A Better Way to Manage Pain
September 7, 2023
Chronic pain – a not-so-uncommon issue that can make daily activities nearly unbearable. While occasional, short-term pain is standard and typically easy to treat on your own, chronic pain persists – firing signals in the nervous system for weeks, months or even years.
For many patients, there may have been an initial incident – like an injury or a serious infection. Common chronic pain complaints include headaches and migraines, low back pain, muscle pain or arthritis pain. In addition to injury or infection, many other factors that can increase the risk of chronic pain, including:
- Genetics
- Aging
- Having surgery
- Being overweight or obese
- Stress or mood disorders
- Previous trauma
Acknowledging the profound and debilitating impact of pain is so important to medical professionals, the American Chronic Pain Association devotes the month of September to the 50 million Americans living with chronic pain – recognizing Pain Awareness Month.
At Mississippi Valley Surgery Center (MVSC) in Davenport, Iowa, pain management is part of the patient-centered care plan. With nearly 9,000 outpatient surgical procedures each year, MVSC staff members are experts in the latest, proven techniques that lead to better outcomes and faster recovery.
Long-term pain treatment with leading-edge technology
Between the opioid crisis and misuse of prescription pain medications, medical professionals discovered a need for a better, nonaddictive way to deal with chronic pain. As an expert in the latest advancements in chronic pain management, Dr. Maruti Kari with UnityPoint Pain Center often recommends spinal cord stimulation when nonsurgical pain treatment options fail to provide enough relief.
“With so many opioid deaths and overdoses, medication is not something many physicians want to employ,” Dr. Kari said. “And if a patient who has been taking narcotic pain medication comes into my office, it’s clear that the medication isn’t working. Spinal cord stimulation is a good alternative.”
Used to disrupt and mask pain signals traveling to the brain, spinal cord stimulations target specific areas of the body in a way that change how the brain perceives pain, offering relief in a relatively short amount of time.
Spinal cord stimulation: A three-phase process
Phase 1: When a patient is considered a good candidate for a spinal cord stimulator, they begin a three-phase process with Dr. Kari. The first step is a psychological assessment.
During the assessment, the psychologist evaluates the medical history, chronic pain struggles and coping skills of the patient. With the big picture in mind, the psychologist can evaluate the patient’s mental health and their support system to determine the potential for success through the procedure.
Phase 2: Once they have approval to move forward, phase two allows patients to test the device without getting it permanently implanted. In fact, the spinal cord stimulator is the only device that patients can try first without getting implanted.
When undergoing the trial procedure at MVSC, the patient receives a local anesthetic to numb the area. Insulated wires, called leads, are carefully placed through a needle and connected to a small stimulator that remains on the outside of the body. Dr. Kari and his team check in with the patient daily to monitor the stimulation over a seven-day period, and the leads are easily removed at the end of the trial.
While some physicians recommend taking time off work during the trial period, Dr. Kari recommends that they remain in their usual routines.
“This device is supposed to help you in your normal, everyday life,” he said. “If the patient sits in a chair all day, their pain may decrease. To me, that defeats the purpose if their life is usually more active. I want to make sure the patient goes back to their routines.”
Phase 3: For nearly 90 percent of patients who have success during the trial period, Dr. Kari will move forward with permanent implantation, placing the device in the abdominal or buttocks area. The patient can increase and decrease the level of stimulation using a remote or Bluetooth app, reducing their pain by 50 to 70 percent. Many of these procedures will be completed at MVSC.
Standard pre- and post-op pain management
For other outpatient procedures at MVSC, pain management is kept top-of-mind with patients working directly with one of the center’s certified registered nurse anesthetists (CRNAs).
With specialized graduate-level education in anesthesia care, CRNAs evaluate the most appropriate anesthetic technique, depending on the type of surgery planned. Some procedures can be done with only light sedation, like cataract surgery. Other procedures call for use of a regional block and deep sedation, while some often require general anesthesia.
“The regional blocks we do are for postoperative pain control,” explained Sarah Butcher, CRNA at MVSC. “With the pain block in, we can use fewer narcotics and other mediations that can have unwanted side effects.”
The pain block will gradually wear off, segueing into postoperative pain control. While it is normal to feel a little groggy and to have some discomfort post-anesthesia, an anesthetist’s job is to make sure it’s at an acceptable, safe level for patients to go home. MVSC’s CRNA team credits the good working relationship they have with the center’s surgeons for successful outpatient outcomes.
“We’re really in tune with the surgeons, especially because of the ongoing opioid crisis,” Sarah said. “We want patients to limit the use of narcotics. In the short term, narcotics can have lots of complications that keep patients from being able to go home, such as nausea and/or prolonged sedation. Long-term, we also know there is a risk for addiction.”
If you’re interested in learning if spinal cord stimulation would be a good fit for you, work with your primary care doctor to get a referral to Dr. Kari with UnityPoint Pain Center. To learn more about Mississippi Valley Surgery Center, go to www.mvhealth.net or visit the center’s Facebook page at facebook.com/MississippiValleySurgeryCenter.