My Aching Back – Doctor’s Interview

Why is chronic back or leg pain so debilitating?

Dr. Faller: Primarily because it’s a long-term problem. It’s something that is, in many cases, not going to get better. The people who experience it are experiencing a severe intensity of pain and many of them are told, “I’m sorry you’re just going to have to live with it.” And that is something that affects usually every aspect of their lives. They are unable to work. They are unable to function as they normally would, and they find any kind of activity to be very, very painful to them.

Because almost anything you do involves your back?

Dr. Faller: Just about anything you do will affect it. Some people find it hard even to find a comfortable position in which to lie. Some people find it very difficult to sit for any period of time. Standing is uncomfortable. Walking is uncomfortable. There’s just no way to get around being uncomfortable.

Why is back pain so difficult to treat?

Dr. Faller: First of all there are a lot of different areas in the back that can contribute to the generation of pain. Sometimes it’s difficult to isolate exactly where the pain is coming from which can make it very difficult to treat. Many people find that they have a problem that would possibly be helped by surgery, but then they have the surgery and their pain continues. So it’s something that’s sometimes difficult to diagnose and secondly is difficult to treat in many cases.

What can you do with the myeloscope that you can’t do through standard diagnostic tools or standard surgery?

Dr. Faller: The myeloscope allows us to go into the central access of the back, into the epidural space and actually visualize what’s happening there. Which is something that to this point we have been really unable to accomplish. We’ve been able to do things like x-rays and MRIs and myelograms, but these things don’t give us a direct visualization of what’s occurring in that area. And so it lets us see what’s happening around the nerves that are involved that are generating the pain.

So you can actually see that?

Dr. Faller: Yes. We can see that. It’s like taking a small camera and putting it in there and looking around.

How does that help the patient?

Dr. Faller: Well for one thing it helps us in some cases to be able to identify the problem. And in many people, we find that the problem is related to scar tissue that has developed in the area around the nerves. And in some people, it’s secondary to surgery that they may have had. Just the natural healing of the body produces scar tissue. In other cases we find that the scar tissue might develop because of something that’s been chronically irritating the area. Such as a degenerated disk or a bone spur or a bulging disk or something to that affect.

What patients are good candidates for the use of the myeloscope?

Dr. Faller: The best candidates are people who have a very well-defined pathologic problem. And by that I mean we can trace the path of the nerve that’s affected and there’s one location that is causing the problem. People who have back pain from their neck down to their tailbone are people who are not very good candidates for this kind of problem because the problem is extremely diffused, and it’s very unlikely that we are going to be able to help something that is that extensive. So usually a problem that is coming from one specific location would be the very best candidate.

If I’m a patient at home and I tend to always have a nagging pain, what are we talking about?

Dr. Faller: Actually we’re talking about an area that follows the course of the nerve. So it would be more likely to come from your back and head down into your hip and maybe down your leg and to your foot. But it would follow a distinct nerve pathway.

It would almost be like a line?

Dr. Faller: Essentially, it could cover a wider area than a line, but it would follow the course of that nerve.

Is it always back to leg to feet?

Dr. Faller: Not always. Some people come in saying, “Man, my ankle is killing me,” and come to find out it’s not really their ankle that’s the problem. It can be coming from a nerve in their back. So it may not actually follow that entire course. They may not see pain that starts in the back and very nicely progresses down the leg. They might find it somewhere more distal to that without really thinking that their back is even involved.

Who are you trying to reach for this? Are you able to say you should check into this if you have ankle pain? Are you able to characterize the clinical profile?

Dr. Faller: The type of people who would probably require this type of treatment are usually people who have been seeing their family doctors or some other type of doctor for a problem that is just not getting better. And it’s usually something that has been looked at but has not been helped yet. And usually if a problem just developed, the first step would not be to come to us for this type of procedure. There are a lot of other types of things that can very often help the problem with just conservative treatment. And so that’s something that usually we would like to have looked at first. Things like medications and rest and physical therapy and things like that are usually the first line for problems like this.

How did the myeloscope help Mrs. Bragg?

Dr. Faller: With the myeloscope we were able to go into her back and look at the problem and discovered that there was a great deal of scar tissue that was affecting one of the nerves. And that was the source of her pain. So with the myeloscope, we were able to bluntly dissect the scar tissue away from the nerve. And then we were also able to directly inject medication in the area of the nerve where we could see that it was being injected right where we wanted it to be.

Is that a permanent fix?

Dr. Faller: We’re not entirely certain of that. Actually the procedure itself is quite new. It’s only been FDA-approved since September. We don’t have a lot of really long-term data. We do have patients who have had the procedure done a year or 18 months or so ago who are still doing quite well. But we don’t really know what to expect at 10, 20 years from now.

What should a person who feels they may benefit from this do?

Dr. Faller: What they need to do is first talk it over with their family doctor or if they’re seeing a spine surgeon or an orthopedic surgeon or someone like that, talk it over with their physician and see what they think of the issue. There are a lot of patients who have not had very much done in the way of just the first treatments, and if they came to us having had not much else done we would not jump right to this type procedure. We would start with more conservative treatments. However if they are the kind of patients who have been to pain clinics all over the country and they’ve had every type of imaginable procedure done, this might be something that would be effective for them. But what we would do initially would have them be referred to us, and then we would consult with them and evaluate their situation and what types of things have been done and what their problem might be related to. And if we felt this might be something that would be helpful to them, then we would recommend that this be done. I do have to say that not everybody really would be a candidate for this.

Are there any side effects or complications?

Dr. Faller: There are complications to any type of procedure. However this is really a very safe procedure. To this point there have really been no complications of any kind to my awareness.

Are you excited about the myeloscope?

Dr. Faller: Oh, we’re very excited about it. It does give us a distinct tool that we can use to help people get better. And it’s something that’s very fascinating and very effective in many patients.

Once it spreads to other doctors around the country, do you envision it changing back treatment? Do you feel this is a new path to be taken?

Dr. Faller: I think this is kind of a new path to be taken. It is a new instrument that we have available to us now that I think is in a very embryonic stage. I’m hoping that we’ll see further development of it. We’re looking forward to the day when perhaps we can pass instrumentation down through it to maybe be able to work more with small instruments in that area. There’s talk of perhaps laser capability. There are a lot of different things that are probably on the horizon, in the works being developed. But at this point in time, it’s very new and consequently it’s still in the growing phase.

It’s very safe?

Dr. Faller: Very safe. We’ve done close to 200 cases at this point in time here in our clinic and have never had any complications from them. I don’t know how many cases have been done overall, but at this point in time I’ve not heard of any problems of any kind as far as long-term effects or anything. One thing that I usually do tell patients is initially following the procedure for the next several days to maybe a week it might increase the intensity of the pain just a little bit because we are working in there around nerves that are already irritated. So most patients are aware of that but that’s not really a complication or a side effect. That’s kind of an expected outcome. But then the long term effect is what we’re actually looking for.

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