Janet Lazzaro

Breaking Through the Pain: Therapies To Get Your Life Back
September 2009

Janet Lazzaro had a history of back trouble; she’d had spinal disc surgery when she was only in her twenties. That resolved her problem for several decades, but when she was nearing her 60’s she hit a wall of pain.

“It got to the point that I couldn’t even push a grocery cart through the store,” says Lazzaro. “The pain was that bad.” Not only was the pain immobilizing, it was exhausting, so she constantly felt fatigued.

Janet had a second back surgery. But her condition, spinal stenosis putting pressure on the spinal cord, was not relieved. That’s when her neurosurgeon recommended she see the specialists at Greenwich Hospital’s Sackler Center for Pain Management.

“I didn’t even know there was such a thing as ‘pain management’,” recalls Lazzaro. But she became a believer after her first visit. Paul Sygall, MD, a pain management specialist, spent more than two hours with her discussing her history and considering her options. “He gave me a lot of hope,” she recalls.

A Multi-Specialist Approach to Pain
“Pain management is a relatively new subspecialty,” says Dr. Sygall. “It had minimal recognition until the mid-1980’s with the development of the International Association for the Study of Pain. Since then, it has grown to encompass many disciplines. We work with surgeons, oncologists, physiatrists, psychiatrists, internists, pharmacists, and physical and occupational therapists. We may also involve the hospital's integrative medicine and spiritual care providers. Pain is multi-factoral and crosses over so many lines.”

The process begins by listening carefully to patients. As Dr. Sygall has learned over the years, “ninety percent of your pain diagnosis comes from the patient’s history.” In Lazzaro’s case, they first tried medication solutions. When these did not diminish the pain, they tried a neurostimulator.

Neurostimulators work by sending an electrical current into the nervous system. The current “scrambles” the transmission of pain signals to the brain, relieving the pain sensations. Lazzaro initially wore an external device and when–to her joy–it worked, a permanent neurotransmitter was implanted in her spine. “The pain specialists at Greenwich Hospital gave me back my life,” she says. At age 69, Lazzaro enjoys all her usual activities, which include two-mile walks with her dogs.

Help for Short-Term, Long-Term or Unresponsive Pain
Pain is challenging to treat because everyone has a different threshold of pain tolerance, and there's no objective way to measure it. At the Sackler Center for Pain Management, patients may be seen for a pain consultation before or after surgery, or if they are suffering from longstanding pain syndromes that have been unresponsive to other therapies.

Pain can be related to nerves or muscles, or generated from a supporting structure. Cancer patients may have pain caused by pressure of a tumor or cancer cell secretions. While back or neck pain is the number one complaint, doctors often find pain being generated at multiple levels. New advances in pain management offer Sackler Center patients more options than ever:

• Nerve blocks, usually pain medications, local anesthetics or steroids, which are administered through injection directly into the source of pain.
• Infusion pumps, which most often deliver a steady, continuous dose of medication directly into the central nervous system. Pumps may be worn externally or implanted under the skin.
• Spinal cord stimulators (like Lazzaro’s), which mask pain by providing an alternative sensation and stimulating release of the body’s pain-killing endorphins.
• Radiofrequency and cryoanalgesia to diminish pain by selectively destroying nerve cells.
• Percutaneous Vertebroplasty, a minimally invasive procedure that helps relieve pain from compression fractures of the spine.
• Intradiscal Electrotherapy, a non-surgical treatment for disorders of the spinal discs.

Don’t Suffer In Silence
What are the most important things to remember about pain?

1. You are not alone. Greenwich Hospital offers support groups to share information and insights.
2. You are not imagining it. Pain is real.
3. Get your symptoms checked out. You may be surprised to learn that the pain you experience in one area is being caused by a different part of the body.

By postponing a visit to the doctor, you may be letting a condition worsen. A good guideline: If you have to think about seeing a doctor, it’s probably time to make the appointment.

The Sackler Center for Pain Management accepts referrals from your primary doctor or specialist. Or you can start the process by calling 203-863-3579.