MetroHealth Dialogue
Neurosurgeon takes aim at chronic pain, spasticity
 Procedures to minimize chronic pain and spasticity are two highlights of the care Sean Nagel, MD, brings to MetroHealth's Department of Neurosurgery. He recently came to MetroHealth after completing a stereotactic and functional neurosurgery fellowship at the Cleveland Clinic.
Dr. Nagel is keenly interested in developing a deep brain stimulation program at MetroHealth for patients with diseases including Parkinsons and essential tremor. Dr. Nagel said his first priority will be to work with patients who have spasticity and help patients who have chronic pain which has not responded to more traditional pain management therapies.
Some patients with spasticity do not respond that well to oral drugs. An alternative therapy is called intrathecal baclofen therapy, or ITB. Dr. Nagel surgically implants a small pump into the patient's abdomen, and the drug is pumped into the spinal cord fluid. Because the baclofen isn't circulating in the bloodstream, side effects are reduced and more of the drug reaches nerve cells.
To determine if someone is a good candidate for the pump, Dr. Nagel says a small amount of baclofen is injected into the spinal fluid to see how well it works. Once a pump is installed, it can be refilled every few months via injection. Pumps generally last about four years.
Dr. Nagel also offers functional neurosurgery treatments for patients suffering from chronic pain of the arms or legs resulting from a variety of causes.
"In patients who have chronic pain that is not controlled with medication, electrical stimulation or neuromodulation may be an option,'' he explains.
These treatments work by electrically stimulating the neural pathways in the dorsal columns of the spinal cord. A major neural pathway for tactile impulses runs along the dorsal columns. Often, patients will first undergo a trial with a percutaneous spinal cord stimulator to see if the therapy provides them pain relief. If it does, Dr. Nagel will surgically implant a spinal cord stimulator that should provide lasting pain relief.
"These are not curative procedures,'' says Dr. Nagel. "But if someone's pain is a 10 and we can cut it in half, this will decrease the amount of oral pain medications needed and improve the chance that they will be able to participate in day-to-day activities.''
Dr. Nagel also treats occipital neuralgia and other pain in the head and face by implanting neurostimulators. The electricity used results in a tingling sensation that masks the pain patients are suffering.
"When it works, it can be very effective,'' he says.
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| Reducing Pain: A paddle lead is inserted into the posterior epidural space of the spine. The wires are tunneled underneath the skin and connected to a pulse generator that is implanted in a subcutaneous pocket. |
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