Back Pain Goes Away With New Technology

Daily Herald

February 7, 2000

By Lorilyn Rackl

 

Dr. John Prunskis readily admits that this case was tougher on his patient than on himself.

His patient, a 51-year-old man plagued with serious back and leg pain, had to be well endowed in the patience department to deal with all the waiting.

 

He had to wait while Prunskis tried to figure out what was causing the man's pain.

And he had to wait some more while Prunskis tried different treatments to take away the pain. Sometimes, it took months to know if a procedure had really worked.

 

The Northwest suburban man first visited Prunskis, a pain management physician and board certified anesthesiologist, almost two years ago. He had undergone surgery on the lowest disc in his back. Things were looking good for about a year. Then the man started to develop pain in his legs and back.

He tries everything to make the pain go away. Physical therapy, muscle relaxers, herbal remedies, anti-inflammatories, acupuncture, magnets- nothing worked.

 

“We started hom on some medications to decrease the irritation of the nerves,” said Prunskis, of the Illinois Pain Treatment Institute. The institute has offices in five locations: Elk Grove Village, Libertyville, McHenry, East Dundee and Chicago.

 

“He got some improvement, but there was still pain in his back and legs,” he added. Next, Prunskis gave him two epidural steroid injections, which made things just a little bit better. The next step was a procedure called an epiduragraph. It’s when the doctor injects a contrast dye that shows up on an X-ray. It helps identify areas where there might be post-operative scarring after back surgery. Sure enough, the epiduragraph showed scar tissue had built up.

 

“If it wraps itself around one of the nerve roots, it can cause pain,” Prunskis said.

Recent technological advances meant Prunskis had a good shot at getting rid of this scar tissue. He performed an epidurascopy.

 

"Through a needle, we can place a tiny, tiny catheter with an even tinier fiber optic cable running through it," he said.He was able to break some of the scar tissue and inject therapeutic substances to minimize the effects of the tissue he couldn't break."Now, his leg pain was virtually gone," Prunskis said. "He was able to do a lot of the things he couldn't do before - play with his kids, work."

 

But the back pain lingered.Prunskis tried injecting a local anesthetic into the small joints between each back bone to see if that was the root of the pain. The anesthetic made no difference.

At this point, Prunskis started to suspect the culprit might be a minor bulge that showed up on an MRI of the man's back.

 

"In the past, doctors would pretty much ignore a minor bulge," he said. "But research has shown that sometimes the nerves inside a disc that is even minimally bulged is what's causing the pain."

That meant another test: a discography. The doctor injected a small amount of dye into the disc. If the disc is healthy, there's no discomfort when the dye is put in.There was discomfort, so Prunskis knew he was on the right track.

 

That called for another technological innovation, dubbed intradiscal electrothermal therapy. A small catheter goes into the disc and heats the nerve endings to the point where they no longer transmit pain impulses to the brain. It takes about four to six months to know if the procedure is a success.

 

"After six months, his remaining back pain was gone," Prunskis said. "He's doing fine now."

Prunskis had to use a lot of tools along the way, but the end result was a good one. The patient's pain was fixed. A few years earlier, the outcome might not have been as good.