Whether a patient presents with pain in the head and neck, foot and ankle, or any location in between, the goal of treatment is the same — the least invasive approach that will provide safe, effective pain relief with minimal risk or side effects. Dr. Genaro Gutierrez, a board-certified interventional pain specialist and SPR consultant, discusses how the non-destructive, minimally invasive SPRINT PNS System has provided the versatility to effectively manage pain targets from head to toe.
How did you get started with SPRINT PNS?
Before SPRINT PNS, my treatment options for patients experiencing pain from shoulder surgery or inoperable shoulder pathology were limited — periodic injections, nerve blocks that offered only temporary relief, ablations with variable success and the potential for post-procedure weakness, or in many cases, prescription pain medication.
With no great solution to offer these patients, I was immediately intrigued by the potential of the SPRINT System. My initial shoulder pain patients had impressive results, so I expanded my use of the SPRINT PNS to specific mononeuropathies. Again, I saw consistently positive outcomes. Since then, I have used SPRINT PNS with great success on pain targets throughout the body, from low back and foot and ankle pain to, most recently, head and neck pain and complex regional pain syndrome (CRPS).
In your experience, which patients are most likely to find treatment with SPRINT PNS appealing?
The SPRINT System is very versatile. I identify candidates on a broad spectrum of neuropathic pain, but also arthritic pain without an alternative treatment option. My patients with arthritis pain are typically very happy because SPRINT PNS works pretty quickly and doesn’t have the side effects of other treatments.
Beyond pain types, I find that SPRINT PNS is appealing to patients who are averse to any kind of permanent implant. It’s also a great option for patients who cannot discontinue blood thinners, and for those who are too sick or frail for surgery or a permanent implant.
Tell us about your experience with using SPRINT PNS for patients with head and neck pain.
I’ve been having great success with the SPRINT System in my head and neck patients. Lead placement feels very safe and familiar, particularly using fluoroscopy because you can see right where you’re landing.
My APPs are finding people with headaches who had previous ablations, chronic or repetitive occipital nerve blocks and almost every single one is enthusiastic about the possibilities of SPRINT PNS.
What experiences have you had using SPRINT PNS for patients suffering pain from CRPS?
From my perspective, SPRINT PNS has an advantage over dorsal root ganglia (DRG) stimulators and spinal cord stimulators (SCS) due to its reduced invasiveness, lower risk and decreased morbidity. And unlike DRG and SCS, the SPRINT device is not a permanent system. In fact, many of my patients have experienced several years of CRPS remission after a 60-day treatment with the SPRINT System. Given these results with my patient population, I haven’t seen the need to jump to a treatment like SCS when an effective, non-permanent alternative is available.
How have your patients responded to SPRINT PNS treatment?
The response has been overwhelmingly positive — both in the degree of pain relief they experienced as well as its longevity. Initially, I was concerned that patients may find wearing a device for 60 days cumbersome, but nearly all my patients have said they didn’t mind wearing it at all.
For patients whose pain returns, I ask whether they want to try the SPRINT treatment again or transition to a permanent system. Many quickly choose the SPRINT treatment again. Overall, the response is very, very good and some of my patients are saying “I would do this again, I’m really happy with it.”
What is some general advice you would give to a physician just starting their journey with SPRINT PNS?
Start with a few simple targets. Foot/ankle can be very easy and straightforward and so can low back. When starting with the shoulder, choose a thinner patient for better visualization and targeting.
I also encourage them to not let imaging be a barrier. The SPRINT MicroLead™ is designed to create a big monopolar field. When I first started using SPRINT PNS, I hadn’t touched an ultrasound in about six years and had to relearn how to use it. With some of the other PNS systems out there, you have to be really precise to get adequate coverage.
I also urge physicians to consider the potential of SPRINT PNS in managing arthritis pain. Many people believe that SPRINT PNS is only for neuropathic pain. However, both my personal experience and the experiences of my colleagues who use the SPRINT PNS System suggest otherwise. In these cases, I target two small nerves, and many of these patients almost immediately exhibit improved shoulder mobility, previously limited by arthritic pain, moving in ways that were previously very painful or even impossible. It’s not that the bone-on-bone arthritis has been reduced or that the bone spurs have gone away. The only difference is that the SPRINT PNS System is believed to recondition how the brain perceives the pain signals such that the affected area may not hurt as much. The SPRINT System is a great option to consider for these patients.
What would you say to a colleague who has yet to try SPRINT PNS?
We all have patients who would potentially benefit from this. It’s a low-risk procedure with a lot of potential upsides. Even if you’re the most risk averse pain physician, this is ideal — you’re not entering the spine, you can use the SPRINT PNS System if the patient is on blood thinners, and given the risk profile, it’s a good option to consider.
As interventional pain physicians, we offer more invasive, higher risk approaches for the same pain generators. We offer SCS for low back pain all the time. We offer SCS and DRG for CRPS and peripheral neuropathy all the time. Why not start with something a lot less invasive and lower risk? If SPRINT PNS fails, you can always go on to more invasive approaches. But I feel that offering SPRINT PNS first is many times the right thing to do and is a real service to many patients.
For more information, view SPR Therapeutics’ Clinical Outcomes & References for SPRINT PNS. Or call SPR at 844.378.9108 to learn how to expand your approach to pain.
* The SPRINT PNS System is not intended to be placed in the region innervated by the cranial and facial nerves.
The SPRINT PNS System is indicated for up to 60 days for: (i) Symptomatic relief of chronic, intractable pain, post-surgical and post-traumatic acute pain; (ii) Symptomatic relief of post-traumatic pain; and (iii) Symptomatic relief of post-operative pain. The SPRINT PNS System is not intended to be placed in the region innervated by the cranial and facial nerves.
Physicians should use their best judgment when deciding when to use the SPRINT PNS System. For more information see the SPRINT PNS System IFU. Most common adverse events are skin irritation and erythema. Results may vary. Rx only.
Important safety & risk information: https://bit.ly/2FU92NH