Implant relieves Parrish woman’s pain after 6 tough years

Oct. 03--Imagine being in pain for six straight years.

Then imagine, due to continuous, low, electrical impulses coursing through the spine, of having that pain instantly disappear.

That's the unlikely medical story of Jessica Kuehn, a 33-year-old Parrish woman.

Kuehn suffered a severe fracture of her right ankle and a kidney laceration in a car crash on Rye Road in East Manatee on March 21, 2010. She was going home after a work shift, fell asleep at the wheel of her Honda Civic, and ran into two trees.

Kuehn spent five days in the intensive care unit at Manatee Memorial Hospital, then two more weeks in the hospital.

"I broke the talus bone in the ankle joint that allows all the ranges of movement," Kuehn said.

Kuehn underwent multiple surgeries designed to stabilize her ankle and many bouts of physical therapy, but nothing seemed to make the pain in the ankle go away. Her doctors were puzzled because they felt the procedures had made her ankle structurally sound again.

"The pain was unbearable," Kuehn said.

She couldn't stand on her right foot for long. After work she would go right to bed.

She was on pain pills for years, she said.

"I had to find someone to help me," Kuehn said.

Keuhn was referred to Dr. Nomen Azeem, an interventional pain physician who works for Sarasota Orthopedic Associates in Lakewood Ranch.

When he heard Kuehn's story, Azeem theorized that she had been in pain so long that her ankle was now automatically sending out pain signals to her brain.

There's a name for this little known condition -- complex regional pain syndrome, or CRPS, Azeem said.

"This happens to people when the central nervous system malfunctions following an insult or injury which could include a broken bone, an actual nerve injury or surgery itself," Azeem said.

CRPS is rare, fewer than 200,000 cases in the United States each year, but it usually affects arms, legs, hands or feet after a trauma to that limb, Azeem said.

What happens with CRPS is that the nervous system runs amok, runs unabated, Azeem said.

"The sympathetic nervous system goes uncontrolled," Azeem added. "It can lead to this chronic pain, changes in temperature, swelling, redness, just overall misery from pain itself."

"I questioned that I really had CRPS but my skin would grow sensitive," Kuehn said. "I didn't want anything touching it. I hated the feel of sheets. It would drive me nuts to wear shoes. To this day my ankle is red. These are all symptoms of CRPS."

Kuehn's case came to Azeem around the time when a new treatment developed by St. Jude Medical became available.

A global medical device company that focuses on therapies for the treatment of chronic pain, St. Jude Medical had developed a neurostimulator device which is implanted in the spine to stimulate the dorsal root ganglion, a part of the spine densely populated with sensory nerves that transmit information to the brain via the spinal cord.

The device was approved by the Federal Drug Administration in February.

"At the time I wasn't even sure exactly what it was called, but I wanted to do it," Kuehn said.

Kuehn put into twilight state for new procedure

In early August, Kuehn became the first person in Bradenton or Sarasota to have a dorsal root ganglion, or DRG, trial, Azeem said.

The dorsal root ganglion is Grand Central Station for nerves that go to the ankle, Azeem said.

Azeem described how the procedure worked:

"There are no incisions," Azeem said. "She was in an operating room. We used X-ray guidance in order to use a spinal needle to enter into the spinal space."

Inside the spinal needle were small wires that were injected into Kuehn's spinal canal, Azeem said.

At the tip of each tiny wire was a roughly inch-long lead, which would provide electrical impulses designed to block the pain signals from Kuehn's ankle to her brain.

"Once the wire was in the spinal space I was able to guide it into the correct location adjacent to the dorsal root ganglion," Azeem said.

Kuehn became essentially hard-wired. The tail end of the same wire that went into her spinal space exited her skin through the needle hole and was eventually connected to a battery implanted under her skin on her back.

The battery was smaller than the size of a credit card.

Azeem adjusted the wire in Kuehn's dorsal root ganglion to where he believed it would block the pain to her brain.

Kuehn was in a twilight state and helped him guide the wires by responding to questions he asked about what she was feeling in her ankle. When she felt nothing, Azeem had found the spot.

After she recovered Kuehn said she could hardly believe it but she was pain free.

"When I walked into the office that day for the trial my pain was about at a four out of 10," Kuehn said. "After they put the leads in me, I was pain free. My right foot felt like my left foot. It was like the accident never happened."

When the three-day test period was over, the doctors removed the wires.

"Twenty minutes later the pain was back," Kuehn said.

On Aug. 18, Kuehn received a permanent DRG. Her insurance covered it.

"Dr. Azeem says I will probably have it for the rest of my life," Kuehn said.

For a cash customer, the entire DRG procedure, including sedation and hardware, now runs between $35,000 and $40,000, Azeem said.

Kuehn walked 4 miles just three days after her DRG implantation.

"I have stopped taking pain medicines for the first time in six years," Kuehn said.

Kuehn only turns the impulses off when she is driving. A rear-end collision could dislodge the leads. When she sleeps, she turns the impulses down.

"I am 100 percent completely pain free," Kuehn said with a big smile Wednesday. "This is the answer after six years for me. I didn't think it would ever happen. I thought I would be suffering the rest of my life for this stupid mistake. I can walk. I can jog. I can swim. I have my life ahead of me."

The Rev. Todd Kuehn, Kuehn's husband, also is amazed at the difference in his wife.

"She is a lot happier," said Kuehn, a pastor at Beautiful Savior Lutheran Church in Manatee County. "I can see her wanting to do more. Before, when she came home, she wanted to stay off the foot for the whole night. Now, she doesn't have to do that."

The range of suitable DRG patients is vast

Azeem is thrilled over Kuehn's outcome. He said he is most pleased she is off pain medications.

"This procedure gives patients pain options at a time when we are very aware of the epidemic of opioids in the country," Azeem said. "There has been a paradigm shift in pain medicine and we are trying to provide more interventional procedures and pain-blocking devices in order to provide pain relief without the use of chemicals."

Azeem advises people who wonder if they would be a good candidate for DRG to find someone trained in placing DRG stimulators.

"DRG patients can range from people who have had traumatic accidents such as Jessica or pain after surgery," Azeem said. "There are a large amount of patients who have had pain on either their hip or knee or knee surgery or foot and ankle surgery that continue to have pain after the surgery and sometimes the pain can worsen. Those are ideal candidate for this treatment."

Azeem can be reached at Sarasota Orthopedic Associates at 941-951-2663.

Richard Dymond: 941-745-7072, @RichardDymond

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