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A new era of spinal cord stimulators introduces tailored approaches for back relief

In 2015, just as he was about to wrap up his career, Gregg Lynk took on one of the most challenging jobs of his life, transferring from the private sector to the public sector, where he spent three years managing the city of Palm Bay. 

JORDAN PYSZ / FLORIDA HEALTH CARE NEWS Spinal cord stimulation erased Gregg’s bothersome back pain and got him on the golf course again.

“Palm Bay is the 15th largest city in Florida, and I managed the overall operations for the entire city,” Gregg elaborates. “I was responsible for managing information technology, human resources, procurement, finance, police, fire, facilities, public works, and parks and recreation.” 

After moving on from the position in 2018, Gregg had his left knee and left shoulder replaced and took the first steps in an effort to ease the low back pain that has plagued him since he was injured in a car crash in November 1999. 

“An individual ran a red light and hit me at about 55 to 60 mph,” Gregg recalls. “The pain was awful. There was no sleeping because of it, which was bad enough. But I used to travel a lot for work, and being on an airplane was the worst. After a while, I had to get up and walk around because the pain was unbearable. In 2000, I ended up having three vertebrae in my lower back fused.” 

The surgery provided only minimal relief. Gregg reports that his pain level depended on his level of activity and fluctuated from a 3½ to a seven on a scale of one to 10. 

“If I was busy and bending while doing normal activities of life, the pain level would increase,” Gregg explains. “The only thing that reduced the pain was lying down. When I did that, it was like a nice cold pail of water was thrown on my back, which brought relief.” 

Gregg’s back pain interrupted his favorite pastimes as well. 

“After the accident and even after the surgery, I didn’t swing a golf club for seven years,” he notes. “When I did golf again, I had to be smart about it. Sometimes I played nine holes and would try to play 18, but I would pay a price, even post-surgery.” 

In the years since his surgery, Gregg has been treated with multiple modalities, including epidural injections, radiofrequency ablations and chiropractic care. He also discussed spinal cord stimulation with his pain management physician, but nothing came of that conversation. 

“My wife got sick and tired of that pain management doctor,” Gregg admits. “She’s very good at research, so she went looking for a new provider for me. Her search led her to Dr. Esposito, so I made an appointment with him.” 

Michael F. Esposito, MD, is a board-certified anesthesiologist and pain management specialist at Interventional Spine & Pain Institute in Vero Beach. 

During his initial meeting with Gregg, Dr. Esposito broached the idea of trying spinal cord stimulation. 

“Spinal cord stimulation is a type of neuromodulation, which is the alteration of nerve activity typically with electrical stimuli,” Dr. Esposito explains. 

With spinal cord stimulation, a small device that applies electrical impulses to the pain source is implanted in the epidural space around the spinal cord. It can reduce the feeling of pain and replace it with a more comfortable tingling sensation called a paresthesia. The device can also be programmed to have no paresthesia. 

Dr. Esposito offered Gregg a trial of a new spinal cord stimulator from Boston Scientific called the WaveWriter Alpha™, which uses specialized therapies identified as FAST™ and Contour™. 

Proprietary Waveforms 

“FAST stands for Fast-Acting Sub-perception Therapy,” Dr. Esposito informs. “It is one of the proprietary stimulation waveforms that only Boston Scientific offers. FAST stimulation provides a rapid onset of pain relief that is above and beyond what other stimulator therapies provide. And it is sub-perception, or paresthesia-free, meaning patients don’t feel any tingling.” 

Contour is Boston Scientific’s other proprietary stimulation waveform. In most cases, it delivers broad paresthesia-free pain relief using less energy than conventional paresthesia-free therapies. 

The WaveWriter Alpha can be programmed to run stimulation waveforms that provide paresthesias and those that don’t. It can also be programmed to provide a combination of stimulation types. 

“For example, Contour is a non-tingling stimulation that can be run in the background,” Dr. Esposito maintains. “It can also be programmed to run a tingling stimulation at the same time. The advantage of this is that one type of stimulation targets the nerves in a certain way, and the other type of stimulation targets the nerves in a different way. 

“Using this approach, we can take advantage of different mechanisms of action to decrease pain. By combining the stimulation and targeting different parts of the nerve, we achieve better pain relief for the patient than if we simply used one type of stimulation. 

“With a variety of options, the WaveWriter Alpha allows for personalization of the therapy so patients can choose those options that best treat their pain.” 

Before implanting a WaveWriter Alpha, Dr. Esposito positions a temporary version for a weeklong trial. The aim is to determine whether the patient will receive sufficient pain relief to warrant implantation of a permanent stimulator. 

“During the trial, Mr. Lynk experienced more than 90 percent relief from his back pain,” the doctor notes. “Because he did so well with the trial, I went ahead and implanted the stimulator for long-term use. He reports that he feels great relief and has been able to reduce the amount of pain medication he takes.” 

“Wonderful” Outcome 

Dr. Esposito implanted Gregg’s spinal cord stimulator in December. Gregg was amazed by how quickly he felt a difference in his low back pain. 

“I felt relief immediately,” Gregg enthuses. “And now, my back feels wonderful. My pain level is maybe a one, and I’ve been consistently reducing the amount of oxycodone I take. The goal is to get off all medications, and I’m going to do everything I can to reach that goal.” 

Gregg’s pain relief is allowing him to sleep through the night and perform regular activities without constant pain. 

“Before, I’d come home and have to lie down after golfing,” he relates. “The first time I golfed after the spinal cord stimulator was implanted, I came home and didn’t have to lie down. Instead, I grabbed my pole saw and started trimming the palm trees on my property. I hadn’t done that in 20 years.” 

Gregg’s experience has left him great regard for the pain management and neuromodulation specialist. 

“Dr. Esposito is wonderful,” Gregg raves. “He’s open-minded, a brilliant man and a fantastic practitioner. I’m very pleased with Dr. Esposito and his office, and very pleased with my outcome with the spinal cord stimulator.”

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