What is Chronic Pain?

Pain lasting longer than three months is considered chronic. You might experience the pain continuously or intermittently. It has many different causes and can occur anywhere in your body. People may become so affected that they are unable to work, eat healthily, exercise, or enjoy life. It is a serious medical problem that needs to be treated.

According to recent research, chronic pain is still a major health issue for adults in India. According to a 2022 study that examined data from the Longitudinal Ageing Study in India (2017–2018), which involved 58,328 adults 45 years of age and older, almost 37% of them experienced discomfort often. The incidence rose with age, reaching 43.4% in people 75 years of age and older, and it was higher in women (41.4%) than in men.

About half of middle-aged and older persons in India reported joint pain, 31.7% claimed back pain, and 19.9% indicated ankle or foot pain, according to another analysis of the same dataset. Older persons, women, people living in rural areas, and people with less education were more likely to have these illnesses.

These results demonstrate the significant incidence of chronic pain in India’s adult population, especially among women and older adults, and its negative effects on day-to-day functioning and quality of life.

One of the most frequent conditions for which people seek medical attention is chronic pain. Approximately 20.9% of American adults (51.6 million) reported having chronic pain in 2021, according to a U.S. Centres for Disease Control and Prevention (CDC) study.

Your body uses pain as an alarm to let you know that anything is wrong. However, if that alarm keeps going off for months or years, it can overpower many of the things that make life enjoyable. Additionally, it can negatively impact your mental, emotional, and physical well-being. For this reason, getting treatment for chronic pain is crucial. Your medical professional and you can work together to create a strategy that will help reduce chronic pain.

Chronic pain continues to be a major medical concern that calls for innovative approaches to therapy that go beyond traditional medications and invasive surgery. By using powerful techniques like radiofrequency, ultrasound, and radiation to modify pain pathways without compromising the skin barrier, non-invasive lesioning techniques have become feasible substitutes. The processes, indications, effectiveness, and therapeutic uses of several non-invasive lesioning procedures in neurosurgery are thoroughly examined in this article.

A key component of neurosurgical therapy is pain management, especially for patients with cancer-related and refractory neuropathic pain. Traditional treatment approaches, such as medicine, physical therapy, and invasive neuromodulation, have drawbacks in terms of expense, procedural risks, and adverse effects.

Non-Invasive Lesioning Mechanisms

The precise energy delivery used in non-invasive lesioning procedures disrupts the brain networks linked to pain perception. Among the primary mechanisms are:

Thermal Ablation: Causes coagulative necrosis and is brought on by concentrated ultrasonography or radiofrequency waves.
Radiation-Induced Neuromodulation: Pain-conducting pathways are disrupted by targeted gamma radiation.
Low-intensity electromagnetic fields can modify neuronal excitability by electromagnetic modulation without causing irreversible structural damage.

Non-Invasive Lesioning Techniques

FUS, or focused ultrasound

Mechanism: Impacts specific neurological structures by producing heat through high-intensity sound waves.

Trigeminal neuralgia, neuropathic pain, and essential tremor are among the indications.

Benefits include accurate lesioning, real-time MRI guidance, and few adverse effects.

GKR, or Gamma Knife Radiosurgery

Mechanism: Causes delayed axonal degeneration by delivering large doses of radiation to certain brain regions.

Indications include cancer-related discomfort and trigeminal neuralgia.

Benefits include long-lasting pain alleviation, an outpatient treatment, and no incision.

Magnetic stimulation of the brain (TMS)

3. Magnetic stimulation of the brain (TMS)

Mechanism: Modulates cortical and subcortical structures via electromagnetic waves.

Indications include complicated regional pain syndrome, fibromyalgia, and neuropathic pain.

Benefits include non-invasiveness, repeatability, and patient response adaptation.

HF-SCS, or high-frequency spinal cord stimulation

HF-SCS, or high-frequency spinal cord stimulation

Mechanism: Uses high-frequency electrical stimulation to alter pain signals without producing a noticeable feeling.

Indications include failed back surgery syndrome and persistent back discomfort.

Benefits include being well-tolerated, reversible, and adaptable.

Safety and Clinical Effectiveness

Non-invasive lesioning approaches have been shown in numerous trials to be effective in lowering chronic pain scores and enhancing quality of life. Long-term statistics are still developing, though, and the response varies depending on the patient. Skin burns (FUS), radiation-induced alterations (GKR), and temporary neurological abnormalities are possible side effects, however they are uncommon in comparison to invasive procedures.

Prospects for the future

The accuracy and efficacy of non-invasive lesioning will be improved by developments in imaging, computational modelling, and biomarker-driven patient selection. New methods like thermal ablation mediated by nanoparticles and low-intensity focused ultrasound have the potential to advance pain neuromodulation research.

Non-Invasive Lesioning for Pain https://www.youtube.com/watch?v=eoL-A66yIIk&list=PLLAcpSdjdtd-dcgH9EXK1gyk1GtriOiyx&index=19

In conclusion

One innovative method in neurosurgical pain management is non-invasive lesioning for pain. These methods are a priceless addition to the neurosurgical toolbox because they use concentrated energy modalities to deliver long-lasting pain management with low procedural risk.

What is Chronic Pain?