But it wasn’t until he was referred by his primary care physician to Kevin Wong, DO, earlier this year that Hostler finally found significant relief. Dr. Wong, Board Certified in Anesthesiology, specializes in pain management at Eisenhower Desert Orthopedic Center.
“I had low back pain every day that was pretty unbearable, at a level of 8 out of 10,” Hostler says. “It was affecting my ability to simply live my life; I couldn’t walk any distance, go bowling, or just get up and go somewhere. We have a weekly VillageFest here in Palm Springs, and I couldn’t even walk around, get something to eat, look at things.”
The reason for Hostler’s chronic pain was, in a word, complicated.
“A physical examination and imaging revealed that his lower back had several issues, including herniated discs causing nerve impingement, and arthritis of the lumbar facet joints and sacroiliac joints,” Dr. Wong explains.
Facet joints make the back flexible and enable bending and twisting; there are two of them at each vertebra of the spinal column. Each facet joint is connected to two medial branch nerves that transmit pain signals.
“In a situation like Mr. Hostler’s, there are multiple pain generators, so I approach it step by step,” he continues. “First, I wanted to shut down the major pain generator, which was his lower-back facet-joint arthritis. Then we’d see what remained.”
Dr. Wong recommended a newer technique called radiofrequency ablation of the medial branch nerve. It uses heat generated by radio waves to destroy the nerve and turn off its ability to send pain signals to the brain.
“First we did two medial branch block tests,” he explains, referring to a procedure in which an anesthetic is injected near small medial nerves connected to a specific facet joint. “Mr. Hostler experienced 80 percent or greater pain relief lasting hours to days, so based on the success of the test, he was a candidate to proceed with radiofrequency ablation.”
Hostler underwent the outpatient radiofrequency ablation procedure on March 14. He was given a local anesthetic and mild sedation. Then, under X-ray guidance to ensure proper placement, Dr. Wong inserted a needle through the skin to deliver the radio waves to the six targeted nerves associated with three lumbar vertebrae.
“When I woke up, I had no pain in that region,” Hostler says. “It was instantaneous. After bearing it for so long, I couldn’t believe the difference.”
Dr. Wong explained that while the pain relief should last a long time, the nerves can regenerate and the procedure may have to be repeated.
Hostler still had some discomfort related to dysfunction in his sacroiliac joints, which connect the spine to the pelvis. For this, Dr. Wong administered corticosteroid injections, which brought his pain level there down to “about a 2,” according to Hostler.
“With lower back pain — or chronic pain of any kind — there can be multiple pain generators, and it takes a comprehensive, multidisciplinary and multi-modal approach to address it, versus a single medication or injection,” Dr. Wong says.
“In pain management, it’s so important to address the whole clinical picture,” he adds. “It’s not just about looking at the MRI or X-ray, but it’s also observing and listening to how a patient presents their pain, and what a physical exam reveals.”
“From my first visit, I was impressed by the amount of time Dr. Wong spent with me and listened to my concerns and pain issues,” Hostler says. “He asked me about my general well-being, not just my symptoms, which a lot of doctors don’t do.
“I also told him I knew there were other people who are far less fortunate than me,” he continues, “and he told me that I still deserved to have a good quality of life, and had a right to live pain free.
“I needed extra time to understand that and he provided it,” he adds. “He was really gracious.”
To contact Eisenhower Desert Orthopedic Pain Management Clinic, call 760.568.2684.
Pain Management Options
The specialty of pain medicine offers a growing array of options for managing chronic pain that go far beyond “take two and call me in the morning.” The pain management approaches in Dr. Wong’s tool kit, which are tailored to each patient’s individual needs, include:
Dr. Wong notes that while lower back pain is the most common pain complaint made to doctors, he also treats other chronic pain conditions including migraines, cancer-related pain, arthritis and other inflammatory diseases, and pain from autoimmune disorders.