When you are able to grit your teeth through terrible pain, they call you stoic, tough—even brave—but what they don’t call you is content. No matter how high your pain threshold, chronic pain from an injury, an illness, or a long-term condition wears you down and has the potential to suck all the joy out of your life.
But pain is something plenty of us live with every day—50 percent of visits to primary care physicians are related to pain, with back pain being the most likely offender. But whether you suffer from back pain, arthritis, or cancer-related pain, there is hope for chronic pain sufferers in the form of new techniques and treatments, says Ricardo A. Cruciani, M.D., Ph.D., director of the Capital Health Center for Comprehensive Pain Management at its Institute for Neurosciences, which aims to customize treatment for its patients to alleviate their pain to the greatest degree possible.
While there’s a wide array of medication that’s traditionally been used to treat pain, Dr. Cruciani, a board certified neurologist and pain management specialist says he discovered early on in his career that some patients didn’t find relief from those options. “When I was doing pharmacology [earlier in my career], I started to realize all the limitations we had with our options for medications. That included opioids and analgesics, like antidepressants and anticonvulsants that we use for the management of pain,” he says. “I started to think of alternatives that could increase the scope of the strategies that we would have at our disposal.”
In 1995, Dr. Cruciani read an article about success doctors were having manipulating the brains of amputees who were experiencing phantom limb pain. “According to this article, in the patients with phantom limb pain, if you treat the pain, the pain goes down and then the area of the brain that had shrank when the patient lost the limb re-expands again. The article explained that changes in plasticity correlates with the improvement in pain. “Based on this, I started to wonder what strategies could be utilized to manipulate the cortex.”
One strategy, which Dr. Cruciani employs in the Center for Comprehensive Pain Management and Palliative Care is called Transcranial Magnetic Stimulation (TMS), in which the doctor uses a powerful magnet outside the head, which is oriented to the motor cortex in the brain while the doctor stimulates nerve cells in that area. “TMS has been shown to be helpful in several pain syndromes, including Complex Regional Pain Syndrome, some other types of neuropathic pain, including fibromyalgia. The beauty of this is that it’s noninvasive and is not addictive like opioids can be,” Dr. Cruciani says. “That’s why it’s a tool that we are trying to explore and we are offering to patients in order to stay away, as much as we can, from strategies that are more traditional.”
Another neurostimulation treatment Dr. Cruciani employs, called Transcranial Direct Current Stimulation, uses a constant, low current delivered directly to the brain area of interest, which essentially creates an electrical field. With the employment of both of these strategies, Dr. Cruciani says his patients are seeing improvement in their pain. “For a patient who comes in 5 days a week for 20 minutes to have the stimulation done, we see pain that started at an 8 on a scale of 0 to 10, goes to a 6, then it goes to a 4, and then it goes to a 2,” Dr. Cruciani says. “In addition, scrambler therapy that we recently acquired is another promising tool to treat chronic pain.”
While the degree of the decrease in pain has been variable, Dr. Cruciani says these treatments are consistently helping patients feel better. “If you think of someone that is having constant pain, from when they wake up in the morning until when they go to sleep at night, and you can give them a relief for 3 months, that’s a very good thing. These patients are very grateful for it.”