It has been said that a picture is worth a thousand words, and I asked a patient of mine, a delightful grandmother, to tell her story so that anesthesiologists who do not commonly treat pain patients could see a “snapshot” of just one patient and the difference effective pain treatment made in her life. Any pain physician will have countless similar stories from his or her patients on any given day, so Jackie’s story is not meant to be extraordinary, but it is a common example of the work that pain physicians do every day. Recently the hospital CEO came to me at a party and told me how one of our patients told her that the treatment we had given him had “changed his life.” She was amazed and said, “I bet you don’t hear this often.” My comment was “No, in fact we hear this comment many times a week,” and indeed, so do my pain colleagues all across the country and across the world. I think she was surprised not only at the scope of pain practice but the positive results.

— Doris K. Cope, M.D.

et me begin by saying that on February 4, 2004, I had an intrathecal pain pump implanted for control of severe back pain. This, by far, is the best treatment I have ever received. I’m doing things I never thought I would be able to do, and this has given me new excitement and hope for the future. In the two months since I had the implant, I have returned three times for revision of the delivery of medicine to fit my highly active times of the day. This is a noninvasive, painless procedure that takes 10-15 minutes.

Jacquelyn A. Cowher

I will give you a short history of my back problem over the last 43 years and the various treatments I’ve tried before making any decision on the implant. I believe the problem began on my first day of school, first grade, age 6. My mother had drilled into me all summer that I was to wait outside the school for my older sister, and I was to walk from school to the streetcar stop with her. Streetcars were the mode of transportation in those days. There were no school buses.

Apparently her class was dismissed a few minutes before mine, and the nuns would not allow her to wait in front of the school for me so she had started to walk ahead to the streetcar. I was dismissed, saw her up ahead, and I panicked. I thought she was leaving without me. I broke away from my class line and ran out in the street hoping to catch up to her before she reached the streetcar stop. I was not even sure what streetcar to take home that first day. As I ran across the street, past the school guard, an 18-wheel truck approached, tried to stop, but couldn’t and ran over me. I had a snowsuit on, which probably saved my life. I had a slight concussion and some bumps and bruises but no major injury. As time went on, around the age of 14 or 15, I began to have painful episodes with my back. Of course no one ever made a connection to the truck accident eight years earlier. First I was told I merely had growing pains because I had grown a lot in one year. As time went on and I pursued more medical advice, I was told it was because I was tall (5’8”), and I had to bend over to do a lot of tasks. By the time I was 17 or 18, I was having a lot of intermittent painful episodes with my back and right leg.

I started working the day after graduation from high school as a secretary for a large insurance company in downtown Pittsburgh and soon noticed that the bus rides (we had graduated to buses by that time) were very difficult. I always had to stand and hang onto a pole, and the buses would sway to the left and then to the right causing all the riders to sway with the bus. Then I noticed there were some tasks at work that were very hard to complete. Here I was at 19 years old, looking the picture of health and youth and yet feeling horrible by the end of each day. At 21 years of age, I was married, and shortly after that, my husband and I decided to investigate the problem and see if the problem was “fixable.” I had X-rays, and nothing showed up. The diagnosis was back strain, and bed rest and pain pills were recommended when these episodes would occur. In 1962 I had my first child. Between 1963 and 1966, I was hospitalized eight times for bed rest, physiotherapy, traction and medication (pain pills and corticosteroids). Resting seemed to help while I was resting. As soon as I would return to my regular routine, the pain would return.

At the same time, I was advised by my obstetrician/gynecologist that if we wanted more children, I should do it soon because he felt that in another few years, I would need a hysterectomy. So we had our second child, a daughter, in 1965. After her birth, I started having more symptoms. I was dragging my right leg and had a lot more weakness on my right side. I had problems lifting my 3-year-old and infant. I finally went to see a neurosurgeon. More X-rays were done along with a myelogram. The diagnosis was a slightly slipped disc, nothing that could cause all the pain I was experiencing. The neurosurgeon recommended an exploratory laminectomy, meaning he would go in and look around. If there was something to fix, he would fix it; if not, he would close me up. I was 26 or 27 and couldn’t lift my baby out of bed. I felt I had to try. My husband and I were both scared. The doctor had told us the odds, and they didn’t sound too good. The odds were:

1. No better, no worse than before surgery;

2. A little better than before surgery but not pain-free;

3. A lot worse than before surgery with the possibility of never walking again.

But I still felt I wanted to try to get rid of the pain that was keeping me from enjoying my children and my husband.

I had the surgery, and to everyone’s surprise but mine, I had a fully slipped disc on both sides of the spinal column. They did a fusion using cadaver bone, and the surgery was over. The surgeon came to talk to my husband and family. He apologized for not believing the level of pain I was experiencing. He confirmed I could not have moved without being in excruciating pain. He said he found a very old herniated and degenerated disk and literally just picked pieces of it out of my back. It was at that time that we figured out it must have been the accident. I had a good outcome with that surgery and eventually went back to work. I had 10 good years. Then in 1977, the pain returned on the right side of my back and the back of my right leg. This time it was scar tissue. So I had that removed. The surgeon ordered a brace to wear during the busiest parts of the day. Finally in 1980, I had a third surgery to remove more scar tissue. The scar tissue had crushed my sciatic nerve. At that time, they did a rhizotomy in which the back of my leg was supposed to get numb, but my luck had run out. The rhizotomy numbed the front of my right leg and I ended up with continuing pain in the back. It was at this time that they referred me to a pain clinic. I thought this was a temporary thing and that eventually I would be O.K. Shortly after starting at the pain clinic, I realized this is a long-term treatment clinic where they just try to make it more comfortable for patients with chronic pain. I was frustrated and depressed.

At the pain clinic, all kinds of nerve blocks were tried, starting with conservative treatment and ending with epidurals, caudals, nerve blocks with fluoroscopy, nerve blocks under anesthesia and radiofrequency treatments. Radiofrequency is a relatively new treatment that gave me a good result, but it didn’t last long enough to justify its use. I was lucky to get about three weeks’ relief while some patients got from six months to one year. There were side effects from all the medication. All the pain pills and all the muscle relaxants have side effects. I got early cataracts from the steroids I’ve taken off and on over the years. I also had a severe case of cellulitis that required two surgeries. So none of this treatment came without consequences. I’ve even tried a TENS unit.

With my new implant, I feel my pain is in control, and I feel that I have a new lease on life. I have walked around the lake I live on (two miles) two or three times, and I’m looking forward to walking some more. I also kept my grandchildren for four days recently (ages 5 and 2). I would have never attempted the babysitting until now. At the moment, I’m not taking any pain medication or muscle relaxants. This has reduced my drug bill quite a bit, also.

I want to thank my doctor, Doris K. Cope, M.D., Director of the Pain Clinic at St. Margaret’s Hospital in Pittsburgh for suggesting this mode of treatment for me. It has made a significant difference in my life, and I will be forever grateful. Her advancements in the care of people in chronic pain are outstanding, and her staff has been wonderful. They answer all my questions and have been very supportive.

— Jacquelyn A. Cowher,
Chalk Hill, Pennsylvania

Doris K. Cope, M.D., is Director, University of Pittsburgh Medical Center (UPMC) Pain Medicine Program, and Professor of Anesthesiology, UPMC, Pittsburgh, Pennsylvania.