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Dr. Christopher Winfree specializes in the neurosurgical treatment of chronic pain disorders. Chronic pain is a common problem worldwide and is the most common cause of disability in United States. Chronic pain can be a devastating condition and patients suffer greatly from it. The most effective way to treat chronic pain is through a comprehensive multidisciplinary approach, typically with a pain management specialist with some combination of medications including anticonvulsants and antidepressants. Other medications can be utilized to treat chronic pain disorders. Sometimes topical therapies, patches and noninvasive therapies such as acupuncture, chiropractic and feedback can be utilized. Topical electrical stimulation can also be used. If these noninvasive strategies are insufficient, then number of patients may be candidates for number of different injection therapies including epidural steroid injections, trigger point injections, selective nerve root blocks, Botox injections, sympathetic blocks and nerve blocks. These procedures are all typically performed by a nonsurgical pain management specialist. Patients should exhaust their less invasive treatment options such as these before considering neurosurgical pain management. Patients will typically work with their existing physicians, which include primary care physicians, neurologists and pain management physicians to exhaust these less invasive treatment options before seeing Dr. Winfree.

Patients who do not get sufficient pain relief with nonoperative strategies may then be considered for more aggressive neurosurgical pain management strategies, which Dr. Winfree can discuss with you in detail. Neurostimulation is a type of neurosurgical pain management in which an electrical device is placed along the nervous system.   The device administers a weak electrical current, which patients feel as a tingling sensation, and blocks the subjective experience of pain. These techniques have been around for several decades and have been used in hundreds of thousands of patients in United States with success. Neurostimulation is safe, reversible, and nonablative, meaning that it doesn’t damage the nervous system in any way.  Most patients can experience a temporary trial of stimulation, which lasts about 1 week.  Patients who do well with the temporary trial may then undergo permanent implantation of an electrode and battery system.

Dr. Winfree specializes in the placement of neurostimulation devices and has a vast experience with spinal cord stimulation, peripheral nerve stimulation, ultrasound-guided peripheral nerve stimulation, and motor cortex stimulation to treat a variety of chronic neuropathic pain disorders. When patients respond well to neurostimulation they are often able to substantially decrease or even eliminate their baseline pain medications and the relief of a lot of side effects from medications can dramatically improve the quality of life for chronic pain patients.

In some patients, neurostimulation is ineffective.  At that point patients may wish to consider intrathecal pain medication.  As for neurostimulation, patients undergo a trial of intrathecal medication first.  During this trial, a single dose of medication is injected into the spine.  Patients who benefit from the spinal medication may then go on to have a spinal infusion pump implanted.  This pump can then provide a constant infusion of spinal medication, resulting in durable pain relief.  Most commonly, narcotics such as morphine are utilized but other, nonnarcotic medications can be utilized instead.  Dr. Winfree can discuss with you whether a spinal infusion pump would be a good option for you in the event that neurostimulation and other less invasive pain management strategies are ineffective.

Patients who are unable to get sufficient pain relief with multidisciplinary pain management, neurostimulation, and/or a spinal infusion pump may then be candidates for a new technique we are developing at Columbia called laser cingulotomy. This procedure is truly considered a last resort treatment option for patients that have had no success with other treatment options. This is a therapy used to treat pain that is otherwise untreatable. This therapy is designed to target the area of the brain that processes pain as a bothersome sensation. The therapy does not take away the pain but it takes away person’s ability to be bothered by the pain. Although this sounds like it would not be particularly helpful, patients find that the procedure can dramatically improve their quality of life. It is as if the pain is consigned to the background noise of their day-to-day lives rather than being at the forefront of their minds and disruptive. By pushing the pain into the background of the conscious awareness this frees up patients to pursue their normal activities of daily living and resume their lives as normally as possible without being bothered by the pain. Dr. Sameer Sheth can help determine whether you might be a good candidate for this procedure.

If you have chronic pain and wish to make an appointment with the Neurosurgical Pain Center, please call (212) 342-2776 to schedule an appointment.

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