Photograph by Jeremy Kramer
Marc Orlando, M.D., is an interventional pain management specialist at Mayfield Brain & Spine, an internationally recognized leader in neurological surgery known for patient-centered care. He’s researching spinal cord stimulation to help relieve pain for those with Restless Legs Syndrome and possibly other medical conditions such as Parkinson’s.
I started my career as a physical therapist and, while doing my med school rotations, became intrigued by physical medicine and rehabilitation. At the time, interventional pain medicine was still in its infancy, with few established procedures or specialists, so I’m self-taught. I’ve been doing this for 30 years, the last 12 with Mayfield, and to date I’ve conducted 1,500 spinal cord stimulator trials.
The brain and the spinal cord are what make us who we are as individuals, athletes, and humans. Simply put, if something is off with the spinal cord, it affects everything. Nerve fibers travel through the body and to the brain.
We discovered that all of those nerves come to the top of the spine, the dorsal, and we’ve been able to pinpoint the spine’s “sweet spot” where a minimal amount of stimulation through an electrode can provide a sensation to the brain that provides significant pain relief.
It’s not dissimilar to a pacemaker. We implant a very small battery that’s rechargeable and able to be controlled remotely by the patient. It’s customizable based on different activities and situations and can deliver varying levels of electrodes via a small remote.
We are über-conservative when it comes to spinal cord stimulation. The main indication for it is “failed back syndrome,” which is when all other options, treatments, and therapies have been exhausted.
It’s estimated that 5 to 15 percent of the population is affected by Restless Legs Syndrome (RLS), which can appear spontaneously with no underlying causes. That’s frustrating for patients. The majority of people with RLS have it mostly in their legs, but it can affect other parts of the body. Despite being individualized and subjective, RLS can have an official FDA approval for treatment, and that’s when we can help.
We are currently conducting a small study where we insert a small spinal cord implant in five patients with an official FDA approval for diagnosis. While the group was small, each experienced great pain relief.
This study is the first of its kind in developing an off-label indication for RLS. Other conditions we’re considering treating include deep brain stimulation for patients with Parkinson’s, gastroparesis, chronic visceral pain, chronic abdominal pain, and pelvic pain. In Europe, it’s not uncommon to be used for vascular problems, either.
People living in chronic pain can be depressed. As a medical provider, I feel for them and I want to help.
Sometimes a patient will run into my wife at an event or just while out and about, and they’ll tell her, Dr. Orlando changed my life. That’s what fuels my fire.
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