NEW TOOLS TO FIGHT EXCRUCIATING AGONY.

• Position: Pain relievers and new spinal injection techniques - Brief Article

A drug derived from the poison of a Philippine sea snail and fiberoptic technology for viewing the spine are providing powerful new tools with which to relieve the suffering of patients with persistent, excruciating pain, the American Society of Anesthesiologists reports. "Eighty-six million Americans suffer from chronic pain," notes Peter S. Staats, director of the Division of Pain Medicine, Johns Hopkins University, Baltimore, Md. "Though we can control most of this pain with nerve blocks and oral medications, some conditions require more radical approaches. Advancements in the use of these techniques are allowing us to bring long-lasting relief to people for whom traditional methods have not worked." Among the noteworthy developments:

Spinal endoscopy gives anesthesiologists their first direct view of the nerves, scar tissue, and coverings of the spine. A fiberoptic camera inserted through a small incision near the spine sends an image to a video monitor. "With a direct view of tissue in the epidural space surrounding the spine, we can locate the source of pain for many types of problems and test whether a given treatment, such as the injection of medication along a particular nerve route, will be worthwhile," explains Timothy R. Deer, CEO of the Center for Pain Relief, Charleston, W. Va. The small fiberoptic technology allows anesthesiologists to insert special instruments through the scope to remove an accumulation of scar tissue that can occur after spine surgery or injury and cause extreme pain.

Intrathecal infusion systems. Small devices, surgically implanted by anesthesiologists, that deliver medication via a tube placed directly into the fluid surrounding the spine (the intrathecal space) have been used since the 1980s to relieve severe pain. Now, programmable systems let anesthesiologists vary the rate of infusion of medication to the intrathecal space during the course of the day to match a patient's pain level. The programmable systems fine-tune pain control for patients whose discomfort worsens at certain times of day.

New drugs for use with intrathecal infusion devices are enabling anesthesiologists to help patients. A promising one is derived from the venom of the conus magus, a sea snail found off the coast of the...