Innovative Approach, Recommendations Dealing With Intractable Neuropathic Pain
By Dr. Richard Gayles With Dr. James Palermo, Editor-In-Chief // June 21, 2012
SPACE COAST MEDICINE Q&A
Although the precise number of Americans afflicted with pain is hard to determine with great accuracy, several key pain statistics from the National Pain Foundation show that the sheer quantity of individuals suffering from pain is staggering.
Among the general population pain stats include:
• About 89% of Americans age over 18 suffer from pain at least once a month. Over a three year period, 76 million Americans reported pain lasting 24 hours or more;
• Approximately 42% of adults age 20+ who reported pain stated the pain lasted 1 year or more;
• Americans spend more than $100 billion annually to relieve pain;
• The trend toward even more people experiencing and living with pain will only grow as America’s baby-boomers age, making effective pain management an integral and very important aspect of healthcare services.
We are delighted to welcome Dr. Richard Gayles, who has touched countless lives through expert patient-centered pain management over the past 15 years here on the Space Coast, to bring us up to date on an innovative approach that he sometimes recommends when dealing with a broad scope of neuropathic pain.
SPACE COAST MEDICINE: What cutting edge treatments for pain do you advocate other than injections and medications?
At Florida Pain we routinely use a technique called Spinal Cord Stimulation (SCS). This is an FDA approved technique that utilizes a small wire, which emits a tiny electrical current blocking pain from damaged or irritated nerves.
DR. GAYLES: At Florida Pain we routinely use a technique called Spinal Cord Stimulation (SCS). This is an FDA approved technique that utilizes a small wire, which emits a tiny electrical current blocking pain from damaged or irritated nerves.
SPACE COAST MEDICINE: Is this the same as a TENS unit?
DR. GAYLES: That is a great question, but SCS and a TENS unit are two totally different treatments. SCS has been called a TENS unit on steroids by some patients. The TENS uses pads, which are placed on the surface of the skin over the painful areas, and an electrical current to stimulate only tissues close to the skin surface. The SCS uses a tiny wire or electrode placed carefully within the spinal canal to directly stimulate the spinal cord or an individual spinal nerve. The electrical stimulation of the SCS blocks pain from damaged nerves and substitutes the painful sensation for a pleasant, artificially produced sensation.
SPACE COAST MEDICINE: Can you walk with this device?
DR. GAYLES: When the SCS is used, a patient can certainly walk, and in fact, walking and exercising may be easier without pain. The purpose of the SCS is to reduce pain while increasing function and activity levels. After placement of the SCS, patients are strongly encouraged to begin a program of stretching and strengthening exercises.
SPACE COAST MEDICINE: How do you decide who gets a SCS?
DR. GAYLES: Most patients will get better with time, exercise, physical therapy, medication and/or injections. For patients who do not respond to the more conservative treatments, SCS may be considered after a thorough physical exam, review of MRIs, X-rays, and nerve testing. After a review of the medical records, to ensure that all conservative measures have been exhausted, and there is no urgent need for surgery, a trial of SCS may be scheduled.
SPACE COAST MEDICINE: What is the process of getting a SCS?
DR. GAYLES: After careful patient selection, a temporary percutaneous SCS trial is scheduled. The trial is like a test drive to determine how much pain the SCS will relieve. During the trial, SCS wire electrodes are inserted trough a needle into the spinal canal under x-ray guidance and are placed over the spinal level where signals from the damaged nerves are processed. When the SCS is turned on the patient will feel a pleasant tingling sensation over the painful areas. The SCS wires are then secured in place sterilely on the back. The patient is sent home with a small external battery/programmer and is encouraged to perform activities, which may provoke their usual pain. This trial lasts for 5-7 days, and when completed the SCS wire electrodes are pulled out and a band-aid is placed over the injection site. If the patient has greater than 50% reduction in pain and much improved function then a permanent system is inserted.
SPACE COAST MEDICINE: What does insertion entail?
DR. GAYLES: Wire electrodes are inserted through a needle into the spinal canal in a similar fashion as described for the trial. For the most common type of pain—the back–the SCS generator is usually implanted in the lower abdominal area or in the back in the upper gluteal (butt) region, and should be in a location that patients can access with their dominant hand for adjustment of their settings with the patient-held remote control. The SCS is then connected to wire electrodes. The procedure is done as an outpatient either under local anesthesia with sedation or a general anesthetic.
SPACE COAST MEDICINE: How is the SCS powered?
DR. GAYLES: The SCS is battery powered, and the battery lasts approximately 5 to 7 years. There is now a rechargeable SCS, which can last 10 years and is charged by a special belt.
SPACE COAST MEDICINE: Is the implanted SCS permanent?
DR. GAYLES: No, the SCS can be easily removed if desired. There are no permanent changes to the body after removal of the SCS.
SPACE COAST MEDICINE: Does insurance cover the SCS?
DR. GAYLES: Yes, virtually all insurances cover the SCS, including Medicare.
SPACE COAST MEDICINE: What conditions does the SCS treat?
DR. GAYLES: The SCS treats chronic sciatica (radiculopathy), neuropathy, occipital neuralgia, reflex sympathetic dystrophy, phantom limb, pain from peripheral vascular disease, back pain and many other painful conditions caused by nerve damage. In Europe the SCS is also used quite extensively for chronic refractory angina and peripheral vascular disease.
SPACE COAST MEDICINE: Are there limitations after the SCS is implanted?
DR. GAYLES: You can swim, walk, bicycle, jog, but be smart, and avoid the extremes of physical activity. SCS may be picked-up by the airport security machines, but patients avoid problems and carry a card to alert security to the presence of this device. The Medronic SCS has also been used successfully with patients with pacemakers.
To contact Dr. Gayles call 321-784-8211 or log on to FloridaPain.net
Florida Pain Doctor, Richard Gayles, MD
Dr. Richard Gayles brings a wealth of training and experience to Florida Pain. He received a Bachelor of Science in Psychobiology from the University of Michigan in 1987 and his Doctor of Medicine in 1991 at the University of Michigan’s School of Medicine. After graduation, Richard completed a residency and Pediatric Anesthesia Fellowship in the Department of Anesthesiology and Critical Care Medicine at Johns Hopkins Hospital in Maryland.
Dr. Gayles obtained further clinical experience in anesthesiology at St. Bartholomew’s Hospital in London, England. He completed a Chronic Pain Fellowship at the Cleveland Clinic Foundation in Ohio, where he was awarded the “Fellow of the Year Award” in June of 1997. He currently utilizes his expertise at Florida Pain, Merritt Island Surgical Center and Space Coast Surgery Center (located at our facility).
In addition to his clinical experience, Dr. Gayles has participated in research over the past fourteen years, both here at home and abroad. Dr. Gayles is Board Certified by the American Board of Anesthesiology and a Diplomat of the American Academy of Pain Management. He is also certified by the American Board of Pain Medicine, National Board of Medical Examiners and by the American Heart Association in Basic and Advanced Cardiac Life Support. Dr. Gayles holds the Following Special Affiliations: Member of Coast Guard Auxiliary and FAA (an Aero Medical Examiner) ANGEL Flight.
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