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.
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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.
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 – a psychological 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.