This week is National Pain Week. Pain Australia says one in five Australians live with some form of regular pain. It’s often an “invisible condition” which steals enjoyment and quality from people’s lives. For midwife Jannie Milborrow, it’s been a long road back - but she says she has her life back, thanks to Dr Ramsey Jabbour, a leading specialist Pain Medicine Physician and Specialist Occupational Physician at St Vincent’s Private Hospital Northside and St Vincent’s Private Hospital Brisbane.

May 20, 2021 was the day that the course of two lives were changed dramatically all at the same time - as midwife Jannie Milborrow performed an emergency lifesaving procedure on a young mother who had just given birth in hospital.

An experienced midwife at a North Queensland hospital, Jannie responded to the emergency, performing bi-manual compression of the uterus to stop post-partum haemorrhaging by the patient. Jannie’s instinctive action however, meant that she had to place herself in an awkward position on the hospital trolley for the procedure for several minutes to continue the compression, as the patient was wheeled to theatre for emergency surgery.

Thankfully the mother survived – but it resulted in a life-altering back injury for Jannie, now aged 45.

Life quickly became a roller coaster of chronic pain, sick leave from work and seeking various avenues of pain relief and pain management for Jannie – with the worst days seeing her pain rising to a what felt like an 8 or 9 out of 10 and limiting her to walking no more than 10 metres and to standing up for no more than a few minutes.

Jannie tried a range of treatments and pain management options including steroid injections, endless painkillers and nerve pain drugs. Having exhausted those options, she feared she might have to give up work – although she says her manager at the hospital was very understanding and empathetic. 

However, at one stage, the relentless pain was so intense for her, Jannie briefly considered taking her own life!

With Jannie, Dr Jabbour initially trialled various modalities of treatment, to help manage her pain. However, unfortunately in Jannie’s case, they were not providing her the pain relief required in order for her to return to her chosen profession.

When the pain management plan wasn’t providing Jannie the long-term relief required, and through ongoing further assessment, Dr Jabbour established that Jannie was a suitable candidate for interventional management and suggested the option of trialling a spinal cord stimulator (SCS) device. 

The trial is a procedure in which epidural leads are placed, through epidural needles in the back, into the space behind the spinal cord (the epidural space) with the remainder of the leads being connected to an external device, for a seven-day trial. (During this trial period, Jannie, and the team, could assess how effective the device was for her.)

The spinal cord stimulator device consists of two epidural leads and an implantable pulse generator [a battery]. The stimulator can reduce the amount of pain signals which continue to be generated from the source of pain, reaching the brain, by acting as a ‘signal dampening device’ on the spinal cord. 

This can then provide a reduction in the amount of pain an individual experiences, allowing them to have an improved quality of life.

In Jannie’s case, after a successful trial, the device was fully inserted in late November 2023 and she says after some initial programming adjustments to achieve the right settings, she hasn’t looked back. 

“When I saw Dr Jabbour, I was willing to try almost anything. I told him I just wanted to be out of constant and severe pain. He’s been fantastic in his advice and treatment and in guiding me down a better path where the pain that used to be an 8 or 9, is now a 1 or 2 most days,” she says.

“It has definitely given me my life back. While there’s certain things I can’t do, such as running and lifting too many things, you learn to accept the parameters of what’s safe and not safe. You find a new normal - so for me, for example, that’s riding a bike instead of running.

“There’s good weeks and bad weeks but recently I’ve been very good and haven’t had so much as a Panadol for the past fortnight.”

Dr Jabbour says spinal cord stimulator devices have been around since the late 1960s and over time, have gone through a number of significant new technological advances. With these new developments, and through ongoing published research, the indications for their use have increased. 

The devices are used worldwide, and have become a proven and effective option in the management of chronic pain, for carefully selected patients, who have not received significant pain relief from other treatment modalities; and for patients who remain significantly hindered due to their pain. Importantly, they have been identified as having a specified medical condition that is likely to respond when the devices are used.

Dr Jabbour says that patients with long term injuries who still suffer from chronic pain are in some cases medically challenging to manage. 

“However, the data also shows that around 20-30% of patients undergoing a trial of the stimulator device, even with meticulous screening to ensure they are suitable to undergo this form of treatment, do not respond – and don’t achieve 50% or more relief in their pain, and so they would not be suitable to undergo permanent implantation. In these cases, it is imperative that we don’t give the patient false hope. 

“Like with any surgical procedure involving the spine, there are rare but significant risks associated with the procedure which need to be thoroughly discussed with the patient before undergoing the SCS trial.

“In summary, it is important to remember, that with chronic pain management one has to take a holistic approach to treatment – that is the spinal cord stimulator device is not a solitary treatment option, although in some cases it can be an important one. 

“It should be used in tandem with a multi-disciplinary approach to management which may include a combination of therapies including physical therapy, as well as, psychological therapy, focusing on the treatment of all aspects of an individual’s suffering, as a result of living with their chronic pain.”

St Vincent’s operates the Brisbane Centre for Pain Management at St Vincent’s Private Hospital Brisbane (Kangaroo Point), offering one of Australia’s most comprehensive range of pain management services and specialties in one location.

St Vincent’s Brisbane has a dedicated operating theatre equipped with state-of-the-art technologies to support complex pain procedures, consultation rooms, spacious recovery suites and a variety of surgical and therapeutic options. It’s also been running the Pain Management Program (a group program with some one-to-one sessions) since 2012 helping thousands of patients with a multi-disciplinary approach. 

The program can also cater for any St Vincent’s outpatients aged over 14, offering the only adolescent pain management program in Australia designed to help young people who suffer chronic pain.

Dr Michelle O’Brien is a specialist pain medicine physician and anaesthetist also working at St Vincent’s who specialises in chronic pain and minimally invasive neuromodulation techniques, including radiofrequency ablation and advanced neuromodulation delivered in the multidisciplinary team management setting.  

Dr O’Brien, who is also currently President of the Neuromodulation Society of Australia and New Zealand, says with this model, the patient plays the central role to develop a multimodal approach to their pain management, incorporating a tailored combination of evidence-based pain education, psychological strategies, physical therapy and rehabilitation, medications - as well as interventional procedures including advanced neuromodulation such as spinal cord stimulation.

“It’s important that people who suffer from chronic pain know that there are medical experts who just specialise in managing pain. There are pain services with trained people who can help specifically in pain and there are numerous management options. 

“Patients just need a referral to a pain specialist who can then assess the patient and then come to an agreement about the best approaches.” 

Jannie is aware of some controversy and adverse media coverage regarding some patients who have had less successful outcomes from spinal cord stimulation at various hospitals around Australia - but she says that people shouldn’t be unduly influenced by negative media.

“Start by seeing your GP and get referred to the right sort of specialist - I was lucky to be referred to a specialist pain physician in Dr Jabbour. People should make their own informed decision but don’t be scared of the options because one of them could just give you your life back,” she says. 

“I definitely feel that I have got mine back. I’m back at work, keeping active and I have a grandson who I can pick up and cuddle. That makes it all worthwhile.”