Individuals who experience low back pain know the debilitating effects it can have – like missed workdays, reduced enjoyment of activities, and time spent in bed. Fortunately, medical advances have introduced options for relief, with UTMB striving to bring patients effective procedures to combat the pain.
UTMB’s Pain Management service in the Department of Anesthesiology is committed to helping patients with these needs. The team has experienced recent growth, offering more procedures to more patients at its main location at Town Center in League City, as well as in Clear Lake and Galveston.
They are also staying at the cutting edge of technology, offering a new and highly effective procedure called Intracept for chronic low back pain.
Erik Hustak, MD, is the first physician at UTMB credentialed to offer Intracept. He explains that the procedure is different than the common nerve ablation procedure performed for axial back pain.
“It is still the ablation of a nerve, but the nerve that we are ablating is the basivertebral nerve, which actually lives in the vertebral body,” Dr. Hustak says. “This procedure is indicated for patients that have ‘vertebrogenic pain,’ which is pain coming from the vertebral body itself.”
Dr. Hustak says patients with this type of pain will have what are known as modic changes on an MRI, showing the natural progression of degenerative disc disease with concomitant adjacent level vertebral body changes. Those with this indication, who have experienced axial pain (not radiating down the legs) for more than six months, may be candidates for the Intracept procedure now offered at UTMB.
The procedure is minimally invasive, with a trocar inserted safely in the posterior aspect of the vertebral body. A curved cannula is then utilized to access the precise location of the basivertebral nerve and a probe is placed for to conduct the ablation which takes seven to 15 minutes.
“It’s not fixing the degenerative process, but it’s like a breaker turning off the nerve that is radiating pain coming from a diseased endplate-disc interface,” Dr. Hustak says.
As literature has supported the safety and effectiveness of Intracept, Dr. Hustak says it has become easier for patients to gain Medicare and commercial insurance approval. Now, as more patients are able to undergo the procedure, more UTMB faculty members are on the way to becoming credentialed for it.
For primary care physicians referring patients who report experiencing back pain, imaging can help determine the next course of action, particularly if the patient has had pain for more than six months.
Dr. Hustak says the collaborative relationship between departments and services helps to ensure the patient is matched to the right intervention.
“We all work together – ortho spine, neurosurgery – and in our spine center we literally sit next door to one another. We have shared space, and that has improved our collaborative relationships,” he says.
Although most patients who are indicated for this procedure are in their 60s and older, Dr. Hustak notes that some patients between their 40s and 60s are showing modic changes on their MRI. Whether to intervene, he says, depends on whether the clinical exam and patient history supports it. Occasionally, he has seen this in even younger patients, usually due to the physical nature of their occupation.
“For the right patient, with the right indication, it is a really great procedure,” Dr. Hustak says.
Intracept is performed as an outpatient procedure, with the patient going home the same day. Recovery is generally described as easy. The patient may only have a Steri-Strip or two on their back, and “wonder if we even did anything,” Dr. Hustak says. The patient may experience soreness for three or four days but should be walking normally and can usually return to work pretty quickly.
The pain relief is also pretty immediate. However, just because the procedure is effective, it does not guarantee the patient to be pain-free forever. Physical therapy, focusing on core strength, flexibility, and mobility, plays an important role in helping the patient combat pain. Dr. Hustak also asks all of his patients to focus on their nutrition, sleep, and mental health when dealing with a chronic pain condition in a holistic approach to the underlying problem.
“Once we get therapy on board and everything else, at the one-month follow-up, and two- and three-month follow-up, we're seeing really great results,” he says. “The literature conducted shows promising benefit specifically for a pain intervention. There's some great level-one evidence showing pain relief is not just six weeks, but it's extending out two years, five years.”
 | Erik Hustak, MD sees patients at the UTMB Pain Management Clinics in League City Town Center, Clear Lake, and Galveston. Learn more about Pain Management services at UTMB. |