New ways to ease pain in people with cancer, back problems, diabetes

As the U.S. marks Pain Awareness Month, MUSC Health has several new options for treating pain. In this article, pain management specialist Martin Burke, M.D., highlights four key areas:

• The new cancer pain program.
• The new perioperative (before and after surgery) pain service.
• Diabetes pain management.
• The newly arrived ReActiv8 neurostimulator for lower back pain.

MUSC Health has a long track record in helping to reduce people’s pain, with three Pain Management Clinics in West Ashley, Mount Pleasant and downtown Charleston. The fact that there are multiple sites in the Charleston area serves as a reminder of how widespread the problem of pain is. Here’s a staggering statistic to back that up: Almost 100 million suffer from chronic pain in the U.S., according to the American Academy of Pain Medicine.

Cancer pain program

Some cancer patients won’t be surprised to hear that high number. The National Cancer Institute estimates that 20% to 50% of patients with cancer suffer from pain, and “roughly 80% of patients with advanced-stage cancer have moderate to severe pain.” Causes include the cancer itself, along with surgery, radiation, chemotherapy, targeted and supportive care therapies and diagnostic procedures – all things designed to heal that can also have pain as a side effect.

 

With that in mind, MUSC Health’s pain management team now has a specialist, Andrew Mendelson, D.O., who focuses exclusively on easing cancer pain. “He's really been growing the program and collaborating with palliative care and oncology and gotten it up and running,” Burke said.

Cancer pain treatments include medications, nerve blocks and physical therapy. And, as of this year, MUSC Health also has a dedicated team implanting and managing intrathecal pumps for cancer pain. Burke explained how those pumps work.

“The pumps are implanted under the skin with a catheter that goes to the spinal fluid and delivers medication slowly around the clock. It's a surgical procedure. And then the medication can be refilled in the cancer pain clinic. It’s a really useful option for cancer patients,” he said. “It reduces pain and improves quality of life and function.”

Perioperative pain program

Reducing pain and improving quality of life are the goals of all pain treatments, including those now offered by the new perioperative pain service at MUSC Health. Perioperative refers to the time near surgery. Burke said the first patients to benefit are people having spine surgery. There’s a great need – people with spinal pain make up more than half of the MUSC Health Pain Management Clinics’ patients.

So here's what happens through the new program when a spinal patient is slated for surgery. “With patients who are having spine surgery, you walk in the room, you look at the patient's chart, and you may see that the patient is going to have a hard time with recovery because they've had surgery before,” Burke said.

 

“It may be a repeat surgery. Or maybe they're on high-dose pain pills, an opioid medication and/or they have other health risks. You know that that patient is probably going to have a longer length of stay in the hospital or a higher risk of bouncing back to the ER,” Burke said.

“Surgeons identify these patients before they operate and refer them to the perioperative service. Then, Dr. Justin Wikle evaluates them preoperatively, gives them recommendations for how to optimize pain management before surgery, sees them in the hospital to evaluate them, sees them postoperatively for a short period of time and then gets them back to their primary care doctor or their regular pain physician,” Burke said.

“The goal is to decrease length of stay in the hospital, improve patients’ satisfaction and pain scores and decrease the odds they’ll end up back in the hospital.” 

Diabetes

Diabetes doesn’t always send people to the hospital, but the disease can cause a substantial amount of pain. And it has a wide reach. South Carolina had the sixth-highest rate of diabetes among adults in the country, according to the Department of Public Health’s latest figures. Some of them face chronic pain, Burke said. “A large percentage of people with diabetes have hand and foot pain related to the elevated blood sugars affecting their nerves over time.”

 

Long-time treatments include trying to reduce blood sugar levels and managing the condition, along with medications. But diabetes pain can be tough to treat. “There's always been a need to try to find other options,” Burke said.

One option he’s enthusiastic about is Qutenza. “Qutenza is a prescription patch that is only applied in clinic. And it's a capsaicin patch. Capsaicin is what makes a pepper spicy,” Burke said.

“You can buy capsaicin patches over the counter, but their strength is about 0.04%. The Qutenza patients we prescribe are 8%. So it's orders of magnitude more potent. They have this patch on for 30 minutes to an hour. We take the patch off, and many people get three months of relief.”

ReActiv8

A source of relief for a different group of patients involves a device called ReActiv8. “It's basically a treatment option for folks with a specific type of low back pain that is caused by the muscles in their low back not functioning appropriately. It’s for people when conservative care, physical therapy, hasn't restored that function,” Burke said.

 

“It's similar to a spinal cord stimulator. It works very differently, but it's similar in that it's a battery and two wires that are implanted. And it causes the muscles to stimulate and contract, which regains their function over time. There's no other treatment in our field that is similar to it. I'm passionate about that one because it works so well.” 

Read about a woman’s experience with ReActiv8 at MUSC Health.

More to come

Burke said other pain treatments for patients of all kinds are on the way, including one that helps turn down pain signals for people before they have knee replacement surgery, called Iovera, or cryoneurolysis. 

“It lasts about 90 days. Studies from this company are showing that patients are using less pain pills around the time of surgery. They have an increased range of motion from their knee replacement. They’re better able to engage in physical therapy and get out of the hospital quicker from something we can do before they ever even step into the hospital for their knee replacement.”