Drs. Ramsin Benyamin and Ricardo Vallejo of Bloomington’s Millennium Pain Center have a passion for pain.
Well, really, a passion to treat pain.
This duo is world-renowned for their evidence-based research and cutting-edge treatment of chronic pain and its causes. Recognized among the top 70 pain specialists in the U.S., they not only offer advanced treatment for pain, but they also educate other physicians and serve as advocates for health care options that benefit patients.
Certified by the American Board of Interventional Pain Physicians and Fellow of Interventional Pain Practice, they serve nationally on the examination boards of these organizations, as well as serving locally on the faculties of the University of Illinois, Illinois State University, and Illinois Wesleyan University in roles that allow them not only to teach, but also enable them to conduct research for new treatment strategies for common pain conditions.
Their research has resulted in more than 110 peer reviewed articles, 12 book chapters, and roles on several national and international journal editorial boards. They, along with the five other physicians and advanced practice nurses in the seven different Millennium Pain Center locations, have participated in more than 100 clinical trials, many of which have provided significant relief and remedy for certain painful conditions.
The information gained from these trials gives them a wealth of wisdom to share with other physicians. In addition to running clinical trials and publishing results in professional journals, they literally teach other physicians how to do the techniques they have pioneered.
All because they have a passion for treating pain.
Case in Point: Lumbar Spinal Stenosis
Lumbar spinal stenosis is a common, but painful, malady often associated with aging. The lumbar, or lower back, is made up of the five largest and strongest vertebrae between the diaphragm (just below the ribs) and the pelvis — the backside of the abdomen.
Stenosis is a narrowing of the spinal column that is caused by the natural wear and tear on the body due to contributing factors such as thickening of ligament tissue, formation of excess bone, and compression or bulging discs. Stenosis often results in neurological issues such as pain, numbness, or tingling that radiates down through the buttocks and legs.
“Usually lumbar spinal stenosis is an aging issue, characterized by complaints of positional back pain,” says Dr. Benyamin, medical director at Millennium Pain Center. “Patients will have pain in their back, buttocks, and legs, especially after standing or walking. Sitting down or laying down usually helps alleviate the pain, but it can eventually become so painful and more consistent that it sends the patient to a wheelchair. It definitely causes limitations in activity, because walking or standing for periods of time make it worse.”
Dr. Benyamin goes on to explain that quality of life becomes an issue as more walking increases the pain, even during regular activities such as grocery shopping. “That’s a telltale symptom — leaning on the shopping cart to relieve the pain.”
Treatment options for lumbar spinal stenosis used to be extreme. Conservative treatment includes physical therapy, over-the-counter anti-inflammatory drugs, and steroid injections. While these treatments carry low risk for complications and no need for hospitalization, they also provide variable results and usually only short-term relief.
At the other extreme, open back surgery requires a 3-5 day hospital stay, a relatively large incision, general anesthesia, and a much higher risk of major complications. While the success rate of a positive outcome is high — 60-80 percent positive outcome — the risk of complications, especially for older patients, is a deterrent, not to mention the often daunting prospect of undergoing and recovering from a major surgery.
And, as Dr. Benyamin points out, “Older patients also often have multiple issues to consider: hypertension, diabetes, and other health issues that make treatment more difficult.”
Drs. Benyamin and Vallejo are excited about being able to offer their patients another option, however.
The mild® (minimally invasive lumbar decompression) procedure now fills the gap between the two extremes, according to Dr. Vallejo, director of research at Millennium. Approved by the FDA several years ago, the mild procedure is available only to participants in a clinical research trial as mandated by Medicare.
“We [Millennium Pain Center] are the only pain practice in Illinois certified to use the mild procedure,” says Dr. Vallejo. He explains that the diagnosis of spinal stenosis is made using MRI. The procedure itself involves using specialized tools to remove part of the ligament and soft tissues in the spinal canal which are causing the impingement of the nerves.
“We do this by injecting contrast fluid in the epidural space and, utilizing live X-ray, we are able to see exactly what needs to be done to open the spinal canal and reduce or remove the impingement that is causing the pain.”
Since the procedure actually restores space in the spinal column, mobility for the patient is actually restored. “This isn’t a Band-Aid — it is a treatment,” says Dr. Benyamin, meaning it does not mask the pain, but actually eliminates the cause of pain — “kind of like a bypass in the spine.”
The mild procedure has significant benefits because it is a non-surgical treatment for treating spinal stenosis. The incision is extremely small — less than 6 mm — which is smaller than a baby aspirin. The procedure itself is done on an outpatient basis, so the patient does not require hospitalization, nor does the patient undergo general anesthesia. Almost 80 percent of patients who undergo the mild procedure have positive outcomes, which is similar to the more risky open surgery.
“The mild procedure is very safe — it’s less invasive, doesn’t involve leaving implants behind, is less costly, there’s no transfusion, can be done at any level of the lumbar spine — there are very few complications,” says Dr. Benyamin. “And, since the typical patients are older and surgery is riskier for older people, this non-surgical option is very beneficial.”
Advocating for Patients
Although Medicare issued a new policy about the mild procedure which did not include coverage; through the efforts of physicians, including Dr. Benyamin, the policy-makers agreed to pay for the procedure as part of a clinical trial and at specific sites — only 30 facilities in the country are approved research sites.
Dr. Benyamin spoke to the Center for Medicare and Medicaid Services (CMS) in order to continue Medicare’s coverage based on the safety record of the procedure and on-going evidence development obtained through the trial. He and Dr. Vallejo have co-authored the mild procedure study with the Cleveland Clinic and are the principal investigators of the study.
Dr. Benyamin goes to Washington D.C. several times a year to meet with lawmakers “to sit at the table” to preserve patient access to treatment. His efforts have enabled many patients to be part of the mild procedure research trial.
Advocating for patients has become another driving force behind Millennium Pain Center’s efforts. Without the determination to help policymakers understand and see the importance of making new treatments available, many patients would simply not be able to undergo cutting-edge procedures, like the mild procedure, that are ultimately better, less expensive, and longer lasting than many of the conventional methods used to treat various pain conditions.
“Many new treatments for the spine are moving away from surgical intervention toward minimally invasive techniques,” says Dr. Benyamin. “Many, like the mild procedure, are still in the clinical trial stage, so they can only be offered through research programs.”
Still, in spite of the extra requirements and limitations imposed by clinical trial protocols, Drs. Benyamin and Vallejo see great advantages and advances to the process.
“It’s an exciting time,” says Dr. Benyamin.
And for those who suffer with pain, it’s a great time to have access to physicians who not only have a passion for treating pain, but also will be advocates for making sure new treatments are accessible to those who need them most: their patients.
For more information, you may contact the Millennium Pain Center, 309-662-4321 or www.millenniumpaincenter.com.