Procedure Offers Relief From Chronic Back and Leg Pain
For 25 years, Roger Dreisbach tried just about everything medically possible to ease the chronic pain in his lower back.
Prescription and over-the-counter medications, acupuncture, epidurals and two back surgeries -- nothing seemed to help the Southern Pines resident for very long. Then a physician assistant at the FirstHealth Back and Neck Pain Center suggested that he might be a candidate for a spinal cord stimulator.
After a brief trial period to determine if he was appropriate for long-term therapy, Dreisbach got his implanted device in April and is now "doing wonderful."
"It's very amazing," he says.
Spinal cord stimulation, or neurostimulation, uses electrical current to treat chronic pain with a small electronic system that sends mild electrical impulses to the spinal cord through medical wire leads.
Programming directs the electrical impulses to cover the specific areas where the pain is felt, essentially blocking the way the body interprets pain signals.
For the right patient, the therapy works extremely well, says neurosurgeon Dr. Bruce Jaufmann of Carolina Neurosurgical Services, who did Dreisbach's implant. "If you select the right patients, the success rate has been really good," he says.
According to Jaufmann, neurostimulation patients often say they haven't felt so well in years.
"A lot of these people have been in pain for a very long time," he says. "A lot of times, they have been on pretty heavy narcotics, but have not had a lot of success managing their pain with them. They've run through the gamut of treatment over a long time."
The therapy involves several phases of testing and evaluation before the permanent device can be implanted, however. Unlike other treatments for severe pain, neurostimulation requires psychological screening to determine if the patient is a good candidate.
After that, a physician specializing in pain medicine conducts a clinical trial to determine the appropriate electric impulse level and if the patient is comfortable with operating the device.
Dr. Paul Kuzma is one of several anesthesiologists at Pinehurst Anesthesia Assoc-iates who conduct the stimulator trials. He says the best candidates are usually patients with back or back and leg pain who have tried "conservative" pain therapies -- medication, bracing, physical therapy, epidurals, even surgery -- for a long time but without success.
"Those patients who don't respond to the simple therapies we may consider for a spinal cord stimulator," he says. "We try to do the less invasive things first and then advance our care."
A trial usually lasts for three days to a week, long enough for the patient to live with the device in his daily environment while going about regular daily activities. If the trial with the pain physician is successful, Jaufmann will surgically place a permanent stimulator.
"If the trial really covers the pain and the patients are really happy with it, they nearly always do well with their permanent device," he says.
The permanent device is implanted under the skin of the abdomen, and the coated wire leads are inserted under the skin and into the spinal canal. An implant is typically done as an outpatient procedure involving a local anesthetic, and the patient is usually awake but sedated.
According to both Jaufmann and Kuzma, neurostimulation therapy has been available for more than 30 years, but the technology has improved significantly during that time, especially in the size of the generator and the batteries.
Jaufmann, who did his first implant as an Air Force surgeon, points out that the generators are now very small, unlike early devices that were roughly the size of two hockey pucks. Batteries, which last for several years, are about the size of a silver dollar.
Current technology also includes more electrodes and more options for programming, and the procedure can be reversed.
Dreisbach wore an inactivated neurostimulator for a couple of weeks while his incision healed and then returned to the Back and Neck Pain Center to have it programmed. Since the device is adjustable, he can increase or decrease the level of electrical impulse as needed to cover his pain.
Now he no longer takes pain medication, not even the over-the-counter Advil he had used for so long, and he is thinking about resuming golf, an activity that previously "would lay me up for about a week every time I'd drive a ball," he says.
"I don't have any pain," he says. "I lower the level when I go to bed, and I turn it up a bit in the morning and do my daily routine. It's fine. It's wonderful."
Carolina Neurosurgical Services has offices in both Pinehurst and Fayetteville. The FirstHealth Back and Neck Pain Center and Pinehurst Anesthesia Associates are in Pinehurst. For more information on neurostimulation therapy, call First Health of the Carolinas at (800) 213-3284.
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