Candice Burnette, MD, Pain Management Physician, Memorial Hermann Surgical Hospital–First Colony and Memorial Hermann-Texas Medical Center, talks about a drug that brings cholesterol levels to such a low point they are able to prevent some heart diseases.
How common is chronic back pain?
BURNETTE: Low back pain is the world’s second leading cause of disability in the United States. About 80% of people in their lifetime will experience low back pain. Of those people, a good portion will experience pain that lasts for three months or longer, and that is what we define as chronic low back pain.
With so many people experiencing chronic back pain, what are the current standard treatment options?
BURNETTE: It really depends on the cause. There are many different causes of low back pain that result from an injury, damage, or irritation to the structures of the lumbar spine. For example, you might have an older individual who has chronic low back pain due to arthritis of the joints of their spine or you might have a younger athletic individual who has pain due to a disc injury. The treatment options really depend on what the cause is.
For someone who has arthritis, what would be the treatment option?
BURNETTE: Things like physical therapy, medications, even various injections with steroids or nerve blocks, are all treatment options for someone with arthritis. What’s important is for a patient with chronic low back pain to see a health care professional who specializes in treatment of the spine such as pain management physicians like myself and the ones here at Modern Pain Management. We do a thorough evaluation and gather information about the cause of the pain to determine diagnosis. Once we do that, we can come up with a treatment plan that best suits the individual’s needs.
The opioid epidemic has been huge especially when it comes to low back pain. How does that blend into the mix when it comes to treatment?
BURNETTE: That’s a very important issue because the opioid epidemic is very real. It affects a lot of our community, so it’s important to have options other than just opioid medications to be able to treat these patients. That’s why when we have novel therapies that have been proven effective like DTM spinal cord stimulation, it’s nice to have that addition to our treatment options available for these patients.
What is spinal cord stimulation and the technology behind it?
BURNETTE: Spinal cord stimulation involves placing small wires in the spinal column that send off signals which interferes with the brain’s ability to perceive pain. DTM, differential targeted multiplex, is a novel form of spinal cord stimulation that was recently developed by Medtronic using its Intellis platform. What makes it different is that it targets multiple areas of the patient’s spinal anatomy and uses various types of waveforms to achieve pain relief.
What are the advantages and disadvantages of using this?
BURNETTE: The advantages would be relief of pain. The thing that’s exciting about the technology is that it was based purely on science. And a recent research study has shown that it is statistically significant and superior in treating chronic low back pain when using the DTM protocol versus conventional stimulation. Some disadvantages are some people not being comfortable with having device therapies. This is something we evaluate before even choosing spinal cord stimulation as an option. If a patient isn’t comfortable with having a device inserted, then we obviously wouldn’t use this for that patient.
Can you walk us through the surgery?
BURNETTE: This is a minimally invasive procedure that starts with a trial. The patient gets to try it first to see if it’s going to work for them. The trial consists of inserting small wires through a needle, no incisions, and guiding the wires up to the correct place along the spinal canal. Then, a single suture is used to hold each wire in place and a sterile bandage is applied. The patient has about a five-to-seven-day trial to see if it’s working for them, or to see if they’re getting good pain relief, but also to see if their functional levels are improving and they’re able to do more things that they couldn’t do prior to having the device. We also look at decreased need for medication during that trial period as well.
Are there any numbers to guess how much more effective this one is prior to the previous version?
BURNETTE: The research study shows that 84% of patients with DTM therapy achieve 50% or greater reduction in their chronic low back pain versus 51% of patients receiving conventional therapy. Furthermore, the research study showed that about 7/10 patients receiving DTM therapy achieved an 80% or greater reduction of their back pain at 12 months. This is significantly more improvement than those receiving traditional stimulation. Results like these are truly game-changing as far as options we have for treating this population of patients.
Once the trial works for them, what’s the surgery like?
BURNETTE: If you have a successful trial, the temporary trial leads are removed and then the patient is scheduled for a minor surgical procedure which involves placing the wires into the same location using the exact same way through needles. Two small incisions are made to hide the leads and the battery underneath the skin. So, it is a minimally invasive procedure.
Since it’s battery-operated, is there a way to charge it, or what is the lifespan?
BURNETTE: The new Intellis battery is the smallest on the market and is groundbreaking. The patients have a little remote-control charger, and at nine years, it retains 95% of its battery life. So, think about your cellphone – the longer you have it, the less charge it holds. However, this battery retains 95% at nine years and is backed with a nine-year warranty from Medtronic.
After the device is implanted, how soon can they get back to normal activities?
BURNETTE: We like to avoid a lot of excessive lifting, bending, or twisting, during the first several weeks after the implant primarily because we don’t want those leads to move out of place and no longer be effective. So, by four to six weeks, scar tissue has formed around the leads or the wires and it’s ok to resume normal activity and even bend and twist. Obviously, nothing too excessive. We don’t want them skydiving or bungee jumping, but within reason. The whole goal is to get them back to doing the things that they want to do.
What do you think this does for a person’s quality of life?
BURNETTE: It can really change their quality of life for the better. Chronic low back pain can be very debilitating and it’s not uncommon for a patient to tell me they’re not able to perform their normal activities of daily living. Things we might take for granted like caring for themselves, playing with their children, or even performing their life or work duties. Chronic low back pain has been linked to depression, sleep problems, and anxiety. So, having something that can effectively treat these patients who have been suffering really does improve their quality of life.
How did Arlene come to you?
BURNETTE: I saw Arlene for the first time about a year ago when she came in for evaluation of her chronic low back pain. She had been having pain for years and had recently worsened over the six-month period prior to when she saw me. We talked about her issue and her treatment goals, and they were simple. She wanted to be able to play with her grandchildren and do her art, which is her passion. We did a physical examination and came up with her diagnosis and developed a treatment plan that involved DTM spinal cord stimulation. She went through the trial and had 70% relief of her low back pain. She did not need as much medication and was able to do her art and play with her grandchildren.
When you give percentages like that, is it based off patients who are reporting?
BURNETTE: It’s subjective and totally patient-dependent. I explain it to them, if 0% is absolutely no relief and 100% means you have zero pain, where would you say your relief is on that scale? Then, they come up with the number themselves.
Is this covered by insurance?
BURNETTE: Most insurances, yes. The cost varies widely.
Can you go into more detail on how the stimulation helps with the pain?
BURNETTE: It’s hard to explain without getting too technical, but there are little electrodes on the lead that send out signals, or energy waveforms. These waveforms interfere with the spinal cord and brain’s ability to perceive pain and the perception of pain. So, interfering with those pain signals is what gives us the relief or gives the patients the relief that we’re seeing.
Is this only for lower back pain or can it be for neck pain also?
BURNETTE: Currently, DTM is only indicated for chronic low back pain with or without leg pain.
How big is this device?
BURNETTE: It’s really small, comparable to the size of a silver dollar, but a little thicker. This is one of the huge advantages of it because it is the smallest implantable stimulator on the market. So post-procedural pain causes a lot less discomfort for the patients after the implant, which is important.
Is there anything I didn’t ask that you feel people should know?
BURNETTE: As far as DTM itself, I’m so excited about it because the technology was based purely on science and is backed with clinical research. It’s so nice to have an extra tool in our toolbox for treating these patients who have been suffering for so long. I’ve seen great results with it in my practice and I’m just thrilled that we have this option now.
Interview conducted by Ivanhoe Broadcast News.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
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