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BackTable / MSK / Podcast / Episode #40

Innovating Pain Management: The Role of Spinal Cord Stimulators in Outpatient Care

with Dr. Douglas Beall

In this episode, guest host Dr. Dana Dunleavy and guest Dr. Douglas Beall delve into the transformative potential of neuromodulation in the treatment of chronic pain, particularly for painful diabetic neuropathy (PDN). Dr. Beall is an interventional musculoskeletal radiologist practicing at Oklahoma Spine in Edmond, Oklahoma.

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Innovating Pain Management: The Role of Spinal Cord Stimulators in Outpatient Care with Dr. Douglas Beall on the BackTable MSK Podcast)
Ep 40 Innovating Pain Management: The Role of Spinal Cord Stimulators in Outpatient Care with Dr. Douglas Beall
00:00 / 01:04

BackTable, LLC (Producer). (2024, January 29). Ep. 40 – Innovating Pain Management: The Role of Spinal Cord Stimulators in Outpatient Care [Audio podcast]. Retrieved from https://www.backtable.com

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Podcast Contributors

Dr. Douglas Beall discusses Innovating Pain Management: The Role of Spinal Cord Stimulators in Outpatient Care on the BackTable 40 Podcast

Dr. Douglas Beall

Dr. Douglas Beall is the Chief of Radiology Services at Clinical Radiology of Oklahoma.

Dr. Dana Dunleavy discusses Innovating Pain Management: The Role of Spinal Cord Stimulators in Outpatient Care on the BackTable 40 Podcast

Dr. Dana Dunleavy

Dr. Dana Dunleavy is a musculoskeletal and vascular IR in Buffalo, New York.

Synopsis

Dr. Beall recounts his journey, from his beginnings in the military to his experiences with navigating institutional resistance to his clinical practice, and finally the process of moving to private practice. He discusses the positive impact of spinal cord stimulation on patients with PDN and reflects on its effectiveness in reducing pain and improving neurologic function. He underscores the crucial role of interventional radiologists in managing PDN, while also advocating for the integration of these specialists in pain management clinics. Dr. Beall argues that interventional radiologists possess unique skill sets adept for neuromodulation, which opens up new treatment possibilities in the process. He shares insights on the evolution of spinal cord stimulation technology, reimbursement considerations, and the importance of clinical trials in refining treatment approaches. The episode ends with an invitation for interested physicians to participate in professional forums and learn more about this burgeoning field.

Timestamps

00:00 - Introduction
02:30 - Challenges and Triumphs of a Solo Practice
14:44 - Evolution of Neuromodulation in Practice
17:05 - Impact of Neuromodulation on Painful Diabetic Neuropathy
31:53 - Unique Mechanism of High Frequency Neuromodulation
46:02 - Role of Interventional Radiologists in Neuromodulation
54:11 - Future of Neuromodulation in Interventional Radiology

Resources

Douglas Beall, MD Research Gate Profile:
https://www.researchgate.net/scientific-contributions/Douglas-P-Beall-39583252

Long-term efficacy of high-frequency (10 kHz) spinal cord stimulation for the treatment of painful diabetic neuropathy: 24-Month results of a randomized controlled trial:
https://pubmed.ncbi.nlm.nih.gov/37536514/

High-Frequency 10-kHz Spinal Cord Stimulation Improves Health-Related Quality of Life in Patients With Refractory Painful Diabetic Neuropathy: 12-Month Results From a Randomized Controlled Trial:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9256824/

Neuromodulation Interventions for the Treatment of Painful Diabetic Neuropathy: a Systematic Review:
https://link.springer.com/article/10.1007/s11916-022-01035-9

High-frequency spinal cord stimulation at 10 kHz for the treatment of painful diabetic neuropathy: design of a multicenter, randomized controlled trial (SENZA-PDN):
https://link.springer.com/article/10.1186/s13063-019-4007-y

Transcript Preview

[Dr. Douglas Beall]
The honor is mine, Dr. Dana Dunleavy. It's an interesting path and I think most of the time to realize where we are, you have to realize where you don't want to be. I came out of the military, started to practice. My office was actually in the Department of Orthopedics and I'd come back after a fellowship in MSK radiology from Mayo Clinic and really started off in interventional and I was taken by the military and didn't really have a chance to finish that fellowship. I was placed in the Department of Orthopedics and worked that as an amalgam, working a lot with those guys. Then when I went to the University of Oklahoma, I did an interventional call, which is every third night at a level 1 trauma center, and had a chance to work with orthopedics and work as an IR, without even having finished a fellowship in it.

Then when the chairman changed, what I had set up at the time, I had developed what I called “clinical practice programs” and these were an amalgam. These were problem-solving, pain-solving, and issue-solving programs where people would come in and at the time they were doing almost no vertebral augmentation. I set that up and immediately went from zero to hundreds of cases a year, a lot of which were fed by level 1 trauma centers, a lot of which are just garden variety, osteoporotic vertebral fractures, as you know. Then, they would come back and they'd have back pain that was unrelated to extension with twisting.

Okay, that's a different pain. Let's do some facet injections. They'd come back with radiculopathy and I'd do epidural injections and do an amalgam and very quickly expanded to doing pretty much everything. I saw people with complex regional pain syndrome and then got into neuromodulation and grew it really way beyond the bounds of just simple augmentation. We've always had these skill sets and always played around. I remember it in residency and I did it in Baltimore at the Johns, same as you, Dr. Dunleavy. We would do injections and we would do anything, interventional spine in its formative years. I brought those techniques to bear.

Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.

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Articles

Neuromodulation: A New Service Line for the Interventional Radiologist

Neuromodulation: A New Service Line for the Interventional Radiologist

Neuromodulation: A Solution for Painful Diabetic Neuropathy?

Neuromodulation: A Solution for Painful Diabetic Neuropathy?

Topics

Chronic Pain Condition Overview
Vertebral Augmentation Procedure Prep

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