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Chronic pain management

Townsend Letter for Doctors and Patients, Jan, 2005 by C. Norman Shealy

During my neurosurgical residency at the Massachusetts General Hospital, I was convinced that the neurosurgical approach to many chronic pain problems was unacceptable. At that time, Massachusetts General had a reputation as the center for intractable pain. (1)

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The major approach as either cordotomy or cingulotomy was an attempt to get around the word frontal lobotomy. I could see no future for either of these procedures in the management of chronic benign pain. Thus began over ten years of research into pain physiology. In 1965, I theorized that we should be able to control pain by stimulating the dorsal columns of the spinal cord and published my research paper on that in Analgesia and Anesthesia. (2) It was considered too controversial for the Journal of Neurosurgery. By the time I had done only six or eight patients, neurosurgeons were clamoring to be able to do this procedure, which I considered highly experimental. We set up a national dorsal column study group with the goal of inserting this glorified pacemaker-type equipment just dorsal to the spinal cord itself with a goal of following patients for five years before we could determine whether it was safe and effective. Unfortunately, two companies began marketing the procedure long before it reached its goal. This led to changes in the design of the electrode, which was not nearly as acceptable as our handmade electrode, and led me to discontinue the procedure on May 30, 1973. I have never recommended it or done it since that time. (3,4)

Meanwhile, it was obvious to me that vast majorities of people suffering from chronic pain were actually the result of unnecessary back surgery. In one study, I demonstrated that at least 80% of those who had had lumbar surgery for a presumed ruptured disc had not had a ruptured disc before their first surgery. (5) But by the time they had had between 5 and 7 unsuccessful back operations, they certainly were invalids. Meanwhile, I had introduced the concept of transcutaneous electrical nerve stimulation for relief of pain but I was never satisfied that any of the modern TENS devices gave the degree of pain control that the old Electreat[R], patented in 1919 by a Naturopath, C. W. Kent, gave. Interestingly, ten years ago after a return from the Ukraine where they were using microwave frequencies, I discovered that the Electreat[R] put out exactly the same strength as the Ukrainian devices and although it has a much broader band than the ones they were using, it does have the 54 to 78 billion cycles per second output at approximately 50 to 75 decibels. Thus, it led me to redesign and receive permission from the FDA to market the SheLi TENS[R]; the only one that I know that includes these frequencies, which according to Ukrainian nuclear physicists are the frequency of human DNA. (6,7)

Beginning in 1971, I focused my entire clinical work on management of chronic pain and over the next thirty-one years, treated some 30,000 patients with chronic, disabling pain. The majority were failures of back surgery but, of course, there are many other incapacitating chronic pain states ranging from migraine, chronic daily headache, various osteoarthritic pain problems, pain from compression fractures, sensory deprivation or deafferentation pain from major nerve or cord injury, rheumatoid arthritis and cancer.

As our work evolved in the 1970s, it became clear to me that we could easily teach a majority of pain patients how to control their pain using biofeedback, autogenic training and other similar approaches. From 1974 through 2002, our approach has included the following:

Acupuncture -- I began doing acupuncture in 1967. I considered it one of the most important tools for managing both acute and chronic pain. In the last few years, it has been our impression that the SheLi TENS[R] is more effective than acupuncture. That will be mentioned briefly below. The Ukrainian physicists believe that the Giga frequencies of 54 to 78 billion cycles per second are twenty times as effective as acupuncture needles.

TENS -- Even before we developed the SheLi TENS[R], the commercial TENS devices were of some benefit. (8,9) Properly used, about 50% of chronic pain patients can have their pain reduced 50 to 100%. Essentially, this means placing electrodes on either side of or above and below the site of pain, not directly over the site of pain. Since the advent of the SheLi TENS[R], we find that instead of needing to apply it 8 to 16 hours a day, most patients do very well with about 2.5 hours a day. If it does not work when properly applied around the area of pain, then application to the Ring of Earth is often effective, probably because this significantly raises calcitonin as we have reported. (10)

Biofeedback & Autogenic Training -- I began using biofeedback in 1972. We have found temperature biofeedback to be the most useful for two reasons. Pain and temperature travel in the same part of the spinal cord, the anterior spinothalamic tract. If you can learn to control temperature, you essentially have mental control over pain. We, therefore, teach patients to control the temperature of fingers and then transfer that skill to areas of pain.

Health Care Industry

Chronic pain management

Townsend Letter for Doctors and Patients, Jan, 2005 by C. Norman Shealy

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