HJAR May/Jun 2022

HEALTHCARE JOURNAL OF ARKANSAS I  MAY / JUN 2022 59 Julio Olaya, MD Arkansas Pain Centers, Ltd. IT IS OUR BELIEF that “pain management” is an outdated term as it implies that pain is untreatable. These days, we believe “pain medicine”is a more appropriate description for our practice; it is impressive and very rewarding to see how, during the last two decades, we have witnessed an evolution in how to approach and treat chronic pain conditions — that we are not limited to just trying to modulate and palliate, but rather, we have access to new, minimally invasive techniques that have been changing people’s lives and have spared them long surgical procedures that require screws, rods, and bolts, with a very high possibility of end- ing up with something such as “failed back surgery syndrome”with as high as a 45-50% risk of development. It is important to stress the real benefits of the newminimally invasive technologies that offer a more permanent solution to ra- dicular pain, neuropathic pain, nerve im- pingement, etc. The benefits are overwhelm- ing; patients get immediate relief of their leg pain, the need for higher dosages of opioids diminishes dramatically, the need for fre- quent visits to the pain clinic goes down, the need for ongoing physical therapy goes down, the expense of radiological studies goes down. In many instances, the need for a “classic fusion,” which most patients fear (Nobody wants sharp instruments close to their spinal cord!) goes down. Tomake mat- ters more concerning, these surgeries are long — on average, they can last from two to four hours depending on the levels fused — putting the patients at risk for more health complications, especially in a population of patients that can have multiple co-mor- bidities, e.g., morbid obesity, sedentarism, diabetes, heart disease, and heavy smoking (as we all know, the more common causes of chronic pain are morbid obesity and lack of conditioning). This further increases the possibility of bad outcomes or, as I men- tioned earlier, ending up with “post lami- nectomy syndrome”or “failed back surgery syndrome.” To give us an idea of the new minimally invasive techniques, dynamic interspinous spacers are an ingenious solution to spinal stenosis with neurogenic claudication. This condition makes the patient lean forward to open up the foramens where the radicular nerves leave the spinal cord to relieve the pressure and the pain. Aclassic description of this manifestation is the famous “shop- ping cart syndrome” or such a scene as an elderly patient leaning forward and using a cane or a walker to preserve balance, pre- vent falls, and ease the pain. I tell my pa- tients: “You have a mechanical problem, we have a mechanical fix.”Another recently de- veloped treatment is an interlaminar spinal fixation system. This wonderful technique was developed in Macon, Georgia, and is called “StabiLink.” These two procedures can be performed in 25 to 40minutes withminimal downtime. Sometimes when describing the procedure, my patients look at me with disbelief, so I tell them the story of how the minimally inva- sive therapy for coronary stenosis evolved where the cardiologist or interventional radiologist accesses only the femoral ar- tery or the radial artery, places the device, and the patient goes home practically the same day. Four decades ago, these kinds of procedures were unheard of, and the same patients needed to have open-heart surgery with venous bypasses and grafts. It took sev- eral decades for these procedures to find their place and to establish their relevance in modern medicine. Such developments are now happening for lower back pain and spinal stenosis conditions. I insist on labeling our subspecialty “pain medicine” because it takes more than just opioid prescriptions, steroid injections, blocks, and ablations to provide an appro- priate medical treatment that would adhere to the standard of care that our patients ex- pect fromus. It is important to recognize the actual health status of our patients and the co-morbidities that are frequently part of their medical history and to be mindful of the pharmacological therapies prescribed by the rest of the medical doctors who take care of them in order to prevent deleterious drug interactions that could worsen their al- ready friable health status or basically slow down the response to our prescription and treatment plan. Thanks to newminimally invasive proce- dures, we can diminish the degree of pain to the point that our patients will need less dosages of opioids and, in some cases, will be able to live their lives without the need for potent opioids to treat moderate to se- vere pain. n Julio Olaya,MD, is a board-certified anesthesiologist specializing in pain medicine at Arkansas Pain Centers. He was an assistant professor of anesthesiology and critical care at SLU School of Medicine, pediatric anesthesiologist, director, and founder of the Pediatric Pain Service at Cardinal Glennon Children’s Medical Center in St. Louis, Missouri, from 2013 to 2015. He was an assistant professor of anesthesiology and pain medicine at the UAMS College of Medicine from 2004 to 2012. Olaya did a pediatric anesthesia fellowship at Arkansas Children’s Hospital and a fellowship in pediatric painmanagement at Cincinnati Children’s. He has been practicing adult painmedicine and spine intervention procedures since 2015. Originally from Mexico, he completed a medical degree from La Salle University in 1986 and was the sports medicine doctor for the Mexican Tennis Federation from 1990 to 1993. He completed an anesthesiology residency at UAMS in 2003 before joining the UAMS/ACH faculty in 2004.