Virginia Duprey just wanted to go out dancing. But the Newark woman, now 62, had long been sidelined by chronic pain from a childhood back injury that often forced her to rely on a cane or a walker, plus massive doses of powerful drugs, just to navigate life.
That began to change about two years ago, when Duprey met Dr. Jason Chiu, the director of pain management at Newark Beth Israel Medical Center. Chiu opted instead to treat her using a new take on an older treatment, a combination of radio frequency and cooling that deadens nerve pain, available at only a handful of sites statewide. The results were powerful.
“The pain I was suffering was tremendous,” Duprey said. But the treatment “worked really good. I am no longer walking with a cane or a walker. I feel like a new person!”
In addition, Duprey said she rarely needs painkillers anymore. “There wasn’t a day that goes by that I wasn’t popping pills — the strongest ones they had,” she recalled. “Now I might take them once in a blue moon. I don’t like taking pills.”
Duprey’s experience, and the work of Chiu and others, is part of a larger trend in which patients, physicians, and policy makers are seeking to move away from opiates and other addictive medicine when it comes to treating pain. Narcotics and other drugs — which experienced massive growth in recent decades as clinicians put greater priority on addressing pain — have now come under fire themselves as addiction rates skyrocketed in states like New Jersey.
State and federal officials have rolled out new regulations aimed at shifting the way physicians approach pain treatment, encouraging them to consider non-narcotic approaches first and be cautious and conservative when they do prescribe addictive drugs. Last month Gov. Chris Christie signed what may be the nation’s strictest limit on opiate prescriptions, permitting only five days worth of drugs for acute pain patients at first, plus a mandate requiring doctors discuss opioid risks in detail with young patients and track their use carefully.
Providers are also altering the way they approach pain care. Early last year leaders at St. Joseph’s Regional Medical Center in Paterson launched a program to reduce the number of addictive drugs dispensed for acute pain through their emergency room, one of the state’s busiest. Dr. Sagar Parikh, an interventional pain expert at the JFK Johnson Rehabilitation Institute in Edison, uses a similar multimodal approach — a mix of nerve blockers and physical therapy or alternative treatments like acupuncture — to address chronic pain caused by everything from arthritis to sciatica.
Chiu, who went to medical school in Texas and did an anesthesiology residence at what was then the University of Medicine and Dentistry of New Jersey, and now part of Rutgers University, first encountered the “Coolief” technology he is now using during a pain management fellowship he did at a public hospital in Chicago. That experience involved a multimodal approach to pain relief that emphasized alternatives to opioids, he said.
His fellowship also led to a better understanding of the dangers of opioids, which can reduce respiration, cause memory loss, and lead to addiction, while providing diminishing returns for pain relief as patients become increasingly tolerant to the medication. By introducing other treatments, like Coolief, Chiu said he has helped many of his patients reduce or end their dependence on addictive painkillers.
Making patient comfortable
“This provides a bridge to bring them down [off opioids] at a reasonable pace, while at the same time making these patients comfortable,” said Chiu, who also runs a private practice with several locations in northern New Jersey.
While radio frequency has been used in the past, combining this technology with the cooling system has allowed physicians to treat a larger area more effectively and with fewer side effects, Chiu said. The patient is given a mild sedative and a local anesthetic before the physician makes a tiny incision and inserts small wires to deliver high-frequency radio waves to the inflamed nerves.
The process is often used to treat knee, hips, and back pain, Chiu said, and patients can usually walk out of the office within a half hour or so and many remain pain-free for at least six months.
“It’s both safer and a more effective way of treating pain,” Chiu said, noting that many of those he sees have tried many approaches with little relief. “It’s kind of a last resort for these patients and it gives them hope.”
‘…I’ll try anything’
Duprey was one of these last-resort patients. After dozens of diagnoses – “whatever it was at the time, that’s what they would blame it on,” she recalled, “it was like the latest fad” – and decades of treatments, the pain persisted.
“Nothing helped me,” Duprey said. “I would get frustrated, looking out the window and seeing everyone doing things, and I couldn’t do anything,” a feeling she said eventually led to depression.
When she heard about Coolief, Duprey thought, “sure, I’ll try anything.” Nearly two years later, she said her pain level is down and her quality of life has improved dramatically and she is eager to recommend the treatment to others with chronic pain. “You’re going to feel so much better,” she said, adding, “You’re walking, you feel great!”