Earlier this summer, Dr. S. Chris Tian, an expert in interventional pain management, became the first doctor in Rhode Island to perform a new treatment for patients looking for relief from a specific kind of chronic lower back pain known as vertebrogenic pain.
Tian performed two Intracept procedures at University Orthopedics Inc.’s East Bay Surgery Center in East Providence. The procedure works by targeting the basivertebral nerve in the spine with radiofrequency energy. During the procedure, Tian used a probe to heat the nerve, so it is unable to transmit pain signals to the brain. The procedure is also minimally invasive, implant-free and takes approximately one hour to complete.
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PBN: Can you explain the differences between this procedure and previous treatments?
TIAN: This is the first proven, nonsurgical procedure that is able to treat chronic lower back pain long term. Before this procedure, we would typically either try injections such as epidurals or radiofrequency ablations but that would result in suboptimal pain relief, as the primary mechanism of pain is not being targeted. At that point, unfortunately, the next option would be a surgical procedure in the form of a discectomy.
The Intracept procedure has proven to provide people suffering from chronic vertebrogenic pain resistant to conventional treatments long-lasting relief – with about one-third of the patients pain-free for five years after the treatment, and the other two-thirds experiencing a more than 50% reduction in pain.
PBN: How have you seen the opioid crisis in Rhode Island affect the pain management specialty?
TIAN: The opioid crisis has made chronic pain management extremely challenging. While still serving an important medical purpose, the long-term use of opioids for people with chronic conditions can be a double-edged sword. The drugs may provide relief, but side effects, including addiction, are always a concern. Any physician who prescribes opioids is obligated to educate patients about their condition and the role opioids may play in their treatment.
We must then closely monitor these patients for compliance to make sure they’re taking the medication as prescribed. We also look for signs of tolerance, hyperalgesia – which is when your body overreacts to pain – and abuse. It is also vital that we continue to use different interventional tools – like the Intracept procedure – as well as surgical procedures, when necessary, to treat underlying causes of pain to further reduce opioid use.
PBN: How has your background prepared you to be the first doctor in the state to perform this procedure?
TIAN: I started my career in Houston, Texas, where I conducted five years of research pertaining to the management of chronic pain. There, I obtained my residency training and completed my fellowship in pain management. I then practiced in Wisconsin, where the focus was more of a broad scope in treating chronic pain using interventions such as epidural injection therapy; ultrasound-guided nerve blocks; vertebral augmentation; neuromodulation, including peripheral nerve stimulation, along with spinal cord stimulation; and intrathecal drug delivery systems to help patients manage their pain.
I moved to the Northeast in 2018 and began practicing at a more specialized practice at University Orthopedics treating primarily spine-based conditions such as chronic neck/low back pain, post-laminectomy syndrome and complex regional pain syndrome.
My background, which is comprehensive in both research and technology, has well-prepared me to pioneer a new approach to managing chronic low back pain in a noninvasive procedure with minimal risk and no recovery time. My research experience ensures that I not only have confidence this is an effective treatment option, but that it is also a safe and successful alternative to surgery that is backed by well-established evidence and is research-based.
PBN: Are there other nonsurgical pain management options?
TIAN: There are multiple nonsurgical pain management options. Sometimes surgery is necessary, but not always. That is why at University Orthopedics, we customize treatment for each of our patients, utilizing a comprehensive approach for chronic pain management that includes pharmacotherapy, physical therapy, interventional procedures, including radiofrequency ablation for osteoarthritis, epidural steroid injection, basivertebral nerve ablation for bony and discal back pain, spinal cord stimulation and target drug delivery system, to name a few.
PBN: What are the current trends in pain management?
TIAN: Minimally invasive procedures such as spinal cord and peripheral nerve stimulations, nerve ablation procedures, as well as other endoscopic surgeries are becoming more popular to treat the underlying causes of chronic pain, providing long-term benefits.
As innovators in our field, my colleagues at University Orthopedics and I are always on the cutting edge, developing and researching how we can get our patients back to doing what they love with the least-invasive interventions and treatments possible.
