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++++++++++++++++++++++++++ + +++ +CLINICAL SPOTLIGHT ��� +++ ++++++++++++++++++++++++++ Englok Yap, MD, is a board-certified anesthesiologist and pain management specialist who joined the Cleveland Clinic Department of Pain Management in 2011 after completing a 3-year Anesthesia residency and an 18-month Pain Management fellowship at Cleveland Clinic. Interventional Trends in Pain Management By Robert Janek C HRONIC PAIN AFFECTS an esti- mated 100 million American adults ��� more than the total affected by heart disease, cancer and diabetes combined ��� according to a report released by the Institute of Medicine (IOM) in 2011. Often, when pain becomes chronic, traditional treatments such as non-narcotic analgesics and physical therapy are not effective. Neither are long-term narcotic treatments. ���The short-term use of opioids might be appropriate for acute pain, but there���s not much data that shows that long-term use of opioids is beneficial in many situations 28 | Cleveland/Akron/Canton MD News for chronic pain,��� says Cleveland Clinic anesthesiologist/pain management specialist Englok Yap, MD. In fact, the opposite has proven to be true. In addition to the risk of abuse and addiction, long-term opioid use can result in immunosuppression, hormonal imbalances, constipation and other negative side effects. It also has the potential to increase anxiety and depression and, in some patients, can cause increased pain. As an alternative, interventional procedures such as spinal cord stimulation (SCS) and an outpatient minimally invasive lumbar decompression (MILD) ��� MDNEWS.COM ��� JANUARY-FEBRUARY 2013 procedure for spinal stenosis are playing a more significant role in chronic pain management. Spinal Cord Stimulation (SCS) Although SCS is not new for patients with spinal cord injuries, recent expansion of its use for chronic pain management is. SCS involves the implantation of a small electrode array, similar to multiple pacemakers, on a temporary or permanent basis. Once implanted, the device delivers controllable electrical impulses to the spinal cord to modulate pain and improve the patient���s mobility and physical functionality, which can be especially beneficial during physical therapy sessions, as well as during activities of daily living. The amount and level of electrical impulses can sometimes be gradually reduced when the patient no longer needs SCS for pain control. ���At Cleveland Clinic, spinal cord stimulation has traditionally been utilized for patients with persisting pain after lumbar spine surgery. Recently, we���ve expanded its