Paliatívna medicína a liečba bolesti Brožúra Liečba chronickej bolesti/2011

Invasive methods in the treatment of chronic pain

Invasive methods in the treatment of chronic pain are used as an adjunct to pharmacotherapy or as a last therapeutic option when other therapeutic procedures have failed. Invasive therapeutic techniques are classified into reversible and irreversible according to the temporal nature of their effect; diagnostic, prognostic and therapeutic according to the expected benefit; and single, repeated and continuous according to the nature of the administration of the active substance. In the last ten years, there has been a clear shift from irreversible and destructive invasive techniques to reversible procedures. Neurodestructive chemical and surgical procedures have been replaced with modern methods, neuromodulation in particular. The most commonly used agents still include local anaesthetics that are often combined with corticoids or opioids. Among the most recent agents designed to treat pharmacoresistant chronic pain is ziconotide, a substance delivered directly into the subarachnoid space by means of sophisticated programmable devices.

Keywords: invasive techniques, blockade classification, neuromodulation, sympathetic blockades, spinal blockades.