In Search of the Best Pain Clinic in Los Angeles: Failed Back Syndrome – Setting Goals

By | April 30, 2012

Dr. Witt asked George, "How many fish did you catch with your grandson last Saturday?"

The best pain clinic in LA would know that the psychological preparation of the patient is at least as important and often more important than the skill of the implanter in determining the long-term success of neuromodulation therapy for the chronic pain of failed back syndrome. Patients need to understand that neuromodulation, whether it be in the form of an intrathecal drug delivery system (spinal pain pump, IDDS) or spinal cord stimulation (SCS) is a form of therapy and not a cure for post-laminectomy syndrome. At Schlesinger Pain Centers we start the process of patient education on the very first visit. The best pain clinic in Los Angeles would begin the process of attitude adjustment by telling these patients that they will have good days and bad days and the success of therapy will be judged not in relationship to pain scores on a visual analog scale (VAS), but in terms of function. At Schlesinger Pain Centers patients are asked to write down three things that they used to be able to do before the pain got in the way, that they would like to be able to do again. If a year after implantation the patient is able to do two or three things on the list, they will usually agree that therapy has been successful regardless of the VAS score on any particular day.

The best example I know of this is a story that Billy Witt, the Emeritus Professor and Chairman of the Department of Anesthesiology and Pain Management at the University of Kentucky likes to tell about a patient of his with failed back syndrome who underwent pump implantation for failed back syndrome. At their first meeting, Dr. Witt asked George what he would like to be able to do after the pump was implanted that he could not do now. George answered that he would like to be able to go fishing with his grandson and Billy said fair enough. George did very well with the pump implantation and micro-dose therapy, but came back to see Dr. Witt about 2 years later saying the pump didn’t seem to be working as well as it had been. After checking both the patient and the pump and finding no problems, Billy asked George how many fish he had caught last Saturday with his grandson. George got very animated and told Dr. Witt that they had caught their limit in only two hours and so they went home tossed a softball around until lunchtime. Billy just smiled. A minute later George shook Dr. Witt’s hand and said, “I guess that I’m doing better than I thought.”


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