The Difference Between Evolutionary and Revolutionary Pain Management

Pain management has evolved substantially over the last 15 years. Completely new technology has come into existence but there has also been improvements on existing technology. This includes such things as new ways to do injections, new methods of spinal manipulations, along with new machines such as radiofrequency ablation.

When looking at the changes in pain relief treatments some have been evolutionary while others have been revolutionary. The difference is as follows. Evolutionary means you take an existing technology and changed it to make it better. Revolutionary technology are things that come along that did not exist before. If these work and provide excellent outcomes for patients in pain, then it is truly a revolutionary technology and can also be termed a "disruptive" technology.

Let's look at a few of the evolutionary technologies in pain management. Sixty years ago epidural injections first were invented. These were done as intra-laminar procedures and this technique still exists to this day. Results are over 75% excellent for patient relief and they can be great at avoiding surgery.

Over the last 10 years however, transforaminal epidural injections have become much more common and this evolution in technique has provided for the ability to place the steroid medication much closer to the area of the pinched nerve. So it's not a new technology, it just represents a nice improvement over the previous technique.

Another evolution in pain treatments is the type of medications that are used to provide pain relief. First is that there are steroids now that do not have as much of a particulate matter as before and this can decrease the incidence of complications. There are also some nonsteroidal medications that can be injected which represents another evolution in injections.

Another evolutionary technique in pain procedures has been spinal cord stimulators. The newest variations of spinal cord stimulators has been an improvement on the leads being placed so that better back pain reduction and leg pain relief can be achieved.

What it comes to revolutionary technology, the leader of the pack is radiofrequency ablation. This technology did not exist in pain management approximately 10 years ago. For the management of facet arthritis and other conditions, it has truly revolutionized the ability to gain long-term pain relief in patients.

It's been very exciting because until radiofrequency neurotomy nothing has existed that could give pain relief for longer than a few months which is what facets injections typically get for patients and then they need to be repeated. Radiofrequency procedures can give pain relief for up to 2 years.

Another revolutionary technology in pain management is spinal decompression therapy. This involves an intermittent computerized traction that is completely different than regular lumbar traction. Some may refer to it as an evolution, but it really does represent a revolutionary approach to treating these conditions.

It is important in pain treatments that we continue to achieve both evolutionary and revolutionary techniques. One of the most hyped revolutions will be when stem cell injections become mainstream as this is becoming the future of pain relief which is more regenerative in nature as opposed to just masking pain.