When pain won’t go away

Tuesday 1 September, 2015

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On this page: Epidural or spinal medicines | Nerve block | Other pain relief methods


Sometimes pain can be difficult to relieve completely with medicines. In these situations, your doctor may suggest you see a pain medicine specialist in a multidisciplinary pain clinic. They may recommend the following therapies.

Epidural or spinal medicines

Sometimes to control pain, morphine is used in such high doses that severe side effects can occur. However, delivering the morphine directly onto the nerves in the spine via a tube (catheter) causes fewer side effects. Other drugs can also be added to improve pain control. Spinal medicine can be given in a number of ways:

Tunnelled spinal catheter

A small tube put in the space around the spinal cord and then tunnelled out to the body’s surface through the skin. The tube is attached to an external syringe pump, which delivers the medicine (e.g. anaesthetic and/or opioid). Medicine may be delivered in a single dose, as a continuous infusion, or using a combination of these methods.

Port-a-cath spinal system

The tunnelled catheter is attached to the skin of the chest or abdomen through an opening (port), which allows needles and bags of pain relief to be inserted. Usually a nurse needs to replace the bags every 1–2 days.

Tunnelled spinal catheter and pump

The catheter is connected to a pump that is implanted in the fatty tissue of the abdominal area. The pump is refilled every three months with a needle through the skin into the pump’s port.

Nerve block

Injecting a local anaesthetic into or around a nerve will stop that nerve from sending (transmitting) pain messages. This is called a nerve block, and the effect is temporary. There are different types of nerve blocks. Sometimes nerves to part of the bowel or pancreas can be blocked to provide pain relief, especially in pancreatic cancer. This is called a coeliac plexus block.

Other pain relief methods

Your specialist may suggest one or more of the following options:

Intensive cognitive behaviour therapy (CBT)

A talking therapy that guides people to change the way they cope with the pain and to resume normal activity as much as possible.

Desensitisation 

Apsychological technique that involves focusing on the pain and relaxing at the same time; it is used for neuropathic pain (e.g. numbness or tingling).

Specialised physiotherapy

Helps reprogram the brain (e.g. dealing with phantom limb pain after an amputation).

Radiofrequency ablation (RFA)

Uses heat to destroy the nerves causing pain.

Neuromodulation treatments

Uses electrical pulses to change nerve activity; the pulses cause the body to release a substance that stops feelings of pain from nerve damage (e.g. after surgery, chemotherapy or radiotherapy, and for non-cancer causes).

Surgery to the brain or spinal cord

In rare cases, you may have neurosurgery to relieve pain. 


Reviewed by: Dr Melanie Lovell, Clinical Ass Prof, Medicine, Northern Clinical School, Sydney Medical School, University of Sydney, and Palliative Medicine Consultant Physician, Greenwich Hospital, NSW; Nathaniel Alexander, 13 11 20 Consultant, Cancer Council NSW, NSW; Anne Booms, Palliative Care Nurse Practitioner, Canberra Hospital, ACT; Dr Roger Goucke, Consultant, Department of Pain Management, Specialist Pain Medicine Physician, Sir Charles Gairdner Hospital, and Clinical Ass Prof, School of Medicine and Pharmacology, University of Western Australia, WA; John Marane, Consumer; and Dr Jane Trinca, Director, Barbara Walker Centre for Pain Management, St Vincent’s Hospital, VIC.

Updated: 01 Sep, 2015