For those of us addicted to The New York Times’ weekly section, Science Times, January 8 was a grand day indeed. NJMS pain management guru Andrew Kaufman was front and center in an article by science writer Tara Parker-Pope on the “ins and outs” of implantable spinal cord pulse stimulators to fight pain. With the amazing improvement of this technology in the last five years, the small “pacemakers” are being utilized to address an array of serious medical conditions.
Inserted into the “fat pad” just south of the lower back, the stimulator sends measured pulses of electricity via implanted leads to the spinal cord. This blocks pain signals from going up to the brain, although patients feel a “buzzing” in the area. “We try everything else first,” says Kaufman, “because implants always present risks and this doesn’t stop the underlying process or problem.” A three day “real time” trial with the pacemaker is crucial. “It has to be life-altering for me to go ahead,” says Kaufman. Patients average about 75 percent overall relief.
As a pain management consultant, Kaufman studies the “whole picture” to determine the best treatment. Other pain-stoppers he sometimes recommends are implantable drug delivery pumps for cancer patients (not just for end-stage) and a procedure called percutaneous disc decompression, which is “elegantly simple, like releasing air from a tire.” Patients leave the hospital within hours. Pain relief is usually immediate, but can take one to two weeks.
High tech remedies work for some pain, low tech for others. Also covered in The New York Times was a massage therapy clinical trial for relief of pain from osteoarthritis of the knee led by SHRP’s Adam Perlman. Working with investigators from Yale, he found a pronounced and long-lasting effect on pain, stiffness and range of motion. Results of their clinical trial were published in the Archives of Internal Medicine. The team is continuing their work to demonstrate the cost effectiveness of massage and to broaden their patient base.