Less Common Treatments
Doctors vary from professionally conservative to more adventurous. I am an early adopter. That is to say that if I am met with a condition or problem that I cannot currently treat I am prone to go out and look for something and, assuming I am satisfied with the known risks and benefits, adopt it for my own practice. The result is that some of my patents have had first in UK treatments in situations where none of the available methods are effective. This increases opportunity but at the expense of using treatments (usually variants on existing themes) which may not have much data to prove how they work (especially over the longer term).
Here are some examples
Pulse RF for post surgical knee pain and for degenerative joint pain:
Pulsed Rf energy is in common use for nerve root pains. It has also been explored for joint pain. Data from Dr Pietro Scianchi, shared with me by a Dutch colleague, Olav Rohoff shows good medium term (ave 13 months) results in small numbers: Knee 40, shoulder 28, toes 11 etc. The treatment is safe and simple and appears superior to standard steroid joint injections. I have recently upgraded my RF equipment to be able to deliver these specialised protocols. So far the first patient who has had post knee replacement pain for years is pain free at 2 months, so this is optimistic where no other treatment has helped (including more surgery). A lady with very disabling finger joint pain was also pain free until a episode of gardening so I’m not sure how that will last. I will continue to explore this in selected cases.
Coblation Nucleoplasty in disc-related back pain:
percutaneous decompression of slipped discs is quite established relief of sciatica but not cases of dominant back pain which remain almost non-treated in most settings. I used this first about 7 years ago and continue to have reliable results in highly selected cases. I am currently designing a placebo controlled trial to examine this formally.
Grey Ramus Communicans Block in osteoporotic vertebral fracture:
Crush fracture of a vertebral body usually occurs in patients with age related bone thinning or osteoporosis, often after minimal trauma or simply under body weight. Currently most painful vertebral fractures are untreated but can be severe or disabling. Interventions to place bone cement in the fractured vertebra vertebroplasty, kyphoplasty) are quite major interventions and not widely practiced. Blocking, or removing with RF heating, the nerve which runs around the vertebral body to conduct the pain signals was reported in 2001 by Dr Chandler an American physician in Georgia whom I visited to learn the technique in 2004. Since then many patients have benefited from this uncommon but simple and effective treatment.
I was, I believe the second in the UK to use a spinal endoscope for the visualisation and relief of complex epidural adhesions in post surgical and mechanical spinal pain cases. The technique has not been widely taken-up in the UK and is most avidly used and reported on by Jan-Willem Kallewaard and colleagues in Holland. While this is not a trivial treatment and has potential for major adverse events, it can achieve improvements in situations which are otherwise untreatable.