pain signals from the nerves. A handheld programmer allows individuals to adjust the level of stimulation based on their pain level and activity. Gorsak’s initial procedure, which allowed for a trial of the device before permanent implantation, was done in June 2013 by Dr. Mellender. The results were immediate, Gorsak says. “When Dr. Mellender did the trial—you’re awake, because you have to give feedback—at one point, I said, ‘That’s it; Tackling Chronic Pain you’re done! You got the spot,’” he recalls. “I could feel the egional anesthesia techniques have expanded difference right away.” beyond the operating room, into outpatient uses at During the initial procedure, electrical leads are placed in facilities such as the New Jersey Pain Institute, the epidural space with the intention of finding the proper Dr. Mellender says—for example, using epidural spinal injections coverage for all areas of pain, Dr. Mellender explains. An for back pain, easing pain experienced external device that functions the Robert Wood Johnson Medical School’s Robert Wood Johnson Medical School’s after hernia operations or with metastasame as the permanent stimulator is Regional Anesthesia Team: Regional Anesthesia Team: tic cancer, and helping people get back provided, and patients are able to Geza K. Kiss, MD ’95 to work or sports after an injury. And make adjustments based on a number Clinical director of acute pain and advances continue to be made overall in of different settings, he adds. After a regional anesthesia management of chronic pain. trial period of several days to deterAssociate professor of anesthesiology “It all goes back to quality of life,” mine whether the device would proScott J. Mellender, MD Dr. Mellender says. “We try to improve vide adequate relief, Gorsak returned Clinical director of New Jersey Pain Institute quality of life in the operating room, but to Dr. Nosko for the surgery to Assistant professor of anesthesiology beyond as well. People think they may implant the permanent device. William R. Grubb, MD, DDS have to live with their chronic pain for With SCS, Gorsak has seen dramatic Division head of pain management Program director, Pain Management Fellowship the rest of their life. We can decrease it, changes in his quality of life. He’s able Associate professor of anesthesiology in some cases by 80 percent, and they to walk short distances with a cane or Rose S. Alloteh, MD are able to become fully functioning.” even, on smooth surfaces, unassisted. Director of pain management education For Jeff Gorsak, these methods Three toes that he was unable to move Assistant professor of anesthesiology helped make everyday life bearable. prior to the procedure now have Antonio Chiricolo, MD A traumatic accident on January 11, restored motion. And the catnap-only Assistant professor of anesthesiology 2011, left Gorsak with severe neck and nights are a thing of the past, he says: Vincent J. DeAngelis, MD back injuries and marked the beginning “If I get woken up at night, I just adjust Associate professor of anesthesiology of his daily battle, living every moment the setting and go back to sleep.” Gina George, DO with excruciating pain. He was unable The device is “always running for Instructor of anesthesiology to walk, his movements were severely me, because I’m never without pain, Tejal H. Mehta, MD ’07 limited, and he went more than two but this helps keep it in check,” he Director of regional anesthesia education years without a full night’s sleep. adds. “I honestly don’t know what I Instructor of anesthesiology “It was an extreme challenge just to would have done without it.” Shruti Shah, MD While SCS is not technically a get through every day,” says Gorsak. “I Assistant director, Pain Management Fellowship regional anesthesia technique, pain was on opiates for the pain, but I don’t Clinical assistant professor of anesthesiology management and regional anesthesia like pills and didn’t want to be on that Melissa Wu, MD ’09 go hand in hand, says Dr. Kiss, who medication.” Instructor of anesthesiology first became interested in regional That’s when his neurosurgeon, anesthesia during fellowship training in pain management. Michael G. Nosko, MD, PhD, associate professor of surgery “The skill set is essentially the same for both,” he says. “It’s and chief, division of neurosurgery, suggested spinal cord a continuum—acute pain intraoperatively in one, while the stimulation (SCS). SCS uses a small pulse generator, similar to other deals with chronic pain—and we are able to provide a pacemaker, that is implanted under the skin to send the that full continuum for our patients.” M spinal cord low-voltage electrical pulses that interfere with riences using these techniques, it reinforces the benefits of regional anesthesia, so now it’s actually being requested. In some cases, they are even insisting on it,” says Dr. Fratzola. Requests for regional anesthesia also are coming from patients, she says: “There are a lot of educated patients who have been going online, becoming more informed about regional anesthesia, and now know more about the different options than they did in the past.” r Robert Wood Johnson I MEDICINE 11