Sharing Mayo Clinic: Putting pain in the past

Sharing Mayo Clinic: Putting pain in the past

By
Dana Sparks

November 18, 2018

For years, Jerry Grant endured debilitating leg and foot pain as the result of a severe spinal injury. When he turned to Mayo Clinic in 2017 for help, he was offered a new pain management device. It made all the difference. Today, Jerry is enjoying a life that's no longer dominated by pain.

When pilot Jerry Grant was involved in a serious helicopter crash in 2002, his lower vertebrae shattered, leaving him unable to use his legs. Although he eventually was able to walk again, he was left with terrible pain in both legs, especially on the bottom of his feet. Even walking on carpet was painful.

"It felt like I was walking on very hot asphalt," Jerry says. "I had an electrical, biting pain that went up the right shin to the knee."

Jerry lived with that daily discomfort for 15 years. But then he decided to explore treatment options for his excruciating pain at Mayo Clinic. There, Jerry's care team recommended a device that had the potential to minimize his pain. And it worked.

Within a few weeks of having a new type of spinal cord stimulator implanted, Jerry was able to get back to living life the way he wants, with minimal pain.

"I'm a helicopter pilot, an avid fisherman, and I do archery. I also own a management company and rent out hangars," Jerry says. "But it's the simple things like being able to paint my house this year that are big accomplishments for me. The device has helped me live a lot fuller life."

Devastating damage

Immediately following the helicopter crash, Jerry's outlook seemed bleak. He had two titanium rods installed in his spine to stabilize the injury. But when he tried to walk, he had no feeling in his legs. He was diagnosed with paraparesis — a condition that involves significant weakness of the legs, but not total paralysis. For a long time, Jerry couldn't even move his toes.

His medical team in Bozeman, Montana, told Jerry he would never walk again, and he should forget about ever being able to fly.

Jerry refused to accept that. He worked hard to regain the function in his legs. At one point, his strenuous effort broke one of the titanium rods supporting his back. Jerry engaged in daily physical therapy. He pushed himself to stand and then to walk — first with a walker and then with a cane.

"Quality of life is everything to me. I didn't want to be on pain medicine that would make me feel like a zombie."

Jerry Grant

Despite his remarkable recovery, Jerry lived each day in extreme pain. He recalls that his discomfort would start at about a level 6 out of 10 in the morning and escalate to an 8 by late afternoon. Eventually, after gaining more mobility, Jerry was able to return to flying. It became his sole respite.

"Flying was one of the few things I could do to kind of forget about the pain and the stress," Jerry says. "The fall colors, a lake or a mountain stream, the varying field patterns, it's incredible."

Jerry consulted several pain specialists around Bozeman and was offered medications to manage his pain. But he wasn't satisfied with the options presented to him.

"Quality of life is everything to me," Jerry says. "I didn't want to be on pain medicine that would make me feel like a zombie."

New technology, new possibilities

Jerry lived with the pain for years. But in 2017, a family member went through treatment at Mayo Clinic's Rochester campus. Jerry opted to do the same. He set up an appointment in Mayo's Pain Clinic, which has a team that specializes in delivering advanced therapies to a wide variety of patients with complex pain histories.

At the Pain Clinic, Jerry met with Christine Hunt, D.O., and Jason Eldrige, M.D. Jerry also underwent MRI and CT scans to provide more information about his condition. The imaging revealed that the bones in Jerry's spine were riding on one another or fusing together, and that was triggering his pain.

Jerry's care team talked with him about spinal cord stimulation — a pain management technique that sends a mild electric current to the spinal cord, masking pain signals before they reach the brain. But because the area in the back of Jerry's spine where the device is normally placed was obstructed by scarring, a traditional stimulator was not an option.

Instead, Jerry's team set up a consult for him with fellow Pain Medicine physician Markus Bendel, M.D., to see if Jerry would be a candidate for a new kind of spinal cord stimulator called a dorsal root ganglion, or DRG, stimulator.

"With this technology, we still place a small needle into the epidural space of the spine, but rather than guiding the specialized stimulator leads into the middle part of the spine, where the spinal cord lies, we direct them through the areas of the spine where the nerves exit, allowing for electrical stimulation of those specific nerves," Dr. Bendel explains. "The stimulation interferes with the signals coming from the nerves going to your brain and minimizes the pain."

Approved by the Food and Drug Administration three years ago, the device allows health care providers to be more selective in treating certain pain conditions, like foot pain.

"When you are stimulating the spinal cord itself, you don't always know exactly where the stimulation needs to occur to cover a certain region of the body," Dr. Bendel says. "With the DRG therapy, we can target a specific area in the spine to stimulate the nerves that go to a specific area, like the feet."

Before the stimulator could be placed, Jerry needed to do a one-week trial of the therapy. During that time, temporary leads were inserted through small holes in his skin to see if the dorsal root ganglion stimulator provided adequate pain relief to meet his functional goals.

Optimism renewed

Jerry's trial phase of the treatment, which took place in December 2017, was a success. He was then scheduled for outpatient surgery to implant the stimulator on Jan. 31. The minimally invasive procedure involved placing three leads in his spine and implanting a battery that sends electrical impulses to those leads.

In addition to the surgery, Jerry attended classes in the Pain Clinic that focused on deep breathing and other techniques to help him manage his pain.

"This was what I really wanted, rather than just taking a pill that would clog my mind and prevent me from flying," Jerry says.

Although the Pain Clinic set some parameters for the stimulator, Jerry has the ability to communicate with the device with a remote control to turn it up, down or off. In addition, there's a local representative from the company that makes the device who can reprogram it, if needed.

"Dr. Hunt, Dr. Eldrige and Dr. Bendel were very concerned about my well-being and longevity. They spent a lot of time with me and gave me a lot of hope.”

Jerry Grant

Once the stimulator was in place, Jerry was able to redevelop his leg muscles, which were easier to control with the stimulator minimizing his pain. Freeing people from pain, so they can go about their daily lives, is a big part of the goal for patients like Jerry, according to Dr. Bendel.

"For 15 years, Mr. Grant couldn't do some of the simple things that most of us would take for granted," Dr. Bendel says. "When I hear that some of these things now are easy for him, that's one of the biggest impacts we can have on a patient, and it's a huge success in our field."

For Jerry, the attention and care he received from his team in the Pain Clinic has not only eased his pain, it's changed his outlook.

"The collaboration between the doctors at Mayo is great," he says. "Dr. Hunt, Dr. Eldrige and Dr. Bendel were very concerned about my well-being and longevity. They spent a lot of time with me and gave me a lot of hope.”

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