The treatment of acute and chronic pain is challenging. The Department of Anesthesiology Division of Pain Management provides acute pain services 24hrs a day for the management of postoperative epidurals and peripheral nerve sheath catheters. In addition, patients with difficult chronic pain problems are managed with modalities such as dorsal column stimulators, morphine pumps, neurolytic blockade, many different types of nerve blocks and pharmacologic methods. Signs and symptoms include pain, hyperesthesia, vasomotor and sudomotor disturbances, and increased muscular tone followed by weakness, atrophy, and trophic changes involving the skin, and its appendages, muscles bones, and joints. Once established, the entire syndrome will continue even after the direct cause of the syndrome has healed or disappeared.
Therapy needs to be instituted as soon as possible.
Otherwise, the syndrome may reach a point where it becomes irreversible. Abdominal and pelvic pain associated with cancer are particularly difficult to treat. These long-term epidural infusions can be used not only for abdominal and lower extremity pain, but also thoracic pain. The localization of the opiates in the epidural space decreases the systemic side effects we frequently see with intravenous or oral opiates. Cervical plexus, intercostobrachial, intercostal, and epidural blockade can be initiated to provide relief.