Pain management: Establishing a role for implantable technologies

Pain due to terminal illness such as AIDS and cancer-related pain should be managed according to the guidelines set forth by the World Health Organization. These guidelines suggest a pharmacologic tailoring approach to the level and intensity of the patient's pain. These guidelines obey the KISS principal (keep it simple) suggesting the use of less potent analgesic agents before utilizing more potent agents. Likewise, the treatment of non-malignant pain should be based on the same KISS principal utilizing least costly and least invasive therapies either in series or in parallel until the patient's pain is well managed. Interventional strategies and certainly implantable technologies for pain control have a place as 'tools' for the management of cancer, AIDS, and non-malignant-related pain syndromes. Since these therapies are costly and invasive, they should be used only after the failure of more conservative, less invasive and less costly therapies. This paper outlines a rational place for the use of implantable modalities for the treatment of cancer, AIDS and non-malignant pain.