Stimulus Package

Out on the sandlot, Gretchen Becker was just as good a baseball player as any of the boys she grew up with. The boys in her neighborhood weren’t any better than her on the basketball court either.

Gretchen’s spinal cord stimulator has her moving pain-free again.

Unfortunately, Gretchen grew up at a time when girls weren’t allowed to play alongside boys on the same youth teams.

That’s all right, though. Gretchen did just fine for herself against the girls. After all, she went on to play softball and basketball in high school and college, at Grand Valley State University just outside of Grand Rapids, Michigan.

“That was back when they first started giving out athletic scholarships to women,” says Gretchen, 67. “It was a great time, and I really enjoyed myself. But I paid a price for playing sports all those years.”

The price came in the form of knee problems that have so far resulted in nine surgeries, including a total reconstruction of her right knee. Gretchen also deals with back trouble, though that’s not a result of her athletic career.

“My back problems go back to 1987, when I was working on the assembly line at General Motors, building cars,” Gretchen reveals. “I was what they classified as a utility person, which means I had to know how to do every job in my department.

“If someone in my department was out sick or on vacation, I would fill their spot on the line.

“One night, I was sent out to a different department that I was not familiar with and they had me securing liners in the trunks of vehicles. I was bending over in the trunk trying to pin this liner in with my thumbs, and I guess I just exerted too much pressure because, all of a sudden, I heard a pop go on in my back. From that point on, I was in excruciating pain.”

As she did often as an athlete, Gretchen trudged on through the pain, literally fighting through it for nearly two years. Finally, after moving to Jacksonville in 1989, she sought medical help.

“I went to a neurosurgeon and had an MRI done,” Gretchen remembers. “The MRI showed that I had a herniated disc, so the neurosurgeon wound up doing a (laminectomy) where you remove part of the (vertebral) bone to relieve pressure on the nerve.”

“I have had absolutely amazing pain relief from this spinal cord stimulator.” – Gretchen

The laminectomy allowed Gretchen to live relatively “pain-free” for about 15 years. Then, in 2005, her back pain returned. This time the pain didn’t stop at her back. It traveled through her buttocks, into both legs and down to her feet.

For help with this problem, Gretchen turned to Jax Spine & Pain Centers, which specializes in the use of progressive interventional treatment options to address chronic joint, neck and back pain.

At Jax Spine & Pain Centers, Gretchen was placed in the care of John Carey, MD, who treated her stubborn back, leg and foot pain primarily with epidural steroid injections until two years ago, when Dr. Carey and an associate suggested another approach.

“Like a lot of patients with this type of pathology, Gretchen became caught in this cycle of receiving interventions and getting some relief, but it wasn’t long-lasting relief,” says Justin D. Mann, MD, of Jax Spine & Pain Centers.

“In October 2018, Dr. Carey and I mentioned to her that there may be a better option. That led to a decision where we all agreed to see how she might do if we gave her a spinal cord stimulator.

Signal Disrupted

A spinal cord stimulator is a small device that alters pain signals running to the brain. It’s powered by a small battery that is implanted under the skin near the patient’s hip, and the technology behind it has improved markedly in recent years, according to Dr. Mann.

The first spinal cord stimulators, developed about 30 years ago, replaced pain signals with a tingling sensation called paresthesia. The latest models work the same way as the old, but advanced technology replaces the pain with no sensation at all.

“We used to think that the pain signals were blocked by distracting the brain,” Dr. Mann educates. “But we now know that we’re actually affecting pain on a cellular level, and that is what is decreasing the patient’s sensation of pain.”

The first phase of spinal cord stimulation therapy is a three- to seven-day trial period during which the stimulator’s effectiveness is gauged. If the patient experiences a significant reduction in pain during the trial, the stimulator is implanted permanently.

“Setting someone up for the trial is a lot like giving them an epidural steroid injection,” Dr. Mann adds. “We do it right in our office, and the only difference is that instead of injecting medication, we thread leads or electrodes through the epidural needle.

“The top end of the electrode is fed into the epidural space of the spine, which is on the inside of the spinal canal but outside of the spinal cord. It’s a unique place anatomically that is especially receptive to this type of therapy.

“The bottom of the electrode is attached to a battery that sits on top of the skin during the trial. The battery is about the size of a half-dollar, and it is that battery that creates the electrical impulses that block the pain signals.”

About 90 percent of patients going through the trial receive enough pain relief to have the stimulator implanted permanently. That implant procedure is similar to the one performed for the trial, except that it is done at a hospital or surgery center.

“During the permanent implant procedure, the patient lies down on their stomach, they’re given intravenous sedation and the process done for the trial is recreated in terms of putting the leads into the spine,” Dr. Mann explains.

“Every time I went to roll over in bed, I would feel that pain. Not anymore.” – Terry

“During the procedure, we actually wake the patient up at one point and ask them if they’re feeling the delivery of energy through the device. We do that to make sure we’re covering the areas where they are experiencing the most pain.

“If they indicate that we’re successful in capturing these painful areas with the electrical signals, we complete the procedure, which includes placing the battery under the skin.

“No bone or muscle is cut during the procedure and the only thing that’s visible afterward is a small incision about an inch long over the lower back and another incision near the hip where we place the battery.”

The battery is charged wirelessly with an external generator that’s attached to a small belt. A non-rechargeable battery is also available, but most patients choose the rechargeable battery that can be recharged in an hour every two days.

100 Percent Relief

After a five-day trial during which she reported receiving “100 percent pain relief,” Gretchen had a spinal cord stimulator permanently implanted in the spring of 2018. She has remained pain-free ever since despite giving her back a rigorous daily workout.

“I’m now a paint associate at Lowe’s, and so I’m on my feet all day,” she says. “That can be pretty tough on your back sometimes, and I have had absolutely amazing pain relief from this spinal cord stimulator. I think it’s a great alternative to pain medications and injections and just about anything else you can try for back pain. That’s why I tell people who complain about back pain to go to Jax Spine & Pain Centers and try the spinal cord stimulator.

“I have always said that nothing beats failure better than a try, which is why I was so willing to try the spinal cord stimulator. I can’t thank the folks at Jax Spine & Pain Centers enough for suggesting it, and for everything they’ve done for me. They’re all great people.”

Road Warrior

There isn’t a major airport in the United States that Terry Kiser doesn’t know as well as her own home. It was through her 23-year career in pharmaceutical sales that Terry gained her intimate knowledge of such places.

Spinal cord stimulation has rid Terry of her “stabbing groin pain.”

“I was the liaison between the medical department at Bayer and some of the top physicians in their field who spoke at conferences all over the country,” Terry relates. “So, I did quite a bit of traveling, especially near the end of my career.”

Despite spending nearly a quarter of a century living out of a suitcase, Terry, 70, still enjoys traveling. Before the coronavirus hit, she usually made at least one trip to Europe each year. In recent years, however, incessant back pain made those trips quite taxing.

“Those problems go back many years,” Terry confides. “I think all the traveling I did for work was one reason for them. But as a kid growing up, I played every sport offered in high school, and after school I played a lot of golf, tennis and I also water-skied.

“It all started to catch up to me when I was 47 and had to have vertebrae restructured in my neck. Then, three years ago, I had to get fusions done on my lumbar spine. A year later I had more work done on the vertebrae above that. Then things really went south. My back pain was so bad that I had to give up all sports. Even walking became difficult. I was at a point where this pain I was dealing with was majorly impacting my quality of life.”

As it often does, Terry’s back pain traveled to other parts of her body, including her left groin area. At its worst, Terry could barely take a single step or even roll over in bed at night without feeling its debilitating impact.

“It was like an icepick stabbing me, and believe me, I threw everything I could think of at it,” Terry explains. “I tried chiropractic care, massage therapy and supplements. I even tried a personal trainer, thinking that strengthening the muscles in that area might help. It didn’t. In fact, it made things worse.

“After that I went to Jax Spine & Pain Center. They gave me epidural injections. After a while, though, epidurals stop helping.

“I consulted with a neurosurgeon, but at the same time, I was talking with my niece, who works for Abbot, the company that makes the spinal cord stimulator. She thought I might be a candidate for it and suggested I talk with Dr. Hanes.”

Michael Hanes, MD, of Jax Spine & Pain Centers, specializes in neuromodulation. He is considered one of the country’s leading experts in the field, which includes spinal cord stimulation and intrathecal drug delivery.

“Terry first came to see us in the summer of 2019,” Dr. Hanes reports. “She came to us on the advice of her niece, who knew of me because I also teach courses nationally about spinal cord stimulation and have had several articles on it published in
medical journals.

“From the very start, I looked at Terry as a classic candidate for spinal cord stimulation because she already had multiple back surgeries, but she still had chronic back and leg pain despite having tried other therapies.

“A lot of people view spinal cord stimulation as a last-line therapy, but I don’t consider it a last-line therapy anymore. Sometimes, spinal cord stimulation is the first thing I’ll offer a patient because I know it’s going to be the best thing for them.

“With most patients, we do try a couple of injections first, but Terry is one of those patients I thought we should go straight to spinal cord stimulation before trying anything else because I thought it was going to be more effective.

“With patients like that, my thinking is, Why do six injections before trying spinal cord stimulation when you know that most likely spinal cord stimulation is going to give them the long-term relief they want? That’s how I viewed Terry.”

Long-Lasting Relief

Terry agreed and has had her spinal cord stimulator for a little more than a year. Just as Dr. Hanes suggested, it has given her the long-lasting pain relief she couldn’t get from epidural injections or other therapies.

“It has helped me tremendously,” Terry raves. “That stabbing nerve pain I had in my groin? Gone. And that was the worst problem I was dealing with because it was affecting so many areas of my life.

“Every time I went to roll over in bed, I would feel that pain. Not anymore. It’s even helped alleviate some of the arthritis pain I have. That’s why I’m so thrilled to have met Dr. Hanes and to have found Jax Spine & Pain Centers.

“Dr. Hanes is wonderful. He’s so kind and professional and informative. In fact, I only have good things to say about him and the people at Jax Spine & Pain Centers. They’re all just awesome and so helpful. They really are top-notch professionals, and I have no trouble recommending them or spinal cord stimulation to anyone.”

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    • Jax Spine & Pain Centers

      Jax Spine & Pain Centers is one of north Florida’s leading providers in progressive interventional pain relief for the treatment of back, neck, shoulder, knee, hip and chronic pain. Their team of board-certified physicians and ... Read More

    • Michael Hanes, MD

      Michael Hanes, MD, is a board-certified anesthesiologist and interventional pain medicine specialist. He earned his bachelor’s degree from the University of Michigan in 2006 and his medical degree from Michigan State University in 2010. He comp... Read More

    • John Carey, MD

      John Carey, MD, is board-certified in anesthesiology and pain management and specializes in interventional spine pain management, the application of neuromodulation and advanced implant therapies in the field of interventional pain man... Read More

    • Justin D. Mann, MD

      Justin D. Mann, MD, is a board-certified anesthesiologist and interventional pain medicine specialist. He earned his bachelor’s degree from Valdosta State University in Georgia in 2006 and his Doctor of Medicine degree from Mercer Unive... Read More