tic decisions and deliver medication for therapy in a more effective
way. While the technology has been in use for 20 years, it's now
becoming the expected standard."
Meanwhile, the use of ultrasound for administering blocks and injec-
tions is increasingly becoming standard as well, since it lets a physician
easily identify potential complications. "In some cases, the two
machines are used simultaneously," says Dr. Kramer.
Both technologies have made the use of blocks safer, and this is
important, since a nerve block can open additional avenues for a
chronic pain sufferer. If a patient experiences relief via a diagnostic
block, for example, she may be a candidate for radiofrequency abla-
tion (RFA), a minimally invasive procedure in which heat is applied to
a nerve via a probe in order to disrupt that nerve's pain signal. This
temporary treatment will ward off the patient's pain until the nerves
grow back in 6 to 12 months.
Recently, improvements to the technology — namely, a cooling
mechanism — have expanded its scope. During cooled radiofrequen-
cy ablation, cool water is run through the tip of the probe, allowing a
physician to heat a greater area of tissue without charring it and caus-
ing additional pain. In other words: "This gives you a better chance of
ablating the nerve you're intending to ablate," says Dr. Kramer.
"They've basically improved upon technology that's been used for
spinal arthritis for more than 20 years, making it applicable to pain in
the joints as well."
New neurostimulation
Three therapies — spinal cord stimulation, peripheral nerve stimula-
tion and pain pumps — reduce pain without extensive surgery. Some
of the most exciting advancements in the treatment of chronic pain
are in the area of neurostimulation. During a minimally invasive pro-
1 0 6 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • J U N E 2 0 1 7
