Chronic pain and invasive therapy

The chronic pain "three-step" OMS ladder is likely to be revised, in order to introduce a "fourth step" including clinical indications for the invasive analgesic procedures. The number of patients who undergo such procedures is likely to increase, as well as modern oncology and palliative medicine development.Most of invasive approaches include central (spinal neuromodulation) and peripheral (gangliar neurolysis, percutaneous vertebral reduction) techniques, as well as pharmacological (opioids and adiuvants), chemical (alcohol) and physical (electrical stimulation, thermic neurolysis) means. Rarely effective as unique therapies, invasive procedures have to be accurately patient-selected and considered supplementary to conservative approaches, in order to minimize the adverse events deriving from a long term opioid therapy.In the near future, the development of both pain science and biomedical technology will probably be accompanied by the improvement of the knowledge regarding the recourse to invasive analgesic procedures.