The Metro Spinal Clinic (MSC) began using Peripheral Nerve Field Stimulation (PNFS) in 2006 for the treatment of chronic intractable pain. PNFS has been found to be a safe, reversible and cost-effective alternative to traditional analgesic and surgery options. Our initial data was encouraging,^28;29 and this data has since been verified by subsequent data.

All procedures have the potential to either not work or produce side-effects. The inherent risks of each procedure should be understood. These are outlined in the description provided for each procedure. However, the best way to investigate these issues further is by discussion with the practitioner involved inthe procedure. Additionally, any procedure performed by lcinicans at a MPC are outlined by one of the team of nurse practitioners, who will go through a check list that includes the identification of any pertinent health risk, a description of the procedure itself inlcuding its goals, and an outline of the potential risks.

The major risk of any needle procedure is infection. The risks of infection are minimised by the use of sterile protocols. The other substantial but temporary side-effect is post-procedural pain. This can be managed by the use of adequate rest, the application of soothing applications inlcuding heat and/or ice, and by medications. 

Epidural injection provides an alternative to analgesia or surgical treatment for the management of radicular pain caused particularly by disc prolapse or canal stenosis. In this procedure, a combination of a steroidal anti-inflammatory agent and local anaesthetic is injected near the site of nerve irritation.

Epidural injection may be delivered by interlaminar, caudal or transforaminal approaches. In the management of pain these procedures should be performed under x-ray guidance with the use of contrast to accurately delineate the flow of the introduced medicine.

Botox for treatment of migraine

Botox® is the registered trade name for botulinum toxin A, which is a toxin that is derived from bacteria and used in a purified form to cause local muscle paralysis and probable inhibition of local pain sensors (nociceptors). It has traditionally been used as a cosmetic agent to reduce facial wrinkles and as a treatment for abnormal muscle conditions such as dystonias and torticollis. It was noted that patients who had cosmetic treatment for frown lines and who had migraine not only improved cosmetically but also noted a trend for improvement of their migraines. After further studies, Botox now has an approved role in the management of migraine. 

Botox Treatment for Chronic Pain - Patient Information Booklet

Headache Pre-Assessment Card

Patient Injection Diary

Neuromodulation is the selective application of a programmable pulse waveform through a series of electrodes within a lead to stimulate sensory nerve fibres and subsequently reduce the perception of pain.⁶ This treatment is most indicated in cases of severe localised pain, intractable to analgesics and other conventional therapies.

Electrical stimulation for the treatment of pain was first used in the late 19 century.⁶ Spinal cord stimulation (SCS), in which leads are placed onto the sensory pathways of the spinal cord, have been used in the management of pain since the 1960s, subsequent to the publications by Melzack and Wall⁹ and Shealy et al.¹⁶

Nucleoplasty Percutaneous Disc Decompression is a recent scientific advance in minimally invasive intra-disc needle intervention for the treatment of discogenic back pain as well as sciatica derived from contained disc protrusion.

The procedure uses a thin catheter to create an accurate one-millimeter pathway into the disc. Normally, the entire procedure takes 20 to 30 minutes. Nucleoplasty percutaneous disc decompression is designed to offer a fast-acting option when conservative therapies are leading nowhere, on the one hand, and a minimally-invasive alternative to open surgery, on the other.

Spinal cord stimulation (SCS) involves delivering a low voltage electrical impulse to the spinal cord to block the sensation of pain. It is a treatment generally reserved for severe intractable pain including lower back, pelvic and leg pains that have not responded to the usual conservative treatment, and also for chronic neuropathic origin.⁵ Conditions typically treated by this modality include failed back surgery syndrome, complex regional pain syndrome, phantom limb pain, and some cases of intractable abdominal or visceral pain.

Effectiveness has also been demonstrated in cases of angina, ischemic limb pain and diabetic neuropathy.³ The literature shows that spinal cord stimulation can produce at least 50% pain relief in 50 – 60% of patients with diagnosed failed back surgery syndrome.³ When proper follow-up is provided, these results can be well maintained over several years.³ The procedure has a relatively low risk of complications,⁷ and, despite large initial expense, has been shown to be cost effective over the lifetime of the patient.⁶

Neuromodulation by SCS and stimulation systems works by creating a paraesthesia (experienced as numbness or a tingling sensation) that covers the patient’s pain distribution. This is achieved by implantation of one or more leads containing electrodes onto the spinal cord. The implantation procedure is non-destructive, relatively simple and completely reversible.