By Brenda Dickinson
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Jeffrey Rosenthal, D.O. |
Faculty at the University of Michigan Multidisciplinary Pain Center, who recently added spinal cord stimulators and intrathecal morphine pumps to their treatment options for selected patients, have successfully implanted a spinal cord stimulator for the treatment of intractable chest pain. The patient, a 63-year-old male suffering intractable angina, had a medical history of three myocardial infarctions, two CABG surgeries, hypertension, congestive heart failure and pulmonary disease. His cardiac surgeon deemed him inoperable due to the small caliber of his coronary arteries and diffuse nature of his coronary disease. He suffered daily, crushing chest pain despite maximal medical therapy. The patient’s referring physician, Kim Eagle, M.D., Chief of the Division of Cardiology, was reluctant to recommend transmyocardial laser revascularization, a new procedure that has unknown long-term efficacy and carries a five percent mortality.
In a trial operation last June; the U-M team implanted a spinal cord stimulating electrode in his high thoracic epidural space. This being successful, he underwent implantation of the pulse generator. In the immediate postoperative period the patient experienced marked improvement in the control of his chest pain. He also claimed to have improved ease of breathing. His remarkable outcome continues to date. “This treatment has changed my life,” wrote the patient in a letter of appreciation to Kevin K. Tremper, Ph.D., M.D., Robert B. Sweet Professor and Chair of the Department of Anesthesiology.
As a result of this case, Drs. Eagle and Jeffrey Rosenthal, Assistant Professor of Anesthesiology and a faculty member in the pain center, aggressively pursued industry support to study spinal cord stimulation in similar patients. Currently, there is no FDA indication for applying this therapy to patients with intractable angina due to coronary artery disease. The doctors learned that Medtronic Corporation is seeking such an indication. A protocol was written and the company gave a preliminary award to the U-M as the lead investigatory site. Drs. Eagle and Rosenthal are the principle investigators for this 20 site, prospective, randomized study. “We are eager to work on such a worthwhile project,” said Dr. Rosenthal. “Personally, I am thrilled to work closely with such an experienced and accomplished investigator.”
In collaboration with Susan Urba, M.D., Associate Professor of Palliative Care, U-M faculty are participating in a second study involving intrathecal morphine pumps. This study compares early use of intrathecal morphine, via the implanted pump, for control of cancer pain with medical management in a control group. Both studies remain open and potential study subjects may be referred to the Multidisciplinary Pain Clinic for inclusion screening.