08:18am Monday 23 October 2017

A hot (and cold) new concept in pain management

Dr. Michael Gofeld is a chronic pain management specialist and an anesthesiologist at St. Michael’s. (Photo by Yuri Markarov)

Dr. Michael Gofeld smiles in front of a computer

Some physicians have been using a minimally invasive treatment called intradiscal biacuplasty to treat this “discogenic” pain that originates in the spinal discs that act as cushions between the vertebrae.

Dr. Michael Gofeld, an anesthesiologist with expertise in chronic pain management, recently treated an 18-year-old woman who had debilitating back pain for four years, making St. Michael’s the first hospital in Ontario to use this procedure.

During the procedure, two probes are inserted through a needle with X-ray guidance into either side of the affected disc. High-energy radio waves are then passed through the tips of the probes, causing molecules to move rapidly and gently warm up. The probes are cooled internally by sterile water, which dissipates the heat around the needle. Tissue is destroyed but no residue is left behind, so the probe’s reach is greater and the procedure can destroy larger areas of tissue.

The procedure may close small tears and fissures associated with disc pain and destroy pain-transmitting nerves inside the disc. The procedure is done on an outpatient basis, takes only about 45 minutes, and the patient requires only light sedation and local anesthesia. Similar equipment has been used for liver and lung tumour ablations.

    A few facts about pain:

  • 60-90 per cent of Canadians will experience lower back pain at some point.
  • Chronic pain costs Canadians $10 billion annually.

A multicentre clinical study in which Dr. Gofeld participated as the senior investigator has just been completed and demonstrated significant and lasting benefits, such as reduction of pain and disability and improvement in quality of life. A followup study demonstrating cost-effectiveness of this method is in preparation.

Dr. Gofeld is also using radiofrequency ablation to treat pain associated with cancer that has spread to bones. By using probes cooled by water, the same size needle with cooled probes can destroy a lesion eight times bigger than one that is not. While the procedure can reduce the size of tumour, effectively slow progression of metastases and alleviate pain, it is not a cure.

About St. Michael’s Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael’s Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.


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