half my pelvis) since 1962 due to cancer. I've also been a
doctor since 1972, specialty is Anesthesiology. I am not an expert in the
phantoms, but I know them personally, still suffer occasional bouts. I've
done extensive reading and am familiar with most of the current treatments.
Some basic facts:
There is NOT ONE treatment which is 100% effective for all people.
There are many different treatments which may be 100% for specific
individuals, each person's pain must be evaluated and treated on an
individual basis, there are no guarantees.
TENS units have been helpful in some chronic pain problems including the
phantoms, but there is very little in the medical literature specifically
relating to the phantoms. It is an EXTERNAL treatment. Pads are placed
on the skin and an electrical stimulation is given. This stimulation
travels through the nerves and in some cases can over-ride the pain
impulses of the phantoms. Results are variable, but it is very safe and
SPINAL CORD STIMULATORS consist of a wire or lead which is placed in the
epidural space near the nerve roots. The exact placement depends on where
the pain is. Usually a trial placement of leads is done first under local
anesthesia with sedation. The lead is attached to an external device which
provides electrical stimulation which causes a "buzzing" or "tingling"
sensation. The goal is first to cover the area of pain with this tingling
and various amounts of stimulation are provided which hopefully will
over-ride the pain impulses with non painful stimulus. If the person gets
relief, a week or 2 later, the leads and the generator are buried under the
skin. This is usually done under a general anesthetic. The amount of
stimulation is variable and can be adjusted by an external adjustment
gizmo. The results have been variable, it depends on each individual. The
generator needs to be changed about every 2-3 yrs to replace the
batteries. As with ANY treatment for chronic pain, the effects appear to
decrease over time, in other words, it may work great at first, but may
become less effective over a few years time.
MORPHINE PUMPS consist of a very small tube which is also placed in the
epidural space, again exact placement depends on the area of pain. A
certain concentration and amount of morphine is placed in the pump and the
amount of medication delivered is adjustable. A trial is done first, and
if successful, the person returns a few weeks later to have the tube and
pump surgically placed under the skin. Additional supplies of morphine are
added as needed by being injected through the skin directly into the pump
reservoir by way of a large syringe and special needle. Again, the results
have been variable, and very little is in the medical literature about this
treatment specifically for use in treating phantom pains.
Both the spinal cord stimulator and morphine pump are INTERNAL devices,
which require surgery and anesthesia. Therefore all of the inherent risks
involved with ANY surgery or anesthetic are present. Be aware that there
are no 100% guarantees. Even in the best trained and skilled hands,
complications can and do occur. Most common and most disturbing is
infection. Both the leads or tubes are placed close to the spinal
cord, infection may result in meningitis and even death. I've seen this
personally.... twice! Therefore, I would advise anyone who is considering
these treatments to fully investigate and try all other non-invasive
treatments first. Also, be sure that your pain doc has the credentials,
professional training and experience in these devices.
To check your pain docs credentials, contact your local county or state
medical board. Other sources for information are:
American Society of Anesthesiologists (ASA) has a web site covering the
subject of management of pain: www.asahq.org/Patient_Education/pain_manage.html
American Pain Society: www.ampainsoc.org (This organization can provide
referrals for patients, listed by state, and is a good source for
World Wide Congress of Pain, sponsored by the Dannemiller Foundation
www.pain.com - has a listing of pain specialists according to
state. Other parts of this site involve consumer information and permit
users to "Ask the pain doc" questions.
Hope this answers some questions and clarifies the differences. Good luck.
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