Therapy in Pain Clinic for Intractable Pain

-Nerve Block Therapy and Low Reactive Level Laser Therapy-

Abstract

We describe the therapies used in pain clinics, such as nerve block therapy and photo-therapy, for intractable, chronic, non-cancer pain. When starting these therapies, we first need to comprehend the pain that afflicts the patients. Secondly, we have to check the therapy that the patients have already received. There are various mechanisms that can induce intractable pain, therefore we believe that it is useful to elucidate the mechanisms using drug challenge test for the management of pain. However, we should recognize that the pain mechanism can be very complicated and that there are some cases in which the pain mechanism will not be elucidated even when we use drug challenge test. Various kinds of nerve block therapies, such as stellate ganglion block, epidural block, thoracic sympathetic ganglion block, lumbar sympathetic ganglion block and intercostals nerve block, etc., are used for the management of intractable pain. On the other hand, there are many patients who cannot be treated with nerve block because of old age, complication and bleeding tendency, etc. In these patients, photo-therapy including irradiation with a low reactive level laser, linear polarized near infrared radiation and xenon light, may be alternatively selected because these therapies rarely induce complications. If pain relief is not obtained using nerve block or photo therapies, other therapies should be considered either alone or in combination.