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Pain may be problem of past

By BARBARA JOY
Hernando Today correspondent


BROOKSVILLE - Patients who suffer from chronic pain caused by conditions like arthritis, facet or nerve root problems, failed back syndrome, post herpetic neuralgia (shingle pain) or spinal stenosis may benefit immensely from Radio Frequency Lesioning (RFL).

Dr. Sea Lee, board certified in anesthesiology and pain management, is now offering this new treatment option to area residents at the Hernando Endoscopy and Surgery Center (HESC).

Dr. Lee comes to Hernando County with impressive credentials, training and expertise in his field. He performed his anesthesiology residency at the nationally renowned Montefiore-Albert Einstein Medical Center in New York followed by a pain management fellowship at Harvard/Brigham and Women's Hospital in Boston. He received his medical degree from Albany Medical College, N.Y., as well as a bachelor's degree from the City University of New York Medical School/Sophie Davis School of Biomedical Education.

He makes it clear that he is committed to finding the cause for his patients' pain rather than just treating symptoms.

Explaining that radio frequency lesioning is the most conservative treatment when compared to cryotherapy and chemical treatments, the success rate for prolonged relief of pain for six to twelve months is experienced by about 70 to 80 percent of patients undergoing the procedure, Dr. Lee said. Long term relief of unremitting, debilitating pain without drugs is good news for chronic pain sufferers.

 Dr. Lee further explained that patients with diagnoses of arthritis benefit the most from treatment, however patients with the catch-all diagnosis such as failed back syndrome (continuing pain after spinal surgery for a multitude of reasons) or a diagnosis such as reflex sympathetic dystrophy (RSD) have good results as well.
He added that RFL is a minimally invasive technique performed by placing a needle into the spinal area near the nerve root causing the pain, followed by insertion of a RF probe through the needle that delivers electrical impulses to interrupt nerve conduction, particularly the nerves responsible for pain signals.

 "Assessing the patient for candidacy for the radio frequency lesioning is a two-step process which has built-in mechanisms for patient safety," Dr. Lee said. "The first part of the testing is needle placement under fluoroscopy-guided X-ray to ensure that the right spinal nerves causing the pain are identified."

 The testing step includes injection of a numbing medication, commonly known as a spinal block, into the area causing the pain to see how the patient responds and to determine the cause of the pain. If the patient obtains total relief of the pain during the first step in testing, he or she goes home and keeps a pain experience diary, where detailed records of pain are documented. Using this tool makes it extremely helpful to the doctor to determine the cause of the patient's pain.   If the patient's pain returns, Dr. Lee moves on to determine if the patient is a candidate for RFL.

"If the patient obtained total relief of pain and the pain returned, the patient is an excellent candidate for RFL as the cause of the pain is arthritis," he says.
RFL is then performed to obtain pain relief that may last for six to twelve months.
The RFL procedure is similar to the first step of testing where the patient undergoes needle placement to identify the correct nerves responsible for pain. Additional tests are then performed to ensure safety by first identifying the sensory nerve and then the motor nerve.

"Testing sensory nerve function duplicates the pain the patient normally feels, essentially eliciting a positive pain response," adds Dr. Lee. "Then I move to the motor testing portion."

If the patient obtains a negative motor response and fluoroscopy-guided X-rays verify correct placement of the needle, Dr. Lee then delivers the radio frequency to the specific site causing the pain for 60 seconds.
"The RF impulses generate heat, which works by altering the protein channels of nerve conduction," he added.

There is relatively little pain involved in treatment. Dr. Lee explained that the patient may experience mild muscle spasm or minimal discomfort during the procedure, but emphasized the use of light anesthesia for all parts of the exam except during the testing of the sensory and motor nerves.

"The risks of the procedure are very low secondary to several safety measures in place during the testing phase and are similar for any invasive procedures, such as a potential for infection," said Dr. Lee.

Post procedure, the sedation is quickly reversed and the patient can go home with prescribed rest without strenuous activity for the day. He or she should have pre-arranged transportation home due to the administration of anesthesia.
Dr. Lee added that the patient can resume normal activities the following day.
The doctor's commitment to high quality patient care is clear in his caring bedside manner.

Receiving a post procedure telephone call from him the next day is standard practice for all of Dr. Lee's patients as he is highly involved in tracking his patients' outcomes personally.

Area resident Fred Heales, 76, is a patient of Dr. Lee's who struggled unsuccessfully with trying to manage his pain for three years after two lumbar laminectomy surgeries only to have about three months of total pain relief. He was referred to Dr. Lee by his neurologist.

 Heales described trying many medications in his struggle to relieve the constant pain and said that they worked only to take the edge off the pain, not relieve it totally. He also added the pain medications' annoying side effects of constipation and drowsiness interfered with his normal activities.

"Without medication, my low back pain was severe," said Heales. "With medication, the pain was barely tolerable."

Heales saw Dr. Lee, who diagnosed the cause of his pain and was thrilled to hear he was a candidate for RF. After undergoing the procedure recently, Heales said that he felt no pain during the process because of the anesthesia and experienced no problems afterward.

"The next day, I was completely pain free and it's quite remarkable," Heales reported. He said he's also astonished that his pain hasn't returned and is very appreciative, not only of Dr. Lee's medical skills and knowledge, but raves about the doctor's communication skills and diligent manner of treatment.

"Dr. Lee explained everything to me and my wife at each visit and during and after the procedure," Heales reported and said that he was stunned after receiving a call from the doctor personally the day after the procedure.

The radio frequency lesioning procedure is covered by Medicare and most major health insurance plans. Patients who are interested in learning more details about pain management and RFL are encouraged stop by the Hernando Endoscopy and Surgery Center located at 12180 Cortez Blvd. in Brooksville for a brochure or call 596-4999 for an appointment.


This story can be found at: http://www.hernandotoday.com/health/MGAG499JBOD.html

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