Pain Relief Without Opioids

PISA relies on technology to improve patients’ well-being

BY CHRISTINA FUOCO-KARASINSKI

Dr. Eric Cornidez says this is one of the most exciting times in interventional pain management.

The opioid problem has paved the way for the use of procedures like radiofrequency ablation or kyphoplasty.

“The opiate problem opened our eyes and led us to fi guring out what else we could do for our patients,” Cornidez says of the Pain Institute of Southern Arizona.

“I’m not saying the use of opioids is bad, but too much of something is never really a great thing. It’s pushed the culture to think about other procedures.”

One of the alternatives is cortisone shots, but again, they have their own set of side eff ects.

Radiofrequency ablation

Also called rhizotomy, radiofrequency ablation is a nonsurgical, minimally invasive procedure that uses heat to reduce or stop the transmission of pain. The radiofrequency waves burn — or ablate — the nerve that is causing the pain so it can no longer send pain messages to the brain.

During the procedure, radiofrequency needles are placed alongside the nerve that goes to the joint. The physician makes the joint numb with local anesthetic and then heats the needles with radiofrequency waves to burn the nerves that go to the joints.

Ablation is useful for patients who have spinal, knee, shoulder or hip pain. Patients typically experience 80% to 100% pain relief that can last for six months to several years, he says.

“It breaks that communication between the painful area of the brain that says, ‘Ouch,’” Cornidez adds. “It generally decreases pain from six to 18 months because those little rascals actually grow back.

“The nice thing is many patients go beyond just 18 months. This is my theory. I’m not fi xing the problem. I’m empowering the body to be more active. If an ablation works for a year, I tell my patients to be as active as possible to build up their core strength. By the time those little nerves grow back, they can rely on the stronger muscles.”

Spinal cord stimulator

When chronic pain fails to respond to conventional medical care, patients can try a spinal cord stimulator. It uses mild electrical impulses to block or mask the pain signals transmitted by nerves. When any part of the body is in pain, sensory nerves pick up the message and transmit it to the brain. People only feel the pain after the brain receives and interprets the message.

Spinal cord stimulators have three parts: a small generator, a wire with multiple electrodes, and a controller. The generator, which produces the electrical impulses, is implanted under the skin of the abdomen, upper buttocks or chest.

The long, fl exible wire is threaded along the spine. The physician uses fl uoroscopic imaging to see the wire and place its electrodes near the spinal nerves responsible for sending the pain signals to the brain.

The physician then uses the remote controller to initially program the strength and frequency of the electrical impulses. Then the patient will use it to turn the spinal cord stimulator on and off .

“It makes a signifi cant diff erence,” Cornidez says.

“With neuromodulation, the technology is so good that patients don’t have to feel the buzzing or stimulation anymore. It’s not really a valid phrase. We don’t stimulate anything.”

Dr. Eric Cornidez is breaking barriers with new procedures and treatments that don’t require opioids after the opiate problem. (Photos by Noelle Gomez)

Kyphoplasty

A patient undergoes radiofrequency ablation to reduce or even stop pain for a period of time.

Cornidez utilizes kyphoplasty as well. This minimally invasive procedure repairs a vertebral compression fracture and helps restore the spine’s natural shape. Some patients experience rapid pain relief after the procedure.

After a patient is sedated, the physician guides a needle through the skin on the back and into the fractured vertebra. A special X-ray device called a fl uoroscope helps the physician position the needle.

A balloon device is placed through the needle and into the vertebral body. The physician carefully infl ates this balloon to expand the fractured bone. When the balloon is defl ated, it leaves a cavity in the middle of the vertebral body. The balloon is then removed.

The physician then injects bone cement through the needle, which fi lls the cavity. The cement hardens inside the vertebral body, stabilizing the fracture. When the procedure is complete, the needle is removed and the opening in the skin is closed.

“If grandma falls and she breaks one of the vertebrae in her spine, with the X-ray guidance and the use of big needles — it’s the size of a coff ee straw — we place those through the diff erent bones of the spine to access where the fracture is and fi x the fracture,” Cornidez says.

Vertifl ex

Cornidez calls the Vertifl ex procedure “groundbreaking” for lumbar spinal stenosis. He says the procedure is a simple and minimally invasive treatment, but it can provide eff ective long-term relief by lifting pressure off the nerves to alleviate leg and back pain.

The Vertifl ex procedure uses a small spacer designed to relieve pressure on the nerves. Physicians place the spacer between the spinous processes through a small tube that is approximately the size of a dime.

Once the spacer is placed, it is intended to relieve pressure off the nerves and Relief...continues on page 11