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Pain management team uses little-known technique to ease chronic pain

Rahim Mohamad endured an excruciating pain in his neck for four very long years.

It gave him migraine headaches, kept him awake at night, and shot down through his arm, making it nearly impossible for him to even lift his small children.

“The doctors tried pain pills, but they didn’t work. Shots in the head and neck didn’t work. Massages every day didn’t work,” said Rahim, 43, an Iraqi refugee and father of six children under age 13.

The pain was so intense, he rarely left his house. His wife, who doesn’t speak English, became the sole provider for their family, working a part time job.

Then Rahim was referred to the UF Health Pain Management Center – Jacksonville, where a treatment even many physicians are unaware of would finally give him relief.

Finding the right nerve

At first Sanjeev Kumar, MBBS (MD), assistant professor of anesthesiology and pain medicine at the University of Florida College of Medicine – Jacksonville, gave Rahim a thorough physical exam while Rahim explained where pain was the worst. Kumar said that is a critical starting point to determine where the pain originates.

“A good history and physical evaluation is extremely important. That points to the problem, and then imaging such as an MRI can be used to support the diagnosis,” he explained.

After Rahim’s exam, Kumar delivered electrical pulses to the nerves he suspected were at the center of the pain, using something called sensory stimulation. He located the nerves using ultrasound images. When Rahim confirmed those were the nerves, Kumar injected a local anesthetic around them. Rahim’s pain disappeared immediately.

“The diagnostic block gave him temporary relief, and he was very happy. For about a week, he had full range of motion in his neck and the pain was gone,” Kumar said.

That meant Kumar had found the correct nerves. The next step would offer long-term relief.

In a matter of minutes

In a simple outpatient procedure later that same month, Kumar stopped the nerves from transmitting pain altogether. The process, called radiofrequency ablation, uses a high frequency current to heat and cut the nerves.

When Rahim came for the procedure, Kumar located the nerves using ultrasound and another imagining technique called fluoroscopy. Using small needles to specifically target the nerves, he was able to eliminate the root of the pain. There was no need for sedation. The process was complete in less than 20 minutes.

Rahim felt immediate relief, but he was cautious. He expected the pain to return because it always had.

“After a couple days, I was still good. One week, there was still nothing going on. I told my wife, let’s wait and see what happens next week. After two weeks, still nothing,” he said.

Months went by, and Rahim’s pain didn’t return.

Finally accepting that the pain was gone, he began to take back what he had given up because of his pain. On the top of his list: play time with his kids.

“Now I can hold them and toss them in the air,” he said, gesturing to two of his daughters, ages 2 and 3. “Dr. Kumar found the spot exactly. I don’t know how to explain it enough in English to say thank you. I am very happy. Very, very happy.”

“Like a pacemaker for pain”

Once a patient’s nerve is treated, the pain will be gone until the nerves grow back.

“It takes a long time, so the pain will be gone for at least six months, or as much as several years,” Kumar said.

Radiofrequency ablation is just one of the pain management team’s remedies for chronic pain. The department also offers several cutting edge pain management procedures. Another technique, spinal cord stimulation, uses small electrical devices placed in the spine to block the sensation of certain pains from ever reaching the brain.

“Pain goes through the spine to the brain. Using the spinal cord, we can eliminate pain from any part of the body from the neck down,” Kumar said. “You can think of it like a pacemaker for pain.”

These treatments are not meant for minor aches or acute pain, which warns a person of an injury. Rather, it is for sensory pain that persists for a long period of time.

For example, Kumar said pain management brings relief to patients who have had shingles. The disease creates lesions on the skin along the sensory pathway of a nerve. After the lesions on the skin heal, they can leave behind damaged nerves that will continue to cause lifelong pain. Radiofrequency ablation or spinal cord stimulation can eliminate that pain.

Kumar said he chose his profession to help people like Rahim.

“I was always fascinated with chronic pain and wanted to help people. I found a lot of unnecessary surgeries and procedures were being done that weren’t really helping patients. Our minimally invasive approaches bring back their quality of life in a matter of minutes,” he said.

He recommends that anyone with long-term pain consider the possibility of finding relief through pain management.

“Chronic pain is a disease. Don’t ignore it.”

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