PainCare - Pain Management in New Hampshire

That changed when Dr. Joshua Greenspan of PainCare in Merrimack and Somersworth implanted two electrodes at the back of Louis' head, just beneath the skin, at an area known as the occipital nerve. Tiny charges of electricity were sent into the electrodes, and James said the pain vanished within three hours.

"It's mind-boggling," he said.

Greenspan, one of a handful of doctors to administer this specific procedure, set up a trial for nine patients including one with migraine headaches and a laborer who suffered a traumatic brain injury when he was hit on the head by a 16-pound rock dropped from six stories. Each had severe chronic pain.

The results were striking. Greenspan said all nine patients reported that their chronic pain went away entirely or nearly so. Those results were a vast improvement over medications, steroid injections and localized electrical impulses that give partial relief to about 65 percent of patients.

The results follow a 2006 Mayo Clinic study involving 16 patients with chronic migraine headaches. Ten said they had 50 percent to 100 percent pain relief. The study concluded the new procedure was safe.

No one is exactly sure how it works. Greenspan said he thinks the electrical volts stimulate areas of the brain that are known to inhibit chemical information about pain.

"We are trying to work our way through the darkness, but we are seeing profound differences," he said.

The nine patients each underwent up to a monthlong trial period where electrodes were implanted beneath the skin on the back of their heads, and wired to battery-powered pacemakers. The patients can now come back for a 90-minute operation to permanently implant the electrodes.

After the surgery, Louis said, he intends to reduce his pain medications and shut off a similar localized electrode device that was implanted in his back three years ago, something he tried during the trial.

After the electrodes were implanted at the occipital nerve, he turned off the back implant, and the pain was gone. "It was unbelievable," he said.

Michael J. O'Connell, who earned his M.D. from Dartmouth Medical School and founded PainCare in 1992, said doctors are only beginning to understand how pain is generated and communicated.

"It can be defined to the point where a particular structure in the spine, discs or muscle is a root cause, but we often don't know what is happening at a cellular level because pain comes in extremely small packages," O'Connell said.

The immune system sends tiny packets of inflammatory chemicals to injured sites and those pain signals return to the brain.

"Pain is registered in only one place, and that is the brain," O'Connell said.

The Gate Control Theory of the 1960s suggested that pain was regulated by the patient "choosing" between signals the body was sending. The theory suggested that choice was complicated when neural receptors showed pain to have a biological basis.

The bottom line is that pain signals face competition for attention and modulation in the brain. O'Connell said placing electrical impulses at the occipital nerve have an effect much like eastern acupuncture in which the signals given by the nervous system beat out the pain for attention in the brain, he said.

It could be the reason that acupuncture signals, electrical stimulation and even multiple tasks in a crisis situation cause pain signals to be downgraded on the list of priorities or pushed out of the mind, he said.

"The basic human machine is set up to handle a few things at a time, and in a crisis where people have no perception of pain, there is actually a power in the limitation of brain," O'Connell said.

In general, pain is a benefit as it works as a biological defense system, but in cases of chronic pain, it can backfire by keeping a person from work, relationships and exercise that in fact promote recovery.

Louis is now getting outside for walks, and after five years is considering a return to work.

"That is one of the things I am thinking about," he said.