Painless Pain Treatments
Painful treatments are over! Today we have several approved painless methods and therapies so that no one needs to worry about going to the doctor anymore. Of course, the pain treatments providing the treatment needs to have the necessary specialist knowledge and the appropriate technical equipment at hand. In our practice we offer a choice between different anaesthetic methods: apart from the most frequently applied local anaesthesia you can also decide on sedation. You will see: your treatment will be over before it even started!
The most common method of pain relief is the traditional use of 'on demand' intramuscular opioid or NSAI injections. Better pain relief can be obtained with newer techniques such as epidural, local opioids, anasthetics, steroids and patient controlled analgesia. However, some techniques such as pre-emptive analgesia have not been fully evaluated and others, such as infiltrating local anaesthetic into wounds, may not reduce the patient's analgesic requirements. Patients should be counselled before surgery because an explanation of what to expect, and other simple measures, may reduce their analgesic needs.
Radiofrequency neurotomy (also called radiofrequency ablation or lesioning) is a minimally invasive procedure that can provide lasting relief to those suffering from facet joint pain. In fact, multiple clinical studies show that radiofrequency neurotomy significantly reduces pain severity and frequency for 1 to 2 years in the majority of patients.
Flexibility is the skill that enables us to perform the movements in a big range in the joints. The maximum development of flexibility is not necessary. The most significant is the mobility of the dorsal segment of the spine, the hip and the shoulder joints. The factors that affect flexibility are; the elasticity of muscles and joint ligaments; the amount of the resting tension of the muscles; relaxation skills; technical skills; outdoor temperature, time of the day.
Cryosurgery and Pain Treatment
The analgesic effect of cold was first recorded by Hippocrates. Early physicians such as Avicenna used cold for preoperative analgesia. Robert Boyle published a classic monograph nearly three hundred years ago entitled "New Experiments and Observations Touching Cold". In 1851, Arnott reported the application of cold in relieving cancer pain. Smith and Fay in 1939 reported finding regression of tumor following localized freezing. The first cryoprobe was developed by Cooper and colleagues in 1961. Subsequently, Amoils developed a more practical enclosed gas expansion cryoprobe that operated based on the Joule-Thompson principle. In the early 1970's, the concept of therapeutic peripheral nerve freezing was reintroduced by Nelson, Brain, Lloyd and others. Lloyd and coworkers in 1976 used this method for pain relief and coined the term "cryoanalgesia". Additionally the technological advances which have caused renewed interest in cryosurgery are the development of intraoperative ultrasound to monitor the therapeutic process and the development of new cryosurgical equipment designed to use supercooled liquid nitrogen. The thin, highly efficient probes, available in several sizes, can be placed in diseased sites via endoscopy or percutaneously in minimally invasive procedures. The manner of use is to place the probe in the desired location in the diseased tissue with ultrasound guidance. If required by the size or location of the tumor, as many as five probes can be inserted and cooled to -195 degrees C simultaneously. The process of freezing is monitored by ultrasound which displays a hypoechoic (dark) image when the tissue if frozen. Rapid freezing, slow thawing, and repetition of the freeze/thaw cycle are standard features of technique. Clinical applications which have become common in the past 4 years include the treatment of prostatic cancer and liver tumors. The cases selected for cryosurgery are generally those for which no conventional treatment is possible.
Technology of Cryosurgery
Using different sized cryoprobes to create different sized "iceballs" necessary for smaller or larger tumors. Cell death starts at -20°C. Holding the temperature below -20°C for some duration,depending on the cell type, allows intracellular changes to occur and cell destruction to adequately take place. Effective Cryosurgery • Tissue temperature changes must be extremely fast (50-100°C/min). • Final temperature of tissue cells must be colder than -20°C. However, especially in prostatic cancer, the operative morbidity is so low and the results of therapy are sufficiently good in the short term to merit consideration of use in earlier stages of the disease. Diverse tumors in other sites, such as the brain, bronchus, bone, pancreas, kidney, and uterus, have also been treated in small numbers by cryosurgery. Judging from this experience, further expansion in the use of cryosurgical techniques seems certain.