Dr. Karim Rasheed likes to take photos of his patients. The Pain Specialist at Lexington’s St. Joseph’s typically takes a photo of each patient when he meets them for their first appointment. Six months later, he’ll take another so that he and the patient can notice the difference in their appearance and demeanor once their pain is under control. “They’ll realize that they look less tired,” he says. “Women might be spending more time on their make up. They carry themselves differently because they’re not in as much pain.” Now the Iraqi-born doc, who has been in Kentucky since 1991, with the exception of a brief interval in Indiana, has a new addition to his pain management arsenal with the Spectra Spinal Cord Stimulation system, from Boston Scientific.
Pain management implants have been around for some forty years, but technological advances mean that they’ve come a long way since the original one lead device with a battery life of months. The newest Precision Spectra System can utilize up to 32 contacts and the battery won’t need replacing for a dozen or so years. The Precision Spectra system works by delivering electric pulses from an implantable pulse generator to leads which stimulate contacts in order to mask pain signals traveling to the brain. While the therapy can’t cure the root cause of pain, it will replace the pain with a pleasant massage sensation. A patient who might be a candidate for an implant meets with Dr. Rasheed to discuss the options and to learn more about the process. He gives them the opportunity to chat with other patients who have undergone the procedure. They also have a psychological evaluation, necessary to determine that they can cope with the idea of a device being inside the body. Rasheed is quick to emphasize that there are no guarantees with the treatment, but that it gives the patient control over their pain management plan.
The candidate first undergoes a trial period, where a temporary version of the system is implanted. Unlike the permanent system, the trial version remains outside the body, with only the leads placed in the epidural space through small needles. Precision Spectra incorporates a new technology called Illumina 3D Algorithm which will allow the representative to manipulate the contacts, while talking to the patient and targeting the desired area within seconds. Through this process, she is then able to program the remote control with specific settings for that patient and their individual pain needs. Whereas the early systems had just one or two settings, the most modern systems allow for up to 16 different settings, so that a patient can increase or decrease the electrical impulses, and can direct them to certain areas of pain. The trial implant usually remains in place for up to a week so that the patient has the opportunity to gauge their level of response. An estimated 80 percent of trial patients go on to receive the permanent implant, having seen a significant improvement in their quality of life. In fact, both Rasheed and Amy Statom, a clinical specialist for the Spectra system, mention that it is not uncommon for a patient to want to keep the trial implant, such is the relief they experience.
Assuming the trial is a success, a permanent version is implanted, with the entire system (save the wireless remote control) placed under the skin. Regular checks allow Statom and Dr. Rasheed to make any minor adjustments to the settings that may be needed, but the patient now has control of their pain at the touch of a button and, since the control looks like a mobile phone, no one else needs to even know that they are adjusting their pain relief settings. With a current programmed service of 12 years (and a simple replacement process when the time comes) implant patients can look forward to a marked improvement, perhaps being able to noticeably reduce their need for oral pain medication or even being able to return to work… and that makes for one happy follow-up photo.
By Fiona Young Brown, Editor