How pain management must evolve to improve spine outcomes

Written by Anuja Vaidya | April 11, 2019 | Print  |

Two spine surgeons weigh in on the latest trends in pain management.

Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. We invite all spine surgeon and specialist responses.

Next week's question: What is your best advice for payer negotiations?

Please send responses to Anuja Vaidya at by Wednesday, April 17, at 5 p.m. CST.

Question: What is innovations would you like to see in pain management to improve spine surgery outcomes?

Brian R. Gantwerker, MD. Founder of the Craniospinal Center of Los Angeles: In terms of newer technology, we are not seeing drastic changes, but rather refinement and evolution. Most of the companies in the realm of functional pain relief have some sort of entry that involves high-frequency stimulation. What is exciting is seeing DRG stimulators, cervical paddle leads and MRI compatibility. The natural evolution of these technologies is exciting to see but will never obviate surgery as a treatment. More importantly, I think surgeons as a specialty must know when 'enough is enough,' and [be able] to recognize when to decline to do more surgery on some of these unfortunate failed cases. Many surgeons need to know when to offer these [pain relief] alternatives to more titanium.

Issada Thongtrangan, MD. Orthopedic Spine and Neurosurgeon at Minimally Invasive Spine (Phoenix): I would like to see more development on long-acting local anesthetic, either in the form of local injections or patches that can be used safely around the incisions, as most of the spine surgeries nowadays can be done in an outpatient setting. We knew the data that one of the most common reasons for readmission after outpatient spine surgery is inadequate pain control. In addition, we are in the era of an opiates crisis, and I would like to see powerful local injections or patches that can help minimizing postoperative use of opiates.

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