Very many treatments have been used in patients with chronic pain. Published studies describe techniques varying from the drug treatment of phantom limb pain with anticonvulsants,2[II] to heating vertebral disks to treat back pain,3[II] and from the physical exercise of yoga4[II] to spiritual healing.5[II] It is hardly surprising that interpretation of the results of these individual treatments is difficult for the clinician, even without the added complications of several sequential or concurrent treatments, some of which may be unknown to the treating clinician. Patients naturally demand the best, but many factors are involved in determining what is best. For example, whether the simplicity, safety, and availability of transcutaneous electrical nerve stimulation (TENS) outweighs the precise stimulation localization, but inevitable risk of complications with spinal cord stimulation (SCS) cannot be reduced to yes or no. A great deal will depend on the patient and their attitudes to risk and benefit.
The collection and analysis of large sets of data have now enabled the construction of algorithms to guide clinicians through sequences of treatment, for example when treating neuropathic pain,6[I] and we will see how material is being made accessible for patients in order to help them with these decisions (www.nice.org.uk).
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