Pain Including Trigeminal Neuralgia

A careful review of your symptoms and high-resolution 3T MRI scan focusing on the trigeminal nerve and nearby blood vessels can help your surgeon determine if a microvascular decompression may help with your facial pain. If a blood vessel may be the cause of your trigeminal neuralgia, both endoscopic and microscopic techniques can be used to decompress your trigeminal nerve to provide long-term benefit for your facial pain.

Though for many patients, microvascular decompression can provide the best long-term benefit for facial pain, there are many patients who choose to not undergo this treatment. This may be due to other conditions, such as multiple sclerosis, which would not be amenable to microvascular decompression, or due to a personal choice to pursue a less invasive option. For these patients, we have extensive experience in both radiofrequency ablation of the trigeminal nerve and balloon compression of the trigeminal nerve. Both of these techniques can provide immediate relief of pain from trigeminal neuralgia which will likely last for several years. Both these procedures are outpatient procedures which take about an hour in the operating room.

For patients who desire the least invasive option for the treatment of trigeminal neuralgia, we offer expertise in both Gamma Knife and CyberKnife radiosurgery. These outpatient procedures deliver a focused dose of radiation to the trigeminal nerve, and can provide symptomatic relief for those who are not candidates for microvascular decompression or percutaneous approaches.

Some facial pain conditions like trigeminal neuropathic pain may not respond to either microvascular decompression or percutaneous interventions. For this subgroup of patients, peripheral nerve stimulation can provide an effective and minimally invasive option for treating facial pain. Our team has a large clinical experience with craniofacial neuromodulation, and has participated in multi-center clinical trials studying peripheral nerve stimulation for refractory facial pain.

A broad range of complex pain conditions may be effectively treated through the electrical stimulation of the spinal cord. Recent, well-designed clinical trials have demonstrated the effectiveness of spinal cord stimulation in significantly reducing chronic back and leg pain. Spinal cord stimulation can be trialed using minimally invasive techniques to determine if this is an effective long-term therapy for the management of your pain condition. Both percutaneous and paddle-type electrodes can be used and are usually performed as outpatient procedures.

Increasing evidence has shown the spinal dorsal root ganglion to be an important structure in the development of chronic pain related to nerve injuries and complex regional pain syndrome. Targeted stimulation of this structure can provide relief to patients suffering from intractable knee pain, inguinal pain, and other focal pain syndromes. Like spinal cord stimulation, this is a therapy which can be trialed through a minimally invasive approach. Patients who have a positive trial can then undergo implantation of the permanent stimulator and battery.

Intrathecal drug delivery is another valuable technique in the treatment of spasticity, chronic pain conditions and pain related to cancer. This therapy can also be trialed using minimally invasive techniques to determine if intrathecal drug delivery may be a positive long-term intervention to restore your functionality. Through collaboration with our Physical Medicine and Rehabilitation and Interventional Pain Management, we can provide the optimal multidisciplinary care to trial and manage this therapy for our patients.

The majority of pain travels in the spinal cord in a pain pathway named the spinothalamic tract. In patients who suffer from a focal pain due to cancer, interruption of the spinothalamic tract in the neck can provide immediate and meaningful pain relief. The procedure is performed in an operating room equipped with a CT scanner and an anesthesiologist present to ensure patient comfort. As the procedure is performed percutaneously (with a needle), it can be performed at any time during cancer treatment and at any stage of illness.

Visceral pain is one type of pain which does not travel in the spinothalamic tract. Visceral pain, like the pain due to pancreatic cancer or rectal cancer, travels in the dorsal columns visceral pain pathway. As with cordotomy, we are able to surgically interrupt this pain pathway in the spinal cord for patients with intractable pain due to abdominal and pelvic tumors. The procedure can either be performed through a short spine operation or in some cases may be performed percutaneously without an incision.

For patients with craniofacial tumors, pain can often reduce the quality of life substantially. For patients who have not obtained relief from the use of pain medication and cancer therapies, selective procedures to interrupt pain signals in the spinal cord can be used. By placing a needle in the neck, we are able to accurately and safely reduce pain transmission due to tumors affecting the head and neck.