NEUROMODULATION ADVANCEMENTS OFFER HOPE TO PEOPLE IN PAIN

For nearly two decades, he lived with phantom pain following an amputation. DRG Therapy gave Raul Silva relief.

Raul Silva just wanted to feel normal. Thanks to his weeklong DRG Invisible Trial, he could.

Sep 24 2020

Raul Silva woke up in the middle of the night and shot out of bed. He was so excited that he was shouting.

"Something's missing! Something's missing!"

His wife gave him a sideways glance, wondering what had gotten into him.

"The pain is gone!"

Earlier that day, Silva began a weeklong trial with DRG Therapy, the latest in neuromodulation advancements for chronic pain management. For 18 years, he had lived with severe phantom limb pain after his left leg was amputated. The pain in Silva's leg had only gotten worse with time; it was particularly excruciating whenever he needed to use the restroom.

But on this particular night, he knew he finally found something that would make a difference.

Living With Chronic Pain

In 2000, Silva was in a motorcycle accident near the California-Mexico border. He was treated for a broken femur in Mexico, but when he returned to California, the limb had developed gangrene. His leg needed to be amputated above the knee.

"When I woke up after the amputation, my leg felt so cold, like my foot was touching the metal bed," he said. "I needed to sit up, to go outside and feel the sun."

That was the start of his phantom limb pain. For nearly two decades, Silva tried managing his pain with over-the-counter medications. A few years ago, his doctor prescribed him prescription pain medications. Neither worked.

"The medicines make me sleepy, and the only pain relief I get is in my sleep," he said.

But it was hardly sleep and wasn't much of a relief. Silva would toss and turn, his wife told him, and his body still reacted as though it was in pain, even if his mind was asleep.

"When I wake up, I feel sore," Silva said. "My head aches. I feel sleepy all day."

Through the pain, Silva still went to his job at a department store — where he walked and stood on his prosthetic leg for long periods of time — and raised his three daughters.

"Work was good in some ways because it kept me busy," he said. "Taking care of customers, I was too worn out to think about the pain. But the pain was still so bad. Some days it would get so bad, I could do nothing but lie on the floor. The pain would become so severe, I would need to go to the emergency room."

Invisible Trial, Palpable Relief

Eventually, Silva's doctor wrote a letter advocating for Silva to be placed on permanent disability. The pain of being on the prosthetic and the attendant risks to his health were too great. Working, standing for so long, was out of the question. Silva's doctor also recommended that he try Proclaim DRG (Dorsal Root Ganglion) therapy, which uses mild electrical signals to treat chronic pain. Proclaim DRG therapy is an aid in the management of moderate to severe chronic intractable pain of the lower limbs in adult patients with complex regional pain syndrome (CRPS) types I and II. Silva had no idea what that meant.

With Proclaim DRG therapy, a physician places thin wires near the dorsal root ganglion — a bundle of nerves in the spinal column that regulates pain signals — and connects them to an implanted generator. It works by sending mild electrical pulses to the nerves responsible for the painful sensations. This could reduce or completely block the pain from the affected nerve to the brain. Those using Proclaim DRG therapy receive a controller to adjust the strength of the pulses as needed. Silva's doctor offered him a weeklong trial.

"I said I wanted to try it because trying something was better than doing nothing," Silva said.

The DRG Invisible Trial System begins with a short outpatient procedure wherein thin wires are placed near the DRG and hooked up to a small, external battery that's worn discreetly under street clothes. It's not exactly invisible, but it's pretty close.

For his procedure, Silva was put under light anesthesia while doctors made an incision for the leads.

They tested the stimulation to make sure leads were positioned in the spot associated with Silva's pain. Then they put him back under. That's how the doctors knew the leads were positioned in the spot associated with Silva's pain. They put him back under anesthesia and finished the procedure. Upon waking, his care team turned on the device and gave Silva an Appleǂ iPod touchǂ. During the trial, Silva used the iPod to change the stimulation settings on his generator to see how the therapy targeted his pain symptoms.

"When I turn (the iPod) on, I see a body, and the parts connected to your body are highlighted in blue," he said. "I choose the area that hurts and put more strength on it. It's so easy to handle. Not too many steps."

Even as he left the hospital that day, Silva felt like a new person.

"Besides the phantom limb pain, I have sciatic nerve pain," he said. "It was gone. Everything was wonderful. For the first time, I felt normal."

Choosing the Next Steps

Silva kept the Invisible Trial for the full seven days. Each day, he discovered that he could do a little more. He could take his teenage daughters to and from school and extracurricular activities. He could help around the house, visit family and friends.

"I was able to walk my dog again," Silva chuckled. "My wife would ask why I was smiling and laughing when we'd go out walking. For the first time, I could wear the prosthetic and feel good. With the phantom pain, I would feel like my foot is touching my shoes, or my leg is there with the prosthetic."

Whenever his pain flared up, he simply opened his iPod, targeted the body part and delivered more stimulation. When the pain subsided, he set the strength back to normal. He felt great.

"I just want to be a normal amputee," he said. "I can't have my leg back, and I don't want it. But the pain, that's the thing. I've been suffering so badly for 18 years. I want a better quality of life, for my family to not have to worry about me. I want to walk my dog in the park." Neuromodulation advancements won't just benefit Silva's chronic pain management. They're a relief for his family, too.

"Proclaim DRG therapy may mean even more to my wife than to me," he continued, his voice breaking as he illustrates how much his wife has supported — and suffered with — him over the years. "From the beginning, she was with me through everything. Being free of pain would mean I can have quality time with my family, travel more, finish college, enjoy being with relatives. There's finally something that works."

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