Cutting-edge treatments for patients with complex, treatment-resistant pain. When conventional approaches have not provided adequate relief, our advanced therapies offer new pathways to meaningful recovery.
Not all chronic pain responds to standard treatments. For patients who have tried medications, physiotherapy, and conventional interventional procedures without finding adequate relief, our advanced therapies program offers a new level of care. These treatments address pain at the level of the nervous system itself — modulating, blocking, or resetting the abnormal pain signals that drive the most refractory and complex pain conditions.
Each of these therapies is subject to a thorough patient selection process. Your specialist will conduct a comprehensive assessment of your history, prior treatments, and current pain profile before recommending an advanced therapy — ensuring that every patient who undergoes these treatments has the highest chance of meaningful benefit.
Ketamine is a dissociative anesthetic with a rapidly growing evidence base as a treatment for chronic pain conditions that have not responded to conventional therapies. Delivered intravenously at sub-anesthetic doses in a medically supervised setting, ketamine targets mechanisms of pain at the central nervous system level that other treatments cannot reach.
Ketamine works primarily by blocking NMDA (N-methyl-D-aspartate) receptors in the brain and spinal cord. These receptors play a central role in a phenomenon called "central sensitization" — the process by which the nervous system becomes hypersensitive and amplifies pain signals far beyond what the original injury would warrant. In conditions like CRPS and fibromyalgia, central sensitization is a core driver of the pain experience.
By blocking NMDA receptors, ketamine effectively interrupts and "resets" these abnormal central pain pathways. This is distinct from simply blocking a nerve or reducing inflammation — it addresses the dysregulated pain processing that underlies treatment-resistant conditions at its source.
Ketamine also promotes neuroplasticity — the brain's ability to form new neural connections — which may help to permanently restructure maladaptive pain circuits over time.
Clinical evidence: An RCT published in Pain (Sigtermans et al., 2009) demonstrated significant pain reduction in CRPS patients lasting a median of 11 weeks after a 4-day infusion series. A separate trial (Schwartzman et al., Anesthesia & Analgesia) showed 69% of CRPS patients achieved ≥30% pain reduction. A consensus guideline from the American Society of Regional Anesthesia (Cohen et al., Regional Anesthesia and Pain Medicine, 2018) supports ketamine infusions for CRPS and recommends consideration for other refractory neuropathic pain conditions. Subanesthetic doses are typically 0.1–0.5 mg/kg/hr IV. Ketamine also promotes neuroplasticity, which may help permanently restructure maladaptive pain circuits over time.
Ketamine infusions are administered intravenously in our monitored clinical environment. Sessions are typically 40 minutes to several hours depending on the protocol. You will be awake but in a deeply relaxed, dissociative state; a physician or nurse is present throughout the entire session.
A standard initial course consists of a series of infusions over 1 to 2 weeks. Some patients experience significant relief after the first infusion; others require the full course to achieve benefit. Maintenance infusions may be recommended depending on your response.
You must arrange for someone to drive you home after each session. You should not drive or operate machinery for 24 hours following a ketamine infusion.
Cryoneurolysis uses the precise application of extreme cold to temporarily interrupt the function of a pain-transmitting nerve. By cooling the nerve to a temperature that disrupts its ability to conduct pain signals, cryoneurolysis achieves a reversible nerve block that lasts weeks to months — significantly longer than local anesthetic blocks.
A specialized probe is placed adjacent to the target nerve under image guidance. The probe delivers nitrous oxide gas or liquid nitrogen, creating temperatures as low as -70°C at the nerve. This extreme cold disrupts the myelin sheath and axon of the nerve, causing a temporary axonotmesis — the nerve loses function but the surrounding connective tissue remains intact. Because the nerve's structural framework is preserved, it regenerates over time, making cryoneurolysis a reversible procedure.
The key advantage over steroid injections and chemical nerve blocks is duration: while most nerve blocks last days to weeks, cryoneurolysis typically provides pain relief lasting 4 weeks to several months.
Cryoneurolysis is a minimally invasive outpatient procedure performed under local anesthesia and image guidance. Procedure time varies by target nerve but is typically 20 to 45 minutes. Patients may experience mild soreness at the probe insertion site for a few days. Because the procedure is reversible, it can be repeated when nerve function returns if the pain recurs.
Reversible by design: Unlike surgical nerve ablation, cryoneurolysis preserves the nerve's connective tissue scaffold. This means the nerve regenerates over time, making the procedure safe to repeat as needed.
Clinical evidence: For knee osteoarthritis, an RCT (Radnovich et al., Journal of Knee Surgery, 2017) demonstrated a 35-point reduction on the WOMAC pain scale versus 16 points for sham at day 30. A separate study (Dasa et al., Knee, 2016) reported 71% of patients achieved >50% pain reduction at 30 days. For post-surgical pain, an RCT published in Anesthesiology (Ilfeld et al., 2021) found intercostal cryoneurolysis reduced post-thoracotomy pain and opioid use by approximately 50%. Relief typically lasts 3–6 months as nerves regenerate at approximately 1–2 mm per day.
Spinal cord stimulation is one of the most established and evidence-supported neuromodulation therapies in pain medicine. A small implanted device delivers mild electrical pulses to the spinal cord, modulating pain signals before they reach the brain. For patients who have exhausted other treatment options, SCS can achieve dramatic reductions in pain and improvements in function.
Thin, flexible leads are placed in the epidural space alongside the spinal cord and connected to an implanted pulse generator (IPG) — a small battery-powered device similar in concept to a cardiac pacemaker, placed under the skin. The device delivers electrical pulses that interfere with the transmission of pain signals to the brain, replacing the sensation of pain with a mild paresthesia (tingling) in some waveforms, or with no perceptible sensation at all in modern high-frequency and burst stimulation paradigms.
Modern SCS systems are sophisticated and adjustable. Settings can be fine-tuned wirelessly using a patient controller, and advanced stimulation waveforms — including high-density, burst, and high-frequency (10 kHz) stimulation — have dramatically improved outcomes compared to earlier generation devices.
A key feature of SCS that distinguishes it from other surgical interventions is the mandatory trial period. Before permanent implantation, a temporary lead is placed and connected to an external stimulator for 7 to 14 days. This allows both you and your specialist to evaluate how well SCS controls your pain before committing to the permanent implant. Only patients who experience meaningful pain reduction during the trial — typically defined as 50% or greater reduction in pain — proceed to permanent implantation.
Try before you commit: SCS always begins with a trial period. This is a unique feature that allows you and your care team to confirm the therapy works for you before permanent implantation.
Clinical evidence: The PROCESS RCT (Kumar et al., Pain, 2007) showed 48% of SCS patients achieved ≥50% leg pain relief at 6 months versus 9% with conventional management for failed back surgery syndrome. A landmark RCT in the New England Journal of Medicine (Kemler et al., 2000) demonstrated significant pain reduction for CRPS with SCS plus physiotherapy versus physiotherapy alone. The SENZA-RCT (Anesthesiology, Kapural et al., 2015) showed high-frequency 10 kHz SCS achieved 76.5% responder rate for back pain — a major advance over traditional stimulation. For painful diabetic neuropathy, the SENZA-PDN trial (Lancet Neurology, 2021) showed 79% of patients achieved ≥50% pain relief at 6 months. Trial-to-permanent conversion rate is approximately 70–80%. Long-term studies show sustained benefit at 5–10 years in 50–60% of initial responders.
SCS systems are fully adjustable and entirely reversible. The leads and generator can be removed at any time if desired. The implanted device does not affect most day-to-day activities; your specialist will discuss any restrictions relevant to your specific device and lifestyle.
Peripheral nerve stimulation (PNS) applies the same principle as spinal cord stimulation — delivering mild electrical pulses to modulate pain signals — but targets specific peripheral nerves rather than the spinal cord. This makes it particularly well-suited for patients with localized chronic pain in a specific anatomical region.
A small lead is placed percutaneously (through the skin) adjacent to the target peripheral nerve under ultrasound or fluoroscopic guidance. The lead connects to a miniature pulse generator, which may be implanted subcutaneously or worn externally depending on the system used. Electrical pulses modulate the nerve's pain signal transmission, reducing or eliminating the chronic pain without systemic effects.
PNS systems have become significantly more refined in recent years. Wireless and ultra-miniaturized implants allow for treatment of nerves in locations that were previously inaccessible, with minimal surgical burden.
For well-localized chronic pain arising from a specific nerve, PNS offers several advantages over spinal cord stimulation: the placement is less invasive (no epidural access required), the procedure targets the exact nerve causing pain, recovery is faster, and the therapy can be trialed and confirmed before permanent implantation — just as with SCS.
Precise targeting: PNS targets the specific nerve responsible for your pain rather than the spinal cord broadly — making it an elegant, highly targeted option for well-defined localized chronic pain.
Lead placement is performed under local anesthesia as an outpatient procedure. A trial period using an external stimulator allows assessment of benefit before permanent implantation is considered. Procedure time is typically under one hour. Most patients experience minimal discomfort and can return to normal activity within a few days.
Advanced therapies are reserved for patients with complex or treatment-resistant pain who have not achieved adequate relief from more conservative measures. The decision to proceed with an advanced therapy is made collaboratively after a thorough review of your pain history, prior treatments, imaging, and functional goals. Our team follows evidence-based selection criteria to identify which patients are most likely to benefit from each treatment.
If you have been living with chronic pain and feel you have run out of options, we encourage you to request a consultation. Many patients who come to us believing nothing more can be done find that advanced therapies open new doors.
If standard treatments have not given you adequate relief, it may be time to explore what advanced therapies can offer. Our specialists are here to evaluate your options with compassion and expertise.
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