Medical therapy must be maximized before a patient is a candidate for a pain procedure. Usually this requires escalating the dose of oral narcotic pain medications until the point that the pain is relieved or the side effects (usually somnolence or hallucinations) are intolerable (e.g. up to 300–400 mg/day of morphine sulfate-MS Contin may sometimes be necessary).
Non-pharmacologic interventions are often effective in reducing pain in the ED. However, most existing studies are small, warranting further investigation into their use for optimizing ED pain management 1).
Pain management following major intracranial surgery is often limited by a presumed lack of need and a concern that opioid analgesics will adversely affect postoperative outcome and interfere with the neurologic examination. Nevertheless, evidence in adults is accumulating that these patients suffer moderate to severe pain, and this pain is often under-treated.
The anterior cingulate cortex (ACC) is a structure involved in the affective component, and targeting it may relieve patients' pain.