CAPTION: Orlando Charry, MD, performs a fluoroscopically guided epidural steroid injection for spine-related back and leg pain at the Fairview Pain & Palliative Care Center.

By Miles Belgrade, MD, Fairview Pain & Palliative Care Center, University of Minnesota Medical Center, Fairview

A 19-year-old woman was admitted to the Fairview Pain & Palliative Care Center (PPCC) at University of Minnesota Medical Center, Fairview, for a hemipelvectomy due to osteogenic sarcoma in her right hip. Morphine and other systemic drugs could not adequately control her severe pain at the surgical wound and in her perineum area. Applying new research on upregulation of opioid receptors on inflamed peripheral tissues, the inpatient pain service recommended application of morphine in a topical gel to the pain site. This measure substantially controlled her pain and reduced the amount of systemic opioid she needed.

Pain specialists once taught that pain was a subjective experience. Over the past 10 years, however, researchers have made dramatic advances in measuring pain objectively, combining real-time imaging of brain blood flow and metabolism with advanced techniques such as functional MRI and PET scanning. In addition, scientists have made significant advances in understanding where pain resides in the brain and nervous system and what happens to allow pain to amplify. Research also has contributed to technical advances in pain management.

The 10-year-old PPCC is a comprehensive, interdisciplinary entity comprised of neurologists, physiatrists, family medicine specialists, pharmacists, nurses, psychologists and physical therapists. These professionals work together in multiple settings to manage the whole spectrum of pain, including pain from cancer

and chronic neuropathic and musculoskeletal conditions.

The PPCC collaborates with University of Minnesota neuroscientists-experts in pain research-to translate their findings to the bedside. Recent developments include:

• The synergy of opioid analgesics with other drugs exponentially increases their analgesic effect in the laboratory. We have achieved dramatic results with patients by using dexmedetomidine (Precedex®) to rapidly reduce narcotic requirements in medically complex patients showing opioid-induced hyperalgesia (increased refractory pain caused by high-dose prolonged use of opioids).

• Research demonstrates individuals are able to train themselves with biofeedback and functional MRI to reduce the activity in pain areas of the brain, thereby reducing the experience of pain. We are using such mind-body techniques to retrain the brain to normalize its responses to pain. This ensures patients will acquire the knowledge, skills and confidence to manage their pain for the long-term.

• The measured use of interventional techniques, such as spinal stimulation and intraspinal drug administration with opioids, clonidine or ziconotide in carefully selected patients, allows Fairview PPCC patients to achieve the most advanced pain treatments possible. 

For more information, clinicians may contact Belgrade at 612-273-9925, mbelgra1@fairview.org.

The Fairview Pain & Palliative Care Center was designated a Clinical Center of Excellence by the American Pain Society in March, one of six centers to receive this award in 2008. There are only 12 such clinical centers of excellence nationwide.

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