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Injecting Hope into a Lifetime of Pain
By Healthy Life Fall 2008



For Jill Joyce, a 36-year-old Lynn science teacher, back pain had become a way of life. “There was never any relief from the pain—it was always there. Standing in front of my classroom was a challenge and sitting was not an option because it was too painful. There was no escaping it,” Joyce said.

The cause of Joyce’s back pain went undiagnosed for more than 15 years. In high school, doctors blamed her back pain on cheerleading. They thought the pain was muscular and caused by the physical demands of jumping, flipping and lifting others.

The pain subsided during college, but when Joyce was 23 and involved in a minor car accident the pain returned and was worse than ever. Her back would tighten up doing simple tasks like emptying the dishwasher. Lying on the floor was the only thing that alleviated the pain.

Joyce was told by her physician to do core-strengthening exercises and to take prescribed muscle relaxers. The problem persisted and got worse after she had her children. The lifting and carrying really took a toll on her back and her life. Joyce decided to seek another opinion and changed her primary care physician to NSMC’s James Brown, M.D. He referred her for an MRI, which revealed that she had degenerative changes in her spine and bulging of the discs—the cushions between the vertebrae—and these changes were interfering with nerve function and causing pain.

NSMC neurosurgeon and spine specialist, Terence Doorly, M.D., evaluated Joyce and decided the first course of action should be a comprehensive non-surgical approach. “I wanted to try to manage her pain with a variety of exercises, electrical nerve stimulation, medications and injections rather than surgery which is painful and has a long recovery time,” said Dr. Doorly.

After reviewing her case, Dr. Doorly decided that Joyce was a candidate for a minimally invasive nerve block procedure. NSMC pain management specialists, Minesh Patel, M.D., and Edouard Vaynberg, M.D., injected a combination of anesthetic numbing agents and anti-inflammatory drugs into different locations in her spine to pinpoint the source of the pain.

In September, after injections adjacent to her third and fourth lumbar vertebrate, she noticed an immediate end to her pain. The effectiveness of pain injections varies for every patient. Some enjoy pain relief for several months after the injection. For Joyce, her pain returned after three weeks. The next step will be a radio frequency ablation in November. During this procedure, Dr. Vaynberg will heat the medial branch nerve behind Joyce’s forth and fifth lumbar vertebrate and he will inject numbing and anti-inflammatory agents in the facet joint. This should provide Joyce six months of pain-free living. Depending on her reaction, she may need repeat procedures or eventual spine surgery.

For now, Joyce is living a less painful life than she was a few years ago. “NSMC’s pain program has given me my life back,” said Joyce. “My care plan was seamless between Dr. Doorly, my physiatrist and the pain specialists. They worked together to find the cause of my pain and then took a systematic, conservative approach to my care. I know I have a long road ahead of me but I am optimistic that one day I will be free of pain."

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