JEDDAH, 21 February 2007 — Wedad Khedar Mohammed, exhausted from the sleepless night she had just endured quietly sat in the ladies waiting area of yet another of the Kingdom’s hospitals. Surrounded by women possibly suffering from similar conditions, she thought about the many doctors she had seen over the past 30 years. She had been to Beirut, Syria, Jordan, the US and even Britain in the hopes of finding some relief from the excruciating pain in her lower back.
The trouble started one morning as she descended the stairs in her Jeddah home. “I don’t know what happened exactly.” said the 60-year-old Saudi mother of seven. “I was walking downstairs and slipped somehow. During the fall I felt a strong shift in my lower back and heard a ‘click’. It was then that I knew something was terribly wrong.” She added.
In the three decades since the accident, Wedad has joined the queue of chronic pain sufferers in the Kingdom that until recently simply had no other alternative but to tolerate agonizing discomfort while striving to complete the routines of their daily lives.
“All the doctors that I saw simply told me that there was no other course of action to correct my condition except to undergo surgery and at the same time warned me that the procedure would be a risky one carrying a 50 percent chance of paralysis from the waist down. It was on a particularly difficult and painful day that I was seriously considering having the surgery at no matter what the cost. When I read an article in a local Arabic newspaper about pain management techniques offered in King Fahd Armed Forces Hospital (KFAFH) that completely changed my mind about having the operation,” Wedad explained.
“It was two days later that I finally found the miracle of pain relief through KFAFH’s Dr. Ahmed Fawzi El Molla,” she said.
El Molla is a professor of anesthesia and pain management, Alexandria University, Egypt, and has been the chief of pain relief/consultant of the neuro-modulation Unit of KFAFH in Jeddah for the past four years. He is also a Fellow of Interventional Pain Practice (FIPP) of the World Institute of Pain from Texas Tech University’s Health Sciences Center in Lubbock, Texas, and is the first doctor in Saudi Arabia and the Middle East to hold this fellowship.
Pain management is the discipline concerned with the relief of pain, which according to the International Association for the Study of Pain (IASP) is defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.
Pain management generally benefits from a multidisciplinary approach that includes pharmacologic measures (analgesics such as pain modifiers or NSAIDS, nonpharmacologic measures, such as interventional procedures, physical therapy, and physical exercise or application of ice and/or heat) in addition to psychological measures such as biofeedback and cognitive therapy.
El Molla explained to Arab News that interventional pain procedures, like those done on Wedad are preformed by pain specialists to treat chronic pain syndromes with the benefit of being done through incisions in the skin under fluoroscopy with local anesthesia and conscious sedation, in which the patient can return home after 1-2 hours of the procedure’s completion on an outpatient basis.
“It is more beneficial and unlike other surgical operations, which requires a lengthier hospital stay,” said El Molla. “In the pain relief unit here at KFAFH we have a large number of interventional pain procedures which are done for all types of chronic pain. Chronic pain is customarily defined as pain, which persists for a specified time that is arbitrarily determined (e.g. 3 to 6 months beyond that expected period of healing) compared to acute pain which is often reversible and may require only transient measures and correction of the underlying problem,” he added.
“Some examples of these procedures are decompressive disectomy for cervical or lumbar disc protrusions, epiduroscopy — a technique in which a scope is introduced by the interventionist through the epidural space around the spinal cord in the vertebral canal to visualize the adhesions around the nerve root causing most of these roots to be removed. A catheter is then introduced for three days, which delivers appropriate inflammatory drugs, which calm the swollen nerves and provide pain relief,” he said.
El Molla is the first Arab doctor in the Middle East to use the epiduroscopy, as well as Spinal Cord Stimulation to relieve intractable pain. He added that these procedures have proved to have a 60-70 percent success rate of pain relief with an 80-90 percent improvement to life to his patients in the Kingdom.
Hind Omer Mohammed, 36 and a government employed schoolteacher in Jeddah told Arab News, before being wheeled in for her pain management procedure, how she developed her back injury as a result of an almost fatal car accident.
“It was about ten years ago when I finished my studies and was sent by the Ministry of Education to a village known as Gilawa for my first teaching job. It used to take me about seven hours by bus to reach the village from my hometown of Jeddah. I used to travel every weekend just to get a chance to visit my family and check in on my aging parents,” she said.
“One morning nearly three years ago my colleagues and I were traveling by car from our home to the school, an additional 70 kilometers away, when we were the victims of a severe car accident. I damaged my lower back, which has been agitated by the lifting of heavy baggage until I was finally transferred closer to home just last year. I heard about the management techniques and decided to see if they really work,” she said.
After the procedure, Hind said that it was still too soon to tell if her back pain was completely cured but would still recommend others to try it as a course of action.
“I just want to tell anyone suffering from chronic pain not to suffer in silence but instead be aware that they do have a choice,” she said.
When choosing a pain management physician, patients should be mindful of certain caveats. While many physicians refer to themselves as “pain doctors” many may not have proper training, unlike El Molla, who often learn a number of procedures on “weekend workshops” as opposed to formal residency training.
While most procedures are safe and harmless, certain ones such as epidural injections and spinal cord stimulators may have grave consequences if preformed by inexperienced physicians. Ask your doctor or potential specialist about his or her credentials.
