DOCTORS USE MAGNETIC RESONANCE IMAGING TO TREAT PAIN
Sean C. Mackey, M.D. ASA ANNUAL MEETING
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DALLAS -- Anesthesiologists are now able to incorporate the clarity and precision of magnetic resonance imaging (MRI) to treat chronic severe pain in patients with cancer and nerve injuries for whom other techniques have failed.
Magnetic resonance therapy (MRT), as it is called, enables anesthesiologists to see "slices" of tissue from any angle on a video monitor. The displayed images allow anesthesiologists to deliver medication via needles or continuous infusion catheters to specific areas without damage to surrounding nerves and arteries. The technique also lets them see where the drug goes after it is injected. "MRT's superior imaging capabilities allow us to more safely target the area we want to reach," Sean C. Mackey, M.D., Ph.D., assistant professor of anesthesia and pain management at Stanford University Medical School, said.
MRT is particularly useful for cancer patients whose advanced tumors have distorted their internal anatomy. This distortion makes it harder for anesthesiologists to direct pain medication to the location where it will do the most good while steering clear of other tissues, Dr. Mackey said.
In a study of 21 patients reported by Dr. Mackey at the American Society of Anesthesiologists annual meeting, MRT allowed pain management specialists to join forces with radiologists to place a successful regional block in every patient without complications.
Other techniques anesthesiologists use to treat chronic severe pain, including fluoroscopy and computed tomography (CT), do not offer MRT's detail and accuracy, Dr. Mackey said.
Fluoroscopy provides images of bone only, not soft tissue like nerves and muscle, while CT lets doctors see soft tissue but in a fixed, two-dimensional plane only. Both techniques, however, expose patients and physicians to radiation and may involve the injection of a contrast agent, which could cause an allergic reaction.
Shaped like two doughnuts, the MRT system's configuration also does away with the claustrophobia -- and spares patients the anxiety -- of traditional MRI scans, in which patients are slid into a narrow chamber.
The patient lies on a table that slides into the doughnut holes. The anesthesiologist and radiologist stand between the doughnuts. Small monitors mounted nearby display the images, allowing the doctors to view the position and trajectory of the needle or catheter.
Doctors at Stanford have used MRT to manage pain in patients with pancreatic and other abdominal cancers, complex regional pain syndrome (a chronic disorder marked by severe burning pain in a leg or arm) and traumatic injuries.
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