A technique called stimulation of the dorsal root ganglions implants the electrode in an area that sends the message to the brain.
Neuropathic pain occurs on peripheral nerves, for example, on the hands and feet, a neuromodulation technique recently arrived and brings hope to patients with one of the most difficult types of chronic pain: neuropathic. This type of discomfort occurs when the injury is on the nerves, marrow or in the brain itself.
Four out of ten people suffer from chronic pain, study says.
The new technique, called dorsal root ganglion stimulation, is indicated for cases of neuropathic pain in peripheral nerves.
Through it, the surgeon implants an electrode attached to a battery that generates stimuli for a part of the spinal nerve responsible for “passing the message” of pain to the brain. It is as if this region were blocked and ceased to send these signals.
The first type of surgery to be performed in Brazil is expected to take place in the next few weeks at the Hospital do Coração (HCor) in São Paulo and will be led by the neurosurgeon Guilherme Lepski, MD, and a free-teaching professor at the USP Medical School. He already does the technique in Germany, where he also teaches at the University of Tubingen. The Brazilian patient who will be operated on at HCor suffers from neuropathic pain caused by a sciatic nerve injury that generates pain and burning in the entire leg.
“Out of the country, I have been doing this technique for about five years. We did a survey of 62 patients in Germany where we saw their superiority compared to other patients,” he says.
New techniques for chronic pain
A problem that affects about 60 million Brazilians and growing because of the ageing of the population, chronic pain becomes the target of new therapeutic approaches that run away from conventional treatments made with medicines and rehabilitation. For the group of patients who do not improve with standard therapies, physicians and scientists have offered and studied techniques ranging from electrical stimulation of the nervous system to relieving pain to the application of the patient’s own stem cells in the injured region in search of regeneration.
Not all new approaches are regulated in Brazil, but even so, the so-called Interventional Medicine in Pain is already treated as a medical subspecialty in the country, with more than 300 members in the society created for this purpose.
“We can say that we have two large groups of techniques in this area: neuromodulation, which uses electric currents or infusion pumps to block the part of the nervous system that signals pain, and regenerative medicine in which substances or cells are used patient to cause a reaction in the injured tissue and, consequently, its consequent regeneration, “explains Fabrício Dias Assis, doctor of the Singular Pain Control Center and member of the executive board of the World Pain Institute.
In the list of alternatives, neuromodulation techniques are the most advanced, with many of them already regulated and practised in Brazil. Regenerative medicine is still mostly considered experimental by the Federal Council of Medicine.
Last week, Assis presided over the Congress of the Brazilian Society of Interventional Physicians in Dor (Sobramid), held in Campinas and focused on discussing the advances of studies in regenerative medicine.
“The mechanism of all regenerative therapies is similar: we inject mesenchymal stem cells (which give rise to bones and cartilage) from some tissue to stimulate the production of a new healthy tissue,” says Assis. Among the compounds used in these therapies are platelet-rich plasma (PRP), which comes from blood; the concentrated aspirate of bone marrow and adipose cells taken from the body fat itself.
In general, the techniques are indicated for patients with chronic pain from degenerative diseases of bones and joints, such as arthrosis.
A specialist in pain management at the Oswaldo Cruz German Hospital, Roberta Risso points out that these therapies are not yet used on a large scale because, although they have shown excellent results in the laboratory, they await more robust studies in humans. “In the future, we believe they can treat arthrosis without the need for prosthesis placement, but for the time being studies have failed to make the cells regenerate as needed, as we have seen in experiments in vitro, “the specialist said.
In addition, further studies would require specific regulation for the processing of these cells. After withdrawals, they need to undergo centrifugation or purification before being reinserted in the body, which calls for strict quality control and rules of the National Agency of Sanitary Surveillance (Anvisa).
While regenerative medicine continues in studies, therapies of neuromodulation, with more scientific evidence, have been used as an alternative for patients who do not respond to analgesics and physiotherapy.
“Neuromodulation includes procedures such as implantation of infusion pumps for drugs or electrodes to surgical procedures in which nerve roots are .”
– Says neurosurgeon Guilherme Lepski, a professor at the Faculty of Medicine of the University of São Paulo (FMUSP) and the University of Tubingen, Germany.
Experts explain that although these techniques have already been the subject of several studies that have proven their benefits, their offerings are still restricted to private clinics or public centres of excellence due to lack of capacity.
“The problem is that it has to be a specialized workforce,” Roberta says.
“The idea of a Brazilian Congress with this theme is precisely to bring international and national speakers who have experience in the subject to train more professionals with this look “, emphasizes Assis, for two years, looking for doctors and all type of professional that had some new technique for his problem.
The pain in the spine, which had only begun with a nuisance, began to take away the autonomy of the retired chemical engineer Hermelindo de Oliveira, 79. “At first, I only felt discomfort when I was standing for a long time. I was already having trouble getting out of bed alone, I could not drive anymore” he says.
Analgesic drugs and physiotherapy sessions were relieving the picture, but they did not bring a significant improvement.
“I was seen by an orthopedist, a physiatrist, a physiotherapist, an acupuncturist, I went to a lot of people, I took a folder and I was collecting the papers from all the professionals. Oliveira, who lived in a house, had to move house because of the difficulties he had to climb stairs. It was then that the elderly decided to seek an interventionist doctor in pain and try neuromodulation and regenerative medicine therapies to treat spinal pain.
He underwent a technique that uses radiofrequency to destroy part of the nerve that brings the sensation of pain. In addition, he underwent a prolotherapy – technique in which a solution of glucose is applied in the injured region, causing irritation in the area, which it takes the body to respond to the inflammatory process, thus regenerating the tissue.
“I had a recovery period after these procedures and now I do not have any more pain. I do my things, I paint my pictures. Now, finally I am well,” he says. Headache? Learn the possible reasons for your migraine.