Transcription:
Orthopedic and Spine Care Made Easy

Bill Klaproth (Host):  Being told that you have a spinal or orthopedic disorder is often a worrying and stressful experience. However, understanding the causes can help reduce your fears and provide a roadmap to manage the pain. With us is Dr. Giriraj Gupta, a Harvard graduate and an orthopedic and spine surgeon at Manchester Memorial. Dr. Gupta will discuss orthopedic and spine care made easy including pain management and neuromodulation. Dr. Gupta, thanks so much for being on with us. First off, what condition of the spine do people suffer from the most?

Dr. Giriraj Gupta:  Well, most commonly, lower back pain and neck pain are the two conditions that patients walk into the clinic for and most of the time, it’s general degenerative changes. We also call it arthritis of the back which is the most common cause of why people have pain in their neck and the lower back. There are other conditions which are called herniated discs which means there’s a cushion between the bones of the spine that makes a hole to the back and starts pressing on a nerve. That’s called a “disc herniation” and that can cause a lot of pain in your leg because the nerve gets stressed and the nerve is what’s supplying the sensation in the leg. So, that’s no uncommon. Then, the other condition that is fairly common is a slip in the spine which we call “spondylolisthesis.” That’s a condition where two bones constituting the spine start slipping in relation to each other rather than being stable. Those conditions are fairly common that I see on a regular basis in my clinic.

Bill:  Those things can happen through one, an injury; a fall; trying to lift something or just normal wear and tear over time, right?

Dr. Gupta:  Most of the time, these conditions are not resulting from trauma. Of course, once in a while, you have a patient that will say, “I was lifting something and then I heard a pop in my back” but a lot of times, it is the back degenerative condition or that’s the back you have and it just didn’t take the stress of normal work which resulted in those conditions. Now, there are those conditions which can arise from trauma but they usually end up going to the E.R. because of conditions like fractures but more common causes of back and neck pain are degenerative.

Bill:  And, on the orthopedic side, what are the more common things you see? Obviously, people suffer from and you hear a lot about carpal tunnel syndrome and elbow pain and knee problems. What’s the most common thing that you see in your practice?

Dr. Gupta:  I would say there’s a range of disorders that I see in the office on a day to day basis but if I had to pick the top 5 problems that patients come up with in my office, I would say arthritis of the knee would be number one. Number two would be something like a carpal tunnel or a trigger finger in the hand and then, the third would be the lower back pain, the neck pain and then fourth and fifth would probably be conditions like a rotator cuff disorder in the shoulder and then other conditions which are like ankle pain, foot pain. Those are the top 5 conditions which probably constitutes about 30-40% of my patient population.

Bill:  Okay. Help us, then. Give us some tips on how to prevent some of these problems.

Dr. Gupta:  Okay. So, the most common problem I would just mention is just arthritis of the knee. Now, it can be prevented. I would say, you can’t prevent but what you can do to ensure that it doesn’t come early and it doesn’t affect you early and then, if it does, it doesn’t progress that fast, and some of the common things we can all do is keep your body weight near to the normal, ideal body weight. Studies have shown that once you have a wear and tear condition in the knee, then if your body weight is more than usual, or more than normal, then the wear and tear process is much faster. Of course, educating kids and, you know, more training in sports activities minimizing trauma of the knee is also one condition that can help prevent the wear and tear that arises from subtle injuries that happen. Once we prevent those initial injuries, the later population in their 40’s and 50’s will notice a difference in the frequency of when they start having the knee pain. There are other conditions like patients, when they start having the knee pain, I would say, avoiding certain activities like jogging or running on a concrete surface and going for less painful options like swimming or elliptical exercises—those are the conditions when you have knee pain, because of arthritis, you can somehow slow down the progression of the wear and tear. Unfortunately, some of the conditions are not totally preventable because it’s inherent with the human posture, the way we walk, there will be wear and tear on the knee. It’s just different on how patients get affected on different ages.

Bill:  So, a great tip there. Maintain a normal body weight; minimize trauma during sports; avoid jogging or running on concrete surfaces and maybe switch it to something less impactful like swimming. So, Dr. Gupta, if someone is suffering from a spinal or orthopedic issue, how do you then best manage the pain?

Dr. Gupta:  Well, initially, most of the time, the patients will have seen their family care physicians and even actually before that, they would have tried over the counter pain pills which are things like Motrin and Aleve and Tylenol. Then, there are prescription pain medications that you can take but if things don’t respond to these or they relieve in the short term, then there are other interventions that can be done, some of them by family care physicians like joint injections and spinal injections. A lot of times, at that point, the physicians will refer to a specialist like an orthopedic specialist or a spine specialist. When patients come to us, there’s a range of things that we can offer them starting from activity modification education, physical therapy, injections, minimally invasive interventions and then, of course, the surgical intervention. So, depending on the patient’s need and the severity of the problem, the treatment varies but most of the patients respond to conservative measures and not all of them need surgery.

Bill:  Right. So first off, you’ve got your over the counter pain pills, your potentially prescription medications, spinal injections and then surgery are the different courses of treatment. So, talk to me about neuromodulation. What is that?

Dr. Gupta:  Well, as the name suggests, modulation the way that nerves are doing their function. Now, neuromodulation has been there for quite some time. But, as spinal intervention has increased, so has the number of cases that have failed intervention so there’s a renewed interested in neuromodulation. This is a procedure that’s indicated for patients whose leg pain or back pain is mostly neurogenic in nature which means the nerves are getting irritated, compressed or making a person feel a lot of pain in their back or leg. So, what essentially this procedure does is it tries to gauge or monitor the way the nerves are carrying their impulses across the spinal cord to your brain to make you feel that they are being painful. So, imagine if I can put a small electric device over the nerve and stimulate it so that the normal conduction of pain impulse is lost, then your brain would probably feel that there’s nothing painful there. So, this is what the neuromodulation is based on.

Bill:  It’s very interesting. So, it is a non-invasive technique? That’s what it sounds like.

Dr. Gupta:  Well, it’s a minimally invasive technique. It’s nowhere near as invasive as a spinal surgery or a lysotomy  or cutting your nerve. It is invasive but most of the time, it can be done with minimally invasive procedures and even if it requires an open procedure, the managing of the surgery is much less than any of the other procedures that  a lot of patients need for their back or leg pain.

Bill:  Is this a one-time procedure or does the patient need to come back several times when they’re getting neuromodulation?

Dr. Gupta:  If it’s properly chosen for a particular patient, usually it requires a trial procedure which just ensures that the patient is the right patient for the procedure and once the trial is successful, if the patient gets good relief after trial, that is the one time procedure. Then, we require implantation of an electrode in your spine and then, of course, a battery that can fire that electrode. Once put in, they don’t need to be removed for a long, long time. These days, I think the batteries last for several years so nothing needs to be changed. The batteries can be charged from outside just as your cell phone is charged. Of course, you don’t need a cable to charge it. So, yes, once the hardware is in, it can last several years without really changing anything.

Bill:  That’s really interesting. So, is this kind of a last resort, then, if all the other treatments don’t work?

Dr. Gupta:  Well, I would say it’s a good option for patients who have failed the back surgeries or who have other conditions like complex regional pain syndromes; people with neuropathy pain with diabetes which is very, very common where I work. So, in those conditions where nerves seem to be why you’re hurting, this is a very reasonable and a good option.

Bill:  Fantastic. Great information, Dr. Gupta. Thanks so much for being on with us today. For more info, you can visit ManchesterMemorial.org. That’s ManchesterMemorial.org. This is The Manchester Difference. I’m Bill Klaproth. Thanks for listening.