Grateful Patients

At 91, farmer Irving Gum isn’t showing any signs of wanting to retire. A resident of Fair Oaks, a rural community east of Sacramento, his 100 acres produces corn, strawberries and hay. And his pumpkin patch, called U-Pick Pumpkins, is a popular autumn destination.  Possessed of an old-school work ethic and an abundance of old-fashioned common sense, Gum is a bit of a humorist. Asked how things are going at his age, he said without missing a beat: “I ain’t going very fast but I try to go yet.”

Helping him along—greatly—is UC Davis pain medicine expert Scott Fishman. Gum, who has suffered from lower back pain since he was a young man, has seen a lot of doctors. But until he started seeing Dr. Fishman, he didn’t get much relief.  “I’ve been to every doctor on the West Coast,” Gum said. “Dr. Fishman is the only one who can do me any good.”  Fishman said Gum’s condition is somewhat unusual. “It’s not a traditional disk problem,” Fishman explained. “It’s arthritis in the very small joints in the back.”  Known as facet joints, they are a bit like little knee joints: “They are what prevent you from leaning backward as far as you can lean forward,” Fishman explained, adding that they are often overlooked as the cause of back pain.  “We recognized the problem,” Fishman said. “At the pain center, we’re committed to understanding the pain. Unfortunately, lots of doctors don’t do that.”

And how does Fishman relieve Gum’s pain? By knocking out the pain signals emanating from the nerves in his lower back via a high-tech procedure known as radio-frequency ablation. Taking the tiny tip of a needle, Fishman uses radio-frequency heat to first find the nerves and then deaden them. “We get on top of the nerve and melt it,” was the way he described it.  It’s taken four or five treatments to cover the entire area of Gum’s lower back that’s been problematic. Which has been just fine with Gum’s 90-year-old wife, Claudia.

“Dr. Fishman has given Irving relief every time he treats him,” she said.  “And he’s real personable,” she added. “He always brings me a cup of coffee.”

George Mironenko suffered progressively worsening back pain for 20 years after he fell while moving a large tree. Following two unsuccessful back surgeries, the self-employed engineer was forced to retire.

Today, thanks to UC Davis pain medicine expert Scott Fishman, Mironenko’s pain is under control, and he is back at work. Fishman first treated him with medication injected during office visits, then with daily pain medication delivered through a patch worn on the skin.

“The results have been very good,” says Mironenko’s wife, Rimma. “He can walk. He can sit. He can drive … he is able to live life again.”

According to Fishman, undertreated pain like that suffered by Mironenko is a growing health crisis in America.

George Mironenko has returned to work after pain specialist Scott Fishman helped end 20 years of chronic back pain. Mironenko and his wife, Rimma, now enjoy a higher quality of life.

Fishman also has been working to shape state and national health-care policy on the use of pain medicine.

He is the current president of the American Pain Foundation, the largest advocacy group for patients in pain.

Fishman worked on getting the Veterans Pain Care Policy Act passed in 2008 and the Military Policy Act passed this past year. These bills guarantee that veterans and soldiers get the pain care they need.

“The wars in Iraq and Afghanistan have had low death rates, but high injury rates,” Fishman explains. “People are surviving injuries that they otherwise would have died from, and the care they were getting was completely inadequate.”

Recently, Fishman helped to craft the National Pain Care Policy Act that has become part of the Health Care Reform Act being considered by Congress. The bill provides guidelines for pain care, as well as resources to fund awareness campaigns and pain management research.

“We don’t know what will happen with health-care reform,” Fishman says, “but we’re optimistic that major improvements in pain care will make it into law, and we are proud to have gotten this legislation to this point.”