Institute for Pain Diagnostics and Care Provides Many Treatment Options for Chronic and Acute Pain

By Vanessa Orr

Living with chronic pain is difficult enough, but undergoing numerous procedures and treatments to control the pain without success can make it even more frustrating. At the Institute for Pain Diagnostics and Care, located in Kennedy Township and now at Mt. Nebo Pointe Commons in the North Hills, David Provenzano, MD, works with patients to not only correctly diagnose where the pain is coming from, but to successfully find a way to lessen its effects.

“Everything that can be done to treat pain, we do,” said Dr. Provenzano, the Institute’s executive director. “We offer an extensive high-end pain program that features cutting-edge, evidence-based treatment options designed specifically to target each individual’s needs.

“After we diagnose the source of a patient’s pain, we develop a multimodal treatment program that can include everything from medication management to physical therapy to cognitive behavioral therapy and minimally invasive procedures,” he added. “More advanced treatments can range from x-ray guided joint injections and nerve blocks to implantable devices.”

One of the biggest strengths of the Institute, a division of Ohio Valley General Hospital, is Dr. Provenzano’s experience in the field. Recruited from Dartmouth Hitchcock Medical Center while undergoing a pain management fellowship, he currently serves as the president of the board of directors for the American Chronic Pain Association, and has recently been selected to serve on the research committee of the American Society of Regional Anesthesia and Pain Medicine.

In addition, Dr. Provenzano serves as an adjunct clinical instructor in the Department of Physician Assistant at the Rangos School of Health Sciences at Duquesne University; as an adjunct assistant professor in the Mylan School of Pharmacology at Duquesne; and as an adjunct clinical instructor in the Office of Experiential Education in the Mylan School of Pharmacy at Duquesne. University pharmacy students also serve a rotation at the Institute.

“One of the reasons for our success—and the success of our patients—is that we work very hard to stay in the forefront of pain management,” explained Dr. Provenzano.
One treatment option that is growing in use is spinal cord stimulation, which was originally developed in the late 1960s. “Over the last 30 years, spinal cord stimulation has undergone substantial refinements,” said Dr. Provenzano of the procedure often used for patients with persistent pain after back or neck surgery. The procedure involves the implantation of a small pulse generator in the back, which sends electrical pulses to the spinal cord, interfering with the nerve impulses that cause pain.

“These small wires stimulate the spinal cord, blocking the brain from pain signals, and also change the chemical compound of the spinal cord, which helps to modify pain,” explained Dr. Provenzano. “The patient has a remote control device that he can use all the time, or just during bad episodes.”

David Wire, 46, had a spinal cord stimulator implanted in August of 2009. “Before I had the operation, I wasn’t able to walk, stand up or feel my legs from the knee down,” he said. Wire had already undergone four previous back surgeries, but continued to have persistent pain and leg weakness.

“When I went to see if I might be a candidate for spinal cord stimulation, I went without any expectation of getting out of pain,” he continued. “Dr. Provenzano explained what he could do, and I underwent a trial to see if it would work. He gave me this controller, which was a neat little gadget. Then he set it up to send electricity to the areas where I needed stimulation.”

As one of the only doctors in the city who is trained not only to do the trial, but also to install the implant, Dr. Provenzano is able to provide continuity of care to his patients. “During the five-day trial, we call patients every day to see how they’re responding to the stimulation,” said Gaye Jarzabek, practice manager. “If it’s not helping, we’ll reprogram it to optimize the trial. The patient then decides if it is suitable or not. Approximately 90 percent of our patients progress to implantation, which I believe is due to how selective Dr. Provenzano is about who he chooses to undergo this procedure.“

The stimulator is implanted during an outpatient hospital procedure, and patients are closely followed thereafter. Once it is determined that the leads are securely in place, patients can begin physical therapy. “It is so rewarding for patients to finally have control over pain, especially when they’ve tried so many other options,” said Jarzabek.

Physical therapy helped Wire to learn to walk again. “Now I go to the gym three times a week and I’m currently doing interval training to see if I can start running,” he said.

“It’s slow, hard work, and it isn’t without setbacks,” he added. “It took a lot of effort and concentration to go from where I was to where I am now, but Dr. Provenzano was really honest with me. He wanted to know if I was mentally prepared to do it, and I was. Now I’m a heck of a lot better than where I was before.”

The Institute also treats individuals with osteoarthritis, herpes zoster (shingles), phantom limb pain, peripheral vascular disease, compression fractures and more. Another technology, the intrathecal pump, can be utilized to help those dealing with persistent pain from cancer.

“As a doctor and a person, you just couldn’t ask for better than Dr. Provenzano,” said Wire. “He is straightforward and he treats you as an individual—not as a patient. The staff is also extremely caring—they really make the effort.”

For more information, visit www.ifpdac.org or call 412-777-6400.