International collaboration eases SA woman’s unbearable pain
Team undertakes advanced pain management procedure locally
Specialists in the field of pain management from Belgium and South Africa have teamed up to help a 29-year-old Johannesburg woman who has suffered unbearable facial pain for a decade.
In a landmark procedure performed at Netcare Jakaranda Hospital on Sunday, 17 December 2017, anaesthetist, Dr Jean-Pierre Van Buyten of the Multidisciplinary Pain Centre in Sint-Niklaas, Belgium, and local chronic pain management practitioner, Dr Russell Raath, implanted specially designed neuro-stimulating electrode leads into Crystal Riekert’s face in an attempt to relieve her facial pain.
Pic: Crystal Riekert (left) suffered unbearable pain for almost a decade before local chronic pain management practitioner, Dr Russell Raath (centre), and Belgian anaesthetist, Dr Jean-Pierre Van Buyten of the Multidisciplinary Pain Centre in Sint-Niklaas (right), teamed up to implant specially designed neuro-stimulating electrode leads into her face during a procedure at Netcare Jakaranda Hospital. A month after the procedure, Crystal reports that her pain has been substantially reduced
“Crystal endured 10 years of excruciating pain, which different specialists have attributed to various conditions and for which she has had a number of treatments but, unfortunately, none of these have brought her relief. Her pain level was considered to be 10, the maximum on the pain level scale and which most of us could not even begin to imagine living with,” Dr Raath explained.
Dr Raath is one of the few full-time pain management practitioners in South Africa and focuses on the alleviation of pain that has no apparent, medically defined cause. “For many of my patients, including Crystal, pain itself is the ailment they are living with, rather than the pain being a symptom of a defined medical condition that can be treated to relieve the pain,” he adds.
“Crystal underwent several major surgeries through the years in an attempt to resolve her severe facial pain. She has had open cranial surgery twice and had her temporomandibular joint, which connects the lower jaw to the skull, replaced in the hope that this may bring her relief.”
“She has also had radiofrequency treatment on the trigeminal ganglion, which is a cluster of nerve cells on the trigeminal nerve that controls sensation in the face. All of these interventions were unsuccessful in relieving the pain she has been living with for so long, and this is when Crystal came to consult me at the pain management clinic at Netcare Jakaranda Hospital,” explains Dr Raath.
Speaking before the procedure, Crystal described her facial pain as debilitating. “It affects every aspect of my life. I cannot drive, I don’t have much of a social life and thank goodness I work for my dad because it would be very difficult to hold down a job otherwise with my condition,” she says.
“I have been using pethidine to control the pain, but it can be addictive and I don’t want to be on heavy pain medication for the rest of my life. The painkillers make me feel sleepy and slow, but without them I am in agony.”
Dr Raath believes that Crystal’s pain stems from neuropathy, and he proposed implanting a neuromodulator to stimulate the affected nerve ganglion with electrical impulses. Several months ago, Dr Raath performed this procedure and Crystal’s pain was significantly reduced, but not entirely resolved, and he remained determined to find a lasting solution for Crystal.
Dr Raath contacted Dr Van Buyten, who is a leading international expert in neurostimulation for treatment of facial pain. The Belgian anaesthetist has designed and custom-made a new type of lead for the neuromodulator that Dr Raath believed could bring lasting relief for Crystal’s chronic pain.
Crystal says she was amazed to hear that Dr Van Buyten had agreed to fly to South Africa to perform her procedure with Dr Raath.
“I had heard of Dr Van Buyten through a neuropathy support group on Facebook, and I had been in contact with one of his patients in Holland who had undergone a similar procedure and had a positive outcome.”
Dr Raath explains that the procedure to implant the new electrode leads into Crystal’s face was not a major operation, and was performed using a surgical needle and x-ray control. “We were hopeful that once the procedure was completed and the neuromodulator activated, she would experience the anticipated pain relief.”
Dr Van Buyten, who flew to Johannesburg on 16 December 2017 to consult with Dr Raath and examine Crystal as well as another patient suffering facial pain, concurred, saying that he fully expected the new implant to provide Crystal with substantial relief and meaningfully improve her quality of life.
“Accurately diagnosing and treating such cases of facial pain is critical and requires a high degree of specialisation and expertise,” noted Dr Van Buyten, who was visiting South Africa for the first time.
A month after the procedure, Crystal says that her pain has been dramatically reduced. “I am now able to drive myself, I am back at work and I am feeling so much better than I have in almost a decade – this procedure has already made an enormous difference to my quality of life.”
“I am no longer in constant pain and I am not so reliant on pain killers anymore, although I have to gradually wean off the pethidine because I had been using it for so long,” she adds.
“For various reasons we are seeing an increased number of these kinds of patients internationally, and I believe that it is important that globally we train more pain specialists and establish more dedicated centres that can diagnose and effectively treat them,” noted Dr Van Buyten, who has years of experience in the field.
“It was good to collaborate with a South African specialist such as Dr Raath, whom I met many years ago at a medical congress in Turkey and who has a special interest in this highly complex but increasingly important field of medicine.”
Asked about the neuromodulator lead that he had custom-made and used in Crystal’s case, Dr Van Buyten said that he had done this with the help of an engineer two years ago. “I wanted to develop leads that would be implanted more securely and we have achieved good results with them over the last couple of years,” he related.
Crystal expressed her gratitude to the doctors and the teams of healthcare professionals that assisted them in their efforts to relieve her of the pain.
“I would like to thank Dr Jaco Jurgens, of Krugersdorp, who has been my general practitioner since I was born. He has taken care of me as if I was his own child, and I don’t know what I would have done without him,” Crystal says.
“Thank you so much to Dr Raath at Netcare Jakaranda Hospital and his team for sticking with me for so long. It has been an extremely trying time for me, and Dr Raath has really stuck with me and gone out of his way to help me. I am very grateful for all that he and Dr Van Buyten have done for me,” she concluded.