FWD:RSD World News-Spinal Cord Stimulator

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From: byrd45 (Original Message) Sent: 6/7/2005 9:43 AM
THOUSANDS of people develop disabling pain each year after suffering
relatively minor injuries.
Here Madeleine Johnston, 32, who lives with her fiancé in Grays,
Essex, and works as a dog carer for Guide Dogs For The Blind, tells
ANGELA BROOKS about her surgery to tackle excruciating hand pain and
her surgeon explains the procedure.
THE PATIENT:
MY PROBLEMS started in November 2002, when I slipped off a step into
the garden. On the way down, I hit my left hand on the doorframe and
the side of my hand, from my little finger down to my wrist, took the
brunt of the force. It was extremely painful.
In A&E, doctors did an X-ray and decided I'd fractured my scaphoid
bone. They put my hand in plaster, but that had no effect on the pain
and I later learned that I hadn't actually broken anything. They also
sent me for physiotherapy, but it didn't really help.
By the time my GP referred me to an orthopedic surgeon, my wrist hurt
so much that I couldn't wash my hair, tolerate having my hand in
either hot or cold water and, worse, I was unable to work.
The surgeon thought I'd probably damaged the nerve on the left side
of my hand and referred me to Dr Simon Thomson, a pain specialist. He
said he would first like to try me on a very low-dose anti-depressant
because they can relax the nervous system to help alleviate pain. But
they didn't work.
I was then given a cream made from chillis which heats the skin and is
supposed to take the pain away, but that didn't work either.
Then, last August, they tried a ganglion block, injecting an
anaesthetic, which was supposed to stop the pain from the nerve going
into my hand. They tried that twice and although I got a little
benefit, it wasn't much.
By the time Dr Thomson broached the subject of spinal cord stimulation
last December, I was willing to try anything.
He explained that the object of surgery was to attach an electrode to
my spine, which would then be threaded down my side to a tiny
battery-operated generator implanted under the skin in my tummy.
I'd have a remote control to activate the generator, and would be able
to raise or lower its pulse in response to the pain.
Surgery would be done in two stages: first to attach the wire to my
spine, which, for the first week, would be linked to an external
generator to make sure it was working properly.

THEN, in a second operation, they would implant the wires from my
spine under my skin down to the new generator. This is the size of a
matchbox but thinner and I will be able to use it for the rest of my life

I was admitted to Orsett Hospital in Basildon in April 2004, and
everything was done under local anaesthetic because the surgeons
needed my feedback to know they were in the right part of the spine.
Once they had given me the spinal block - an injection into the fluid
surrounding the spinal cord - I felt absolutely no pain, but as the
wire was fed up my spine, there was a tingling sensation.

The doctors asked me where I could feel it and to start with it was in
my elbow. As they moved the wire up my spine, the tingling went down
my arm until it got to just where they wanted it - at the side of my hand.
They then channelled the other end of the wire to a spot under my arm,
and I came out of theatre with a lead connecting it to a little
external generator, which I could operate with my remote control.
I knew it was working as soon as I got home, because for the first
time in 18 months, I had no pain in my hand.
Dr Thomson assessed me early the following week and 1 was scheduled
for the second part of my surgery, this time under general
anaesthetic, at Basildon Hospital a few days later.
When I came round, I ached everywhere except in my hand. I had a small
vertical scar on my back and another at the side of my tummy, which
are healing nicely.
I am now back to my old self and am delighted with the result, thanks
to Dr Thomson and his team.


THE SURGEON:
DR SIMON THOMSON, pain physician at Basildon & Thurrock University
Trust Hospitals, says:
PAIN in response to injury is a healthy part of the healing process,
and can be useful because it's a warning signal, helping prevent us
from doing anything that might exacerbate the pain.
But the sort of pain Madeleine was feeling is useless because it is
unremitting. After a relatively trivial injury, some patients
develop complex regional pain syndrome. This causes the pain response
to go into overdrive. The trauma sensitises the nervous system but the
normal body mechanism that reduces pain in response to healing fails
to work.
We consider patients for surgery only after they have exhausted all
the other potential remedies and have been thoroughly assessed by the
multi-disciplinary pain team.
SOME patients who suffer this sort of pain are driven to the most
extreme measures - such as having a limb amputated because they are so
desperate for relief. But sadly, they then get phantom pain from the
amputated limb, so this resolves nothing.
The first part of Madeleine's operation was carried out under local
anaesthetic so we can get the patient's feedback to make sure we are
lodging the electrode in precisely the right part of the spine.
In theatre, the patient is placed in her stomach. We numb the skin and
make a 1-inch incision next to the spine and dissect down to the
muscles to reach the epidural space - the area cushioning the spinal
cord. Our progress and beams the pictures to a screen, we take the
'electrode which is tipped with a special guide wire and slip it into
he epidural space. We gently steer this up towards the base of the
neck, and once we get close to the spot where it needs to be lodged,
we start checking with the patient on where they are feeling the pins
and needles - which is what offsets the pain - from the electrode.
As soon as the patient tells us the pins and needles are at the pain
site, we anchor the electrode with a stitch and special collar to the
spine ligament.
Then we put a temporary extension lead from this electrode and tunnel
it out to just under the patient's arm to allow us to hook them up to
an external stimulator so they can test it.
Once they are sure it is doing the job and they've been assessed,
first by a nurse and then by me, we schedule surgery for the tummy
implant.
For this part of the procedure, under general anaesthetic, we make an
incision in the tummy wall to the side of the tummy button. We dissect
down to the tummy wall muscle and then stitch the tiny generator
implant - a bit like a pacemaker - on to the tummy wall.
Now we turn to the spine to create a tunnel for the wire. I use a
special, flexible 2ft pipe -like instrument for this, pushing it
through the fat under the skin all the way down and around to the
front to the implant pocket.
Through this channel we pull the extension cable all the way to the
spine, connecting the wires at each end with a micro screwdriver and
making the joints watertight with a silicone shroud which we double
tie around each end of the cable.
Now we close all the wounds with dissolvable stitches and put little
dressings on the incisions.
The tummy implant works on a battery, which will last about five
years. The device is also programmable. From my computer and with the
patient a few inches away, I can ratchet up or turn down its pain
mediating capabilities so the pain relief is precisely tailored for
the patient.
Spinal Chord Stimulation surgery costs the NHS £12,000. Pravately,it
casts the same
http://www.basildonandthurrock.nhs.uk/foundation_trust.asp
Taken from The Daily Mail, Tue. Dec 28,2004