Management of chronic pain

Techniques: Spinal cord stimulation, intrathecal drug delivery systems, lesions – open cordotomy and DREZ, Deep Brain Stimulation.

Indications: chronic neuropathic pain; chronic non-malignant pain, including refractory low back pain 

Cancer pain – Treatment for the primary condition, lesions and intrathecal drug delivery systems.

Outcomes are viewed as critically important and over the years the neurosurgical service has several publications to attest to this.

 

Trigeminal neuralgia and other facial pain

There is a major interest in the management of trigeminal neuralgia, and The Walton Centre has an international reputation for this, evidenced by many publications on the subject.

Trigeminal neuralgia is managed by the neurosurgeons who will deliver microvascular decompression as first line treatment, medical management, foramen ovale procedures and stereotactic radiosurgery. It is the only instance in the UK where all treatments are delivered by one service. There is a further interest in other neuralgic pain due to compression syndromes, including hemifacial spasm, tinnitus, otalgia, glossopharyngeal neuralgia.

A joint facial pain clinic is run with pain medicine for cases of diagnostic difficulty; for trigeminal autonomic cephalgias – including cluster headache – occipital nerve stimulation is provided, and for some difficult facial neuropathic pains deep brain stimulation may be appropriate.

 

Many of these techniques involve implanted devices – these are supported on a day to day basis by a team of specialist nurses and physiotherapists working for the neuromodulation service with close support and supervision from the neurosurgical service. There is an intrathecal drug delivery system pump refill clinic, spinal cord stimulator clinics and deep brain stimulation clinics.

Approximately 80-100 spinal cord stimulators are placed every year, 30-40 deep brain stimulators, and 15-20 drug delivery systems; at any one time the cohort of patients being looked after is around 800 stimulators, 100 pumps and 200 deep brain stimulators.

           

Members of the team 

Neurosurgeons 
Prof Paul Eldridge and Mr Jibril Osman Farah, two functional fellows are engaged with all these areas – collaborations exist according to the indication for implantation.


Multidisciplinary working is undertaken:

Pain medicine and neuropsychology consultants for chronic pain

Dr M Sharma
Dr A Goebel
Prof T Nurmikko
Dr B Frank
Dr R Chawla
Dr P Murphy

Cancer pain
Dr Huegel
Dr M Sharma
Dr Coackley
Dr R Chawla

Epilepsy
Dr A Nicolson (Deep brain stimulation and vagal nerve stimultion)

Headache
Dr N Silver

Nurse specialist primarily dealing with pain
A Cox
A Stockley

Physiotherapy and chronic pain
S Johnson
M Draper

Deep brain stimulation for movement disorders
L Westmorland - Tel. 0151 529 8009 or 0151 525 3611 Bleep 5336
B Hammersley