Revolutionizing Pain Management: The Success Story of Spinal Cord Stimulation

JORDAN PYSZ / iFoundMyDoctor.com With her DTM spinal cord stimulator, Karen is able to walk longer distances and go about her daily activities without assistance.

Back in 1999, Karen Chiarantona was working as a patient care tech at a health care facility. While attending to a patient one day, she suffered a serious back injury that left her disabled and forced her to abandon her career. “While I was working, a patient fell on top of me and broke my back,” Karen expounds. “I was in a lot of pain. On a scale of one to 10, it was 10-plus. I had to give up most of my activities because of the pain. When I got injured my family was young. My husband had to take on most of the child care duties and other stuff because I just couldn’t do it.” About a year later, a neurosurgeon performed spinal fusion surgery on her, but the procedure failed to relieve her pain. “There was too much nerve damage,” Karen explains. Finally, after years of suffering, Karen was referred to Harold J. Cordner, MD, a board-certified pain management specialist at Florida Pain Management Associates, which has offices in Sebastian and Vero Beach. “Dr. Cordner recommended a spinal cord stimulator to help with my pain,” Karen remembers. “I received my first stimulator around 2009 or 2010, and I’ve had three different stimulators over the years.” Spinal cord stimulation has been around for decades. The stimulator includes tiny electrodes that are implanted into the targeted area of the spinal cord in a minimally invasive procedure. The electrodes are connected to a small battery-powered device, which sends electrical signals to cells that block pain signals from reaching the brain. There is typically a short trial period before it is permanently placed. Earlier this year, the battery in Karen’s stimulator battery reached end of life, causing the stimulator to no longer work which triggered a painfully disabling period for her. “My nerves were shot, so there was stabbing, shooting pain going from my low back down into my legs,” she describes. “I had to give up most of my activities again. I couldn’t walk very far before I had to sit down, and I couldn’t do any housework. “In March, Dr. Cordner and I discussed the different types of spinal cord stimulators, and Dr. Cordner recommended a new type for me. I did a four-day trial with the new stimulator, and it provided great pain relief, so I had Dr. Cordner implant it in my back.” The newer device is Medtronic’s Differential Target Multiplexed™ (DTM) stimulator. It is the byproduct of years of research into the way spinal cord stimulation works, according to Dr. Cordner.

Modulating Glial Cells

“Only 10 percent of the spinal cord is made up of nerve cells, or neurons,” the doctor educates. “Historically, those neurons are what we’ve targeted with spinal cord stimulation. As a result, we’ve only been addressing 10 percent of the spinal cord. “The rest of the spinal cord, about 90 percent, is made up of glial cells, and research has found that these cells are responsible for creating and tempering chronic, severe pain. “We can alter the activity of glial cells with certain medications and gene therapy, but a researcher named Dr. Ricardo Vallejo set out to determine if we can better control back pain by modulating and controlling the glial cells. “Sure enough, after 10 years of basic science research, Dr. Vallejo found specific electrical parameters that will actually return glial cells to normal function, so they do not cause pain.” That research led to the development of DTM stimulation programming, which targets the neurons and glial cells at the same time, enhancing relief of back and leg pain. DTM stimulation uses an algorithm that allows multiple therapy options to be programmed for each patient. According to Medtronic, it involves the coordination of four types of electrical frequencies (multiplexed signals) that work simultaneously on multiple areas of the spinal cord (differential targets). “No other device on the market can apply different parameters to different cells concurrently,” Dr Cordner notes. “It is a proprietary technology only available from Medtronic that offers new hope to those patients who did not respond to conventional spinal cord stimulation in the past or are not getting the pain relief they once did with conventional spinal cord stimulation.” To test its effectiveness in real life situations, Florida Pain Management Associates conducted a clinical trial in which half of the patients received the DTM stimulation and half received conventional spinal cord stimulation. “The success rate that was achieved with the new programming was markedly better,” Dr. Cordner declares. “About 35 percent of patients receiving conventional stimulation achieved 80 percent or better pain relief. In the DTM group, 69 percent of patients achieved that level of relief.”

JORDAN PYSZ / iFoundMyDoctor.com
Karen Chiarantona

“100 Percent Better”

Based on those test results, Dr. Cordner recommended DTM stimulation for Karen. She’s glad he did. “My new stimulator is fantastic,” she enthuses. “My pain is about 70 percent better. It is now about a three or four out of 10, but that’s not so debilitating that I have to sit and rest all the time. “It takes me a while to do a lot of things, but with this stimulator, I’m able to do all my daily activities without any assistance. I can even walk long distances and play with my grandkids. I actually feel like a human being again. “Compared to my old stimulator this is 100 percent better. And it’s so much easier to use. The battery recharges in about 35 minutes, while the old one took hours.” Karen is grateful to the pain management physician that suggested the new device. “I love Dr. Cordner,” Karen raves. “He’s extremely knowledgeable, and I wouldn’t go to anyone else but him. “I used to live in Sebastian, where his office is located. Now I live in Orlando, and I travel all the way back to Sebastian to see him. I trust him that much.”