Chronic Pain: Implantable Pain Control Devices (cont.)

MEMBER QUESTION:
I had a herniated disk, the biggest one my neurosurgeon had ever seen. While waiting for surgery I woke to my legs being useless. I was then sent immediately to surgery and the pain relief was a HUGE help but I still have pain and I lost a great deal of use of my right leg. There is so much more to this story but my main question is would I be eligible for this device and what would the cost be? I am now taking around 12 to 15 Advil a day and my doctor seems to think that's all I need.

KAPURAL:
It has to be determined if permanent nerve damage happened. Usually nerves do grow back to a certain degree, so if it was more than one year after surgery, you should be evaluated and then determine if you are a good candidate for any of those implantable devices. I'm thinking mostly stimulators here.

By the way, we do implant stimulators for severe chronic pelvic pain in the female population. These are the patients who had severe endometriosis for years, were operated on many, many times, with chronic pelvic pain ongoing. We found those patients do respond well to spinal cord stimulation.

MEMBER QUESTION:
I have syringomyelia with syrinx, rheumatoid arthritis, bulging discs, and herniated discs. Will all this pain be helped with this device?

KAPURAL:
You may be a better candidate for an intrathecal pump. However, you need to be evaluated by a qualified intervention pain physician to make this decision.

MEMBER QUESTION:
I heard the Cleveland Clinic has the best pain center in the country. Can I get in to see a doctor within a few weeks?

KAPURAL:
Yes. We changed our policies and we are trying to get a new evaluation in about a 10 to 15 day time period. We expanded the staff more recently and we are the largest pain management department in the country, and the largest educational fellowship. So yes, I think we can fit you in relatively early. The phone number is 216-444-PAIN.

MEMBER:
I'm moving to Cleveland!

MEMBER QUESTION:
Do you have a web site, and can I make an appointment online?

KAPURAL:
The web site is clevelandclinic.org. If you go to clevelandclinic.org/painmanagement you can get information on all the pain devices and the Cleveland Clinic physicians.

MEMBER QUESTION:
How can I find a pain specialist in my area of Reading, Pa., who is knowledgeable in intrathecal drug delivery devices?

KAPURAL:
There are a couple of sources where you can actually find a physician in the area. If you go to Medtronic or ANS, those are the two largest companies who make the stimulators and pumps. They have a list of physicians who are implanting their devices.

MEMBER QUESTION:
I saw a Medical Miracles tape about pain management. Can I get a copy of it? Who can I call?

KAPURAL:
This was produced by the local TV station, and they looked into certain advanced procedures in all kinds of medical branches. That was produced about a year ago. That tape can be acquired for free by calling the same number I mentioned: 216-444-PAIN.

MODERATOR:
What is new for pain or coming in the near future?

KAPURAL:
We are looking into other types of electrical stimulation these days and at the Cleveland Clinic, as I mentioned before, we try to treat occipital neuralgias as well as other peripheral nerve injuries using different types of implantable electrical stimulation devices. So over the last several years, we increased the number of indications for spinal cord stimulation and peripheral nerve stimulation.

MEMBER QUESTION:
Do you have a conference for physicians to attend, where they can learn more about pain management?

KAPURAL:
Yes. If the physician is in internal medicine, rehabilitation, or primary care, we do have our conference for internal medicine and primary care physicians, which is every summer here in Cleveland. For the interventional pain management physicians, a workshop and conference is held every February in Orlando, Fla. It has become the best pain management interventional workshop and symposium in the world.

MEMBER QUESTION:
How can the physicians register for it? When is it?

KAPURAL:
You can go to our web site, clevelandclinic.org/painmanagmenet. Information for both of those meetings is on our web site. Or you can call my office and I would be glad to give you information about both of these venues.

MODERATOR:
We are almost out of time. Before we wrap things up for today, do you have any final words for us, Dr. Kapural?

KAPURAL:
I just wanted to say that we've come a long way with implantable devices, and over the last five years they've become very safe and effective treatment for severe chronic pain. Hopefully issues with the payers will not prevent us from using those for the good of the patient.

MODERATOR:
Our thanks to Cleveland Clinic pain management expert Leonardo Kapural, MD, PhD, for joining us.



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