Ride the Stimwave

Advanced spinal cord stimulator eliminates persistent pain.

In 1999, Maggie* was only 18 when her agonizing journey of pain began with a constant aching in her left knee. She was initially diagnosed with osteochondritis, an inflammation of the bone-cartilage juncture. From that point, the discomfort intensified, and complications with her knee condition caused the pain to spread to her lower back and hip.Dr. Sunil Panchal of National Institute of Pain, which has locations in Lutz and Riverview, treated Maggie’s (alias) chronic pain with an advanced spinal cord stimulator.

“My doctors tried to relieve my pain with various treatments such as surgery and pain medications, including opioids,” relates Maggie. “But they didn’t work for me. I didn’t get lasting relief from them.”

Although Maggie was treated for her pain, her overall condition deteriorated further until the fall of 2017. That’s when she consulted Sunil Panchal, MD, a board-certified interventional pain specialist. Dr. Panchal is president and medical director of National Institute of Pain, which has centers in Lutz and Riverview.

“After her osteochondritis diagnosis, Maggie was treated with bone graft surgery and cartilage replacement,” reports Dr. Panchal. “Over time, she had six more surgeries on her left knee and four on her right knee.

“With the repeated surgeries, Maggie developed neuropathic nerve pain, so she had symptoms of numbness in her legs and pain and burning with light touch. Her left leg also turned purple, which meant the nerve control to her blood vessels was abnormal.

“The pain she experienced altered the way she walked, and that triggered her back pain,” continues Dr. Panchal. “Then, after her last surgery, she developed hip pain as well. The back and hip pain had been going on since 2014, so in October 2017, she came to me for an evaluation.”

Dr. Panchal knew pain medications were not a treatment option for Maggie. He also knew that other treatments such as physical therapy and injections had provided limited relief for her, so he knew he would have to dig deep into his arsenal of treatment tools to find an effective alternative for her.

He began that process by first performing a sympathetic nerve block test to determine if her sympathetic nerves were involved. A sympathetic nerve block is an injection during which a needle is placed into the back alongside the spine where the sympathetic nerves are located.

Maggie achieved significant pain relief from the nerve block that lasted approximately three days. The test thus confirmed that her sympathetic nerves were indeed involved in her pain condition.

“After we determined the source of the problem, we discussed treatment options,” notes Dr. Panchal. “Maggie wanted something that would be effective and long-lasting, so I recommended the spinal cord stimulator.”

New Generation

Spinal cord stimulation uses implanted electrodes to send electrical impulses that keep pain messages from traveling from the affected nerves to the brain. By interrupting these messages, the stimulus for pain is not detected, so there is less pain felt by the patient.

When it was first introduced some 40 years ago, spinal cord stimulation involved implanting the electrodes near the problem nerves coming off the spine and a pacemaker-sized control device under the skin of the lower abdomen. Battery changes, however, required a surgical procedure.

“The newest generation system I use, called Stimwave, requires only a small wire implant,” explains Dr. Panchal. “It’s essentially a tube that has metal contacts where the electrical current exits. The tube contains a computer chip that receives power from the battery, and it has an antenna at its end. The antenna communicates with the battery.

“The Stimwave’s battery is external and wireless. It’s housed in a small control box. It has a cable attached to a flat antenna, which is placed over the site of the wire implant. The battery device is generally worn under the patient’s clothing. Some clip it to their pants; some women clip it to their bras to keep it as unobtrusive as possible.”

The latest generation of stimulators also uses a different type of programming that provides more comfort for the patient.

“When stimulators first came out, they used tonic stimulation,” Dr. Panchal educates. “With that type of stimulation, the patient’s pain was replaced with a tingling sensation, called a paresthesia. Some patients didn’t like the tingling, however, and in many patients with neuropathic pain, the tingling actually aggravated their symptoms.

“Now, they’ve developed a high-frequency stimulation that sends the electrical signals at a much faster rate, so patients don’t feel any tingling at all. It simply reduces pain. As it turns out, the success rate with the paresthesia-free approach to stimulation is actually higher than with the old approach.”

The newer technology stimulators are also less bothersome to patients because they don’t feel changes in their condition when they move their body positions, which occurred with older models. There’s also nothing to aggravate neuropathic symptoms, explains Dr. Panchal, who has particular expertise with Stimwave stimulators.

When the system’s first generation of devices was launched in 2015, he performed the first surgery with that system in the United States. When the second generation was released, Dr. Panchal did the first implant of that system worldwide.

Relief at Last

Dr. Panchal has now performed more than 100 permanent implant procedures with the advanced Stimwave system, the most procedures of anyone in the world. As the first step in that implant process with Maggie, he performed a stimulator trial that involved placing a temporary wire on her spine and evaluating the results.

Dr. Sunil Panchal of National Institute of Pain, which has locations in Lutz and Riverview, treated Maggie’s (alias) chronic pain with an advanced spinal cord stimulator.

“Spinal cord stimulation
is an excellent, drug-free option that works effectively to relieve people’s pain.” -Dr. Panchal

The trial gave the doctor a good idea of the extent to which a permanent stimulator would benefit his patient.

“Maggie got sixty-five to seventy percent relief from the trial and qualified to receive a permanent stimulator system,” Dr. Panchal states. “I then implanted the permanent Stimwave system under Maggie’s skin, and she reported as much as eighty percent relief from that. She also reported that her episodes of numbness went away.

“Maggie had been treated with pain medications, including opioids,” notes
Dr. Panchal. “Neuropathic pain tends not to respond well to narcotics, and too many people in our country have a problem with opioids. Spinal cord stimulation is an excellent, drug-free option that works effectively to relieve people’s pain.”

“I achieved great results with the new spinal cord stimulator,” says Maggie. “I recommend it and Dr. Panchal to anyone in pain.”

*Patient’s name withheld at their request.
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    • National Institute of Pain

      We treat each patient individually, using the latest equipment and various innovative procedures to diagnose pain and determine your care needs. We then assemble the appropriate interdisciplinary team of health care professionals who can best... Read More

    • Sunil J. Panchal, MD

      Sunil J. Panchal, MD, is board certified by the American Board of Anesthesiology in interventional pain medicine. He earned his Bachelor’s degree in Biology from Rensselaer Polytechnic Institute in Troy, NY, and earned his medical degree from... Read More