January 21, 2012

A Pain Relieving Procedure
By Karla Clark

Jacksonville Daily Progress

JACKSONVILLE - Jack Middlebrook had a splitting headache for more than 11 years.

“We had been to every doctor that anyone ever told us about, we did every type of treatment they suggested, he even had Botox injections,” his wife, Jimmie Middlebrook said.

Jack and Jimmie Middlebrook searched years for a solution, and had just about given up hope, until they were referred to Dr. Peter Sirianni at the Interventional Pain Management Clinic in Jacksonville.

Middlebrook said when they went to Sirianni, he had the answer.

“Mr. Middlebrook told me the day and hour the headache started,” Sirianni said. “All my patients recall the day the pain started.”

Jimmie Middlebrook said she asked him what he could do about her husband's headache.

He told her he might have an answer. Neurostimulation Therapy.

“The most efficacious mode of therapy is using electrosensory stimulation. You find the nerve that is involved and expose it to electrical stimulus,” Sirianni said.

In essence, a device based on pacemaker technology is surgically placed under the patient's skin.

The device sends electrical signals through two leads, or insulated wires, with nodes that send electrical impulses to the nerve causing the pain.

“The key thing is placement,” he said.

He said steering the wires to the correct nerve requires a good deal of accuracy.

“One thing I do love about it, besides helping the patient, is the precision involved,” he said. “You can get to a nerve in the right third finger.”

He said the device is very similar to a pacemaker, the main difference being “our patients get a remote control, and no cardiologist would give a patient a control to their pacemaker.”

As a patient experiences pain, they can use the control to adjust the level of stimulation. Instead of feeling pain, they feel a tingling sensation where the electricity is applied to the nerve.

“Your nerves are electric,” Sirianni said. “So say you touch a hot stove, the nerve sends an electrical impulse, 100 meters per second to your brain.”

The device interrupts the message and essentially distracts the nerve from sending the pain signal, he said.

Sirianni said the neurostimulation is an effective treatment, but is not the first resort for patients experiencing pain.

For starters, Sirianni gave Jack Middlebrook an injection, and told him the pain would likely return, Jimmie Middlebrook said.

“On the way home we had gotten in the car to drive home to Henderson, and I asked him if he had a headache. He said no,” she said.

But, the pain came back.

Jack Middlebrook was then given a temporary neurostimulation device, with a three-day trial period. After the trial period, he returned and wanted a permanent implant.

“Ninety percent of all patients who go through the trials go to a permanent device,” Sirianni said.

The surgery for a permanent device typically takes Sirianni 45 minutes, he said. The neurostimulator is implanted under the skin, typically in a patient's back or buttocks.

Sirianni said he makes an incision, makes a slow, gentle dissection to form a pocket for the device and tunnels the leads to the appropriate nerve.

“The patient is usually left with two incisions,” Sirianni said.

Jimmie Middlebrook said it took her husband two weeks to recover from the surgery.

“It all boiled down to having a little battery control he could hold in his hand when his headache started up.” She said. “So far, so good.”

She said she only has one question.

“Where had Dr. Sirianni been for 11 years?”