Long-Term Back Pain
Dealing with longer-term back pain is a common problem among primary
care physicians.While back pain resolves over a six-week period for most
patients, some inevitably advance to spine surgery.When spinal surgeries
fail, patients may suffer from Failed Back Surgery Syndrome or FBSS.
These patients present with chronic back pain and neuropathic leg pain
and should be referred to a pain specialist; for carefully selected patients,
spinal cord stimulation may be proposed as a pain management modality.
Conventional Spinal Cord Stimulation (SCS) systems have been implanted
regularly over the past 40 years to address the pain experienced by FBSS
patients. Implantation typically involves the use of needle introducers
to place two lead wires into the epidural space.The lead wires are
connected to an implanted pulse generator placed within a subcutaneous
pocket, much as a pacemaker would be.
Moderate relief of leg pain with little or no effect on back pain has been
the norm until recently. Conventional SCS systems produce paraesthesias
that serve to mask the sensation of pain in the region.While paraesthesia
itself is considered irritating by most patients, it is nonetheless preferable
An SCS system that overcomes these two major shortcomings has
recently become available. Dr Adnan Al-Kaisy, Consultant in Pain Medicine
at London Bridge Hospital, indicated,“I’ve been evaluating a novel SCS
System (Nevro Corporation, Menlo Park, CA USA) as part of a clinical
research trial and I’ve been quite impressed with the results.The system’s
ability to address back pain is unparalleled and there have been no
paraesthesia-related complaints. On average, we’ve observed 88% relief
of leg pain and 74% relief of back pain with the Nevro System.” According
to Dr Al-Kaisy, comparable studies with conventional SCS systems report
only 47% and 25% pain relief, respectively.
Dr Al-Kaisy plans to continue his research efforts and to offer the
Nevro System to the back pain patients in his practice for whom it is
indicated.The Nevro System has received the CE mark and is available for
implantation following the standard period of trial stimulation.According
to Dr Al-Kaisy, approximately 80% of the patients who undergo an SCS
trial go on to permanent system implantation.
Dr Al-Kaisy holds clinic and theatre slots at London Bridge Hospital
on Mondays.Ad hoc appointments are available on request. For further
details, please contact Dr Al-Kaisy’s secretary,AnneWhitehead:
T: 01795 530 530
or email[email protected]
MB ChB FRCA FFPMRCA FIPP
Consultant in Neuromodulation
and Pain Medicine
Dr Al-Kaisy is currently Clinical
Lead and Consultant in Pain
Management at Guy’s and St
Thomas’ Hospital. He trained in
Chronic Pain Medicine at The
Walton Centre, Liverpool, for
Neurology and Neurosurgery.
He has a fellowship in Chronic
Pain Management at University
of Toronto Hospital, Canada.
He has a number of
publications and research in
a variety of categories in pain
management. His interest
is in management of Spine
and Neuropathic pain. He
has extensive experience in
Neuromodulation: spinal cord
stimulation for Failed Back
Surgery Syndrome, intractable
angina, nerve lesion and sacral
nerve stimulation for urinary
incontinence, interstitial cystitis
and bowel incontinence.
Dr Al-Kaisy was voted the
Hospital Doctor of theYear in
2001 for Pain Management.
Long-Term Back Pain