Address: 5055 West Park Blvd Suite 400 Plano, TX 75093
Email: [email protected]
[email protected]
Office Phone: 972-762-1602
Fax Referrals: 972-761-5228
From the West/Dallas North Tollway – Take the Park Blvd exit and go East. When you get to Ventura Dr. take a left (North). If you reach Preston Rd. you’ve gone too far. Pull into the second driveway on the right. The suite 400 building is on your left.
From the East on Interstate 75 – Take the George Bush Turnpike heading West. Exit Preston Rd. and turn right (North). Turn left (West) on Park Blvd. When you get to the second stop light on Park, turn right (North) on Ventura Dr. Pull into the second driveway on the right. The suite 400 building is on your left.
Your doctor may have prescribed a Spinal Cord Stimulator or Pain Pump with the goal of helping you manage your chronic pain. These two devices have been used successfully for many decades and can provide many years of pain relief for patients. We will briefly describe each device here. Should you have further questions or need more detailed information please contact your physician or device representative.
Your body has a unique and sophisticated operations system called the central nervous system (CNS). The central nervous system controls most functions in the body and mind. Doctors describe it in two parts: the brain and the spinal cord. The brain is like the chip or motherboard in your computer or phone. It interprets our external environment from our senses and then can react by controlling our body functions. The spinal cord is the way that information gets sent to and from the brain to other parts of the body. When a part of the body is injured, a nerve sends the signal to the brain to alert it that something is wrong.
There are times when an injury to a nerve lingers and doesn’t get well. Pain that lasts for more than 90 days and doesn’t subside with treatment may be considered chronic pain. If you are being considered for SCS or a Pain Pump your doctor has most likely diagnosed you with chronic pain. Typically your doctor will prescribe conservative treatments to attempt to calm the pain, such as physical therapy, medications, injections, etc. If those treatments don’t provide significant, long-term relief an SCS system or Pain Pump may be considered.
SCS has been around since the mid-60’s. The concept was based on a theory called the “Gate Control Theory of Pain”. This theory proposed that a non-painful stimulus or input can close the nerve “gates” to painful inputs or stimuli, which then prevents pain sensations or signals from reaching the central nervous system. SCS is the “non-painful” stimulus that is acting as the gate-closer. When the stimulation signal is received in the spinal cord, it is able to “close” some of those nerve gates that were previously sending the painful signal to the brain.
Modern technology has advanced dramatically since the early days of SCS. So much so that current SCS companies can provide patients with many different stimulation programs and waveforms to help alleviate pain. Some programs the patients actually feel the sensation while it is on. Some people describe the sensation, called paresthesia, as a tingle or buzz. Other programs can provide the desired pain relief without the tingling sensation. Each company has nuanced differences but they all operate on the concept of trying to block the nerve signals.
There are typically two staged procedures for SCS therapy. One of the unique things about SCS is that you get to have a temporary evaluation period called a “trial” prior to actually implanting the final device. Consider it like a test drive. You are able to have the device for typically 3-7 days and consider how it affects your daily activities and pain levels. The trial procedure can be done in a physician’s office procedure room, a surgery center or hospital operating room. The procedure is usually minimally invasive with only two needles used to access the epidural space. Most physicians choose to perform this procedure with patients under anesthesia. Once the needles are placed the doctor then advances two small catheter-like wires called “leads” into the correct position. Think of the leads like tiny pieces of angel-hair pasta. Each lead has small metal contacts called electrodes on them that allow the physician and device representative to program the stimulation. The procedure is done using live x-ray called fluoroscopy. Once the leads are placed then the needles are removed and the physician will secure the leads to your back. You will have a portion of the leads that are outside of your back. That area is considered sterile so your doctor will place a clean dressing on it to ensure it stays clean during your trial period. the doctor or representative will then attach the leads to an external device that powers the stimulation. Some of the external generators are secured under the tape and use bluetooth technology to connect to a remote that you use to control the therapy. Others are connected to the wires and worn on your waistline like a pager.
During your trial period there are sone restrictions that most physicians stress to their patients. typically they do not want patients to do any strenuous activities like heavy lifting or twisting of their torso. Also, because you will have a sterile dressing on your back that needs to remain clean during the trial you will not be able to get that area wet with a shower or sitting water. After the trial period is complete you will return to your doctor’s office and the temporary system and leads will be removed. Your doctor will discuss the results of your trial with you. If you and your doctor feel that the results were significant and SCS positively affected your life and reduced your pain, the next step would be to progress to the second stage of SCS which is implanting the actual entire device.
Some pain physicians will perform their own implants while others will refer you to a neuro or ortho surgeon to perform the implant. There are implantable battery options that you and your doctor will need to consider prior to the implant. The recovery from the implant varies from patient to patient. Once you are healed you won’t have any externalized parts of the device except for your patient controller where you have control of your device. Think of it like your TV remote.
Bariatric Surgery is the broad term for a range of weight loss surgeries designed to overcome obesity. Obesity is a body weight condition that can negatively affect overall health and potentially contribute to other conditions such as diabetes, sleep apnea and heart disease. There are typically 2 categories of weight loss surgeries: Restriction and Malabsorption. Restriction limits the amount of food that a patient is able to eat. Malabsorption reduces the number of calories that the body absorbs. Restrictive procedures include Gastric Sleeve and Gastric Banding. Gastric Bypass and Duodenal Switch are procedures that are both restrictive and malabsorptive.
Gastric Sleeve:
This is a restrictive procedure where the surgeon removes 75-80% of the stomach which creates a “new” stomach that is smaller and tube-shaped. Because the smaller stomach holds less food, patients feel fuller from less calories. It has also been shown to change the body’s hunger hormones in patients.
Gastric Banding:
This is a restrictive procedure where the surgeon places a “Band” around the stomach to restrict the amount of food that the patient can ingest, therefore making them feel fuller with a smaller amount of food. This band is adjustable as each situation is different. It can also be removed in the future if needed.
Gastric Bypass:
This procedure is both restrictive and malabsorptive, so it limits the amount of food a patient can eat and it actually changes how the food is digested. Most surgeons typically perform gastric bypass laparoscopically, which means that only tiny incisions are made in order to access the organs. The stomach is reduced to a fraction of its original size and part of the intestine is bypassed.
Duodenal Switch:
Some surgeons reserve this surgery for patients that have a body mass index over 50. This is a restrictive and malabsorptive procedure in which the surgeon takes out roughly 75% of the stomach. Then the digestive system is adjusted to decrease calorie absorption.
A pain pump is a therapy that delivers medication directly to your spinal cord. The system uses a small “pump” that is surgically placed under the skin of your abdomen. The pump delivers medication through a catheter to the area around your spinal cord. Because the drug is delivered directly to the pain area, your symptoms can be controlled with a much smaller dose than is needed with oral medication. Thus reducing the side effects of medication.
There is a space around your spinal cord that is filled with fluid called the the intrathecal space. Cerebrospinal fluid (CSF) flows through this area, bathing and protecting your brain and spinal cord. An pain pump works better than medications taken orally because it delivers medicine directly into the CSF, therefore bypassing the path that oral medication takes through your body. It takes only about 1/300 the amount of medication with a pump than when taken orally.
The pump is a round metal device about the size of a hockey puck that is surgically implanted beneath the skin of your abdomen. A small plastic tube, called a catheter, is surgically placed in the intrathecal space of the spine and is connected to the pump. A space inside the pump called the reservoir holds the medication
The pump is programmed to slowly release medication over a period of time. The pump stores the information about your prescription in its memory, and your doctor can easily review this information with the programmer. When the reservoir is empty, the doctor or nurse refills the pump by inserting a needle through your skin and into the fill port on top of the reservoir.
This therapy is completely reversible if you should ever decide to have the pump removed.
Determining whether a pain pump will be a good option for you is a complex process. Before a permanent pump can be implanted, you must undergo a trial to see if the device decreases your level of pain. Depending on your particular condition, one of the following screening tests will be necessary:
1: Single injection: you will receive one injection of intrathecal medicine (morphine or baclofen) through a lumbar puncture.
2: Multiple injections: you are given multiple injections over a series of days by either a lumbar puncture or catheter.
3: Continuous trial: a catheter is placed in the correct area of your spine and connected to an external pump. The dose is increased every 2 hours until you notice pain relief.
During the trial, the doctor gathers information about the best location for the catheter and the type and amount of drug that works best for you. If the trial is successful, you will be scheduled for surgery. Prior to surgery you may be scheduled for presurgical tests (e.g., blood test, electrocardiogram, chest X-ray) several days before surgery. Patients are typically admitted to the hospital the morning of the procedure. No food or drink is permitted past midnight the night before surgery. An IV line is started. An anesthesiologist will explain the effects of anesthesia and its risks.
There are two parts to the procedure: 1) placement of the catheter in the intrathecal space surrounding the spinal cord, and 2) placement of the pump/reservoir in the abdomen. The operation can take approximately 2 hours for the surgery. There will be discomfort as you recover from the procedure. Your doctor will give you post-op wound care and restriction instructions.
