Reprinted with Permission
Since its founding in 1995, Denver Pain Management (DPM) has led the way in the treatment and relief of patients with chronic spinal pain, an agonizing reality for millions of Americans. DPM stands at the forefront of an exciting new approach: interventional pain management (IPM). Differing from traditional treatments involving drugs, physical therapy, chiropractic adjustments or surgery, IPM provides a set of therapies that are minimally invasive. DPM is one of the few centers worldwide that regularly performs the full range of advanced IPM procedures.
Clinic founder Robert Wright, MD, a leader in the field of IPM, heads a team of highly experienced IPM practitioners. The group includes pain management physicians Scott Brandt, MD, Eric Kalhoefer, MD, and Bradley Vilims, MD, and research coordinator Mr. David Bailey.
In complement to its clinical practice, DPM conducts research on promising new treatments for the reduction and relief of chronic spinal pain. One of DPM’s current clinical trials centers on comparing systems for the advanced treatment of lumbar disc pain, a condition that affects five million people in the U.S. and is the number one cause of health care expenditure. Traditional surgical approaches (e.g., discectomy and fusion) involve open dissection of soft tissue and bone. In the interest of improving patient outcomes and decreasing recovery time, DPM is investigating the use of minimally invasive techniques that can safely and effectively remove disc material and decrease pain.
Specifically, DPM is testing two methods for long-term effectiveness at improving the patient’s quality of life: radio frequency energy applied with a variety of advanced treatment tools and techniques as well as a new, minimally invasive means of mechanical decompression of the disc. Clinic patients are enrolled in these studies based on their failure to respond to traditional and conservative therapy.
Another clinical trial underway at DPM focuses on testing the effectiveness of different early intervention techniques with spinal cord stimulation for the treatment of Complex Regional Pain Syndrome (CRPS). This physically and psychologically incapacitating syndrome is characterized by sensory, motor and autonomic disturbances. With CRPS, pain occurs in a regional distribution that does not correlate to a single peripheral nerve. Often, the degree of pain experienced by the sufferer is disproportionate to the event that caused the original injury.
There appears to be little doubt that early intervention results in favorable outcomes for CRPS patients. However, the question of which interventions are most effective is still open to debate. To address this issue, the DPM study is comparing the effectiveness of more traditional treatments (i.e., sympathetic nerve blocks, physical therapy, medication) to treatment using a percutaneous spinal cord stimulator. Patients with CRPS are randomly divided into two groups, each group receiving one of the two methods of treatment.
In yet another clinical trial, DPM is following a group of patients from evaluation through a series of diagnostic / therapeutic injections to gain a better understanding of the effectiveness of this form of treatment. This non-randomized study will track patients to determine if they have experienced a reduction in pain without having received further interventional treatment.
In all three of these clinical trials, patients will be assessed regularly for a minimum of one year to track patient outcomes. DPM selected the BBHI 2 (Brief Battery for Health Improvement 2) test as its principal evaluation tool and is serving as a beta site for the test.
Derived from the well-researched, widely used BHI (Battery for Health Improvement) test, the shorter BBHI 2 instrument helps practitioners to quickly screen for a number of psychomedical factors commonly seen in medical patients, such as pain, somatic, and functional complaintsas well as traditional psychological concerns such as depression, anxiety and patient defensiveness.
“We chose the BBHI 2 test because it is specifically designed to track patient progress,” says Mr. Bailey. “I don't believe there is any other diagnostic test that’s structured for this purposecertainly not one that captures the same broad range of information.”
Dr. Brandt concurs. “We’ve been wanting a tool like this for quite a while. With the BBHI 2 test, we can see the patient’s results over time, as well as how the individual’s results compare to those of the average patient with a similar diagnosis. If a test doesn’t give you this kind of information, where’s the value? All you have is numbers on a chart.”
Although the clinic started using the BBHI 2 test to track specific patient groups, the staff quickly realized other ways the test would be beneficial to them. “Most other diagnostic tests are designed primarily for research, which makes them less helpful for clinical purposes,” says Dr. Brandt. “The BBHI 2 test, by contrast, is short and easy to administerand we receive results quickly, which is invaluable in assessing patients effectively.”
Recognizing the BBHI 2 test’s usefulness for clinical applications as well as for research, DPM administers the test to all new patients, not just those enrolled in its clinical trails.
“With the BBHI 2 test, the physician has the test results in hand as he meets with the patient for the first time,” says Mr. Bailey. “He can use the information then and there to confirm or disaffirm his own ‘gut reactions’ about the patient’s psychological profile.”
At two of DPM’s five clinic facilities, patients use an innovative hand-held electronic device to take the BBHI 2 test. “I was the biggest naysayer on using the device,” Mr. Bailey says. “But in fact, we’ve found that patients really like it. It’s a very easy-to-use testing method and typically takes less time than the paper-and-pencil format. And since the data is entered directly into the computer as the patient takes the test, there’s no administrative time needed to key in the responsesso we have results instantly.” In fact, the device has proven so popular with both patients and staff that the other three DPM facilities are requesting that it be introduced at their sites.
The staff at DPM convey their strong dedication to improving quality of life for their patients. “We pride ourselves on trying to provide the best possible diagnostic treatment of spinal pain possibleand on conducting research that’s geared toward providing relief for our patients,” says Dr. Brandt. “In this work, the more global a view we have of our patients, the better. The BBHI 2 test is proving to be of enormous value to us in fleshing out important elements of that picture.”
Prior to founding Denver Pain Management, Robert Wright, MD, served as the staff anesthesiologist for the USAF Academy Hospital in Colorado Springs, Colorado. A graduate of Baylor College of Medicine, Texas Medical Center, Houston, Dr. Wright sits on the instructor panels of a number of medical organizations, including the Interventional Spinal Injection Society, the Advanced Neuro modulation Society, and the North American Spine Society.
With a broad range of medical experience, Scott Brandt, MD, has devoted his practice to IPM full time since 1997. He is actively involved in research and publication, teaching instructional workshops for other physicians, and presenting on a variety of subjects in advanced IPM. Dr. Brandt is a graduate of the University of Michigan-Ann Arbor, and the Bowman Gray School of Medicine.
Bradley Vilims, MD, joined DPM after establishing and serving in directorships of IPM practices in Aberdeen, South Dakota, and Madison, Wisconsin. A graduate of the University of Iowa, Dr. Vilims has more than ten years’ experience using state-of-the-art pain management therapies. His current work includes helping to develop new pain treatment therapies and protocols and conducting physician training on IPM skills.
David Bailey has served as a research assistant or coordinator for most of his professional career. His background includes overseeing clinical evaluations of minimally responsive brain-injured patients and helping develop protocols to assist in communication and “breakthrough” techniques. A graduate of Drexel University, Mr. Bailey was hired by DPM as its fulltime research coordinator in 2001.
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