Chronic Pain Treatments
We have a unique expertise and are recognized as a referral centre for the rational use of opiates and other medications in complex cases where patients may or may not present with problematic medication use or with a history of substance abuse and addiction. We also have expertise in the treatment of a number of headache, and craniofacial pain disorders. Our centre is at the forefront of using methadone for chronic non cancer pain.
This category of therapy includes slow release opiates (e.g. slow release Fentanyl, Oxycodone, and Morphine); long-acting opiates (e.g. methadone for pain, and buprenorphine, under study at our Centre); adjunctive agents such as amitriptyline, an antidepressant and gabapentin, an antiepileptic agent; and various anti-inflammatory agents.
Therapies include using: capsacin, lidocaine, ketamine, and amitriptyline for neuropathic pain. This is an evolving therapeutic area are we are developing our expertise.
Treating chronic pain patients requires the ability to educate the client, and activation and exercise programs. Motivation on the part of the client is essential. Hydrotherapy is a proven effective treatment. The therapist needs to be part of an overall team approach. Physical Therapists and Occupational Therapists can be an important part of a cognitive behavioural program. Programming can include physical therapy and occupational therapy.
At the Centre, therapists provide excellent support to our craniofacial and pelvic region programs and have a very successful hydrotherapy program. Rehabilitative success is not limited to this population but extends to other myofascial and neuropathic pain syndromes as well.
Psychologically-based assessments and therapies are essential to any comprehensive pain management program. Whether it is group therapy, relaxation therapy, cognitive behavioural therapy, psychotherapy, management of addiction, hypnotherapy, or biofeedback; some combination of these interventions is necessary to achieve success.
The Centre has access to psychiatrists, a sex therapist, and our nurse is a trained hypnotherapist. We do not have an on-site psychologist at present, but there is one available off-site. At this time, fees for sex therapy are $100 for the initial two hour assessment, and $80 for each additional one hour session. We are planning the introduction of a cognitive behavioural therapy (CBT) group program.
Increasingly, alternative therapies are being applied tochronic pain and are popular among clients. Evidence for effectiveness of chiropractic techniques in chronic pain is minimal. Acupuncture is effective in headache, vulvar pain, and other pain conditions.
We are fortunate to have an Acupuncture clinic at the Centre which serves as an educational clinic for students of the Acupuncture program of the Michener Institute and as treatment facility for our patients.
In treating chronic pain, injections of local anaesthetics with or without corticosteroids offer some diagnostic and therapeutic value. Studies show variable levels effectiveness with this treatment. There is a body of evidence for the effectiveness of Botulinum Toxin A injections for headache prevention and for chronic myofascial pain.
Wasser practitioners do carry out Botox injections and some dry needling on-site.
Neural stimulation therapies are used to treat chronic pain. Sacral nerve stimulation is used to treat interstitial cystitis and chronic vulvar pain with variable results and evidence. Spinal cord stimulation has been used for chronic low back pain also with evidence accumulating as to its effectiveness.
Implantible pumps, for instance, leading into the epidural space can be used to deliver opiates or other compounds in severe pelvic pain as well as other intractable regional pain syndromes. These therapies are available to Wasser patients on a limited basis at Toronto Western Hospital. Both intrathecal pump and spinal cord stimulation requires psychological screening and inpatient trials.
Destructive Neural treatments such as rhizotomy are sometimes used to treat neural pain. Radiofrequency lesions can be used to treat trigeminal nerve pain and other pains.
In some circumstances, surgery may be offered to manage chronic pain. This must be done judiciously and wisely.
Changes in lifestyle including exercise, weight loss, diet control, and smoking cessation are also important ways of reducing pain.