Saurabh Dang, MD, interventional pain physician, Garden State Pain Control.
For individuals who haven’t responded to traditional forms of treatment and suffer from the pain of sciatica, Saurabh Dang, MD, of Garden State Pain Control has a new option — a small implanted device that provides relief through spinal cord stimulation.
“The pain of sciatica can be intense and debilitating. It takes a major toll on quality of life,” said Dr. Dang, a board-certified anesthesiologist and fellowship-trained pain medicine specialist with Garden State Pain Control, a multispecialty practice with offices in Clifton, Edison, Hazlet and Jersey City.
Sciatica often is caused by a herniated disc in the lumbar, or lower region of the back compressing the sciatic nerve, which branches from the lower back through the hips and buttocks and down each leg. Bone spurs and even a muscle also can compress or irritate the nerve, while in other cases infection or inflammation can affect the nerve and trigger sciatica, Dr. Dang said.
While a common symptom of sciatica is pain that travels down one leg, other symptoms may include pain, numbness, tingling or a burning sensation in the hip, buttocks, lower back or in both legs. In addition, the factors that bring on or intensify symptoms can vary from person to person, with some people experiencing increased pain when sitting and others having a shooting pain when they stand.
Those symptoms result from electrical impulses that send pain signals to the brain, Dr. Dang said. With spinal cord stimulation, a small implanted device delivers a mild electric current, or impulse, to the spinal cord to decrease the transmission of those pain signals.
‘The main message I have for people is: Don’t resign yourself to living in pain. There are a number of good options out there, giving us the ability to create a highly individualized approach to treating your sciatica.’
“Most people are familiar with cardiac pacemakers, which monitor the electrical activity in the heart and send electrical impulses, when needed, to control heart rate and rhythm. Spinal cord stimulators are roughly the size of a pacemaker, and also generate electrical impulses, just as pacemakers do. In this case, however, those impulses stimulate the spinal cord for purposes of pain control,” he said.
Dr. Dang said that spinal cord stimulator systems consist of the device itself, which contains a battery that powers the electrical pulses; a thin wire with several electrodes that deliver those electrical impulses to the spinal cord; and a remote control, similar to one used to change a television’s channels or volume, but which in this case turns the device off and on and allows for settings to be adjusted. Some devices use technology and energy output which provides a tingling feeling while others use electrical impulses to minimize the nerve pain without any tingling sensation.
Spinal cord stimulation to treat chronic pain from nerve damage was approved by the FDA more 30 years ago.
Proper patient selection is key to successful treatment of sciatica pain. Patient selection begins with confirming the diagnosis and includes seeing whether physical therapy or medication can adequately relieve pain in patients whose symptoms arose fairly recently.
“Our goal is to provide patients with the maximum benefit with the least-involved approach that works for them. In many cases, a few weeks of physical therapy and exercise with or without anti-inflammatory medication will be sufficient for recent-onset sciatica,” Dr. Dang said. “If those steps don’t provide enough relief, we may look at an injection or other therapy. If pain persists after those treatments, we can consider surgery, again using the least invasive approach that is appropriate for that patient’s specific condition. Meanwhile, spinal cord stimulation can be very helpful for those patients who have pain that persists despite use of those other modalities, including pain that continues after lumbar surgery. It also is an option for people who want to avoid a more-involved back surgery, and for people with underlying medical conditions that make them poor candidates for surgery.
According to Dr. Dang, the great majority of people who could benefit from spinal cord stimulation are candidates for the treatment, while only a small percentage are not eligible because of an active infection, a severe narrowing of the spine where the electrodes would be placed or other medical considerations. Similarly, most insurance plans will cover spinal cord stimulation for patients whose sciatica has not responded to other treatment.
How Much Relief Should People Expect?
“The goal is for patients to have a 50% or greater reduction in pain,” Dr. Dang said. “When spinal cord stimulation first became available, roughly half of people met that benchmark. However, there have been significant improvements in the technology over the last 10 to 15 years. Thanks to those advances and to careful patient selection, 80% to 90% of the patients receiving spinal cord stimulation in our practice have at least a 50% reduction in pain, with many having an even greater reduction.”
He said that candidates for spinal cord stimulation begin with a temporary device to see how they do with the technology and how it affects their function and pain.
“During an outpatient procedure in our office or an ambulatory surgery center, we place one to two wires through a needle in the lower back and use fluoroscopy — or X-ray imaging — to place small electrodes in the epidural space of the spinal cord,” he said. “The procedure takes about 15 minutes, and is similar to what is involved when a woman in labor is given an ‘epidural’ to deliver medication for pain relief. However, patients who have had both procedures typically say that the electrode placement involves much less discomfort, likely because we’re using the imaging guidance to precisely place the electrodes.”
Those temporary electrodes generally are in place for three to seven days. “We then meet again to assess the experience,” Dr. Dang said. “Did the patient feel comfortable with the electrodes? Was there a noticeable improvement in physical function? Did the patient feel at least a 50% reduction in pain — and hopefully an even greater reduction? For most patients, the answer to those questions is ‘yes,’ and they choose to have a stimulator implanted. If the trial did not yield the desired results, we go on to consider other options. In either case, we remove the temporary electrodes, which is painless and done in the office. For the majority who want to continue with spinal cord stimulation, we perform the implantation two to three weeks later.”
The physician said that the implantation procedure is performed on an outpatient basis under sedation, with general anesthesia used for a minority of patients based on their medical history. The procedure takes 45 minutes to an hour, and involves making two small incisions in the skin of the lower back. Dr. Dang then implants the battery-powered stimulator, and guides the lead wire and its electrodes to the epidural space to allow delivery of those pulses.
“Every type of surgery involves some degree of risk, such as infection, nerve damage or bleeding, but those complications are extremely rare with spinal cord stimulator implantation,” Dr. Dang said.
Stimulators with both non-rechargeable and rechargeable batteries are available. Devices with batteries that can’t be recharged need to be surgically replaced every three to five years. Stimulators with rechargeable batteries last up to 10 years, at which point they also can be replaced with a simple procedure. Recharging typically takes about 30 minutes three times a week, with some variance based on frequency of use, Dr. Dang said, noting, “People can sit and watch television or read during the recharging.”
Cause For Encouragement
“The limitations and pain caused by sciatica can be significant, as anyone who has experienced the condition knows,” Dr. Dang said. “But the discouragement that patients feel when their sciatica doesn’t respond to initial treatment or even to surgery is a particularly heavy burden, and can have a tremendous impact on outlook and quality of life. With spinal cord stimulation and the other treatment modalities available to us today, we’re able to offer patients both new hope and, in most cases, significant relief. I guess the main message I have for people is: Don’t resign yourself to living in pain. There are a number of good options out there, giving us the ability to create a highly individualized approach to treating your sciatica.”
Dr. Dang was born in New Jersey and grew up in upstate New York, where he attended Hamilton College, graduating with a degree in mathematics. He went on to medical school where he received his Doctor of Medicine degree and graduated cum laude. Dr. Dang completed an internship in General Surgery at Beth Israel Medical Center in New York City, then entered his anesthesiology residency at New York Medical College in Valhalla, N.Y., where he served as chief resident in his final year and received the “Resident of the Year” award. He completed his fellowship training in interventional pain medicine at the University of Toledo, where he gained significant experience in the use of implantable devices for the management of chronic pain. Beyond spinal cord stimulation, Dr. Dang has extensive training in intrathecal drug delivery systems, radiofrequency rhizotomy procedures, and in administering epidural steroid injections, selective nerve blocks and joint injections.
Dr. Dang and his Garden State Pain Control colleagues see patients at the practice’s offices in Clifton (973) 291-2057, Edison (732) 256-2927, Hazlet (732) 256-8088 and Jersey City (973) 291-2466. For more information, or to schedule an appointment, call the Garden State Pain Control office closest to you or visit www.gardenstatepain.com.
"device" - Google News
September 04, 2020 at 10:06PM
https://ift.tt/3gWISql
A small device is providing big relief for many New Jersey sciatica sufferers - Jersey's Best
"device" - Google News
https://ift.tt/2KSbrrl
https://ift.tt/2YsSbsy
Bagikan Berita Ini
0 Response to "A small device is providing big relief for many New Jersey sciatica sufferers - Jersey's Best"
Post a Comment