Centered on Health 1-30-25 - New spinal cord stimulator procedure that allows consistent therapy for pain with Dr. Nirav Patel.

Centered on Health 1-30-25 - New spinal cord stimulator procedure that allows consistent therapy for pain with Dr. Nirav Patel.

Episode Transcript

Speaker 1 (00:01):
It's now time for Centered on Health with Baptists Help
on use Radio. Wait forty WYJS Now, here's doctor Jeff Tubbler.

Speaker 2 (00:11):
Good evening, everyone, and welcome to tonight's episode of Centered
on Health with Baptists Health here on news Radio eight
forty whas. I'm your host, doctor Jeff Tublin, and as always,
we're joined from the studio by our producer, mister Jim Finn,
who is on standby to take your calls to be
part of our conversation tonight. Our phone number is five

(00:33):
oh two, five seven one, eight four eighty four if
you want to call in and be a part of
tonight's show. Fifty million people in the United States suffer
from chronic pain, and antestesiologists are the physician who help
us treat chronic pain with various medications and various new technologies.

(00:53):
They are also the physicians that ensure that you are
unconscious during your surgery and during medical procedures. Tonight, we
are talking with doctor Nirov Patel, who's an antithesiologist in
New Albany, Indiana and associated with Baptist Hospital Floyd. He
received his medical degree from Kansas City University of Medicine Biosciences,

(01:13):
College of Osteopathic Medicine and has been practicing for many years.
His expertise is in net and spine pain and doctor Patel,
we welcome you back to the show.

Speaker 3 (01:26):
Thank you, Doctatolin, glad to be here.

Speaker 4 (01:29):
Well, we are thrilled to have you.

Speaker 2 (01:31):
I should mention that one of the things that we
want to talk to about is about these spinal court
stimulators providing consistent therapy for pain. So in the context
of how you treat pain, we're going to get to
that exciting technology. But fifty million people, is that true?
Do you see that many people? Not fifty million, but
with chronic pain.

Speaker 3 (01:53):
Yes, absolutely, there are quite a bit of people who
do suffer from chronic pain. And by definition, chronic pain
patients are the patients who had pain for more than
three months, and unfortunately that number has been increasing every year,
So that number is correct, and we do see quite
a bit of patients unfortunately with chronic pain and try

(02:15):
to help as much as you can.

Speaker 2 (02:17):
Well, I'm sure many of our listeners understand what we're
talking about tonight, but just by way of sort of context,
you know, chronic pain isn't just about the pain, and
we'll probably get into some of this, but you know,
having that chronic pain has so much effects on someone's
daily life and their livelihood and their mental state. And

(02:38):
I just think it's amazing that we have physicians like
you that help us navigate that. And I'm excited to
hear hear about that. But talk to us a little
bit about how you decided anesthesia and pain management in particular.

Speaker 3 (02:53):
So I believe I was fortunate enough to know earlier
on that during my medical school that I wanted to
do pain. I was fortunate enough to do shadowing with
one of the pain management physicians earlier in medical school
and got to see all these procedures, all these medications
they were using to help control pain for a lot

(03:15):
of these patients. I remember there was an eighty year
old lady that came in with severe spine pain from
a broken water one of the bones in the spine,
and we ended up doing a thirty minute procedure what
we call kyphoplasty, which involves creating a cavity and putting
cement in there. And after this thirty minute procedure, patient

(03:38):
was in minimal pain. And she came in a wilture
and walked out without any assistance. So that that provided
that deep impact on me, and I decided to do
a Cgiology residency where we keep patients comfortable during the surgeries,
control their pain during the surgeries and after these surgeries,

(04:01):
and that got me more interested in pain management. So
I decided to do for the rocations during my residency,
and that kind of solidified my interest in pain management,
which led me to do for the specialization and fellowship
in pain management.

Speaker 2 (04:18):
And here I am, so are you someone that's mostly
in the hospital or are you evaluating and treating patients
in the outpatient setting?

Speaker 4 (04:29):
What's kind of your practice like?

Speaker 3 (04:31):
So we do both. Actually in the office setting. Out patient,
we see patients with a variety of chronic pain conditions.
So about three days a week I'm out there in
out patient setting evaluating these patients and based on the
needs of patients pain, we do procedures at the Baptist
Health Floyd Hospital, So I'm there for about two to

(04:55):
three days in the hospital doing all these procedures and
small surgeries.

Speaker 2 (05:01):
Fantastic, So obviously I would imagine that you see a
very wide range of I guess what I would say,
pain tolerance, whereas for some people just a small amount
of pain is debilitating and for others they have a
tolerance beyond that. And so how what is your approach
to a patient in terms of how do you assess

(05:22):
where they are in their pain and how that then
affects how you approach their treatment.

Speaker 3 (05:29):
Absolutely correct, pain is very subjective finding. So pain for
me could be two but it could be tense for
the other person. And so we in pain management apply
what we call multimodal a way to treat the pain
where we take help from physical therapy. We also try

(05:54):
to treat if there's any anxiet or depression involved, we
try to treat that with the psychology. We use a
variety of different medications to help control the pain, and
if pain is not control we may consider a certain
type of new blocks or injections to help control the pain.
But as you said, pain is very different for each person.

(06:16):
We try to treat each patient individually and try to
take care of them that way.

Speaker 2 (06:23):
Absolutely, And I know that the next question that I'm
about to ask you could be a ten day seminar,
So I do recognize that. But given the kind of
the opioid crisis that we've kind of heard so much
about over the last few years. Do you feel like
there's a stigma that patients are avoiding coming to you
for things that might really help them because of sort

(06:45):
of this quote awareness of the opioid pandemic.

Speaker 3 (06:51):
I think, yeah, you're absolutely correct. There's a big misconception
that if you're going to pain management, all you're doing
is getting opioid and getting addicted to this opioids. We
at Baptist pain Management we try to really minimize the
use of opious and try to treat the problem from

(07:12):
root cause rather than throwing kind of bandit of opioids
over it. So we use a lot of different approaches,
a lot of very non invasive or minimal universitive procedures
to help control the pain and try to treat the
cause rather than throwing medication at it, which has, for example,

(07:33):
for opioids, has potential of being addictive, causing side effects
such as respirated depression, constipation, being drowsy, and you know,
have that foginess. And so we try to minimize use
of opious and use it in very very selective cases,
mostly in cancer pain patients or patients who haven't really

(07:55):
responded to anything and try to use it for short term.
But they're many, many procedures that we could do and
we could avoid use of opioids.

Speaker 2 (08:07):
And I'm excited for you to share some of that
with us throughout our discussion tonight. And just lastly, in
terms of kind of understanding the context that you practice,
do you have a team that you work with, like
who's involved with the care of the patient, and do
you assess for things like depression and other things that
might go along with chronic pain.

Speaker 3 (08:30):
Yes, absolutely, depression and chronic pain unfortunately goes hand in hand.
A lot of patients do have depression and it's kind
of catch twenty two where chronic pain, being in pain
not able to do the activities that you enjoy doing
causes more depression, and then depression will cause infusion pain.
So your pain could be four out of ten, but

(08:52):
because of the depression, you are feeling it much higher.
So every patient that walks in will ask about depression,
will do these surveys to see if there's any depression, envrolment,
or any anxiety on a psychological issue. So we do
have a pain psychologist that comes into the office once
a week, so we'll work with them. We also have

(09:14):
excellent physical therapy team that works with us, not in
the office, but very close to us. We also have
new Resurgence at Baptists Health that we work very closely
and we'll refer patients back and forth as needed. So
we do kind of target the pain from a lot
of different ways.

Speaker 2 (09:36):
Well, we are going to take a short break and
we're going to start hearing some of these ways that
you are treating chronuict pain and I'm excited to get
into that. So I want to remind everybody that you
are listening to Centered on Health with Baptist Help here
on News Radio eight forty whas. I'm your host, doctor
Jeff Tumblin. Our phone number is five oh two, five
seven one, eight four eight four. We're talking about neurostimulation

(09:58):
and chroduct.

Speaker 4 (09:59):
Payment with doctor Nirov Patel. We'll be right back.

Speaker 2 (10:17):
Welcome back to Center It on Health with Baptist Help
here on news radio eight forty whas. I'm your host,
doctor Jeff Talblan, and we're talking tonight about spinal cord
stimulation and chronic pain management with anesthesiologist doctor Nirov Patel,
and I want to let everybody know that our phone
number again is five oh two, five seven one, eight
four eighty four. Our producers on standby to take your

(10:39):
calls if you want to ask a question to our
guest tonight, Dr Patel. Doctor Patel, welcome back and thank
you for sharing with us this kind of general approach
to pain management. But I do want to get into
some of the exciting stuff that.

Speaker 4 (10:54):
I know you're doing for our community.

Speaker 2 (10:56):
So I want to jump into the world of neurostimulators
in order to understand that could you give our listeners
a little understanding of the anatomy that is affected and
then therefore how some of these devices might end up helping.

Speaker 3 (11:13):
Absolutely, So I kind of tell patients that brain and
spinal cord plays a huge role in pain signaling. Think
of brain as a control center where all the messaging
from different part of your bodies come together, and then
brain processes those signals and sends them back to different

(11:36):
part of the different part of the bodies and tells
them what to do. And the role of spinal cord
is basically taking these messages from brain to different part
of your bodies and then bringing these messages back from
different part of your bodies to the brain, and so
pain signaling does happen to the spinal core. And so

(12:00):
of course simulators basically use these little electrical pulses to
disrupt specific pain signaling from different part of the body
going to the brain, and that's how it helps control
the pain. So we put this small electrical leads in

(12:22):
a space what we call epidrol space, which is an
empty space outside of spinnel cord where we put these electros,
and depends on which part of the body we are
trying to target, we choose a different location for these
spinel cord leads, and as we discuss before, it sends
out little electrical signals and disrupts that pain signaling going

(12:47):
from some spinnel cord to the brain, and that's how
it helps control the pain.

Speaker 2 (12:53):
So that's an excellent way for us to visualize it.
So I just want to kind of help clarify for
listening who may be familiar with the idea of a
pain pump. You know, sometimes after surgery where you're kind
of controlling pain medicine and stuff, you're not administering a
medication through the stimulator, You're you're using these electrical impulses.

(13:15):
Is that what we're hearing.

Speaker 3 (13:17):
That is absolutely correct. Yes, we do not use any
pain medications for this purposes. Pain pump is where you
are putting a small gas setter and dripping that pain
medication around this punnel cord versus bunal cord. Stimulation stays
slightly outside of this punnel cord and it only uses

(13:38):
those small electrical pulses to help control the pains. If
you're not using any pain medications or pain pump for
those purposes.

Speaker 2 (13:46):
So give us an idea of the types of problems
that you approach that can be treated with a neurostimulator,
What parts of the body, what kinds of symptoms can
get better? Give kind of paint that picture or for us.

Speaker 3 (14:01):
So, one of the biggest indication and FDA approved indication
for spinal corre stimulation is what we call failed back
syndrome or post laminactomy syndrome. What that means in simple terms,
it's patient had one surgery or multiple surgeries and they
still continues to have pain. Imaging does not show anything

(14:25):
that requires another surgery, and so unfortunately some patients end
up having this pain. So that's one of the patient
populations that we could use the spinal corse stimulation in.
One of the other emerging diagnosis that we have started
using spark corre stimulation and it's been approved by FDA

(14:46):
around twenty fourteen, is diabetic neuropathy. It is, and there
are not that many options. Unfortunately, once you fail neuropathic
medication like gabapentting or pre gabbling, there are not that
many options. So that's one of the big reasons that

(15:06):
we use modercross simulation for. Another one is what we
call CRPS or chronic regional pain syndrome, where patients either
had injury or some kind of surgery and still continues
to have pain, and pain is severe enough where you're
not able to explain based on the imaging. So that's

(15:27):
one of the other reasons. So these are the three
main indications that we use it for. I have used
it in some other patients such as patients with shingles
pain and that have been successful. So a lot of
other indications, but the three main ones are diabetic neuropathy,
failed back syndrome CRPS. Recent recently there was an fd

(15:52):
approval for non surgical back pain. That means even if
patient did not have surgery, and has failed multiple other
treatment options. Spartalcles simulation could be an option for them,
although it's a little harder to approve to the insurance,
but it's the FD indication.

Speaker 2 (16:09):
Now, what about the neck? Is neck pain or you know,
radiation of pain from the neck? Is it ever used
for that?

Speaker 3 (16:17):
Absolutely? Yes, patient who had neck surgeries continues to have pain.
Patients could have crps of the arms, so we could
use it for those purposes. A lot of diabetic neuroputy
patients also has hand neuropiity, so we could put the
stimilar eleads all there in the neck and help control
the neck pain, arm pain, lower back, made back, both

(16:41):
the legs a lot of times, abdominal pain and growing
pain as well.

Speaker 4 (16:46):
Wow.

Speaker 2 (16:46):
You know, as a gastroentrologist, you know we see some
of the effects of gastroparesis and some of the ways
that's so difficult with with the chronic symptoms they have.

Speaker 4 (16:56):
So to have something like this is truly incredible.

Speaker 2 (17:00):
Is this something that's permanent and how do you how
do you test to know if somebody's going to respond
to a stimulator?

Speaker 3 (17:10):
So great thing about this technology and I tell patients
that you get to try this technology before you commit
to it. So it's kind of like taking a test
drive off a car. And it's a very simple procedure,
kind of like doing an epigral injections what we call
spinal core simulator trial. So patient comes in as an
out patient basis. A procedure takes about thirty to forty

(17:34):
minutes where we put two small needles in your back.
We use very minimal sedation. It's not a very painful procedure,
no incisions. Once we put the needles, we teed the
gathers where it's supposed to be. The needle comes out,
and then we hook up that gather to small external
battery and we put a big table over it. And

(17:55):
then patients go home and they try it out for
five to seven days and we also look for, you know,
whether the patient is able to walk longer or stand longer,
are they able to do their activities that they were
not able to do because of the pain, And so

(18:16):
they get to try this and then if that is
successful to patient, if patient had at least thirty percent
or more pain relief and they were able to do
more activities, the sleep was better, and if they felt
like it truly helped them. Then they go for the
more permanent option, which is the implant.

Speaker 2 (18:35):
And so what will it look like to the patient
both during the trial period and if it's done permanently,
Like will they see something on their body?

Speaker 4 (18:47):
Is this all internal?

Speaker 2 (18:49):
What will they actually physically either feel on themselves or see?

Speaker 3 (18:55):
So just during their trial period, there is a very
small catheter. It's very flexible. It's like thicker than a
hair that's hooked up to a small battery which is outside.
But we just put a big tape over it, and
there's a pocket, so there's nothing sticking out. They're just
a big tape over your back. During the tilt period
for the implant process, everything is internalized, so we make

(19:15):
a small pocket to put that battery, and batteries these
days have got very very small and thin, so most
of the patients after a couple of weeks can't even
tell the batteries there. And then we also internalize those
stimulator leads under the skin, so there's nothing sticking out.
Everything is futured under the skin, so there's nothing sticking
out permanently.

Speaker 2 (19:37):
And what do you consider I think you mentioned it earlier,
but what do you consider to be successful after it's
putting in. How do you measure success and what is
a reasonable expectation that you set out with your patients.

Speaker 3 (19:54):
So more than number, as we talked about before, pain
is very subjective, and so the relief from the sparerqusret simulation.
So the number we are looking for is at least
fifty percent pain relief or more pain relief. But what
I truly look for in the patients is are they
able to do the activities during this trial period that

(20:16):
they were not able to do before. So when we
start talking about sparal crust stimulation, I ask patients what
are your goals? You know? So a lot of patients
are okay with some form of pain as long as
they're not thinking about it all the time, or they
are able to do their activities without being insignificant pain.

(20:36):
So we'll come up with the goals of what they
want to do after spart crust stimulation and what connectivities
are limiting because of the pain, and the goal is
to kind of try to reach those activities during the trial.
And those are the expectations that I give it to
my patients and trial pro wise, that scenario of how

(21:02):
the life would be after the.

Speaker 4 (21:03):
Implant and then one more time. How long is the
actual trial period.

Speaker 3 (21:10):
Depends on each patient, but average five to seven days.
If patient is unsure, we may extend that to a
couple more days after that, but mostly five to seven days.

Speaker 4 (21:21):
Fantastic.

Speaker 2 (21:21):
Well, we're going to talk a little bit more about
these spinal court stimulators when we come back from the
next break. You are listening to Centered on Health with
Baptist Health here on news radio eight forty whas I'm
your host, doctor Jeff Teblin. We're talking tonight to doctor
Narak to tell about spinal court stimulators and other forms
of chronic pain management. Our phone number five oh two,

(21:43):
five seven one eight four eighty four. If you want
to call and be part of the show, we'll talk
to you soon and we'll see after the break. Welcome
back to Center it on Health with Baptist Health here
on news radio whas. I'm your host, doctor Jeff Tublin.

(22:04):
And if you're just joining us tonight, we're talking with
doctor Nirav Patel, anesthesiologists about spinal cord stimulators and control
of chronic pain. Our phone number five oh two, five
seven one eight four eighty four. If you want to
call in if you have any questions for our guest
this evening.

Speaker 4 (22:21):
Doctor Cotel.

Speaker 2 (22:23):
We were talking right before we went to break about
the neurostimulator and I just kind of want to throw
it out there for those listening to the show. How
should they think about whether this is something maybe they
should be asking about. Who's the right patient out there
that should be considering being evaluated for this.

Speaker 3 (22:44):
That's a great question. Most of the patients that we
get referred to have spoken to that as their primary
care physician, so or if they have surgeries, if they
have established relationship with the surgeons and there's no surgical indication,
or that they could speak to the surgeon or primary

(23:04):
care physician to see if they're candidate for the spinal
cos simulation and they could be referred by them, and
then we're more than happy to evaluate them to see
if they're the best candidate for the spinal cor simulation.

Speaker 2 (23:19):
And once they have it, is this something that they
control themselves at home? Is it do they have to
come into the office to have a certain level of
pulsing set or based on their activity? Do they monitor?
Do they do it themselves at home? How does the
adjustment work.

Speaker 3 (23:39):
So we work with a representative of the spinal cos
stimulator company and will have patients come in the office
or even after the surgeons will set up certain programs
and find four or five programs that work the best
for the patients, and patients will get a small remove.

(24:00):
And nowadays we have artificial intelligence that we use, and
so a lot of patients will just get an app
on their existing phone and that kind of helped them
control the stimulation they're getting. So we basically start them
off with a couple of programs and with the artificial
intelligence nowadays, patients can answer a couple of questions and

(24:23):
the spina cossimulator actually automatically adjust that specific programs for them.
So initially we'll work with them to find a program
for them, and then a lot of times with newer technology,
spina corsimulation kind of just itself.

Speaker 2 (24:39):
And how often do they need to be seen once
they have one place and are they seeing you? Do
they see a technician and ourse practitioner? How often are
they evaluated and by whom they.

Speaker 3 (24:51):
Either see me or the representative depends on the need. Initially,
I would see them right after the surgery about a
week later where we'll do the initial programming. I'll see
them a couple of weeks after that. If they're doing well,
I don't see them up until six months to a
year unless they need any change in programming. So once

(25:13):
everything is set up, patients is happy with the programming,
they don't need to be seen as frequently. As I
spoke about artificial intelligence on the app. On the phone,
patients will answer certain questions and they will be asked
specific what kind of pain they have, how bad the

(25:34):
pain is, where the pain is, and then based on
those results, the spinal cossimulation artificial intelligence will find a
specific program automatically for them and adjust by itself without
patients doing anything else than just answering those questions. So
that takes a lot of burden of coming in the
office and getting this adjusted. So they're coming in less

(25:58):
and less because the programming has been done remotely. Now, okay, I.

Speaker 2 (26:02):
Just want to make sure I understand, because it is
so fascinating what you're telling us. So the artificial intelligence,
it's not they're just they're not just interacting with an
app to record so that you know the data when
they come to see you. There the artificial intelligence is
feeding back through the device to change what they're receiving

(26:22):
based on the answers to their questions.

Speaker 3 (26:26):
That is absolutely correct. So the spall costimulation companies have
hundreds of thousands of patients over the years, and so
they have collected all these data. So based on patients input,
AI goes to this data and finds that specific individualized
pain program that will work for the patients, and it

(26:48):
will predict that this will work for the patients and
then automatically adjust. So just based on those findings, it
will adjust by itself. I will also get the reporting
if I'm able, if I wanted to see that programming,
but it automatically adjust the programming without any interference from
the patient or physicians.

Speaker 4 (27:09):
Wow.

Speaker 2 (27:09):
I mean, that is just such an amazing example of
how AI is getting incorporated into our medical world. I mean,
you know, in GI we're not quite there yet, but
it sounds like this is really implementing it in a
way that's making major impacts on patients. So that's really fascinating.
Do you find that once somebody gets a neurostimulator, they

(27:30):
have it for life. Is this something that ends up
being a bridge to something else? Or does this become
the permanent sort of solution.

Speaker 3 (27:38):
If it works, most of the patients, I would say
on nine out of ten patients will have this permanently.
Very very rarely we may have to take it out,
but very very extremely rare scenario. So most of the
patients who do get permanent implant end up having this

(28:00):
stimulator for the rest of their lives, as it provides
significant pain related to these patients and.

Speaker 2 (28:04):
It's typically the same one it doesn't like. Is there
like a life cycle to the device or that has
to be changed out or just the batteries and things
like that.

Speaker 3 (28:15):
Yes, so mostly batteries. So there are two types of
barrier's rechargeable battery and non rechargeable battery. Non rechargeable batteries
have slightly lower life cycle, so they would average is
about four or five years excuse and then the rechargeable
batteries usually last for about eight to nine years. So

(28:35):
whenever if the battery has run out or not charging enough,
we go back. It takes about thirty minutes of procedure
time to take out that battery and switch it to
the new battery.

Speaker 2 (28:47):
Great, okay, so now they've got this device in there,
and you've described kind of how it's inside and you
don't really see it. What about life after this is implanted?
Are there any restrictions in terms of activity intensity or
you know, sexual activity or going through metal detectors like swimming?

(29:11):
What kinds of things are are not limited after this?

Speaker 3 (29:16):
So most of the restrictions are initially after we put
the implant, just for the wound care and making sure
that the leads are stabilized in there. So I would
recommendations no significant bending, twisting, or lifting for about eight weeks,
and then no swimming or immer you know, immersing your

(29:37):
body in water for about three weeks after the surgery.
Just do not get that wound infected. The leads are
future in well with under the skin, but they're still
kind of floating in that spinal core outside of spinal cord,
and it takes about eight weeks for them to scar
away outside of spinal core, so there's a small chance

(29:58):
of migration of this lead. After eight weeks, patients can
resume all their normal activities. A lot of patients are
interested in yoga, so they could go back to yoga.
A lot of my patients are into running, so they
could go back to normal running, they could go back
to golfing, so I don't have any specific restriction after
eight weeks once these leads are stabilized. Another question you

(30:23):
asked about was going to the airport. Usually with these
are leads made out of titanium, so it's the battery,
so it usually doesn't get the alarm going at the TSA,
but you always carry your car just in case if
there's any issue. None of the patients I've implanted so
far has ever complained about going to the airport's security
and everything goes well.

Speaker 2 (30:46):
Does it affect any imaging in the future. I mean,
given the fact that you're using this oftentimes and people
that have back problems to begin with, who might need
an MRI or getting MRIs a problem after a neurossimulator.

Speaker 3 (31:01):
So most of the devices this day is our MRI conditional.
What that means is for certain. For example, if the
Spinker similar leads were placed in the lower back, you
could get any kind of normal MRI for your head
and neck. For the lower part of your back, you
have to change the setting of the battery to MRI

(31:22):
mode and then the technician in the MRI will change
the dosage of that MRI to slightly lower dosing, but
you could still get the MRI with most of these
stimulators nowadays.

Speaker 4 (31:36):
That's good to hear.

Speaker 2 (31:37):
Well, we're talking tonight to doctor Narav Patel about spinal
board simulators and treatment of chronic pain. We are going
to take our final break here. You're listening to Centered
on Health with Aptics Health here on news radio eight
forty whas. And if you have missed any part of
tonight's show or want to hear all of this excellent
information in its entirety, download the iHeartRadio app.

Speaker 4 (31:59):
It's it's easy to use, and we'll be right back.

Speaker 2 (32:17):
Welcome back to Center it on Health with Baptist Health
here on news radio eight forty w ahs. I'm your host,
doctor Jeff Tebum, and we've been talking tonight to doctor
Narrat Patel about spinal cord stimulators and we are downloading
this to the iHeartRadio app if you want to re
listen to this or any of our previous segments and
have access to all the other features that the app

(32:39):
has to offer. So, doctor Patel, this is a procedure,
and procedures sometimes have some risk, So can you talk
to us about what you talk to your patients about
as far as potential risks of having this done.

Speaker 3 (32:57):
So I tell patients this is not a major spot surgeries.
I'm not doing anything to the spinal core. I'm not
taking any bones out, I'm not putting any bones in there.
But every time we introduce a needle there's always a
small chance of bleeding and infection. That's why we make
sure if the patients are on blood tinners, we stop

(33:18):
them before we use the skill technique. So risk of
infection is extremely low, very low chance of damaging any
nerves or anything like that. We use fluoroscopy, which is
X ray guidance, so we know exactly where the needles
are at one hundred percent of times, very very low
risk in terms of nerve damage or anything like that.
But in the red scenario there could be some complication.

(33:40):
But overall, compared to other big spine surgeries, this is
a very very low risk procedure.

Speaker 2 (33:47):
And do patients do they feel it in them working
or is it sort of a background that they don't
really feel day to day.

Speaker 3 (33:56):
So nowadays there are two different types of stimulating. Some
patients like to have that feeling off a little bit
of tingling kind of massogic sensation, so we could use that.
Some patients absolutely hate that sensation, so we could use
what we call high frequency stimulation rights in the background,
you don't feel anything at all. So it depends on

(34:19):
patient's preference. If they like to feel that sensation in
painful area, we could do that. If they don't want
to feel at all, if they just wanted to let
it work in the background, we could do that as well.
So patients have a lot of options there.

Speaker 4 (34:32):
Oh, that's interesting.

Speaker 2 (34:35):
Are there any patients that are not good candidates to
have this done?

Speaker 3 (34:40):
So? I usually recommend patient's spinel corssimulation if the pain
is nerve related. If pain was from authentic pain, spinel
cars simulation do not significantly help with that pain. If
the pain was more kind of generalized all over body
pain like fibermiology or something like that, that wouldn't be helpful.

(35:01):
If the pain was more muscular skeletal muscle pain, then
it wouldn't be a right choice for those patients, but
we do have different procedures to help control that pain
as well. Well.

Speaker 2 (35:13):
I think we have a pretty excellent understanding of the neurostimulator,
So thank you. For sharing all that, but I know
your expertise goes way out beside just the neurostimulation in
terms of how we deal with pain. So I'm just
going to kind of throw it out there. I mean,
one of the things we hear about in any specialty
with people who deal with any type of pain is

(35:34):
the use of cannabis.

Speaker 4 (35:35):
So can you tell us, like, is that valid?

Speaker 2 (35:39):
Are there studies about the use of cannabis and pain management,
what's the story with that?

Speaker 3 (35:47):
So that's a great question. Cannabis, there's not a significant
long term research. There have been a couple of studies.
They were done in Canada. We're very very microdosing of
cannabis could be helpful in some specific set of patients.
It usually was helpful and cancer patients, and then it

(36:11):
helps with the nausea in those cancer patients. But in
chronic pain scenario, there hasn't been any research providing any
significant thoughts on cannabis and haven't been found to be
significantly helpful. They may take the mind off from pain
and that could be the reason why some patients may

(36:33):
feel some pain relieve, but there is no significant literature
supporting that. Other than cancer pain patients and nausea in
cancer pain patients.

Speaker 4 (36:44):
Thank you.

Speaker 2 (36:45):
And earlier you mentioned something about yoga and that some
of your patients you know, can get back to doing
yoga and things like that, which you know, makes me
think about some other ways people may find to manage
chronic pain. As an adjunct, are there any things that
you have found your patients to do that have been

(37:05):
beneficial in terms of their ability to either cope with
pain or manage their pain, because I'm assuming that with
chronic pain it's very difficult to get one hundred percent relief.
So what have you seen out there in terms of
things that have helped?

Speaker 3 (37:19):
Absolutely so, a lot of variety of things, you guys.
One of them meditation, As we talked about the pain
processing helps goes to the brain and that's how it's
getting processed. So meditation has been fun to be very
effective in coping the pain. A lot of times patients
will benefit from pain psychology who will teach them how

(37:41):
to cope with patients and how to think about the pain.
It teaches some breathing exercises to help control the pain.
In certain patient population, acupuncture could be helpful. Massage therapy
could be helpful as well, we also recommend water therapy,
especially in older patient population, because the water takes over

(38:03):
the gravity and they're able to do more. So these
are the adjuncts that we very frequently use in pain management.

Speaker 4 (38:11):
Can you describe that?

Speaker 2 (38:13):
What did you mean by water therapy like being in
a pool and swimming or doing exercises or what so.

Speaker 3 (38:20):
A lot of physical therapy places have their aquatic pools,
so the therapists will work with you to do exercises
that you're doing in the water. So by taking away
the gravity, you're able to do more exercise in the
water and it's a little easier on the body as well.
So aquatic therapy is what we call. We will refer
patients to physical therapies for that as well.

Speaker 4 (38:43):
That's fantastic.

Speaker 2 (38:44):
I mean I have a whole other grouping of questions
that I wanted to ask you about, but we're rapidly
running out of time here.

Speaker 4 (38:51):
But in terms of.

Speaker 2 (38:53):
Other ways to manage pain, how do you use injections?
And what are you injecting when you do injections and
how often can patients get them?

Speaker 3 (39:05):
So each injection is different most of the For example,
if we use epidol for what record reticalapid is if
the pain is raiating from the lower back to the
legs or arms, and if there's a pinching of the nerves,
we could use epidules, which basically uses loaders of steroids.
We try to limit the steroids that patients most of

(39:28):
the time can get it every three to four months
if needed, and if they're providing significant pain. Well, if
we also do some nonstraild injection for arthuric pain where
we could heat up those nerves, and those procedures may
help up to six months two years, so that's more
kind of long term solution. We also use a lot

(39:48):
of nerve blocks, a lot of numbing medication, some long
term numbing medication, and some steroids us as well.

Speaker 2 (39:56):
And how often can you provide injections? Is there a
limit either by insurance or by medically how often they
can get them.

Speaker 3 (40:06):
So if we usually if we're doing any sture injections,
we want to see at least two to four months
of significant pain relief, and depends on patients come mobilities,
if they have diabetes, then that kind of limits the
sturreed use if they're not getting significant pain relief, and
if there's a need for surgery, then we may send

(40:27):
them to get it fixed with the surgeon, and so
that kind of limits the medication that we use. But
healthier patients, if we are providing significant pain relief the
stirred injections, we could do it every two to four
months until they stopped getting release.

Speaker 4 (40:43):
Well, thank you, doctor Pateel. That's going to do it.

Speaker 2 (40:45):
For tonight's episode of Centered on Health with Doctors Health,
I'm your host, doctor Jeff Telban. Thank you doctor Pitateel
for sharing all this information with us. Thank you to
our producer mister Jim Fenn, and of course see the listener.
Join us every Thursday night for another seton I hope
everybody has a good rest of your week and a
very good weekend.

Speaker 4 (41:04):
Take care.

Speaker 1 (41:10):
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medical advice, diagnosis, or treatment. This show is not designed
to replace a physician's medical assessment and medical judgment. Always
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(41:32):
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