Our Services
Advanced Therapies
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 before recommending an advanced therapy — ensuring the highest chance of meaningful benefit.
Ketamine Infusion Therapy
CRPS • Neuropathic Pain • Fibromyalgia • Treatment-Resistant Pain
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.
How It Works
Ketamine works primarily by blocking NMDA receptors in the brain and spinal cord. These receptors play a central role in "central sensitization" — the process by which the nervous system becomes hypersensitive and amplifies pain signals. By blocking NMDA receptors, ketamine interrupts and "resets" these abnormal central pain pathways. Ketamine also promotes neuroplasticity — the brain's ability to form new neural connections — which may help permanently restructure maladaptive pain circuits.
Conditions Treated
- Complex Regional Pain Syndrome (CRPS / RSD) — Types I and II
- Neuropathic pain from nerve injury, peripheral neuropathy, or post-herpetic neuralgia
- Fibromyalgia refractory to standard treatments
- Centrally sensitized pain syndromes
- Treatment-resistant depression co-occurring with chronic pain
- Phantom limb pain
Clinical evidence: For CRPS, controlled trials show significant pain reduction lasting approximately 11 weeks after a short infusion course. For fibromyalgia and central sensitization syndromes, ketamine can help "reset" an overactive nervous system. Ketamine also produces rapid antidepressant effects — often within hours — making it uniquely valuable for patients where chronic pain and depression overlap. For phantom limb pain, it can interrupt the brain's persistent pain signals.
What to Expect
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. A standard initial course consists of a series of infusions over 1 to 2 weeks. You must arrange for someone to drive you home after each session and should not drive for 24 hours following a ketamine infusion.
Cryoneurolysis
Intercostal Neuralgia • Knee Pain • Peripheral Nerve Pain
Cryoneurolysis uses the precise application of extreme cold to temporarily interrupt the function of a pain-transmitting nerve — achieving a reversible nerve block that lasts weeks to months, significantly longer than local anesthetic blocks.
How It Works
A specialized probe delivers temperatures as low as -70 degrees C at the nerve. This extreme cold disrupts the myelin sheath and axon, causing a temporary axonotmesis. Because the nerve's structural framework is preserved, it regenerates over time, making cryoneurolysis a reversible procedure.
Conditions Treated
- Intercostal neuralgia (rib pain from nerve injury or post-herpetic neuralgia)
- Chronic knee pain — targeting the genicular nerves
- Peripheral nerve pain from identified nerve injuries
- Post-thoracotomy pain syndrome
- Localized neuropathic pain in the trunk or extremities
Reversible by design: Unlike surgical nerve ablation, cryoneurolysis preserves the nerve's connective tissue scaffold. The nerve regenerates over time, making the procedure safe to repeat as needed.
Clinical evidence: For chronic knee pain from osteoarthritis, controlled trials show that freezing the genicular nerves achieves more than double the pain reduction compared to placebo, with about 71% of patients getting at least 50% relief. For post-surgical pain after chest and breast surgery, cryoneurolysis of the intercostal nerves dramatically reduced both pain and opioid use. For occipital neuralgia, freezing the occipital nerve provides 3-6 months of relief.
Spinal Cord Stimulation (SCS)
Failed Back Surgery • CRPS • Neuropathy • Neuromodulation
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.
How It Works
Thin, flexible leads are placed in the epidural space alongside the spinal cord and connected to an implanted pulse generator (IPG). Modern SCS systems include high-density, burst, and high-frequency (10 kHz) stimulation — dramatically improving outcomes compared to earlier generation devices.
Conditions Treated
- Failed Back Surgery Syndrome (FBSS)
- Complex Regional Pain Syndrome (CRPS) Types I and II
- Painful diabetic neuropathy
- Refractory angina and peripheral vascular disease pain
- Post-herpetic neuralgia
- Chronic radicular arm or leg pain
The Trial Period
Before permanent implantation, a temporary lead is placed and connected to an external stimulator for 7 to 14 days. Only patients who experience 50% or greater reduction in pain proceed to permanent implantation.
Try before you commit: SCS always begins with a trial period, allowing you and your care team to confirm the therapy works before permanent implantation.
Clinical evidence: For failed back surgery syndrome, about 48% of patients achieve at least 50% pain relief — compared to just 9% with medications alone. For CRPS, SCS combined with physiotherapy significantly outperformed physiotherapy alone. Newer high-frequency (10 kHz) SCS technology achieves about 85% response rates for back pain. For painful diabetic neuropathy, 79% of patients achieved at least 50% pain relief at 6 months. About 70-80% of patients who trial the device go on to permanent implantation, and long-term studies show sustained benefit at 5-10 years.
Peripheral Nerve Stimulation (PNS)
Localized Chronic Pain • Nerve Injury • Minimally Invasive
Peripheral nerve stimulation 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.
Conditions Treated
- Chronic occipital neuralgia and intractable migraine
- Chronic shoulder pain from nerve injury or post-surgical pain
- Chronic knee pain — targeting saphenous or genicular nerves
- Ilioinguinal, genitofemoral, or lateral femoral cutaneous neuralgia
- Post-amputation or stump pain
- Localized chronic pain from identifiable peripheral nerve injury
Advantages Over SCS
For well-localized chronic pain, PNS offers less invasive placement (no epidural access required), exact nerve targeting, faster recovery, and can be trialed 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.
When Are Advanced Therapies Considered?
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 is made collaboratively after a thorough review of your pain history, prior treatments, imaging, and functional goals.
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.
Still Searching for Relief?
Our specialists are here to evaluate your options with compassion and expertise.