Pain and Spasticity

The UW Multidisciplinary Pain Center was founded in 1978 by Dr. John J. Bonica and serves as a focal point and international model for patient care, research and teaching on all aspects of acute and chronic pain. Dr. John D. Loeser, a leading expert in the management of chronic pain and spasticity, heads the neurosurgical effort within this center. There are acute pain services at each of the University of Washington Affiliated Hospitals that are staffed primarily by anesthesiologists. Some chronic pain treatment occurs at each hospital as well, but the primary treatment facility for patients with chronic pain is the Pain Center located in the Roosevelt Clinic. This facility includes examination rooms, a block room and recovery room area, a superb exercise treatment center and rooms to permit patient education and other group activities. Physicians and psychologists from seven different departments, including Neurosurgery, Anesthesiology and Rehabilitation Medicine, participate in the Pain Center. In addition, there are nurses, physical and occupational therapists, vocational counselors and hospital-based support staff.

All types of chronic pain patients are seen at the Pain Center; most are seen by a single physician for diagnosis and management through a wide array of treatments including medical, physical, anesthesiological and neurosurgical strategies. Patients who have failed to obtain relief by standard treatments and who have become disabled by chronic pain are evaluated and treated by a multidisciplinary team of physicians, psychologists, nurses, physical and occupational therapists and vocational counselors. Many of these patients are placed in a three week, highly structured, intensive rehabilitation program that is aimed at reducing pain and disability and restoring patients to gainful vocational and avocational status.

UW Multidisciplinary Pain Center
http://www.uwmedicine.org/PatientCare/MedicalSpecialties/SpecialtyCare/UWMEDICALCENTER/MPC/

For more information on chronic pain and spasticity, please read the following primer:

Pain and spasticity are conditions that may result from a variety of diseases and disorders, including trauma, infection, multiple sclerosis, and cerebral palsy. While medications and physical therapy may help relieve the symptoms associated with pain and spasticity, surgery and other therapies may be used to treat patients.

Pain
Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage. The emotional component of pain is called suffering. Pain is familiar to everyone but is so complex and subjective that it cannot be easily described or treated. Pain is the body's mechanism of self-preservation. It acts as a warning to indicate harm or potential danger to tissues in our bodies. However, when pain persists or reoccurs over a long period of time (more than six months), it is said to be chronic pain. Because this pain is not protective and not a result of a continuing injury, it is "pathological" nerve injury pain and, therefore, treated as an end and not as a symptom.

More than 75 million Americans suffer chronic, handicapping pain. Approximately 75 to 80 million people in the United States are estimated to suffer chronic pain, and this is generally considered a conservative estimate. Chronic low back pain, for example, affects nearly 31 million Americans and represents the most common cause of disability in persons less than 45 years of age. Persons with chronic pain fall into two groups -- those with ongoing tissue injury, as occurs with cancer-related pain, and those without ongoing tissue damage, perhaps as a result of a previous injury.

Chronic pain can be a challenge to treat. Treatment regimens may include medications, surgical procedures and physical therapy. Neurosurgeons can sometimes treat chronic pain by augmenting or stimulating functional parts of the nervous system, especially the spinal cord. Candidates for such surgery must undergo an operation that consists of temporarily implanting an electrode over the tough membrane (dura) that surrounds the spinal cord. If successful, this electrode produces a pleasurable sensation that overlaps the regions of pain in the body. If it alleviates pain adequately, a permanent battery or "pulse generator" is connected and implanted surgically, much like a heart pacemaker. This generator can be frequently reprogrammed using a computer without resorting to further surgery. Other surgical options include a number of ablative procedures. Ablative operations involve creating a precise injury (or lesion) in the sensory portion of the central or peripheral nervous system that replaces the sensation of pain with numbness or tingling.

Spasticity
Spasticity is a condition in which certain muscles are continuously contracted. This contraction causes stiffness or tightness of the muscles and may interfere with walking, movement and speech. Spasticity is usually caused by damage to the portion of the brain or spinal cord that controls voluntary movement. It may occur in association with spinal cord injury, multiple sclerosis, cerebral palsy, anoxic brain damage, brain trauma, severe head injury, some metabolic diseases such as adrenoleukodystrophy and phenylketonuria. Symptoms may include hypertonicity (increased muscle tone), clonus (a series of rapid muscle contractions), exaggerated deep tendon reflexes, muscle spasms, scissoring (involuntary crossing of the legs) and fixed joints. The degree of spasticity varies from mild muscle stiffness to severe, painful and uncontrollable muscle spasms. The condition can interfere with rehabilitation in patients with certain disorders, and often interferes with daily activities.

Treatment of spasticity may include the following: baclofen, diazepam or clonazepam; muscle stretching, range of motion exercises and other physical therapy regimens to help prevent joint contractures (shrinkage or shortening of a muscle) and reduce the severity of symptoms; or surgery, including tendon release, selective dorsal rhizotomy (precise severing of the nerve-muscle pathway) and implantation of intrathecal (inside the sac of the spinal cord) catheters and pumps to deliver baclofen to the spinal cord.

Introduction | Aneurysms | Brain Mapping | Case Studies | Chiari Malformation
Congenital Abnormalities | Epilepsy | Movement Disorders | Pain and Spasticity
Pediatrics | Peripheral Nerves | Radio Surgery and Radiotherapy
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