Tuesday, September 19, 2006
A decade ago, when Dr. Brian Siegel came to Steamboat Springs and Yampa Valley Medical Center, the medical specialty of pain management was just taking off.
Fairly recently, if a patient came to the hospital in severe pain, he or she typically was given an epidural injection of a steroid and sent home. That was true across the United States as well as in Steamboat Springs.
Siegel, director of the Yampa Valley Medical Center Pain Management Service, is a board-certified anesthesiologist and a pain management specialist.
"Pain management was not recognized (as a medical specialty) until 1994 or '95," Siegel said. "I was among the first class of residents (devoting more of their time to pain management) while I was doing my residency in Little Rock (Ark.). The whole field has really taken off during my career."
His outpatient clinic offered relief to 700 patients in 2005. As recently as 1995, they would have had few options.
Some of the patients Siegel sees suffer from postoperative or post-trauma pain. They are in the majority. Others are chronic pain sufferers.
"The theory of pain is very complicated," Siegel said. "There is a big psychological component. I deal with that every day. But really, my job is diagnosis and treatment of somatic (having to do with the physical body) pain. It's putting a needle in the right spot. If a patient has a herniated disc resulting in leg pain, I review the MRI and put medication on the spot that correlates best."
Siegel's pain tool kit is far from limited to injections.
The procedures that he undertakes, sometimes in cooperation with surgeons, include implantation of spinal cord stimulators that can effectively short circuit the nerves that transmit pain messages to the brain.
Some patients are good candidates for a procedure with the imposing label: "lumbar and cervical facet rhizotomy." Siegel draws an analogy to a kitchen microwave. An instrument is inserted beneath the skin, and radio frequencies are used to stimulate nerve endings until the heat generated cauterizes them, blocking the pain.
Trigger point injections are used to put a local anesthesia exactly where it's needed, and botox injections are employed to treat migraine headaches.
Siegel also has an open mind to alternatives to traditional Western medicine.
Acupuncturist Kelley McDaneld, who has a master's degree in Oriental medicine, practices at the Pain Management Service. She offers complimentary therapy to patients who are seeing Siegel. She also treats patients who have not been referred by a physician.
McDaneld said she is working with maternity patients.
Siegel said he's optimistic that over time, more and more patients will be referred to McDaneld by physicians.