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In really difficult cases, we have to kind of pull out, if you will, big gun therapies. These might include implanted electrical stimulators. Sometimes we implant the wires into the spine on top of the spinal cord, or we might implant wires under the skin and the areas of pain. At other times we might implant a pump, that can on a continuous basis infused medicine into the spinal fluid, which of course is sitting right on top of the nervous system and can have a big impact on pain signals. We also at times may use nerve blocks. These are injections where we will inject anesthetic medicines on top of nerves to shut down the function of the nerve. Now this is temporary. It’s never permanent solution, but it almost acts like rebooting a computer. And so even after the effect has worn off, we often see that the pain, when it returns is not as severe, not as intense. And so sometimes a series of blocks can provide significant relief to a patient.

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