Pain can be classified according to pathophysiology (e.g. nocieptive or neuropathic pain), etiology (e.g. post operative or cancer pain), or the affected area (e.g. headache or low back pain) Nocipceptive pain is caused by activation or sensitization of peripheral nociceptors, specialized receptors that transduce noxious stimuli, Neuropathic pain is the result of injury or acquired abnormalities of peripheral or central neural structures.

Acute pain can be defined as pain that is caused by noxious stimulation due to injury, a diseases process, or the abnormal function of muscle or viscera. Chronic pain is defined as pain that persists beyond the usual course of acute disease or after a reasonable time for healing to occur, this period can vary from 1 to 6 months. Chronic pain may be neuropathic, nocipceptive or mixed. Modilation of pain occurs peripherally at the nociceptor, in the spinal chord, or in the supraspinal structures. This modilation can either inhibit or facilitates pain. Moderate to sever acute pain, regardless of cite, can affect nearly every organ function and may adversely influence post operative morbidity and mortality. Neural blockade with local anesthetic can be useful in delineating pain mechanisms but more importantly, it plays a major role in the management of patients with acute and chronic pain. The role of sympathetic system and its path ways can be evaluated. Spinalchord stimulation is most effective for neuropathic pain. Proposed mechanisms include activation of descending modulating systems and inhibatioin of sympathetically outflow. Accepted indications include sympathetically mediated pain, spinal chord lesions with localized segmental pain, phantom limb pain due to peripheral vascular disease, and adhesive arachnoiditis.

Studies shows that patient-controlled analgesia (PCA) is a cost effective technique that produces superior analgesia with very high patient satisfaction. Total drug consumption is less, compared with intramuscular injections. The routine use of a basal infusion is controversial. The administration of local anesthetic -opioid mixture neuraxialy which is particularly epidurally through epidural Needle is an excellent technique for managing post operative pain following abdominal,pelvic, thoracic, or orthopedic procedures on the lower extremities. Patients have better preservation of pulmonary function, are able to ambulate early and benefit from early physical therapy. Patients may be at lower risk for post operative venous thrombosis. Epidural or intrathecal catheters can be placed percutaneously or implanted to provide long term effective pain relief. Tunneling the catheter reduces the risk of infection. Epidural catheters can be attached to light weight external pumps that can be worn by ambulatory patient.

Spinal Needle  can be used in:

  • cervical paravertebral nerve block
  • thoracic paravertebral nerve block
  • lumber paravertebral nerve block
  • trans-sacral nerve block
  • pudendal nerve block
  • thorasic sympathetic chain block
  • Celiac Plexus block
  • ganglion impar block