Pleasure Without Pain

Specialized treatments foil complex headache syndrome.

Gary Brinson, 60, was a warehouse supervisor for a fertilizer plant until 2012, when he fell at work and his world turned upside down. Injuries he suffered from the fall disabled him. They also worsened pain he was experiencing beforehand.

Photo by Nerissa Johnson.

Gary Brinson

“I was already having massive headaches,” the Indiana native shares. “Then when I fell, I broke my shoulder. But when I tried to do physical therapy, I couldn’t do it because my neck and head hurt too bad. And when I tried to do physical therapy on my neck, I couldn’t because my shoulder hurt too bad.

“I had surgery on my shoulder and neck. During the neck surgery, the surgeon went through the front and put in bone grafts as well as plates, cages and screws. But I was still having headaches, so he went in through the back of my neck and put spacers in my vertebrae.”

Unfortunately, neither neck surgery eased Gary’s headaches. His problem, according to his orthopedic surgeon, was severe arthritis leading to degenerative disc disease. The damaged discs in his neck were placing pressure on the delicate nerves going into his head. That caused the painful symptoms he was experiencing.

“My neck was stiff, so I couldn’t turn my head without excruciating pain,” Gary describes. “The pain was constant. It felt like someone was trying to pull off my forehead. And my wife says that I was grouchy.
“The headaches came from the back of my skull. They went through the sides of my head right into my eyes. They were debilitating. On a scale of one to ten, they were at least an eight or nine on most days. All I could do was lie in bed with my eyes closed and try to sleep, or put in my earbuds and listen to music real low to take my mind off the pain.

“I couldn’t drive or ride in a car for very long. If I sat in a chair, I had to get up after a while and move. I had to alternate positions and movements often to keep from stiffening up and hurting worse. I couldn’t ride my motorcycle, and I’ve been riding since I was ten. It’s my passion. We bought a brand-new bike in 2011, and it was just sitting out in the shed.”

After the neck surgeries failed to give Gary relief from his headaches, his orthopedic surgeon referred him to Kai McGreevy, MD. Dr. McGreevy is a board-certified neurologist and pain management specialist at McGreevy NeuroHealth, which has offices in Palm Coast and St. Augustine.

“If I do get a headache, I just adjust the stimulator with the remote control. The further up I adjust it, the more pain it takes away.” – Gary

Dr. McGreevy uses a wide range of advanced therapies to treat pain and many other conditions associated with nerve disorders.

“Gary had undergone cervical fusion surgery in the past, but areas above the fusion were now degenerating,” Dr. McGreevy reports. “Imaging revealed arthritis in his upper cervical spine. Arthritis in this area of the spine can refer pain up into the occipital region at the back of the head, and that can trigger headaches. We call this cervicogenic headache syndrome.”

Initially, Dr. McGreevy treated Gary’s headache syndrome with conservative measures, including medication and physical therapy. He tried interventional techniques, such as epidural injections and facet nerve blocks, as well, but none of these treatments provided the desired relief.

“I received a little pain relief with the injections,” Gary states. “It felt wonderful to get any relief at all, but then the pain got to a point that we had to try something else. That’s when Dr. McGreevy suggested occipital nerve stimulation.”

Photo by Nerissa Johnson.

With his occipital nerve stimulator Gary is
“enjoying life” again.

Occipital nerve stimulation works through an implanted device that interferes with pain signals traveling from the occipital nerves at the base of the skull to the brain. The interruption eases both neck pain and headaches. Before a permanent stimulator is implanted, Dr. McGreevy provides patients with a stimulator trial.

“In setting me up for the trial, Dr. McGreevy placed the wires over the nerves in my neck and taped the battery to my back,” Gary explains. “For four days, I was headache free, so I decided to go with the permanent stimulator.”

Adjustable Relief

When a patient is fit with an occipital nerve stimulator, one electrode lead is placed in their cervical epidural space and two smaller leads are inserted under the skin on each side of their head. The leads cover an area called the occipital ridge that runs along the back of the head where the base of the cranium sits, Dr. McGreevy observes.

“The first lead overlies the occipital nerves as they move off into the head,” the doctor explains. “The two smaller leads serve as peripheral nerve stimulators as they extend over the occipital ridge. We position the leads this way to cover the cervical pain as well as the headache pain.

“All three leads are attached to the same battery. With occipital nerve stimulators, the battery is placed either in the area of the low back or over the buttocks.”

Gary received 100 percent relief from his occipital nerve stimulator trial. That made him an excellent candidate for stimulator implantation, which was performed by a neurosurgeon in late 2018. Two weeks following implantation surgery, after Gary had time to recover, the stimulator was activated.

“During Gary’s recovery period, he was still having daily headaches,” Dr. McGreevy informs. “But the moment the stimulator was turned on, he noticed dramatic relief from his headache pain, as well as a significant decrease in headache severity and frequency. If he starts to get a headache, he simply changes the stimulator’s setting to reduce the headache’s impact.”

“The occipital nerve stimulator is amazing,” Gary offers. “It has an adjustable remote control, and if I start hurting, I just turn it up a little bit. If the headache is really bad, I can turn it up a little more. I adjust the stimulation to my pain level. It’s been a godsend.”

Retirement at Risk

During her working career, Elaine Johnson, 76, managed the production of a major corporation’s proposals for projects up for bidding. Merging data from multiple sources, editing text and inserting graphics on tight deadlines was stressful work.

A West Virginia native, Elaine strongly believes the stress of her job greatly contributed to a long-term issue with back pain, one that she long kept at bay through the use of a combination of therapies.

Photo by Nerissa Johnson.

Elaine Johnson

Over time, though, her pain intensified and eventually threatened to interrupt her laid-back retirement lifestyle, where she was content to relax with her husband, volunteer in the community and work in her garden.

“For at least twenty-five years, I experienced muscle spasms in my back,” Elaine divulges. “Twice a month, I went to a chiropractor and a massage therapist, and they pretty much kept the spasms down. But after I moved to Florida, my back got worse.

“The pain became excruciating. My back ached and throbbed, and it was unbearable. It was like a toothache, and to me, that’s one of the worst pains you can have. The pain throbbed, stopped for a couple of seconds, then throbbed again. And I never knew when it was going to start up.

“It hurt to do everything because of the throbbing. The pain kept me out of the garden and interfered with my sleep. Then, I didn’t want to get up in the morning because my back hurt so bad. The pain was really severe for about eight months, and during that time, I didn’t do much of anything except go to doctors.”

“It’s been more than two years, and I haven’t had any back pain. On a scale of one to ten, the pain was a ten before the injections. Now, it’s zero.” – Elaine

Among the doctors Elaine visited were a neurologist, a pain management specialist and an orthopedic surgeon. These physicians used several techniques in their attempt to relieve her pain, including physical therapy and injections to block the irritated nerves in her back. Unfortunately, their treatments didn’t provide the relief Elaine desired.

“I’d been to every physical therapist in the region,” Elaine remarks. “I even tried acupuncture, but nothing helped. The only medication I take on a regular basis is an antidepressant, and the neurologist switched it to one that’s good for pain, but that had no effect. At that point, my family doctor recommended Dr. McGreevy.”

“When Elaine came in, she reported pain in the region of her thoracic spine, which is the mid back,” Dr. McGreevy discloses. “This area was tender to the touch, and her pain was made worse with coughing, sneezing and bearing down. She described the pain as an electric shooting sensation in the middle of her back that radiated around to her side.

“Elaine’s MRI showed disc herniation as the result of degenerative disc disease. Because she had already tried conservative measures, including physical therapy and over-the-counter anti-inflammatories, we recommended specialized injections called transforaminal epidural steroid injections to relieve the inflammation surrounding the spinal nerve roots exiting her damaged discs.”

Slightly Off Center

The cushioning discs between the vertebrae of the human spine have a hard, outer layer and a soft, jelly-like, inner core. Over time or because of an injury, the outer layer can break open, or herniate. When this happens, some of the jelly-like material leaks out and puts pressure on nearby tissues, including nerves. That’s what happened to Elaine, Dr. McGreevy informs.

“Not only did Elaine’s MRI show her disc herniation, it also pointed me to the inflamed nerve roots exiting those discs that were the likely cause of her pain,” he notes. “I performed a nerve conduction study to confirm those were the nerves involved, then we moved on and began the series of injections.”

Photo by Nerissa Johnson.

Elaine, shown here with Lucky, feels fortunate to have found Dr. McGreevy

Transforaminal epidural steroid injections are specifically placed in the back by a trained specialist using fluoroscopic (continuous x-ray) guidance.

“In the injections, we use the combination of a nerve pain blocker and a steroid, which is a potent anti-inflammatory,” Dr. McGreevy explains. “That combination offers pain relief as well as reduced swelling of the spinal nerves. This takes the pressure off the irritated nerve roots and provides relief, which can last for months.

“Transforaminal is a technical approach to the target nerve. With the classic epidural, the labor or interlaminar epidural, the needle is positioned right at the midline of the spine. The problem with that is the medicine doesn’t necessarily get to the site where the disc is encroaching upon the nerve root.”

The transforaminal approach enables the physician to safely position the needle slightly off midline so the area injected is closer to the site of the injury. It is a technique that produces improved outcomes for patients with nerve root inflammation that Dr. McGreevy is specially trained in.

“Transforaminal epidural steroid injections are performed under local anesthesia,” the doctor reports. “The injections are very comfortable, they take less than five minutes to perform and their results speak for themselves.”

On the Road Again

When Dr. McGreevy performed Elaine’s transforaminal epidural steroid injections, he explained that she might not gain relief from her pain right away, and he was right. Once they did take effect, though, the relief proved to be long-lasting.

“I received the nerve blocks two years ago in January,” Elaine recalls. “About three weeks later, I was driving along when all of a sudden I realized I wasn’t in pain anymore. I remember it well. It was February 12, 2017 when my back stopped hurting, and it hasn’t hurt since.

“It’s been more than two years, and I haven’t had any back pain. On a scale of one to ten, the pain was a ten before the injections. Now, it’s zero.”

With zero pain, Elaine can sleep soundly at night and be active during the day. She credits her turnaround to Dr. McGreevy and his injections.

“Today, I feel really wonderful, and I’m out there gardening whenever I can,” she relates. “My massage therapist says I’m the healthiest seventy-six-year-old she knows.

“I absolutely recommend these injections to anybody with back pain, and I’ve endorsed Dr. McGreevy a number of times already. When people on Facebook ask about a neurologist or somebody for back pain, I recommend Dr. McGreevy and McGreevy NeuroHealth all the time. They’re wonderful!”

Gary achieved dramatic pain relief from his treatment at McGreevy NeuroHealth as well. Before he received his occipital nerve stimulator, Gary’s pain hovered at an eight or nine. But with the device, his pain level is significantly lower and easily managed. And because the stimulator is implanted, there’s nothing keeping him from the open road.

“On a daily basis, my pain averages maybe a two now,” he states. “If I do get a headache, I just adjust the stimulator with the remote control. The further up I adjust it, the more pain it takes away. It’s incredible. I feel like a new person.

“I’m back to riding my motorcycle, which I love to do. My wife recently retired, and we bought a camper, so we’re enjoying life as best we can. With her being retired and me being disabled, the only things interrupting our schedules are our doctor appointments.”

Like Elaine, Gary has high regard for Dr. McGreevy and his staff.

“Dr. McGreevy is awesome,” he raves. “He’s very knowledgeable, he takes the time to fully explain everything and he answers all of my questions. He makes sure I understand exactly what’s going to happen and what kind of results I should expect.

“The staff at McGreevy NeuroHealth is wonderful. They’re friendly, helpful and patient oriented. Whenever I go to the office, it’s just like going home. They always make me comfortable.

“I’m on several groups on Facebook for spinal cord stimulators for the back and neck, and those are wonderful sources of information. I’ve recommended Dr. McGreevy to a large number of people because he is an awesome doctor. I’m very appreciative that my orthopedic surgeon sent me to him.”

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    • Kai McGreevy, MD

      Kai McGreevy, MD, is board certified in neurology and pain medicine by the American Board of Psychiatry and Neurology. The American Board of Independent Medical Examiners also certifies him. His medical training includes completion of a neurolog... Read More