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Help Available for Patients With Complex Back Pain
By Vanessa Orr

For many people with back pain, conservative therapy can be the answer. Yet there are some people whose pain is so severe that it cannot be treated by traditional means, leading to a decrease in overall function, and limiting that person's ability to participate in activities of daily living.

"While many patients respond to first-line treatment, including activity modification, pain medications, muscle relaxants and physical therapy, there is a subset of patients who do not respond to conservative care and whose pain is quite debilitating," explained David Provenzano, M.D., medical director of the Institute for Pain Diagnostics and Care at Ohio Valley General Hospital. "These people may have difficulty sleeping, walking or even getting out of bed. Or they may not be able to tolerate the pain medications that they need to take to feel better."

One innovative treatment offered at the Institute for patients suffering from vertebral compression fractures is percutaneous vertebroplasty, in which bone cement is injected into the weakened or collapsed vertebral body. "What this does is help seal the fracture," explained Dr. Provenzano, adding that patients feel pain relief in the first 24 to 48 hours after the procedure. "This treatment allows patients to function, to get off of pain medications and to return to their regular activities."

This treatment can help limit other medical problems that may develop as a result of compression fractures. In the U.S. alone, more than 10 million people have osteoporosis, and an estimated 700,000 osteoporosis related compression fractures occur annually. Compression fractures also result in more than 150,000 hospitalizations each year.

"Percutaneous vertebroplasty can be performed in our office and only requires mild sedation," said Dr. Provenzano of the procedure. "The cement actually hardens before the person even leaves our office." Patients are evaluated two to three hours after the procedure, and come to a follow-up appointment the next week. Approximately 85 to 90 percent of the operations are a success. The procedure is not recommended for patients with bleeding disorders, neurological or anatomical contraindications, and cannot be used to repair old fractures.

Another option for patients who do not respond to conservative treatment is spinal cord stimulation. This treatment is often used for patients who have undergone previous back surgery, have complex regional pain syndrome, or peripheral neuropathic pain. "During this procedure, we stimulate the spinal cord to block the pain signals from reaching the brain," explained Dr. Provenzano. "We change the chemical makeup of the spinal cord which can help substantially in pain reduction."

This minimally invasive, outpatient procedure can actually be 'tested' by the patient for five days. "We put a small, electric wire within the bony spinal canal, which is connected to an external power generator that is programmed by computer," said Dr. Provenzano. "The patient wears this for five days, and if it substantially helps to reduce pain and increase function, we progress to putting in an implant."

The Institute for Pain Diagnostics and Care offers a variety of other options for back pain. Epidural steroid injections can help patients suffering from acute herniated discs in the neck and lower back, and minimally invasive rhizotomy can be used to relieve back pain caused by arthritic joints in the spine.

Cancer pain can be treated through the use of an intrathecal pump, which is a small catheter that is placed into a fluid sac within the spinal canal. "Through this catheter, we release a small quantity of concentrated pain medications to that area," said Dr. Provenzano. "This treatment has fewer side effects than higher doses of oral medications."

In all cases and with all treatments, a multimodal pain program is designed for the patient that includes the consideration of minimally invasive interventional pain procedures, physical therapy, medication, relaxation techniques, counseling and more.

For more information on the Institute for Pain Diagnostics and Care at Ohio Valley General Hospital, call (412) 777-6400 or visit www.IFPDAC.org.

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