Latest Advances in Pain Management

A Keck Medicine of USC pain management specialist discusses how minimally invasive procedures are changing the way doctors manage pain.

Managing pain once meant alternating between two extremes: On one hand, maybe you took a couple aspirin and hoped to feel better in the morning; on the other, after seeking opinions from several specialists, you scheduled surgery. 

According to Jeffrey Lin, MD, a pain management physician with the USC Pain Center, part of Keck Medicine of USC, pain management today relies on highly targeted, minimally invasive precision therapies, bridging the gap between conservative medical treatment and major surgery that carries lots of promise but also pain risks of their own. 

What are the types of pain? 

“An important first step in deciding how to treat pain,” Dr. Lin says, “is understanding what kind of pain a patient is experiencing.” Pain specialists categorize physical pain into three broad classes: 

• Nociceptive pain: The most common type, nociceptive pain arises when sensory receptors called nociceptors detect actual or potential tissue damage. “Your nerves are telling your brain, ‘Hey, something happened here,’” Dr. Lin says. Nociceptive pain might feel dull, achy, sore or throbbing. Examples include scraping your knee or arthritis pain. 

• Neuropathic pain: Neuropathic pain is more chronic and occurs when the nervous system itself is damaged or diseased. Diabetic neuropathy, sciatica and shingles pain fit this description. “Patients often describe neuropathic pain as tingling, burning, pins-and-needles, stabbing or electric,” Dr. Lin says. 

• Nociplastic pain: More recently, physicians have characterized something called nociplastic plain. “Think of it as when pain pathways themselves are altered or damaged,” Dr. Lin says. Complex regional pain syndrome, fibromyalgia, tension headaches and irritable bowel syndrome all involve nociplastic pain. 

How is pain management improving?

“Now that we’re classifying pain,” Dr. Lin says, “we’re learning about which treatments work best for which kinds.” And in many cases, those treatments are less invasive than they used to be. 

Current approaches to back pain illustrate this. For instance, the radiating numbness, tingling and weakness associated with sciatica are often symptoms of radiculopathy, which occurs when the spinal nerves are compressed or damaged. “We can inject an epidural steroid around that area to calm down the inflammation of that nerve and ease the pain,” Dr. Lin says. “However, more recently, we’ve been offering a minimally invasive lumbar decompression procedure at Keck Medicine that lets us remove thickened ligaments pressing on nerves to provide further relief from radiculopathy.” 

When disc degeneration causes inflammation and pain near the vertebra, a relatively new minimally invasive procedure known as an Intracept can direct radiofrequency energy at the basivertebral nerve, blocking its ability to send pain messages to the brain. Similarly, doctors can implement radiofrequency therapies to stop pain signals from arthritic and painful joints. And for patients with pain from an acute spinal fracture, a procedure called a kyphoplasty lets doctors insert an X-ray-guided needle into the broken bone, where it inflates a balloon and opens a space where the doctor can inject a bone cement that acts as an internal cast to help with pain and stability.  

Many of these techniques and technologies have applications beyond the back, Dr. Lin emphasizes. He’s optimistic about the potential of neuromodulation — using electrical, magnetic or chemical stimuli to alter neural activity in the nervous system — for alleviating not just back pain but pain throughout the body. Doctors use next-generation devices like peripheral nerve stimulators, dorsal root ganglion stimulators and spinal cord stimulators to generate precise signals that calm irritated nerve pathways and interrupt chronic pain signals before they can reach the brain. They are smarter and more customized than ever before, allowing physicians to adapt therapy in real-time to the patient’s unique nervous system.  

“We’ve seen it work well,” Dr. Lin says. “It’s been a rapidly growing field that’s fascinated me because we can now provide more minimally invasive options to people who haven’t gotten relief from what was available in the past.” 

Research is also exploring pain pathways at a molecular level. “Can we identify which inflammatory markers and genes are involved in pain?” Dr. Lin asks. “If we can target those specific genes and markers, we can expand our armamentarium of treatment options.” 

Addressing pain’s social and psychological effects

But while pain physicians focus on understanding the disease processes and biological factors involved in pain, they also recognize its psychological and social components. “At Keck Medicine, we’re lucky to have resources like pain psychologists, physical therapists and occupational therapists to help address those aspects,” Dr. Lin says. 

Keck Medicine’s Lifestyle Redesign program helps patients build habits and strategies around sleep, stress, diet and social support to improve comfort and quality of life. As Dr. Lin stresses, “We have to do better than change the number on a pain scale. We have to show that we’re improving patients’ lives.” 

And more treatments are on the way. “A lot of what we do to help patients today didn’t exist five or six years ago,” Dr. Lin says. “So having Keck Medicine engage in clinical trials is also very important. We’re all trying to move the field forward.” 

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Kimberly Decker

Kimberly J. Decker is a freelance writer for Keck Medicine of USC

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