Thursday, December 18, 2008

Warrenton physician specializes in pain relief

When interventional pain management specialist Dr. Daniel Heller was working at a pain clinic in Richmond, his patients were men and women who had already been to a slew of other doctors, desperately seeking an escape from debilitating pain. He said, “These were people who may have had numerous spine surgeries and were placed on high-dose narcotic medicines. Through the use of spinal cord stimulation, we were able to wean them off narcotics entirely, reduce their pain levels significantly and get them back to work.

“That was satisfying.”

Now a physician with

Blue Ridge Orthopaedic and Spine Center
, Dr. Heller is helping patients in Warrenton find relief from chronic pain.

Spinal cord stimulation involves placing a small battery (about the size of a golf ball, but flat instead of spherical) under the skin, with wires extending out toward the spinal column. The electric impulses produced by the battery modulate the pain signals between the brain and the spinal cord. “Many patients experience about a 50 percent reduction in pain,” said Dr. Heller. He added that before implanting the battery, a patient will undergo a trial procedure for a week or so to confirm that the therapy will be helpful. “They can test drive it; if it provides significant relief we can implant it using minimally invasive surgery.”

He’s enthusiastic about the treatment. “The procedure has been around for 30 years, but the technology has advanced so much in the last ten years. It’s an alternative that shouldn’t be overlooked,” he said.

Spinal cord stimulation is an effective treatment, but it’s only one in Dr. Heller’s pain management arsenal. He believes in a multi-faceted approach, which may include site-specific injections, oral medication, physical therapy, even psychological treatments – or a combination of several techniques.

More than medicine

Dr. Heller said that eighty percent of opiate pain relievers are prescribed by primary care physicians, but sometimes, even these strong medicines don’t provide relief.

“Morphine can be effective, but if it’s not the right pain reliever for the problem, it won’t take care of the pain,” Dr. Heller said.

The key to pain relief is a good diagnosis, said Heller. “Sometimes, opiates are prescribed for chronic pain and when they don’t work, the dosages are increased until they get to a level the doctor is not comfortable prescribing. But if the problem is a nerve injury, an opiate may never work, regardless of the dose. It may be a pain signaling problem, where the brain is signaling pain even when there is nothing anatomically wrong. You’ve got to know what the root cause is before you can come up with a pain management strategy.

“Diagnosis is everything.”

Sometimes, the diagnosis requires a little detective work. Take for an example a case where the pain complaint does not match up with what the MRI reveals. “Sometimes there is more than one problem,” said Dr. Heller. “A person may have arthritis in the hip and a disc problem in the back. The pain might manifest itself in the same way for either injury. In order to devise a treatment plan, you have to know exactly what is causing the pain.”

Sometimes Dr. Heller uses an injection to help with diagnosis. He injects anesthetic into one of the problem areas. If the pain is greatly reduced in that area, that means the pain is originating from the place of the injection. If the pain continues unabated, the pain is being caused by another injury. Again, Dr. Heller emphasizes, “The treatment that may help with disc pain may not work on arthritis-type pain. The treatment must be specific to the diagnosis.”

Multi-discipline treatment

Once the diagnosis is complete, a treatment plan is outlined. Dr. Heller looks at each patient’s history with a holistic eye. Has the pain been chronic and severe? Is the patient experiencing anxiety or depression as a result of the pain? Has a sleep disorder developed because of the long-term pain?

“We take all these factors into account,” said Dr. Heller. “There are situations when we can target more than one problem with a single medication. Some pain medications can have a mood-lifting effect. Others can make a person sleepy. We can take advantage of the side effects to solve multiple problems.”

Sometimes when one medication fails to reduce pain, another – or a combination of medicines – will succeed.

Dr. Heller believes in using the least intrusive treatment possible. A peripheral joint injection directly at the problem area can utilize a lower dosage of steroids than an oral medication, for instance.

Radiofrequency ablation is another minimally invasive technique that can be used to treat pain. After isolating the specific sensory nerve, or nerves, causing the pain a site-specific diagnostic injection -- a needle with a heated tip -- is used to ablate, or destroy, the nerve. This technique, effective for arthritis-type neck and back pain, can relieve discomfort for six to 12 months, until the nerve regenerates.

Benefits of spinal cord stimulation

• A trial can be done first to make sure the patient has the pain reduction they are looking for before a permanent implant is placed.

• It is easily reversible.

• It has few side effects.

• Implantation is a minimally invasive procedure, requiring a minor surgical procedure on an outpatient basis.

• Pain relief can allow patients to reduce or eliminate their use of narcotic drugs.

• Some batteries are rechargeable; others last seven to ten years.

• The pain management system is completely implanted. Patients can travel anywhere and participate in many non-impact recreational activities, including swimming.

Who may be a candidate for spinal cord stimulation?
• If you have chronic trunk or limb pain

• If you have had spine surgery, but still have chronic pain

• If you have peripheral neuropathy

• If you have peripheral vascular disease

• If you have complex regional pain syndrome

• If other treatments have not helped your pain

• If you do not have a pacemaker and are not pregnant

1 comment:

Anonymous said...

Thanks for sharing the information on "Spinal cord stimulation". It can be an effective treatment for the debilitating back pain sufferer who still have chronic pain after a major surgery. Dr. Travis Rader, of Pain Management McKinney, Texas is treating my back pain and Spinal cord stimulation can be an another option for me which I will discuss with him.