First Cleveland Clinic Abu Dhabi patient on new technology can “sit in a chair without struggling to find a painless position.”

 
Abu Dhabi, United Arab Emirates, 05 October 2020:  Cleveland Clinic Abu Dhabi, part of Mubadala’s healthcare network, has expanded neuropathic pain management options for patients in the region by bringing new technology to treat chronic pain in the lower body, including the foot, knee, hip or groin, to the United Arab Emirates.

The therapy works with a small device implanted in the spine that stimulates the dorsal root ganglion (DRG), a structure densely populated with sensory nerves that transmit information to the brain through the spinal cord, enabling targeted pain management. DRG stimulation therapy is approved by the US Food and Drug Administration for causalgia – a severe burning pain in the limb caused by injury to a peripheral nerve – and neuropathic pain in the lower body and is currently only available in the UAE at Cleveland Clinic Abu Dhabi.

The therapy is recommended to patients who have failed to receive sufficient pain relief and quality of life improvements from other conventional treatments, including medications, nerve block, physical therapy and conventional spinal cord stimulation. This is done after a complete analysis of the patient’s history and current health conditions by the multidisciplinary pain management team at the hospital.
Abu Dhabi resident Jonathan Rogers who has had pain since a weightlifting injury from three years ago has become the first patient in the UAE to receive the treatment. 

“It began with a fractured bone in my foot and even after that healed the excruciating pain continued and was getting worse. It got so bad that during a return flight from a work trip I blacked out because of the pain,” says the 36-year-old patient. 
“I have had to give up a lot of things that I used to enjoy, like playing street hockey, lifting weights or going to the beach. I have been unable to travel for more than two years now and have had to avoid loud locations because the noise and vibrations worsen the pain.”
Rogers has been working with Cleveland Clinic Abu Dhabi’s neurology and pain management team since 2018. 

“The various treatments that I have been on have done little to alleviate the pain and it spread to the entire leg. Only now am I beginning to see improvements in my mobility and pain levels because of the addition of DRG therapy.”
Dr. Reda Tolba, the Department Chair of the Pain Management Department in the Anesthesiology Institute at Cleveland Clinic Abu Dhabi, who trained in the United States to perform this procedure, says a lot of patients who undergo surgeries for hernial repair, foot injuries and knee replacement end up with neuropathic pain.

“This can be debilitating and makes even simple, daily activities hard to carry out. The availability of DRG stimulation therapy in the UAE marks an important milestone in the treatment of chronic intractable pain conditions,” he says. 
“This sophisticated therapy brings the much-needed relief to patients suffering from focal nerve pain due to complex regional pain syndrome (CRPS) – a painful condition casing debilitating pain over the extremities and other parts of the body.”

Although the device was implanted very recently, Rogers says he has witnessed up to 50 per reduction in pain. 
“The biggest improvements are in the small actions that make up a big part of my daily life. It is easier to stand up; I can sit in a chair without struggling and I feel safer while standing.  
Dr. Tolba says the patient is seeing a difference now because of focused stimulation. “While the nerve block injections as well as spinal cord stimulation offer some relief, they are not precise enough or don’t offer long-lasting relief.”

Before the permanent implantation, done through an ambulatory surgery, the patient goes through a trial phase for a week where the device is placed externally to assess its effectiveness in reducing pain. 
If that works, the patient is implanted with special leads in the targeted area of the spine, connected through electrical wires and a battery. The battery delivers electricity to the leads that wrap around the DRG sensory neurons and pass electric impulses that distract the brain from perceiving pain.
“We work with the patient to program the best pain relief using a wireless controller. We also see the patient regularly to check wound recovery after surgery and pain levels. We rely on patient feedback about their ease in daily activities and use certain tools like a pain disability index to measure the degree of chronic pain,” says Dr. Tolba.

“The goal is to reduce or eliminate the need of pain medications that can have side effects or other pain management techniques. Recent international studies on its effectiveness have shown a significant reduction in patients' pain. We are seeing those results with our patients on this therapy, as well,” he concludes. 
Rogers says he is hoping for further improvements. “I know these things take time and will continue to work with the pain management team to find the best program for the implant to reduce the pain further. The medical team and staff at Cleveland Clinic Abu Dhabi have been wonderful throughout the process and if I had to pick people to work with all over again, I would pick the same people.”