Christiana Grenoble – Pain Management

Christiana Grenoble remembers the exact moment she knew she had hurt her back. “It was during a Tai Chi class,” she says. “I was in the middle of one of the harder postures, already on one foot. As I twisted into the pose, I heard a pop in my back and that was it.”

It was November of 2010, and Christiana was hardly a novice. She’d been doing Tai Chi for 20 years, a martial art widely known for its sequences of graceful movements and even transitions, a moving combination of yoga and meditation. “That’s true,” she says, “but Tai Chi can also get pretty ‘out there,’ pretty rigorous.” She’s no stranger to rigorous activity, having been a practitioner of Kung Fu as well, and accustomed to exercising every day.

In her early 40s, Christiana was accustomed to the occasional backache after a strenuous workout, but they always resolved within a day or two. So when she felt the pop, she figured she’d be OK after taking it easy for a few days. In fact, she waited about six months, thinking – and then hoping – the problem would just go away. When it didn’t, she made an appointment with her family doctor. “I was in a lot of pain at that time,” Christiana remembers. “I couldn’t walk more than 50 or 100 feet without problems. And my foot was starting to go numb. I couldn’t manage – I couldn’t even do normal household activities anymore.” Knowing Christiana’s high threshold for pain, her doctor suggested that she go to physical therapy and see a pain management doctor. “She didn’t want to just give me a prescription for pain killers; she wanted me to see a specialist,” Christiana remembers.

To call her experience with the first pain management doctor unsuccessful is being charitable. “It was a nightmare,” Christiana says flatly. “He put me through a series of tests, first saying I had this condition and then that condition. And he kept giving me medications like oxycodone that were just way too strong, crazy stuff. I couldn’t sleep; I was edgy all the time. I thought that must be what methamphetamines felt like.” Distressed, and with worsening pain, she stopped seeing that doctor and weaned herself off the narcotic drugs.

She treated herself with over-the-counter Motrin while she looked for appropriate medical care. She was referred to various area orthopedists and chiropractors, who were stymied by her presentation – she was even briefly treated for a slipped disc, without success – and finally, it was suggested she see Dr. Sureja for pain management.

Based on her previous experience, she was skeptical, but made the appointment anyway. “He seemed awfully young, but I felt like he was genuinely interested in helping me,” Christiana recalls. Ever pragmatic, she added, “I figured it could take a while to figure out what was wrong, so I decided to give him two years.”

Dr. Sureja picks up the story. “Throughout the course of her previous treatments, she’d tried various anti-inflammatories, pain medications and non-specific steroid back injections, but they hadn’t helped,” he notes. “I conducted a thorough examination, and reviewed her imaging with her. I suspected her pain was coming from inflammation and arthritis within one of the facet joints, one of the very tiny stabilizing joints located between and behind adjacent vertebrae.” Dr. Sureja observed some swelling around the joint, which “…could have indicated that she might have stressed that area doing one of her Tai Chi exercise,” he says, “we just weren’t sure. Based on how she described her pain – where the findings were located on the MRI and what her physical exam showed – we thought it was probably coming from that tiny little facet joint.”

Dr. Sureja sought to prove his theory of Christiana’s pain, and performed a facet joint injection, a procedure that is done for both diagnostic and therapeutic reasons. Dr. Sureja explains, “Under x-rays, we placed an anesthetic into her joint to determine how much improvement she had over her usual pain. What we found by doing that was that she had significant and tremendous improvement.” Christiana recalls, “He basically found the spinal joint and re-created the pain. Literally, when he put the needle in me, it caused me exactly the pain I felt when I was standing up or walking.”

Once he confirmed that her pain was coming from that particular joint, Dr. Sureja then injected cortisone, which gave Christiana several months of relief. The next step was a medial branch block, another diagnostic procedure which temporarily interrupted the pain signal from the medial branch nerves to the facet joint. She remembers it well: “It was amazing. I had resigned myself to the fact that I was going to suffer the rest of my life, but when he found the nerves and put in the medicine to block them, I felt better immediately. I felt 75% better.”

And it will get better still for Christiana: Dr. Sureja plans to perform a radiofrequency ablation. “We’ll cauterize the nerves going to her joint to help block the painful impulses coming from the inflamed area,” he says, noting that “…it may need to be repeated at some point, especially for someone like Christiana who is extremely active and doesn’t want to continue getting cortisone – and who is adamant about avoiding narcotic pain medication.” But he adds that in some cases, patients who undergo the procedure have no return of pain. Radiofrequency ablation is safe, and performed in Dr. Sureja’s office without general anesthesia. She’ll even be able to return to her job as a computer programmer/engineer the next day.

Christiana is looking forward to the next step. She’s already regained a lot of her quality of life and function, because Dr. Sureja was able to specifically pinpoint where her pain was coming from, and diagnose it successfully. She’s lost 50 pounds and is anticipating a healthy, active lifestyle. Her goal – which she once believed unattainable – is now within her reach: “I want to be able to walk without suffering. I want to be out of pain, without having to take medication every day.”

For patients like Christiana, Dr. Sureja knows, chronic pain is debilitating above and beyond the physical stress it imposes. “For many people, there are psychosocial changes that can occur with pain and loss of function – depression, anxiety, a sense that their self-worth has decreased,” he notes. “But with improvement in x-rays and diagnostic imaging like MRI, we’re able to see the structures in the spine more clearly. We’re able to pinpoint the pain and treat that specifically, rather than simply masking it or putting somebody on opiates for the rest of their lives.”

As for Christiana, she considers herself lucky to have medical insurance that will cover the costs of her treatment. But, she adds, “Even if I didn’t, I’d save the money to have these procedures. It’s very exciting.”