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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

to pain.

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]

Dr Al-Kaisy

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

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Long-Term Back Pain