Health Chats
Minimally Invasive Options for Chronic Back Pain
Wednesday Apr 21, 2010, 12:00PM - 01:00PM (EST)
Emil Girgis, DO, MBBCHBlank
Associate Staff
Cleveland Clinic
Pain Management, Cleveland, OH
Chronic pain can rule your life, interfering with your ability to work, sleep and enjoy your family and friends. When chronic pain disrupts your quality of life and does not improve with standard treatments such as aspirin or ibuprofen, Cleveland Clinic Pain Management is here to help. There are many safe, proven effective treatments available that can eliminate or reduce chronic pain. The sooner you seek treatment, the sooner you can start enjoying life again. On April 21, 2010 from Noon-1pm (EDT), please join Dr. George Girgis of the Cleveland Clinic Pain Management Department, who will answer your questions about minimally invasive options for chronic back pain, including new innovations in back pain treatment. He will also present options ranging from physical therapy, medications, kyphoplasty, neuromodulation and more. Cleveland Clinic Pain Management specialists are among the most experienced in the world, treating more than 10,000 patients each year. Cleveland Clinic Board-certified physicians are dedicated to the goal of helping people with chronic pain return to a normal, productive lifestyle. Using the latest in diagnostic technology, paired with medical and interventional therapeutics, they will work with you to identify the source of your pain, eliminate or reduce the pain and teach you to manage it.
MedHelp:
Hello Everyone! The health chat is going to start at 12pm EST and 9am PST.  Please feel free to start submitting your questions.
MedHelp:
Welcome to the Minimally Invasive Options for Chronic Back Pain Health Chat.
MedHelp:
A special Thank You to Dr. Girgis and all members for joining us here today!
Dr. Girgis:
Hello everybody, it is my pleasure today to be with you in this Health Chat, I will be more than happy to answer your questions.
kevin1023:
I've had three back surgeries with no help. They called it degenerate disk disease.  I then had nerves burned in my lower back.  My question is how long does pain last after having nerves burned and is there anything else that can be done?
Dr. Girgis:
It seems that you have had lumbar spinal fusion secondly to degenerative disk disease
Dr. Girgis:
and then you continued to have low back pain after the surgery
Dr. Girgis:
Likely your pain is 100% in your back with no referral to your legs
Dr. Girgis:
This is why you did the burning of the facet medial branch nerves
Dr. Girgis:
RFA
Dr. Girgis:
Your pain could be controlled between 6 months to 2 years after the RFA
Dr. Girgis:
RFA is a procedure to burn very small nerves that supply the facet joint.
mhaidhoze:
I have been experiencing back pain including right chest muscle pain and occasional breathing problems I have xray but results are normal
Dr. Girgis:
chest wall pain could be musculoskeletal in origin namely, muscle problem like inflammation or a condition called costochondritis, rarely a condition called pseudoarthrosis, the fact that it is worse with breathing means that could be inflammation of the pleural mebrane however chest x-ray was normal then likely it is a muscle or costchondritis.
Dr. Girgis:
treatment should be medical management in the form of NSAIDs like mobic once daily as well as trigger point injection
Dr. Girgis:
if the pain is burning in nature and its course along the distribution of nerve root, this is a neuropathic pain and treatment could consists of membrane stabilizers like gababentin and lidocaine pathces, interventionally intercostal nerve block could help as well.
Mjmiller107:
Can minimally invasive surgery be utilized for L-3-4-5 fusion and laminectomy for Grade I spondylolithesis and severe central spinal stenosis?
Dr. Girgis:
certainly, very new today a procedure called MILD ( minimally invasive laminectomy and decompression whcih we do at our institution, however there are criteria to be a candidate for the procedure based on the MRI findings, for example the central canal stenosis should be only at one level.
Dr. Girgis:
If your pain is axial, mechanical pain i.e, secondary to small joints in the back called facet joints or even sacroiliaic joints, treatment would be different in terms of procedure, namely we can do facet medical branch nerve block as a diagnostic procedure to determine how much of your pain is coming from them, after Dx treatement plan conducted accordingly.
tippy18:
I have had an implantable pain pump until Oct. 26, 2009 and that is when all of the medication dumped at one time and I ended up in ICU.  I had a lethal dose of fentenyl which was to last for 63 days.  I almost died and now the pump is off and I am taking oral pain meds and I stay in severe pain 24/7.  I am hoping you may have some help for me.
Dr. Girgis:
First I do not know what was the indications for the intrathecal opioid therapy, generally speaking we keep that as our last resort for patients who are at higher dose narcotics that developed what is called opioid therapeutic cieling effects and started to develop more side effects with benefiting from increasing the opioid dose. Recent studies showed that narcotics themselves can produce pain, a new term called opioid induced Hyperalgesia, which highly likely what you have now, it was found that if this is the case , weaning off narcotics  would lead to abolishing the pain or sigmnificantly drop its severity.
the_frog:
As a teenager who is currently taking three or four (depending on the pain that day) different types of medicine, acupuncture, physiotherapy and manipulation, while still being in pain, are there any other options for me?
Dr. Girgis:
I believe it is difficult to answer this question based on the information you give, could you be more specific, meaning what is the condition treated??
Nancsc:
what is your opinion of TENS and CES (Cranial Electrotherapy Stimulation) for chronic back pain?
Dr. Girgis:
TENS unit ( Transcutaneous electrical peripheral nerve stimulation) is an extra tool of help in cases like Fibromyalgia, muscle pain disorders, muscle spasms, Low , mid and upper back pain.
Dr. Girgis:
in addition to TENS unit, physical therapy and some intervention therapy like trigger point injections would be very helpful. Generally speaking treatment of chronic pain should be multiapproaches ( medical, physical, interventional as well as psychological)
linnie22041:
I have had chronic pain for almost thirty years and exercise is difficult, but necessary, what is the best thing to do for chronic pain?
Dr. Girgis:
It Depends on the cause of your chronic pain, location, duration, previous treatment etc., if you are a bit specific I may be able to help. If you have generalized all over body pain you may be suffering from a condition called fibromyalgia for which management is avaialble in the form of medications, physical therapy, deep tissue massage.
jeepers103:
I was diagnosed with idiopathic scoliosis with mild-to-moderate degenerative disk on L4-L5 and cervical spinal stenosis, most pronounced at C4-C5 level. Although most of the pain seems to be coming from the Thorax spine which the MRI showed rotoscoliosis with apex of curvature towards right at approximately T7. There is also spondylosis change and disk bulge present throughout region. I have been to two spine surgeons that do not see anything significantly wrong in the Thorax area. Physical therapy has not improved my condition. It only helps temporarily for my lumbar and cervical area. I could only tolerate 2 sessions of PT for the Thorax area - it is too painful and I believe it has made my condition worse. Would I be a candidate for the decompression procedure or some other procedure?
Dr. Girgis:
Certainly, you suffer from idiopathic Scoliosis( for aother attendings scoliosis simply means lateral bending of the vertebral column, ost commom site is the thoracolumbar area)
Dr. Girgis:
each individual has 7 cervical vertebrae, 12 thoracic vertebrae, 5 lumbar and 5 fused sacral + 1 coccygeal. for cervical, thoracic and lumbar, each vertebra articulate with the other with 3 joints, one big in the middle in the front between vertebral bodies called Disc and 2 small  at each level, one on each side called facet joint.  Many times with scoliosis there is severe distress on the facet joints leads to arthropathy of these joints. this condition is manageable with minimally invasive procedure called facet medial branch nerve block as diagnostic first step, if pain and/or function improved by > 50 % the next step is to radiofrequency ablation of the nerves.
the_frog:
Follow up: Yes I suffer from fibromyalgia and rheumatoid arthritis