Non-Operative, Interventional Treatments for Spinal Cord Injury Pain
The University of Maryland Spine Program, part of UM Orthopaedics, is a regional leader in surgical treatment for spinal cord injury (SCI). However, the program also offers solutions for spinal pain beyond medical management, physical therapy and surgery; these include image-guided injections, other interventional spine procedures and even acupuncture – which now has clinical evidence of being efficacious for many patients in reducing spinal pain and improving other chronic complications produced by SCI1.
Interventional Pain Management for SCI and Other Conditions Causing Back Pain
The program’s Physical Medicine and Rehabilitation Specialist, Kendall L. Buraimoh, MD, assistant professor of neurology and orthopedics at the University of Maryland School of Medicine, provides a wide range of care beyond SCI rehabilitation. This dual appointment and background assist her in navigating patients’ pathophysiology of spinal conditions so she can prescribe and administer the ideal nonsurgical course of treatment, including electromyography (EMG) and nerve conduction studies to accurately diagnose the etiology of spinal pain as musculoskeletal, neuropathic or a combination of the two. Should patients require spinal or musculoskeletal injections for diagnosis or as part of nerve block or corticosteroid treatment, she administers them accurately through either fluoroscopic or ultrasound-guidance. Dr. Buraimoh also specializes in other interventional procedures to manage spinal pain, such as radiofrequency rhizotomy.
Acupuncture: A Complementary Option to Improve Pain Relief & Function
Traditional Chinese Medicine is offered at UM Orthopaedics as a complementary therapy to enhance relief from spinal pain. The Spine Program’s two licensed acupuncturists specialize in auricular acupuncture, using needles a fraction of the size of those used in other acupuncture procedures. They are also experts in Chinese herbal medicine, cupping to increase blood circulation, and tuina, which involves pressure on specific acupoints and muscles to encourage circulation and reduce pain. New patients are typically seen two or three times per week and then every two weeks once their pain is well-managed.
While acupuncture is an area in need of more high-quality clinical studies (a clinical trial at the R Adams Cowley Shock Trauma Center is seeking to rectify this), clinical evidence exists that it is particularly beneficial for patients with musculoskeletal spinal pain (80% for whom it provided pain relief) and may be of use for neuropathic pain (42% of patients experienced reduced pain2).
Moreover, Fan et al. cite evidence that acupuncture provides benefits in managing other complications of SCI, including motor and sensory dysfunction, incontinence, and spasticity among others. These researchers surmise that the mechanisms by which acupuncture may work are by decreasing stress, preventing inflammation and neuronal cell death, improving the expression and activity of biological mediators at the cellular level, and boosting the production of stem cells that can regenerate damaged tissues.
Anecdotally, the providers at UM Orthopaedics have found that acupuncture is beneficial for many patients and can help reduce reliance on opioids.
UM orthopaedic physicians are board certified and fellowship-trained. As part of an academic medical center, they are heavily involved in research and teaching in addition to clinical care.
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1Fan Q, Cavus O, Xiong L, Xia Y. J Acupunct Meridian Stud. 2018 Aug;11(4):124-132. doi: 10.1016/j.jams.2018.05.002.