Kelly Carnahan is no stranger to medical procedures.
For the past three years, 52-old Kelly Carnahan has been dealing with chronic back pain and has tried just about everything to get relief from her pain.
"I have a spreadsheet of all the things I've had done to try to get rid of my pain," said Carnahan.
This lengthy list of treatments includes multiple cervical spine fusions, cortisone injections, radiofrequency ablations, trigger point injections, dry-needling, physical therapy, and Botox injections.
Carnahan's neck is fused from C4 to T1. She has multilevel disk degeneration in her thoracic spine as well as severe bilateral facet arthropathy, neuroforaminal stenosis, and multilevel disk degeneration through her lumbar spine. Over the past three years, Carnahan has had treatments on all but five of her vertebrae.
"I am game to do just about anything at this point," said Carnahan.
Carnahan's most successful procedure might be her most recent: spinal cord stimulation.
Although Carnahan has worked with various providers across University of Utah Health, Zachary L. McCormick, MD, a board-certified specialist in both pain medicine and physical medicine & rehabilitation (PM&R), takes care of her spine issues.
"I've been working with Dr. McCormick for multiple years now," said Carnahan. "He is just a great person. Instead of saying 'you have chronic pain, deal with it' he does everything he can to find answers and come up with ideas of how he can treat my spine issues."
When McCormick joined U of U Health five years ago, there were few PM&R faculty members solely focused on spine care, along with one physician assistant. Now, there are eight PM&R faculty members who focus their efforts on spine care, along with a similarly sized group of physician assistants and nurse practitioners, working together as a very cohesive team both clinically and on research and educational efforts.
"We are able to take care of a lot more patients than we were just a few years ago," said McCormick. "There's a lot more access and help for patients like Kelly and others who are struggling with their spine health."
Carnahan struggled with chronic pain for quite a long time before she started seeing McCormick.
"The spine is complex—the anatomy is complex," said McCormick. "You're dealing with an intermingling of the musculoskeletal system and the nervous system. It is not uncommon, as with Kelly, that it can take some time to unpeel the layers of everything contributing to a given patients' symptoms."
Carnahan worked a lot with McCormick on diagnosing the underlying issues causing her so much pain, and how to best treat those issues.
"A lot of it had to do with connecting her to the right specialists," said McCormick. "There are highly skilled spine specialists across the U of U Health campus and having different points of view can help bring additional pearls of wisdom and insight to the table when we are formulating a care plan."
Before the spinal cord stimulator placement, McCormick treated Carnahan with a variety of different minimally invasive techniques that do not require an incision.
"These types of minimally invasive procedures—radiofrequency ablation and fluoroscopically-guided injections—they can work quite well for some patients," said McCormick. "Kelly responded fairly well to some, but we knew there was more we needed to do to improve her pain and function to an extent that it would truly change her life for the better."
It was at this stage of Carnahan's journey that McCormick suggested that Kelly consider enrolling in a study investigating the ability of spinal cord stimulation to address chronic, refractory low back pain in the absence of prior surgery at the lumbar levels.
"The other more conservative care was not helping Kelly's lumbar spine-related pain enough, and it was impacting her quality of life," said McCormick. "It made sense to for her to consider the spinal cord stimulation study."
A spinal cord stimulator is a two-part device implanted into the spine, consisting of electrodes that carry a small electrical current into different areas of the epidural space of the spine, and a small battery that powers the electric current.
The electrodes (small wires) are placed in specific areas of the spine based on each patient's specific pain profile, and the battery is usually placed under the skin just above the belt line. Patients can control and adjust the electrical current using a small remote control. The electrical current reduces or extinguishes the ability of the brain to pick up those specific pain signals (pain signals travel along the spinal cord to the brain) and provides relief to the patient.
Once placed, the spinal cord stimulator can be programmed to fit the patient's specific needs.
Placement of a spinal cord stimulator isn't typically covered by insurance unless the patient has exhausted all other options, often including lumbar fusion surgery in the case of chronic low back pain. However, because it was a research study focused on the outcomes of spine stimulation, Carnahan was able to enroll in the study and have the implant without having a lumbar fusion surgery.
The first two weeks after Carnahan's surgery were, in her own words, "horrible."
But then things started to improve as she recovered.
"At about day 18, I was like 'Wow...Okay this isn't so bad'," said Carnahan. "It's definitely not a cake walk, but things started to heal, and I started feeling better."
Since having the spinal cord stimulator implant, Carnahan keeps a detailed journal of her pain levels each day. Two and a half months after the implant, her pain levels were 70% improved. Now, more than three months post-surgery she has zero pain in her lumbar spine. She no longer takes heavy pain medication, muscle relaxers, or anxiety medication.
"When I went to see Dr. McCormick a few weeks ago the nurse at the office told me I looked like a different person," said Carnahan. "Before [the implant] I couldn't stand up straight, and I walked like I was 90 years old."
While the spinal cord simulator has brought relief in her lumbar spine, Carnahan still suffers from chronic back pain in other areas of her spine.
Carnahan can only do about two hours of work a day. Her doctors are looking for solutions to help her thoracic spine pain, but it's not an easy fix.
"Your thoracic spine is connected to your ribs, so trying to fix that is a monumental thing," said Carnahan. "They are going to do anything and everything else before they consider doing a spinal fusion at thoracic spine, because it might not even help. But my lumbar spine doesn't hurt anymore and it's fantastic. I'm so happy because it's one layer of pain that I don't have anymore."
While it might not seem like much, the pain relief in her low back continues to be life changing.
The spinal cord stimulator can offer even more relief to Carnahan in the future should she need it.
"The battery in my spine has the capability to accept additional electrodes that can be placed in other parts of my spine," said Carnahan. "I have to charge the battery every couple of days, and I'll get a replacement battery in ten years or so when this one wears out."
Carnahan isn't the only one who is happy about the outcome and the hope for even more relief in the future. Her mom, her husband, and her three children are excited about the improvements she has made over the past several months.
"My family is the one thing that kept me going through all the hard times over the past five years," said Carnahan. "My husband always had something wonderful and beautiful to say when I talked to him about feeling poorly. Because he kept giving me that support, I kept pulling myself back up."
Even with amazing support, Carnahan admits there have been some very dark, challenging times.
"I won't say it's been easy. It's been rough. For a long time, it was very difficult because I started to live on medication," she said. "Then I would go in to have something fixed and find that something else was wrong. It's hard to even talk about sometimes."
Humor and a "salty" attitude have helped Carnahan keep her chin up.
"My husband is a fire fighter, and I worked as an emergency responder for years," said Carnahan. "We are salty to begin with, and we deal with a lot of difficult situations on a regular basis. We tend to find humor is the only thing that helps ease the burden. At some point you have to look at yourself and realize, 'This is pathetic, you are too young to just give up...get your head out of your rear end and do something."
However, Carnahan has no regrets about where she is right now and says she would have the spinal cord stimulator implant again in a heartbeat.
"I can do things again," she said. "Prior to [the implant], going to dinner was a monumental thing. If I went to the grocery store that was all I did for the day. I still have a lot going on with my body, but I got 100% improvement in my lumbar spine thanks to [the spinal cord stimulator]."
She will forever be grateful for the care she received—and continues to receive—from her medical team.
"Dr. McCormick, Dr. Mahan, all of my team...they continue to give me amazing support," said Carnahan. "These are really smart people, and I can't really imagine how the U has been able to put together such a great team. They are so supportive and helpful and open to whatever can be done to help me."
Carnahan—and other patients like her—keep McCormick motivated to find even more solutions for spine patients everywhere.
"There are a lot of challenging issues in spine care," said McCormick. "There's a lot of important work to be done on the science and research side, and the clinical care is going to keep evolving. I'm excited I get to be a part of it. Not only for Kelly, but also for any patient facing chronic back pain."
Carnahan is excited about the future, along with the possibilities it brings.
"My journey is not yet over, and I don't expect it to be over," she said. "They relieved my low back pain, and I'm still healing from that. But this has given me some hope that I will be able to go out and do the things I used to do. I don't know that I'll ever get back to where I was before, but to be a bit more functional with less pain has been amazing."
