NEUROSURGICAL PAIN MANAGEMENT PROGRAM

Chronic pain is an exceedingly complex and multidimensional disorder requiring multidisciplinary care. The Neurosurgical Pain Management Program at MUSC offers comprehensive care for patients with chronic pain disorders, with special emphasis on the surgical management of medically-refractory pain problems (eg. failed back surgery syndrome, reflex sympathetic dystrophy, causalgia, spinal cord injury pain, post-herpetic neuralgia, phantom limb pain, and pain following stroke). Psychological evaluation and counseling are available to assist patients in dealing with the non-biological aspects of their pain. Under the direction of Dr. Duc, the Anesthesia Pain Clinic provides multiple non-operative therapeutic options including epidural steroid injections, nerve blocks, lidocaine infusions, etc.

The Neurosurgical Pain Management Program emphasizes treatment using implantable pain therapies such as spinal cord stimulation, peripheral nerve stimulation, deep brain stimulation, and intraspinal drug administration. Two special investigational studies concerning spinal cord stimulation are currently being developed and it is hoped that the first patients will be enrolled beginning in 2001. The first study involves the use of spinal cord stimulation in patients with medically intractable angina pectoris; the second study involves the use of spinal cord stimulation for patients with ischemic leg pain and/or ischemic ulcers due to non-reconstructible atherosclerotic peripheral vascular disease.

In addition to implantable pain therapies outlined above, the entire gamut of ablative surgical therapies is offered including cordotomy, midline myelotomy, dorsal root entry zone (DREZ) lesions, stereotactic ablative procedures (eg. midbrain tractotomy, thalamotomy, cingulotomy), peripheral neurectomy (neuroma surgery), dorsal root ganglionectomy, sympathectomy, and radiofrequency facet rhizotomy.

Not all patients are appropriate candidates for surgical treatment of their pain problem. Patients who are judged not to be candidates for surgical therapy may be candidates for the MUSC Chronic Pain Rehabilitation Program (CPRP) under the direction of Dr. William Kee, Ph.D. The CPRP is a multidisciplinary program that focuses on both the physical and emotional effects of pain. The ultimate goal is to return the patient to an active and productive lifestyle. Treatment is offered in both inpatient and outpatient formats according to the needs and desires of the individual patient. The typical treatment regimen consists of the following: physical therapy and exercise, occupational therapy to improve posture and facilitate body mechanics, relaxation procedures including biofeedback, group lectures to help patients understand the multiple aspects of chronic pain, individual counseling, and vocational rehabilitation when appropriate.

The Department of Neurological Surgery at MUSC is also a nationally recognized center for the comprehensive treatment of trigeminal neuralgia (tic douloureaux) as well as many other types of craniofacial pain. The Facial Pain Program provides special expertise in the surgical treatment of trigeminal neuralgia including microvascular decompression, percutaneous radiofrequency rhizotomy, glycerol rhizolysis, and balloon microcompression.

Patients with chronic intractable pain disorders may be referred to The Department of Neurological Surgery by calling 843-792-7700 between 8:30AM - 4:30PM. Appointments will be scheduled on Wednesdays between 8:30a.m. and 5:00p.m.