Innovating Pain Management: The Role of Spinal Cord Stimulators in Outpatient Care

[Dr. Douglas Beall]
The honor is mine, Dr. Dana Dunleavy. It's an interesting path and I think most of the time to realize where we are, you have to realize where you don't want to be. I came out of the military, started to practice. My office was actually in the Department of Orthopedics and I'd come back after a fellowship in MSK radiology from Mayo Clinic and really started off in interventional and I was taken by the military and didn't really have a chance to finish that fellowship. I was placed in the Department of Orthopedics and worked that as an amalgam, working a lot with those guys. Then when I went to the University of Oklahoma, I did an interventional call, which is every third night at a level 1 trauma center, and had a chance to work with orthopedics and work as an IR, without even having finished a fellowship in it.

Then when the chairman changed, what I had set up at the time, I had developed what I called “clinical practice programs” and these were an amalgam. These were problem-solving, pain-solving, and issue-solving programs where people would come in and at the time they were doing almost no vertebral augmentation. I set that up and immediately went from zero to hundreds of cases a year, a lot of which were fed by level 1 trauma centers, a lot of which are just garden variety, osteoporotic vertebral fractures, as you know. Then, they would come back and they'd have back pain that was unrelated to extension with twisting.

Okay, that's a different pain. Let's do some facet injections. They'd come back with radiculopathy and I'd do epidural injections and do an amalgam and very quickly expanded to doing pretty much everything. I saw people with complex regional pain syndrome and then got into neuromodulation and grew it really way beyond the bounds of just simple augmentation. We've always had these skill sets and always played around. I remember it in residency and I did it in Baltimore at the Johns, same as you, Dr. Dunleavy. We would do injections and we would do anything, interventional spine in its formative years. I brought those techniques to bear.