Experts at the Center for Pain Management get to
the root of the problem
February 15, 2016
Tucker Parris was driving cross-country from Virginia to
San Diego, where he was stationed in the Navy, when
he was involved in a nearly fatal, service-related auto
accident in Flagstaff, Ariz. He broke his neck and a
vertebrae in his lower back and spent the next year
recuperating in a hospital in San Diego.
“The only thing that saved me was that I was in good shape and had
enough muscle mass to compensate for the loss of blood,” says Parris,
who was 19 at the time.
The once-healthy young man had been such a fine athlete he was
assigned to battle harsh and dangerous conditions in his job as a Naval
aviation rescue swimmer on search and rescue helicopter missions. Now,
however, he was wracked by “ferocious” pain. Even though he was able
to resume work in the military and was honorably discharged, Parris was
left with a nagging ache in his lower back that worsened over the years.
Eventually he was gripped in such agonizing pain that he couldn’t sleep,
his mobility began to deteriorate and he walked with a pronounced limp.
“Aside from the debilitating back spasms, the worst part was that I lost
my identity,” he says. “I was always physically active and enjoyed physical
hobbies like running, but I had to stop everything when the pain took
control of my life.” His search for relief was compounded by the fact that
he was deeply reluctant to take heavy-duty narcotics because he had seen
people on painkillers become addicted. For nearly a decade he bounced
from one doctor to another, desperate for an alternative but often having
his concerns dismissed—until he found Dr. Padma Gulur, director of the
UC Irvine Health Center for Pain Management.
Her approach was different from the outset. At their first meeting she
and her team spent more than an hour with him, seeking to uncover clues
that other doctors had possibly overlooked. “Pain is very challenging to
treat, especially when it becomes chronic,” Gulur says.
A subsequent MRI revealed that Parris had an undiagnosed compression
fracture at the base of his spine. Because it had been untreated for so
long, the injury damaged nerves throughout his entire spinal column.
Parris underwent a radiofrequency nerve ablation, a procedure in which
the nerves are cauterized so they stop sending pain signals to the brain. He
felt relief immediately. An hour after his first treatment, he says, “my wife
saw me walk like a normal person for the first time in three years.”
Today, his pain is considerably less severe, and he is able to get a full
night’s sleep. “I have to go in for periodic tune-ups because the nerves
eventually grow back,” says Parris, now 32, who lives with his wife in
Huntington Beach and works in a family business. Under the moniker TAP
Forge, he is now able to devote much of his time to the physically demanding
hobby of bladesmithing, which involves forging and hand-carving knives. “In
many ways, I feel like Dr. Gulur gave me my life back,” says Parris.
The Center for Pain Management, led by Gulur, employs a suite of
different strategies to customize a comprehensive care plan aimed at
alleviating acute or chronic pain, whether it is caused by cancer, arthritis, headaches or serious injuries. “We do
a thorough assessment and then map
out a treatment plan that includes
various modalities, because no single
treatment is completely effective,”
Gulur says. “That’s what sets us apart—
we take the time to understand the
right plan for the patient.”
Generally there are two types of pain:
nociceptive pain, which is throbbing or
aching pain caused by inflammation
in the organs and musculoskeletal
system, and neuropathic pain, when the
nerves are damaged and the pain feels more like a burning sensation as it
radiates from one side to the other and disrupts sleep.
“Neuropathic pain is more challenging to treat and get under control,”
says Gulur. “And not all pain is equal, which is why each type should be
targeted with different treatments. Many patients have a combination so
you have to target both. Unfortunately many patients wait too long to come
in, and by that time the pain has taken up residency and become chronic.”
Consequently, pain specialists at the center take an approach that
employs a combination of medications, physical therapy, biofeedback,
massage and leading-edge interventions like radiofrequency nerve ablation
or transcutaneous electrical nerve stimulation (TENS) therapy, which
uses electrical shocks to dampen nociceptive pain. They’re also looking
at new medications and novel interventions that include spinal cord and
peripheral nerve stimulators to relieve nerve pain, stem cell therapy and
platelet-rich plasma treatments to rebuild damaged tissue and bones, and
cooled radiofrequency that targets nerve pain.
In the future, Gulur and her colleagues hope to personalize treatments
even more by using blood tests that identify genetic markers to
determine which medications will work for individual patients.
They’re careful to monitor patients who are taking opioids—which
include OxyContin, Demerol and Dilaudid—to prevent addiction or
accidental overdose. In 2012 there were more than 1,800 opioid-related
deaths in California, and nearly three-quarters of them were linked to
abuse of prescription pain medications.
“We do risk assessments as well as educate patients about safe
storage and disposal,” Gulur says. “We want their pain treated while
making sure it is being done in a safe way.”
Patients also find relief at the UC Irvine Health Susan Samueli
Center for Integrative Medicine, which offers several approaches that
complement traditional pain management techniques. These include
acupuncture, osteopathic and therapeutic massage, restorative yoga and
classes in Egoscue movement, which helps people with joint pain.
Mindfulness-based stress reduction is also taught at the center. “While
its primary purpose is to help people manage stress, mindfulness was
originally introduced for pain management,” notes Laurie Macaulay, the
Samueli Center’s associate director.
“The good news,” Gulur concludes, “is that we now have a wide array
of tools to relieve suffering and get people back to normalcy.”
Normalcy is just fine with Parris. “The pain is tolerable,” he says, “and I
can actually function. Because of UC Irvine Health doctors, I now have the
freedom and independence that I fought for in the first place.”
Learn more about pain management at ucirvinehealth.org/pain.
— UC Irvine Health Marketing & Communications
Featured in UC Irvine Health Live Well Magazine Winter 2016