A Global View of Evolving Pain Treatment Modalities: An Historical Perspective
by Fritz L. Jenkner, MD, FICS, FNYCS
 Over a period of 13 years, as head of the pain clinic Ambulatorium
Snd in Austria in the period 1976 to 1989, the author personally treated, on average,
3,800 new pain patients each year. Experience derived from the large volume of pain
patients (comprised of 4% benign diseases-various, 7% cancer pain, 10% sympathetic
dystrophies, 25% articular pain, and 54% neuralgias), the extended timeline, and numerous
intervening research projects, has given the author a unique perspective and an extensive
knowledge base. While the average pain reduction for all patients observed over the 13
years was 56%, evolving techniques over that time period resulted in the last 5,500
patients (including 3,000 private patients) experiencing an average pain reduction of 92%.
Treatments can be grouped into three basic strategies: procedures (to treat underlying
causes of pain), conservative measures (that comprises a continuum from PM&R to drugs
in the opiate- and morphine-derivative group), and operative measures. Ideally, a
practitioner should be able to freely select the optimum treatment modality for a given
diagnosis, yet due to resource limitations (especially in certain parts of the world),
alternatives can be used. Table 1 summarizes the three basic strategies together with the
resource requisites.
Procedures for Underlying Conditions
Pain associated with a specific disease or condition is often reduced or eliminated by
treating the underlying causes. Several examples illustrate pain-generating conditions
that, when treated, often reduces or eliminates associated pain.
Thalamic pain, often reported in the aftermath of a stroke, is caused by diminished
circulation through certain areas of the thalamus. A stellate block to increase the
circulation in that region, while not considered a method for pain reduction, does
eliminate the pain.1
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— Jul/Aug 2002
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