Spine center offers continuum of care

HELP FOR PAIN: Dr. Alexios Carayannopoulos, director of the new Comprehensive Spine Center at Rhode Island Hospital,  displays diagnostic equipment at the Lifespan facility. / PBN PHOTO/ MICHAEL SALERNO
HELP FOR PAIN: Dr. Alexios Carayannopoulos, director of the new Comprehensive Spine Center at Rhode Island Hospital, displays diagnostic equipment at the Lifespan facility. / PBN PHOTO/ MICHAEL SALERNO

More than merely a “pain in the neck,” back pain, which costs Americans $50 billion annually, will affect 80 percent of us at some time. The second-leading cause of lost work time, low-back pain is also the third-most-common reason for surgery, reports healthypeople.gov.

Surgery should not be the first, last or only option for back pain, said Dr. Alexios Carayannopoulos, medical director of Lifespan’s new Comprehensive Spine Center. Based at Rhode Island Hospital, it offers on-site physical therapy, occupational therapy, spinal procedures, injections and psychological comanagement of pain, and referrals to trusted chiropractors, acupuncturists and massage therapists.

Access, quality care and outcomes are the focus of the one-stop shop, said Carayannopoulos.

“We look at the patient as a customer,” he said.

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“With few, if any, comprehensive spine centers in Rhode Island, it was part of my ‘master plan’ to establish the [9,000-square-foot] center,” said Carayannopoulos, who came from Lahey Hospital & Medical Center in Burlington, Mass., where he built a comparable program. Possessing anesthesiology, nursing, PT, OT and pain- management expertise, the 18-person team works within the hospital’s neurosurgery department and collaborates with its orthopedic surgeons.

One day before her microsurgery at the center, Gail Moakler advised others, “Have no fear.” With more than 40 years of chronic back pain, complicated by rheumatoid arthritis and a back plate, the Barrington resident found Boston physicians unhelpful. At the center, Moakler receives “very painful” spinal injections that offer temporary relief. Although her quality of life is no better, she is grateful for the compassionate care she receives.

“I may be 70, but I want to have fun and enjoy my family,” she said.

Back injuries hurt businesses, too. Twenty-five percent of U.S. employees report low-back pain, notes the Integrated Benefits Institute, a research organization for businesses. For every 100 employees, low-back pain costs employers about $51,400 annually in medical expenses, lost work time and associated costs. Nationally, back problems represent 20 percent of all workplace injuries.

Consider statewide data: During the past decade, back pain has been – and remains – among employees’ top three conditions for Temporary Disability Insurance claims. R.I. Department of Labor and Training statistics (from 2010, when the DLT last recorded injured body parts) show that back and spine injuries were responsible for 23 percent – the largest percentage by far – of injuries keeping employees out of work for three or more days.

Providers concur that absenteeism varies widely among patients, but differ on preferred treatments.

Recommending the “tincture of time” and injections, Dr. Stuart Schneiderman administers spinal steroid injections to patients at Southern New England Anesthesia and Pain Associates in Pawtucket. His patients, the vast majority of whom heal without surgery, generally have an L4-L5 disk injury due to age, injury or otherwise. “I’m doing bread-and-butter [procedures] to get the pain more manageable and … the healing process going,” said the board-certified anesthesiologist.

For Dr. Alan Daniels, of University Orthopedics, the first approach for work-related back injuries, disc herniations and degenerated discs is physical therapy. Operating at The Miriam Hospital and Rhode Island Hospital, the orthopedic spine surgeon prescribes a coordinated regimen of PT and OT for his pre- and post-surgical back patients.

“New PT protocols and advances in minimally invasive surgery are getting people back to work faster,” he said.

Dr. Maria Guglielmo, Kent Hospital’s medical director of neurosurgery, treats patients with complex spinal disorders, but recommends spinal surgery only “for very specific cases,” she said.

With an extensive PT program, Kent Hospital has dedicated a floor and nursing staff for post-surgical spine and joint patients.

An estimated 60-70 percent of the Lifespan center’s patients have degenerative spinal pain, from age, wear and tear or poor posture; 10-20 percent experienced workplace injuries, trauma or car accidents; and the balance have acute injury pain.

Balancing growth with efficiency and quality care is the biggest challenge, Carayannopoulos said.

“Our bottom line is improving pain, function and productivity,” he said. •

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