Long-lasting, chronic pain complaints are an important health problem that negatively affects quality of life and bring along social and psychological issues. Patients who suffer from prolonged and chronic pain can be treated by applying to pain clinics (algology units) within healthcare institutions. Algology specialists are physicians who are trained in this field and investigate and identify possible causes of pain using various diagnostic methods. Once the cause of the pain has been diagnosed, the source of the pain is treated with the most appropriate medications and interventional techniques for the patient. Pain treatments are managed and coordinated with a multidisciplinary approach.
What is Algology?
Algology, or pain medicine, is a medical discipline that studies the causes of pain and aims to treat it by identifying its source. Algology focuses mainly on chronic pain.
Who is an Algology Specialist?
An algology specialist, or algologist, is a physician who has received additional training in pain medicine. To become an algology specialist, physicians must first complete 6 years of medical school and then a specialty training program in neurology, physical medicine and rehabilitation, or anesthesiology. After that, they undergo 2 more years of subspecialty training in algology.
Diseases Managed in Algology and Pain Clinics:
HEAD AND FACE PAIN
Headache is one of the most common complaints. Head and facial pain, along with acute infections, back pain, and dizziness, are among the most frequent reasons for visiting a doctor. Identifying the causes of head and face pain and treating the symptoms is medically challenging. This is because the International Headache Society has defined about 240 different causes of headache. The most common types of chronic head and face pain include migraine, tension-type headache, facial neuralgia (most commonly trigeminal neuralgia), and spine-related headaches.
NECK, SHOULDER, AND ARM PAIN
Neck, shoulder, and arm pain often arise from spine-related problems such as cervical disc herniation or loss of normal cervical curvature (cervical straightening). In cervical disc herniation, pressure on the spinal cord or nerves going to the arm can cause pain. Medications and physical therapy are the first-line treatments for such pain. However, in some patients the pain cannot be relieved despite these measures. In such cases, help can be sought from the algology department.
BACK AND CHEST PAIN
Back pain is a very common complaint in the community. For many people, this pain subsides within a tolerable period with rest, physiotherapy, and medical or physical treatments. Most patients with back pain suffer only from muscle pain. However, in some cases, ligaments, spinal joints, and intervertebral discs are also involved. This can lead to chronic pain that is difficult to treat. Chest pain may occur as referred pain from intrathoracic organs and can originate from the heart, lungs, or reflux. There are also chest pains arising from the chest wall muscles or from compression of the intercostal nerves.
ABDOMINAL AND GROIN PAIN
Some causes of abdominal and groin pain that do not respond to conventional treatments include nerves trapped within the abdominal muscles, referred pain from back and low back problems, and pain originating from abdominal organs.
LOW BACK AND LEG PAIN
Chronic low back and leg pain refers to pain in the back or leg lasting at least six months. The pain is usually felt in the lower back but may radiate to other areas such as the thigh, calf, or foot. The most important sources of chronic low back and leg pain are problems related to the spine and spinal cord. These may include sciatica, lumbar disc herniation, and disc degeneration.
PAIN DUE TO VASCULAR OCCLUSION
The vessels that carry oxygen-rich blood, which has been oxygenated in the lungs, to the organs are called arteries. When arteries become occluded due to conditions such as diabetes, atherosclerosis, hypertension, or hypercholesterolemia, they cannot deliver adequate blood to the related organs. Pain due to arterial occlusion arises when the tissues supplied by the blocked vessels do not receive enough oxygen. For example, if a coronary artery becomes blocked, chest pain occurs; if an artery going to the leg becomes blocked, leg pain results.
DIABETES-RELATED NEUROPATHIC PAIN
Diabetes not only damages blood vessels but also injures nerve fibers. In about one-third of all patients with diabetes, nerve damage develops due to frequently elevated blood glucose levels. This is one of the most common complications of diabetes and leads to various complaints. Although it is not always possible to reverse nerve damage, there are treatment options that can largely relieve the resulting neuropathic (nerve-origin) pain. Neuropathic pain is often very severe and, in some cases, may not even respond to morphine. In such situations, interventional pain treatment methods come into play.
CANCER PAIN
Cancer pain is a very significant health problem that negatively affects quality of life, especially in patients with advanced-stage cancer. Therefore, oncologists and algology specialists have important roles. The main goal in malignant cancer is to maintain the patient’s quality of life at the best possible level for as long as possible. In these patients, effective pain control is often only possible with morphine derivatives (opioids). With the appropriate dose and schedule of opioids, pain can be brought under control. This requires the expertise and coordination of experienced algology and oncology specialists.
PAIN OF UNKNOWN ORIGIN
In some patients with chronic, persistent pain, determining the exact cause of the pain can be difficult. In such cases, interventional methods can be used to identify which nerves are responsible. By placing a catheter in the suspected region of the nervous system under imaging guidance and injecting medications, the source of the pain can be identified.
Treatment Methods in Algology and Pain Clinics
NERVE BLOCKS
Nerve blocks are a treatment method used for cancer-related pain, chronic pain that does not respond to other treatments, and to control pain before painful procedures. With this method, the nerve fibers that carry pain signals from the relevant organs are blocked. The effect of the procedure may be temporary or permanent.
IMPLANTABLE MORPHINE PUMPS
Implantable morphine pumps can be used in the treatment of cancer-related pain or pain that does not respond to other treatments. The pump is placed under the skin and connected to the spinal cord via a catheter. Low doses of morphine are delivered through this pump, providing effective pain relief. It is most commonly used in pain due to cancer and arterial occlusive disease.
SPINAL CORD STIMULATORS
Chronic neuropathic pain, which most often occurs in diabetes, may also be seen in other diseases that damage nerves. In neuropathic pain, very severe pain can be felt in the organs supplied by the damaged nerve. Such pain may not respond even to morphine therapy. With spinal cord stimulators, which are among the interventional pain treatment methods, these pains can be treated. Spinal cord stimulators are placed in the spinal region associated with pain under local anesthesia and sedation.
INJECTIONS USED FOR LUMBAR DISC HERNIATION
Injections for lumbar disc herniation are used in patients with low back pain who have not achieved sufficient improvement with various medications and physical therapy methods and who do not require surgery. In this treatment, a local anesthetic drug and a steroid are usually injected into the relevant area. In recent years, ozone injections have also started to be used in lumbar and cervical disc herniation. The most commonly performed injections for pain control and disc treatment are:
Transforaminal epidural injections: These are performed to treat edema in the disc region where the lumbar herniation is located and to relieve nerve root compression. Thus, pain due to nerve root compression can be eliminated.
Lumbar facet joint injections: If chronic pain that does not respond to other treatments originates from the facet joints of the spine, facet joint injections can be performed.
Nerve root block: By injecting a local anesthetic and steroid medication around the nerve roots exiting the spinal cord, the nerve root is blocked, and pain relief is achieved.
Sacroiliac joint injections: These are injections made into the joint between the sacrum and the ilium bones in the lower back region.
Injections Used for Cervical Disc Herniation
Cervical disc herniation occurs when the soft central part of the disc located between the vertebrae protrudes outward by tearing through the outer layer. Cervical disc herniation can compress the spinal cord or the nerves going to the arm, causing symptoms such as pain, numbness, and weakness. In patients who do not need surgery but cannot be treated with conventional methods, medication can be injected around the irritated nerve roots within the spinal canal. The procedure takes about 10–15 minutes and is performed under local anesthesia, so no pain is felt. In this application, called epidural steroid injection, the aim is to reduce edema and pain in the nerve roots. In most patients, the pain disappears some time after the procedure.