Last Resort, Lasting Relief

Implantable pump eases pain resistant to treatments, surgery.

Karen Loose’s love of horses began in childhood and extended well into adulthood, where she eventually turned her attention from riding to rescuing horses that had been neglected, abused or abandoned.

FHCN file photo.

It was Karen’s goal to get back in a kayak again, and Dr. Fallows
and her intrathecal pain pump got her there.

“That was our thing,” Karen says of her and her husband, a retired Cincinnati police officer who shared her passion. “We did that while we were living up north near Cincinnati. Before that, I had ridden horses all my life and was very active.”

Karen’s desire to ride and rescue horses has never waned, but the former purchasing manager’s ability to do both became compromised several years ago when pain suddenly began to spread throughout her body.

“It started with what I thought were chest pains,” Karen describes. “At the same time, I had pain in my stomach and kidneys. I didn’t know what was going on, so my doctor ran a bunch of tests. Then he called me and said, You’ve got to see a neurosurgeon because your back is really bad.

“It was after that that I learned I had eight herniated discs – four cervical, four lumbar – degenerative disc disease, osteoporosis and scoliosis. The pain I was feeling everywhere else turned out to be pain radiating from my back to other areas.

“By the time I learned that, though, the pain was so bad that I could hardly walk. It was so bad that I had to quit working, quit with the horses and quit doing just about everything.”
The neurosurgeon Karen consulted recommended surgery, but three separate procedures provided minimal relief.

“The surgeries kept me from being in a wheelchair, but the pain was still very bad, and it kept getting worse,” Karen reports. “More discs were degenerating, and that was just going to continue, so I said, No more surgeries.

Karen’s pain worsened to the point where she could no longer even tolerate the cold Ohio weather, so she and her husband moved to Florida. One of her first goals after relocating was to find a pain management specialist. Her sister recommended Mark Fallows, DO, of Pain Institute of Central Florida in Lecanto.

Comprehensive Treatment

Serving area residents since 1990, Dr. Fallows is uniquely qualified to manage complex pain issues. He is certified by the American Osteopathic Board of Anesthesiology and the American Board of Interventional Pain Physicians, which has certified fewer than 400 physicians nationally. Further, Dr. Fallows is the only physician in Citrus County who is board-certified in
interventional pain management.

To ease his patients’ suffering, Dr. Fallows offers comprehensive treatment for pain, employing an array of modalities. He specializes in a variety of pain management techniques, such as neurostimulator implantation, spinal infusion pumps and radiofrequency ablation. Physicians often refer patients with pain to Pain Institute of Central Florida, although the practice also takes self-referrals.

“The difference with the pump has been incredible. My life has totally changed.” – Karen

When Dr. Fallows saw Karen for the first time he produced a treatment program aimed at reducing her pain that included medication and injections into the lower back and neck. That plan worked for a while, but when its effects began to wane, Dr. Fallows recommended an intrathecal pain pump.

Considered a last-resort therapy, the intrathecal pain pump is reserved for patients for whom everything else has been tried and has failed.

“The intrathecal pain pump is most often used for people who have failed back surgery or for those with intractable cancer pain,” Dr. Fallows notes. “It is also used for people who have had disfiguring injuries or burns, or who have had a limb amputated, but they have pain that has not been relieved by any other means. In these cases, this becomes an absolutely essential part of our tool chest for helping these people.”

The pump, which can be filled with opiate pain medication, is placed underneath the skin in the abdomen. A small tube, called a catheter, leads away from the pump into the thecal sac around the spinal cord, directly to the site where the pain is treated. This is called targeted drug delivery, or TDD, because it delivers the drugs to the target, which is the central nervous system.

“Before we implant the pump, we first do a trial during which we put a catheter in the epidural space,” Dr. Fallows explains. “It’s similar to an epidural a woman may get during labor. By targeting delivery, the pain pump can use much smaller doses of medication to achieve its intended goal.

FHCN file photo.

Karen Loose

“If the trial is successful and the patient gets better pain relief than they were getting with their oral medication, we go ahead and place an intrathecal catheter,” the doctor continues. “That uses about 100th of the oral dose. That means if the patient was getting 100 milligrams per day before, they will get 1 milligram a day. But it is more effective because it goes straight to the central nervous system. It does not have to pass through the gastrointestinal tract and bloodstream.”

“Incredible” Difference

The intrathecal pain pump has made a significant difference for Karen. The relief has enabled her to freely do many of the daily activities that were very painful before the pump was implanted.

“The difference with the pump has been incredible,” she offers. “My life has totally changed. Before, I wasn’t able to get up in the mornings. I’d have to go through a series of exercises and tasks just to stand up, and when I did, I looked like an old lady trying to bend over and walk.

“Now, things are quite different. I’m able to get up, get around and do things. It’s pretty astonishing actually. I would definitely do this again.”

In addition to daily activities, Karen is returning to some of the leisure pursuits she had to put aside when her back and neck problems began, including kayaking.

“Dr. Fallows’ goal was the same as my goal: to feel better and better,” Karen explains. “And he’s done an amazing job for me.”

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