InHealth: New Effective Minimally Invasive Treatments for Chronic Pain

By Fabian A. Ramos, MD, FIPP, DABA, DABIPP, DABPM,

International Pain Medicine, Fellow of Interventional Pain Practice

Board Certified – American Board of Interventional Pain Physicians,

American Board of Pain Medicine, American Board of Anesthesiology

Our specialty of Interventional Pain Medicine continues to evolve. We can now offer more advanced and less invasive out-patient modalities to treat chronic pain. Opioids have proven to not be a favorable alternative of treatment for most patients. These new therapies are now offered sooner to patients whose pain has not responded to entry level procedures, such as injections, steroids, joint blocks or radiofrequency of the nerves.

INTERSPINOUS SPACERS: 

Indicated for patients with moderate lumbar spinal stenosis who have not responded to treatments with steroids.  By inserting a spacer in between the very accessible spinous processes, the narrowing of the spinal canal is improved. In Studies, using the Superion device, 84.3% demonstrated clinical success and provided long-term, durable relief of symptoms of intermittent neurogenic claudication (weakness/numbness in legs when walking) for patients with moderate lumbar spinal stenosis.

M.I.L.D. PROCEDURE:

Minimally Invasive Lumbar Decompression. Lumbar spinal stenosis (LSS) is characterized by narrowing of the spinal canal with impingement of the spinal cord by surrounding tissues of bones. Current management options for LSS include rest, medications, physical therapy, epidural steroid injections, alternative medicine and surgical decompression. MILD is effective, safe and cost-effective and is indicated for treatment of LSS with ligamentum flavum hypertrophy through percutaneous (not open) decompression of the thick ligamentum flavum. The effect is thinning of this superficial, easily-accessible ligament that is a contributor to the spinal canal narrowing.

PERIPHERAL NERVE STIMULATION:

Indicated for non-spine related upper or lower limb nerve pain, nerve entrapment syndromes and neuralgias and peripheral nerve injuries or nerve diseases. This is safe for use in patients suffering from chronic pain of peripheral nerve origin. It is done under ultrasound guidance by inserting a wire-like stimulating lead through a very small incision in the skin.

TARGETED RADIO FREQUENCY ABLATION OF METASTATIC TUMORS:

Indicated for patients with pain caused by metastatic spinal tumors.  It does not affect chemo or radiation therapy treatments and can be done at any time before, during or after these traditional therapies. Treatment is performed under fluoroscopy guided access of the body of the vertebra via a light weight, steerable device, through the skin that navigate the vertebra towards the tumor, allowing for the destruction of the tumor via radiofrequency heat. 

HF10: HIGH FREQUENCY SPINAL CORD STIMULATION: 

This is a paresthesia-free stimulation (the stimulation is imperceptible for the patient), indicated for lower back, leg, neck, arm pain that has not responded to more conventional modalities. The candidate is initially trialed (non-incision step) and if pain relief is achieved during the trial, then the permanent step is performed. The implant is done through two small incisions in the skin and the spinal leads are placed via a needle. These high tech stimulatiosn block the pain signal to the spinal cord. The permanent implantation does not require spine surgery. Close to 80% of patients achieve 80% of pain relief.

SACROILIAC TRANSCUTANEOUS FUSION:

Indicated for patients with recurrent pain in the sacro-iliac joint that has not responded to sacroiliac injections or sacroiliac radiofrequency, this procedure is performed under fluoroscopy guidance through a small incision in the skin.

INTRACEPT PROCEDURE FOR VERTEBRAL ENDPLATE PAIN: 

This is an emergent, minimally invasive procedure that targets the basivertebral nerve for the relief of chronic lower back pain, frequently as a result of chronic disc degeneration (discogenic pain). This procedure is performed under guided fluoroscopy via an instrument inserted through the skin, reaching the body of the vertebra.

Fabian A. Ramos, MD, FIPP,

DABA, DABIPP, DABPM

Ramos Center for Interventional & Functional Pain Medicine

5741 Bee Ridge Rd., Suite 550, Sarasota

100 3rd Ave. West, Bradenton

417 Commercial Ct., Suite A, Venice

941.708.9555