A New Hope
NIH’s Dr. Tom McNamara provides non-opioid chronic pain treatment
Ena Bernor was a hard-working single mom when she first began to experience chronic back pain. Staying home or taking time off was not in the cards, and she worked through her pain for several years before it became intolerable. She finally filed a workman’s compensation claim (at 5’2”, she was regularly tasked with lifting 100-pound containers at her job) and started seeking medical advice.
Bernor was told by several physicians that the only hope for alleviating her back pain permanently was surgery. They ordered restrictions on what she could and couldn’t do at work, and told her she would need to have her neck pulled away from her spine in an operation that would cost her $7-8,000 out of pocket. It would also leave her with a fused spine, a task they planned to accomplish by taking bone from her hip. She was told that there was no guarantee the surgery would alleviate her pain.
Bernor did not get surgery and continued to work to support her family. She declined her doctor’s offers of pain medication. She held out for five or six years, until she had trouble leaving her home and eventually her bed. Around that time, Bernor was prescribed a Fentanyl Transdermal Patch for an unrelated procedure by a pain doctor.
According to the National Institute on Drug Abuse, Fentanyl is a synthetic opioid similar to morphine; except that it is 50 to 100 times more potent. Bernor found the Fentanyl alleviated her back pain and the pain from her surgery—at first. “The fentanyl patch treated the excruciating pain until it didn’t. It was like my body got used to it, and after a while, it was not killing the pain like it had in the beginning,” said Bernor. Her doctor switched her prescription, adding another opioid, called Dilauded, or hydromorphone. She started taking three Dilaudid pills a day in addition to using the Fentanyl patch. When she told her doctor that the medication was no longer easing her pain, her dose was doubled. Eventually, Dilaudid stopped working altogether, and she switched to taking three to four Percoset a day.
Bernor said she took pain medication daily for about nine years. She said the prescription opioids never got rid of her pain, but did take the edge off. “They made me groggy, and my memory was really bad,” she said. “It made me tired, and still, on a scale of one to ten, my pain was at a four or five.” The longer she took them, the less effective they became.
After about 15 years of back pain, Bernor scheduled an appointment with Dr. Tom McNamara at Northern Inyo Hospital. Dr. MacNamera is a pioneer in interventional radiology and Professor Emeritus at the University of California Los Angeles who now practices as an Interventional Pain Management Specialist. According to Dr. McNamara, Interventional Pain Management involves treating chronic pain at its source, often using injections of analgesics or steroids at the site from which the pain emanates. It’s a multi-disciplinary approach that is often combined with physical or occupational therapy and modifications to diet and exercise. Northern Inyo Hospital Executive Director Dr. Kevin Flanigan described it as “the radiologic study of and intervention of pain through injections at the point of inflammation and irritation,” in contrast with a prescription opioid painkiller, which targets the brain.
