Petty Officer 2nd Class Staci Gelb can put on her socks again, this time without pain. The Sailor assigned to Walter Reed National Military Medical Center (WRNMMC) was among the first patients in the U.S. to receive a device that offers new possibilities of therapeutic care for patients with chronic back or limb pain.
Gelb said the neurostimulator helps relieve her pain due to Multiple Sclerosis, an auto immune disease that affects the brain and central nervous system, a pain so unbearable, putting her socks on in the morning was excruciating.
“It’s a constant burning. It’s just like somebody has a blowtorch on my feet, 24/7,” said Gelb, who lived with pain and limited mobility for about a year since her diagnosis. After Dr. David Jamison, an anesthesiologist with the Pain Management Clinic at WRNMMC, tried a variety of more conservative measures to alleviate her pain, Gelb participated in a trial for the new device in May.
On Aug. 8, Jamison, along with Army Lt. Col (Dr.) Richard Liu, director of the Pain Management Clinic, and Navy Cmdr. (Dr.) Michael Jacobs, implanted a neurostimulator, a medical device the size of a stopwatch, under the skin of Gelb’s lower back to deliver mild electrical impulses to the nerves around her spinal cord, which act to block pain signals from going to the brain. Once the device programmed by a clinician, Gelb was provided a handheld controller similar to a cell phone. Used to customize the stimulation within a range of settings, she adjusts the device as her pain increases or subsides throughout the day.
Until now, patients with neurostimulators could not receive full-body magnetic resonance imaging (MRI), a standard of diagnostic care for major health conditions like cancer and stroke, according to Donna Marquard, a spokesperson for the company which developed the new device. The large magnetic fields and radio frequency energy involved in MRI could cause harm to the patient and cause the device to malfunction. These reasons prohibited patients with neurostimulators from obtaining full-body MRIs without complete removal of the device, she said. Without access to full body MRI, a patient could risk delayed diagnosis or inaccurate identification of a serious health condition.
According to Jamison, patients with the device are often more likely to need MRIs. The device Gelb received will enable the Sailor to undergo a full-body MRI scan without removal, after placing the neurostimulator in an appropriate mode for the MRI environment, Marquard explained. Gelb received the new device on the same day her MRI was originally planned. She obtained a brain MRI on Sept. 11 and a cervical spine MRI two days later, with her new neurostimulator firmly in place. “Both occurred successfully without any difficulty,” Jacobs reported.
Gelb said her pain has improved “tremendously” with the new device. “I don’t have that blowtorch feeling anymore,” she explained. The pain she now feels is tolerable. “It’s basically cut in half,” Gelb said. “I can deal with this.”
Before the neurostimulator, the Sailor would wake up nearly a dozen times a night in pain, by the slightest movement in bed. With the new device she can sleep, she said. Life has changed for Gelb and her family.
Family outings to the movies, the mall or routine trips to the grocery store became less frequent over the last year due to Gelb’s limited mobility and pain. Her husband Stuart, 17-year-old son Jonathan, and 14-year-old daughter Arial did most of the household chores.
She said her family was helpful and patient, even when she lagged at a slower pace behind them. Less than a week after receiving the neurostimulator, Gelb and her family went grocery shopping. “We were all moving together,” she said. “It was really nice.”
Jamison said he began treating Gelb using conservative measures before the neurostimulator, examining her medications and exploring other options to help control her pain. The anesthesiologist estimated he has implanted 300 neurostimulators in patients over the last six years, many with both leg pain and persistent pain following back surgeries.
“We’ve seen a lot of injured Soldiers with chronic pain. The most common is some sort of nerve pain, whether it’s a back surgery that hasn’t healed right or caused by some other trauma,” said Jamsion, citing fragmentation injury from explosions along with gunshot injuries.
The anesthesiologist said he’s treated a wide range of patients at WRNMMC, including a wounded warrior who used injections to reduce his chronic costochondritis, a type of chest pain. The neurostimulator resolved 100 percent of the Sailor’s pain.
“The MRI capability is the most significant development that’s happened with neurostimulator technology in about 20 years. Before now, if a patient needed an MRI for anything, they can’t get it unless they had surgery to have their neurostimulator removed first,” explained the anesthesiologist. “It’s a big deal.”