Non-drug pain therapy

Spinal cord stimulation makes use of the physiology of pain transmission. This procedure belongs to the group of so-called neuromodulatory procedures. For this purpose, an electrode is inserted into the epidural space of the patient, through which electrical impulses can then be emitted.

The patient can control the strength of the impulses himself and adapt them to his needs.On the one hand, the electrical currents stimulate pain-inhibiting nerve cells in the spinal cord, on the other hand, the impulses superimpose the pain impulses that are normally transported to the brain via the same nerve cells. However, since these nerve cells have already been excited by the electrical impulses, they cannot simultaneously transmit the pain, so that the perception of pain is suppressed. Transcutaneous electrical nerve stimulation is based on a similar principle as the spinal cord stimulation described above.

In TENS, however, adhesive electrodes are attached directly to the painful area. The electrical impulses that can be emitted via the electrodes stimulate the nerves in this area, which then transmit the impulses to the spinal cord. There, the artificially set stimuli compete with the pain impulses and ensure that these can no longer be transmitted to the brain at full strength.

In addition, in TENS as well as in spinal cord stimulation, inhibitory pain pathways are activated, which additionally suppress the pain transmission. The chordotomy belongs to the so-called neuroablative procedures. Here, fibers of the pain-conducting pathways in the spinal cord are cut through.

This is done with the help of a probe that sclerotizes the pain fibers with either heat or electric current. The chordotomy is used especially for tumor patients who suffer from severe pain that cannot be controlled otherwise. Especially pain that occurs on only one side of the body can be treated well with this procedure, as usually only fibers on one side of the spinal cord are cut.

This leads to a loss of pain sensation on the opposite side of the body, as the fibers in the spinal cord cross. Theoretically, the pain pathways of both halves of the body can also be severed, but the risk of damaging important other nerve pathways increases, which is why unilateral surgery is always preferred. The patients are thus effectively relieved of pain, but the pain sensation can return with time.

This can be explained by the activation of alternative pain pathways. Cryoanalgesia (icing) is used especially for the treatment of chronic pain in the spinal column. The desired nerve is exposed to extreme cold (approx.

-65°C) using a special probe. This leads to the nerve’s destruction, so that the perception of pain in its area of supply disappears. However, there is a possibility that the nerve will recover after some time.

Certain massage techniques can also have a positive influence on pain symptoms. Through the massage the tissue is better supplied with blood, whereby nerve-irritating substances and waste products of the cells are removed faster. Thus the metabolic situation in the musculature is improved.

Massage oils and ointments with arnica, rosemary, devil’s claw or pine additionally improve the blood circulation in the tissue. In addition, reflex zone massage and acupressure can influence internal organs, which can contribute to relaxation and pain relief in these areas. Direct application of heat can also help to relieve pain, as heat also promotes blood circulation and relaxation of the muscles. Hot-water bottles, heat plasters (e.g. ThermaCare®) or heat pads are suitable for this purpose.