06:02am Thursday 17 August 2017

Pain Doctor’s Dedication Relieves Patient’s Torment

Yet one recent evening, the Tampa resident, who was diagnosed in 2007 with interstitial cystitis, (also known as painful bladder syndrome) pelvic floor dysfunction and chronic rectal pain, danced almost til dawn with her husband of 43 years. And though she still endures bouts of intense pain, she’s cooking, tending her beloved orchids, and, most importantly, exercising her pelvic floor muscles again.

“My dream of recovering my life is becoming a reality,” she says. “Now I look forward to every day. Now that I’m in control of my pain I have gained the strength that allows me to exercise my pelvic floor muscles and restore my health.”

Gonzalez owes her transformation to Dennis J. Patin, M.D., associate professor of clinical anesthesiology, who specializes in tailoring solutions for mitigating, or eliminating, the kind of intense, relentless pain that drives patients like Gonzalez into deep despair. In Gonzalez’s case, he is the first physician at the Miller School or UHealth–University of Miami Health System to implant a next-generation spinal cord stimulator for the treatment of chronic trunk or limb pain, the device that is giving Gonzalez her life back.

“It really doesn’t matter what the condition is,” Patin said. “It’s the approach that is important. Pain is individual and pain management should be individualized.”

Developed by Medtronic in the 1970s with pacemaker technology, neurostimulators are usually implanted in the abdomen or buttocks to deliver electrical pulses to the epidural space, blocking the pain signals that travel the nervous system from reaching the brain. The devices are configured with two leads, each lined with eight pulse-emitting electrodes that are inserted adjacent to the nerve or region of the spinal cord where the pain is transmitted.

Approved by the FDA in November 2011, Medtronic’s RestoreSensor™ is also equipped with a three-axis accelerometer, similar to the “smart” technology that enables the Wii™ video game console to detect a player’s movement in three dimensions. So, with the accelerometer programmed to sense changes in the body’s position, the RestoreSensor, which is about the size of a silver dollar, automatically adapts the amplitude of the stimulation the electrodes deliver based on the patient’s optimal setting for each position.

As a result, chronic pain sufferers like Gonzalez have the freedom to move without manually adjusting their neurostimulators whenever they sit, stand, bend or walk.

“That’s the big advantage for patients,” explained Vivian Bernardo, a Medtronic representative who programmed Gonzalez’s device during a March 19 appointment with Patin. “Often patients would get the wrong amplitude because they didn’t want to adjust it all the time. So, it was suboptimal and they weren’t getting the relief they needed.”

About 3,500 of the RestoreSensors are already in use in Europe, Australia and Canada, but, to date, fewer than two dozen patients in the U.S. are using one. Formerly a grants manager for the Moffitt Cancer Center in Tampa, Gonzalez is as grateful to be one of them as she is to have been directed to Patin by her friend Sandy Blanco, director of the University’s Office of Research Administration, whom she met at an NIH seminar.

By the time she saw Patin last fall, Gonzalez, whose interstitial cystitis was long misdiagnosed as urinary tract infections, already had seen countless physicians, undergone back surgery, spent six weeks at the Mayo Clinic in biofeedback therapy, and even tried a different neurostimulator. Nothing helped.

Yet, as he does all his patients, Patin assured Gonzalez he could help her, and would not give up until he did. His confidence and compassion instilled her with a deep sense of trust, which grew stronger in February when he implanted the new neurostimulator, inserting the leads in her sacral canal, right above her tailbone —which few doctors are trained to do.

“It’s a miracle,” she said. “And Dr. Patin is God’s answer to my prayers. Happy is not the word — I am elated.”

University of Miami


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