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Southern Pain Specialists |
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Deploying New Weapons in the War Against Pain By Mike Totty Under mild sedation and local anesthetic, the patient watches as the physician inserts the long hollow needle into his back. Through the needle, a catheter snakes around the intervertebral disc. Over the next 15 minutes the physician gradually increases the temperature in the catheter, applying heat directly to the damaged disc. A couple of hours later, Band-Aid in place, the patient goes home. This revolutionary new procedure is called Intradiscal ElectroThermal Therapy or IDET. It is one more tool in the growing arsenal available to today's interventional pain specialists. "Not too long ago, our tools for treating focal pain problems were not very effective," said Dr. Kenneth Varley, of Southern Pain Specialists. "Blind steroid injections only work about one out of four times. Because of scar tissue and other barriers, we had no way of knowing if we delivered the medication to the injury site at all." The National Institutes of Health estimate that low back pain alone costs this country between $60 to $80 billion a year in terms of medical costs, medications, work hours lost, and litigation. This represents nearly 10 percent of all health care dollars spent in the U.S. It is second only to the common cold as the major cause of missed workdays. Approximately three out of four people will experience lower back pain sometime in their lifetime. The cost of suffering with chronic and acute pain is incalculable. According to Dr. Varley, early intervention and minimally invasive procedures are the best way to avoid more expensive surgery and disability in the patient. Unfortunately, lower back pain is also one of the most frequently misdiagnosed problems. Dr. Varley estimates that 61 percent of patients referred to tertiary pain specialists either have no diagnosis or have the wrong diagnosis. "Internal disc disruption is very difficult to diagnose," said Varley. "It is hard to spot with an MRI or CAT scan." The intervertebral discs act as shock absorbers for the vertebrae. Injury or repeated stress may cause small tears to appear. A normal MRI often shows only very small signs of disruption to the disc. Swelling can put pressure on nerve roots and leakage from torn discs irritates these nerves. Traditionally, such pain would be treated with steroids injected into the posterior epidural space. However, recent studies indicate than most pain pathology occurs at the nerve root in the lateral recess or in the anterior epidural space. Scar tissue and the median band of the epidural space are barriers that cannot be penetrated by blind steroid injections. A recent article in the journal Anesthesia and Analgesia (1999,88,367-372) reported that blind lumbar steroid injections reach the targeted pathology site in only about 26 percent of cases. In severe cases, costly and frequently debilitating surgery to remove the disc and fuse the vertebrae was the only option available. Today, new approaches bring an extraordinary level of precision to treating pain. One of the most important and therapeutic tools for combating pain is the fluoroscope. The use of the fluoroscope also opens the door to a wide range of diagnostic procedures. "Our approach to focal pain problems is to pinpoint the pain generator, whether it is a nerve, a joint, or a disc. Once identified, we deliver medication as close to this pain generator as possible," said Varley. The fluoroscope allows the physician to deliver the injection precisely to the intended location. Fluoroscopically guided injections reach the level of the tissue pathology in 98 percent of the cases. "This precision allows us to use lower doses of steroids," said Varley. Compared to traditional blind injections, fluoroscopically guided injections achieve a much greater chance of success. Patients who fail to respond to steroid injections may be candidates for IDET (Intradiscal Electro Thermal Therapy). "IDET is one of the best examples of the potential of these emerging treatments," said Varley. "The procedure has been performed over 1,000 times in this country. We have performed it 33 times here at SPS. The results, thus far, indicate that IDET is very effective at alleviating pain. It seems to actually seal minor leaks in the intervertebral disc. "This is only the beginning. Right now we are looking at fiber laser technology that promises yet another minimally invasive procedure to treat contained, herniated discs," said Dr. Varley. He believes that "these new interventional pain techniques offer more accurate diagnoses, less invasive procedures, and a much higher rate of positive outcomes." Patients receive better care. These techniques are expected to reduce significantly the staggering costs associated with lower back pain. Southern Pain Specialists was formed in 1997 as a multidisciplinary pain clinic, which combines state-of-the-art minimally invasive pain treatment technology with pain psychology. Dr. Kenneth G. Varley is a fellow of the Royal College of Physicians and Surgeons of Canada with post-graduate training in Internal Medicine and Anesthesiology, with subspecialty certification in Pain Management as well as being a Diplomate of the American Board of Pain Medicine. Dr. Varley specializes in numerous interventional pain medicine procedures, including neurofrequency neuroablation, cryolesions, spinal cord stimulation, narcotic infusion pumps and spinal endoscopy. Dr. Andrew J. Rózsa received his Ph.D. in Psychobiology from Florida State University and was a post-doctoral scholar at Stanford University School of Medicine and on the faculty at Louisiana State University School of Medicine. Prior to specializing in clinical medical psychology, he performed research and taught courses on the neurobiology of pain. He has 15 years of experience in clinical medical psychology, with specialization in the behavioral and cognitive aspects of chronic pain. Dr. Rózsa is a Diplomate in the American Academy of Pain Management. Southern Pain Specialists offers a continuum of care for the patient with acute or chronic back pain. A complete diagnostic evaluation can be performed at the Greystone Neuroscience Center including advanced imaging techniques at the Greystone Imaging Center. The special procedure suite allows patients to be treated on site, in quiet, relaxed surroundings. Successful treatment relies on accurate identification of specific pain generators in the back. This is accomplished by provocative discography, facet and sacroiliac joint blocks and selective nerve root injections. IDET is only one example of the many state-of-the-art treatment modalities offered by Southern Pain Specialists. It is expected that these technically advanced procedures will not only relieve suffering, but also will result in considerable cost savings to the patient, employer, and insurance carrier. The procedures used at Southern Pain Specialists include the following:
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7191 Cahaba Valley Rd, Suite 204 • Birmingham, AL 35242-6042