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Angela Brooks. Updated. 0. 8: 4. BST, 2. 9 December 2. Mark Sappol solved years of back problems with radiofrequency treatment. A third of the population suffers from back pain at some point. Most recover with rest and painkillers, but some will need surgery. Mark Sappol had a pioneering new procedure which killed the nerves causing the pain. He talks to ANGELA BROOKS. THE PATIENT Ever since I was a child I've had a bad back, and over the years have tried everything to resolve it - physiotherapists, chiropractors, osteopaths - although whatever I've done has only helped temporarily. Towards the end of 2. I couldn't bend over to put on my socks and I'd get huge spasms and fall to the floor, unable to move until a doctor came to give me Valium. By Christmas that year I'd developed sciatica, too. The pain ran from my lower back to my right foot - and it was so awful my wife called an ambulance. The paramedics gave me Valium as a muscle relaxant and the painkiller Tramadol. I was in bed for five weeks - but when it eased slightly, my GP referred me to an orthopaedic surgeon, who did a scan. This showed that some of the discs which are meant to cushion the spine had flattened over time. He said this was called degenerative disc disease, something that tended to develop with age. He also thought my condition might not get much worse, so it was best to try to deal only with the pain. He referred me to Dr Rajesh Munglani, a pain management consultant. I saw him in June 2. I might be suitable for a treatment using radiofrequency - basically a probe with a tiny heated needle on the end - to kill the problem nerves in my back that were causing the pain. To see if it would work, I had to have pain- blocking injections of local anaesthetic and steroids. If this lessened the pain, I had a good chance of responding to radiofrequency. After the jabs, which I had in November, my wife said it was the first time she'd been able to look at me without seeing the pain on my face. Because that treatment went well, I had the surgery a month later. But, after two weeks, I was in pain again - and taking a huge cocktail of painkillers. It was so disappointing. Healed: Mark was referred to an orthopaedic surgeon who told him the disks in his spine had flattened. Then, in April 2. Dr Munglani one more time. He said the timing was perfect because Dr Munglani was now doing a new type of radiofrequency known as cooled RF. It's similar to the old technique, but the good news was it could kill a much bigger area of nerves with fewer jabs of the needle. Also, because the probe is continually drizzled with water which cools it, it means it can be left in position for longer, making it far more effective at killing off the nerves. It sounded great, so I agreed to have it straight away. The first part - they treat one side at a time - was scheduled for the following month and the other side a month after that. By the time I had a check- up in September, I felt so much better - my back was more flexible than it had been in years. I can honestly say this operation has changed my life. My wife and I can go for long walks, which were out of the question before. A couple of weeks ago I overdid things by putting up the Christmas tree and doing housework, and that night I felt I had put my back out. But the next morning I woke up with absolutely no pain and it was wonderful. THE SURGEON Dr Rajesh Munglani is a consultant in pain medicine at the Spire Lea Hospital, Cambridge. We have an epidemic of lower back pain and our modern, sedentary lifestyles are the underlying cause. Many people have poor posture and when we do exercise, we'll often overdo it. Miracle cure: The 4. Most people who get an episode of lower back pain recover with gentle exercise, anti- inflammatories and other therapies such as osteopathy, acupuncture and physiotherapy. It's when pain persists or increases after six months - or when it starts radiating down the leg - that doctors become concerned. A slipped disc is often suspected in patients with unremitting lower back pain. This is when the discs, which act like shock absorbers in the spine, become flattened through wear and tear or start bulging out of their slot, irritating the surrounding nerves. But when you look at the scans of the majority of these patients, there is nothing wrong with their discs - it'll be the mechanics of the back, particularly the sacroiliac joints at the base of the spine, that are more likely to be the cause. This sort of lower back pain can be caused by a simple fall that yanks the ligaments and surrounding muscles, causing inflammation and making the joint less stable. It also causes the nerves in the back to go into overdrive. Usually the nerves gather information from the environment and transmit this to the brain via the spinal cord. In some patients, all the nerves are doing is giving unremitting pain - so wiping them out isn't a problem. When patients are referred to us, we'll know the general area giving rise to the pain, but our first step is to target the exact source. We do this by injecting local anaesthetic into the part of the spine we suspect is causing the trouble. Once we've found the right spot, we zap the nerves in that section of the spine with a radiofrequency probe. This probe has a tiny needle on the end that is heated with an electric current. We insert it into the skin and onto the sacroiliac joints where the pain is coming from. Standard radiofrequency, which has been around for about a decade, didn't work for Mark. Now we have a technique called cooled radiofrequency. This also kills the nerves, but because the probe is continually cooled by water, we can leave it in for longer to wipe out nerves over a wider area. This means the patient is more likely to be pain free. The 4. 0- minute operation is done as day surgery and patients have sedation, so I can talk to them in theatre. This way we can identify the right nerves to kill. Under X- ray guidance we first stimulate the nerves with the probe on a low setting and ask the patient if they can feel it. Even though they're groggy, they can respond. And if they feel it, it means it's a problem nerve that needs zapping. Once we've flagged up the right nerves, we inject local anaesthetic and switch the probe into the more intense cool mode. The voltage of electricity is far too low to cause an electric shock, but strong enough to cook these faulty nerves. A week later, patients will start an exercise programme. They do sometimes get increased pain for the first few months, because even though we've killed the nerves, it takes a while for them to settle. But when they do, the difference in quality of life can be amazing. This isn't a permanent solution because the nerves will grow back. But in the two years we've been using the technique, it's had a good record in blocking pain. Also nerve re- growth won't necessarily mean a return of pain. Even giving patients two years' respite from it gives them the chance to work on exercises to strengthen their back. The procedure can also be repeated. The operation costs around . It costs the NHS about.
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