[FoRK] My wife the cyborg

Meltsner, Kenneth Kenneth.Meltsner at ca.com
Tue Mar 9 11:47:32 PST 2004


Janice had twin neural stimulators installed more than a year ago, and
after some tweaking (and a second attempt for one of them), they're
working great.  This is a seriously non-trivial procedure, but after
exhausting all other options (and more than a decade of visiting various
specialists and an extended in-patient treatment), something finally
worked.

The article is mostly accurate; a few details were botched.

Ken

http://www.chicagotribune.com/features/health/chi-0403090043mar09,1,5877
433.story

[free registration required]

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Experts offer myriad ways to combat chronic pain
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By Barbara Ballinger
Special to the Tribune

March 9, 2004

Janice Eisen, 40, who lives in a Milwaukee suburb, understands the
physical and mental anguish associated with chronic pain.

For five years, she had a constant, severe headache that didn't quit
until she fell asleep from exhaustion.

"Sometimes my head throbbed," she said. "Sometimes I felt there were
little men inside mining coal. It hurt all the time."

For Eisen and many others, chronic pain is much more than a symptom that
causes a slight change in physical abilities and behavior. When it lasts
more than six weeks, said Dr. Randy Rizor, medical director of the
Center for Spine Care at Shepherd Center in Atlanta, chronic pain is
classified as a disease, and it stems from a variety of causes.

Besides headaches, chronic pain can come from back and knee injuries,
arthritis, fibromyalgia and pelvic problems. And it triggers a host of
health problems such as stress, depression, weight gain, muscle changes,
high blood pressure, heart attacks and strokes.

According to the American Pain Foundation, a consumer organization in
Baltimore, chronic pain may afflict up to 75 million Americans. It also
costs businesses in lost productivity and wages for sick days. A study
published last year in The Journal of the American Medical Association
pegged annual costs at $61 billion.

In Eisen's case, she first sought help from a neurologist, then a
Chicago headache specialist. They prescribed medications, gradually
increasing the strength of what she took until she was on morphine pills
daily. Some prescriptions briefly eased her pain, but they also produced
side effects that sapped her energy and spirit.

"I barely functioned, and constantly had to tell people that I felt too
bad to do anything," she said. "I became clinically depressed."

Her home life also suffered.

"I wasn't myself with my husband or two children, who were 7 and 2 years
old at the time," she said.

Finally, a pain specialist in Milwaukee learned of Dr. Robert M. Levy's
pioneering work with medicines and neurosurgery at Northwestern Memorial
Hospital's pain-management clinic.

Levy's patients with chronic head pain go through a rigorous process
before he deems them suitable for a procedure known as supraorbital
nerve stimulation. SOS involves implanting an electrode into the
patient's head and a small pulse generator the size of a makeup compact
under the skin in the chest wall. The electrode stimulates brain cells
to block the transmission of pain every time there's a pain impulse or
trigger the release of endorphins, the body's natural pain killers.

A little more than a year ago, Eisen had the procedure.

"I woke up after the first operation and had no headache. I almost
forgot what it felt like to feel that way," she said.

Her medical insurance covered costs, about $50,000, Levy's office
estimates. The electrodes will remain in place, but Eisen will need the
battery pack changed on an outpatient basis, possibly within five years,
said Levy, the pain clinic's director.

A growing cadre of pain-management specialists, related professionals
such as chiropractors and acupuncturists, and even Congress have
recognized the importance of treating pain and doing so with an
interdisciplinary approach that uses conventional and alternative
methods rather than a single therapeutic method. For its part, Congress
has declared this decade as The Decade of Pain Control and Research.

There are several reasons for the more aggressive team action. Chronic
pain is recognized as a good indicator of health problems, as are blood
pressure, temperature, respiratory rate and pulse.

"It's the fifth vital sign," said Dr. Jonathan Wyatt, an
anesthesiologist and pain specialist at Christ Medical Center in Oak
Lawn.

Additionally, sufferers such as Eisen are no longer willing to endure
their pain without seeking help, said Dr. Melvin Gitlin, president of
the American Academy of Pain Medicine, based in Glenview.

And there's an understanding that a host of factors may account for its
prevalence, all of which have to be addressed:

- A larger number of elderly adults experience it as their parts wear
down. Most of the chronic pain patients seen by Dr. Noor Gajraj,
assistant professor in the department of anesthesiology and pain
management at the Dallas-based University of Texas, Southwestern Medical
Center, have osteoarthritis, which causes hip, knee and lower back pain.

- An increasingly overweight population is putting greater pressure on
their backs, knees, legs and other parts.

"There's an epidemic of obesity, which causes chronic pain problems in
all ages," said Dr. Larry Altshuler, an internist who specializes in
chronic pain and diseases at the Balanced Healing Medical Center in
Oklahoma City.

- An increasingly more active segment of the population is more
susceptible to injuries.

"They put more stress on their bodies [through exercise]," said Dr.
Barry Ring, an anesthesiologist and pain management specialist with
Sinai Health System in Chicago.

- Also, an increasingly sedentary segment sits for long hours, often
performing repetitive tasks that lead to chronic pain such as carpal
tunnel syndrome.

And then there are chronic pain sufferers such as Chicagoan Arline
Sands, 69, who didn't know at first why she started having severe pain
12 years ago. A doctor diagnosed her with spinal stenosis, a progressive
disease that causes the spine to narrow and degenerative tissue to press
against it.

"It causes me enormous gales of pain in my lower left back, buttocks and
left thigh," she said.

Her internist ordered an MRI to find the cause of the pain and it showed
the spinal stenosis plus scoliosis and arthritis. These caused nerve
involvement and pain.

"Nothing seemed to work. I dieted and lost more than 20 pounds, though I
wasn't big," she said.

She also started swimming and stretching.

When the pain didn't lessen, she agreed to surgery to open her spinal
area to alleviate the stenosis. The operation was considered successful,
but the pain shifted to a different area of the spine and worsened, she
said. Sleeping became more difficult.

Finally, she found some relief. Dr. Sheila Dugan, a physiatrist (a
physician or doctor of osteopathy who focuses on physical medicine or
rehabilitation) affiliated with the Chicago Institute of Neurosurgery
and Neuroresearch at Rush University Medical Center, recommended new
exercises to stretch the muscles around her spine and pelvis. Dugan's
colleague, Dr. Daniel J. Hurley, another physiatrist, gave her epidural
injections to the nerve roots containing a corticalsteroid and
anesthetic medication.

Her pain remains, but it has decreased enough so that she can live with
it, she said.

"It's frustrating to live in pain all the time, and it's worse when I'm
sitting. But I manage with a pillow and generally function better now,"
she said. She continues to get epidural injections every few months.

Expertise in pain treatment is a subspecialty of three board-certified
disciplines: anesthesiology, physical medicine and rehabilitation, and
psychiatry and neurology, according to the American Academy of Pain
Medicine. A move is afoot to give the treatment of pain its own
specialty certification, Levy said.

In the meantime, he and other healers encourage the interdisciplinary
approach that offers an array of conventional and alternative treatments
-- from pills, injections, a patch or pump, to massage therapy, yoga,
acupuncture, diet and surgery.

For instance, AthletiCo, a company that operates physical therapy and
health/wellness centers throughout Chicago, teaches Pilates to help
chronic pain sufferers move to decrease pain.

"We often find that within four to five sessions, they see some positive
change and [we] then put them on a preventive-maintenance program," said
Katie Lemmon, who received certification through Polestar Pilates in
Miami.

Entrepreneurs also have recognized that the increase in pain is an
opportunity for new products, such as a headache "glove" used to apply
direct pressure to a pain area and a hand-held device that elevates the
deep-tissue temperature in an inflamed area.

The abundance of specialists, treatments and gadgets can confuse chronic
sufferers about where to seek help, whom to ask, what method to try and
what to buy, if anything. The first stop should be to a primary
physician who may refer a sufferer to a pain-management specialist or
center, Dugan said.

Altshuler recommends low-level treatments and alternative methods before
advancing to injections, medications and surgery.

People have to keep expectations realistic.

"The problem," Rizor said, "is that too many want a high-tech solution
or pill to control pain."

Not everything, even a real pain in your neck, can be eliminated, he
said. But, he added, the ache it causes can be lessened.

To find trained specialists, peer support and ways to cope with pain,
consult the American Pain Foundation's Web site at
www.painfoundation.org. or call 888-615-PAIN (7246).


Copyright (c) 2004, Chicago Tribune

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