Beyond Symptom Relief: Kristen Klein on the Power of Restorative Neurostimulation

[00:00:02] Hey everyone, welcome back to the Outcomes Rocket. So glad you joined us again today for an exciting episode in the series we're doing with Mainstay Medical around back pain, chronic low back pain, ways that we could resolve it. It's all about restoration. And today I have a privilege of hosting an awesome guest. Her name is Kristen Klein. She is a certified nurse practitioner at the New York Spine and Pain Specialists in Port Jefferson, New York.

[00:00:30] She joined the practice of Dr. Brian Durkin, where they're treating patients with various pain conditions, providing most cutting edge and minimally invasive therapies. Kristen has her background in nursing, a master's even in nursing from Stony Brook University with a certificate in adult gerontology. So super excited to have her perspective for this series today. Kristen, thanks so much for joining us.

[00:00:55] Kristen Klein Thank you so much for having me. It's a privilege to be here today.

[00:00:58] Kristen Klein Of course. And look, we've had a lot of great discussions with physicians, with practitioners, with patients. And it's so great to get a nurse's perspective because I feel like in healthcare, nurses see more than most. So certainly very valued perspective today. Let's talk about it. Can you describe any challenges or obstacles that clinicians might face when they're attempting to diagnose that multifidus dysfunction in their patients?

[00:01:23] Kristen Klein Yeah. So I work in a primarily interventional pain practice. And the majority of patients that we see that come in the door have back pain. Back pain is so debilitating. It could be a chronic thing that's been really exacerbated for years and years with patients. And it's one of the most number one reasons why people miss work, school.

[00:01:44] Kristen Klein And it affects all the areas of their lives, their hobbies, their livelihood, things that they love to do. So we see this all the time. It's so common. And it can be very hard to treat because there are so many different factors that can contribute to back pain.

[00:01:58] Kristen Klein And multipidus dysfunction is obviously one of them. So the challenges as providers that we have really can be to tease out what pain generators are contributing to this back pain, because most people don't just have one. They have multiple things. So really honing in on that physical exam, listening to your patient story. And that's where us as nurse practitioners really come in. We spend a lot of time with the patients.

[00:02:22] Kristen Klein We get to know what party did they go to last week? Do they have a graduation or know about their grandchildren or what's going on with their job? And you really hear their story. And when their pain comes, what makes it better? What makes it worse? And get to really hone in on that physical exam and story of the patient, because that's going to be really telling to say, okay, how many things do they have that are contributing to their back pain? And how do we kind of peel away the layers of the onion to treat their back pain with multiple treatments?

[00:02:52] Kristen Klein Yeah. And there's a ton of layers. Totally love that you went there with this, Kristen, because there are so many layers. And for clinicians listening to this, what strategies have you found most effective in educating patients about this multifidus dysfunction and its implications to their overall health?

[00:03:09] Kristen Klein So the MRI really is a key indicator when you have an MRI on a patient. And oftentimes I picked up this tip from another physician. If you have an MRI that they've maybe undergone,

[00:03:22] Kristen Klein years ago, or even a decade ago, if you have access to that, and you see what that multifidus muscle looked like then. And then you show them the most recent one that they may have had over the past six months, year or so. And you can kind of see how that fatty infiltration and that weakening has occurred over time. And you show patients that they really start to realize, wow, this is something that is progressive, potentially.

[00:03:45] Kristen Klein And they can see the difference of what has occurred over those years and see, okay, this is where the problem is and we need to restore or fix it.

[00:03:54] Kristen Klein Yeah. That MRI is very revealing. And can you share any experiences or insights into how this integration of technology has enhanced your ability to diagnose or treat multifidus dysfunction?

[00:04:07] Kristen Klein The MRI really is a key indicator along with the physical exam testings. And I'll often refer patients to the website, they have great information for patients as well as other nurse practitioners, physician assistants, physical therapists and providers. It's a great tool. It shows how to do the physical exam testing, what a typical patient may complain of, like the clinical cues of what they may say when they get their pain or what makes it better or worse.

[00:04:35] Kristen Klein And those factors really kind of help contribute to that technology and the knowledge that we have with how to diagnose this pain.

[00:04:45] Kristen Klein They also, it's very different than traditional stimulators. So a lot of the times patients that have been in chronic pain for a while will ask me, well, how does this stimulator differ from the traditional spinal cord stimulation that we've used in the past for things such as lumbar post-lavinectomy syndrome or patients that have had back surgery before?

[00:05:04] Kristen Klein And we tell them this is a restorative treatment. So we're not just masking the symptoms, we're actually fixing the problem, which will help fix their pain as well.

[00:05:14] Kristen Klein And unlike a traditional spinal cord stimulator trial, this one doesn't need a trial, right?

[00:05:19] So there's a twitch test that's done on the operating room table so the patient doesn't have to undergo that weak trial before implanting with this system.

[00:05:28] Kristen Klein That's awesome. It's less invasive. And this is really different, folks.

[00:05:32] Like, you know, you typically go in for a stimulator or surgery. This thing actually gets you back, you know, gets you back into your life.

[00:05:40] Kristen Klein And if you haven't had a chance to listen to the other interviews, listen to the patient interviews because they're the ones that are really living proof of this.

[00:05:50] And look, there's living proof, but there's also data. So would love to really help understand this data.

[00:05:55] Kristen, what clinical evidence or data support the effectiveness of this restorative neural stimulation in this chronic low back pain, multifidus dysfunction patient?

[00:06:05] Kristen Klein Yes. So this is really special because it is the first stimulator company that has data published now five years.

[00:06:11] And so none of the other stimulators, they're not restorative, but they also don't have data that's been published for this long.

[00:06:17] So the data does continue to show that these outcomes are durable and sustainable.

[00:06:22] And just to quickly piggyback on what you just said about getting patients back to living their best lives.

[00:06:26] A thing that I always do as a nurse practitioner when I'm seeing patients is to have the patient write down three goals that they want to do.

[00:06:33] It could be about work, hobbies, activities.

[00:06:37] And OK, these are things that I would love to do or that I used to do that I'm no longer able to do.

[00:06:42] And the whole goal of that is to get them back to completing those goals and hopefully, again, living their best lives.

[00:06:49] So with the data, the five year data that was published did show that their pain scores decreased from like a seven to a 2.3.

[00:06:57] I believe on the scale, their disability index also decreased.

[00:07:02] So patients went from moderately to severely disabled to more minimally or mildly disabled, which is huge.

[00:07:10] So, again, getting patients back to that functional ability, because what good is pain relief without improvement in functioning?

[00:07:15] Health care costs were lowered.

[00:07:18] They helped to reduce opioid or pain medication use, getting people going back to work, their better improvement in their jobs.

[00:07:27] And a lot of them had pain for many years.

[00:07:31] I think the average years was about 13.

[00:07:34] And these are patients that could be in their 20s, 30s, 40s, 50s, 60s and later decades in life.

[00:07:40] So the average age was around 47 years old.

[00:07:42] So this affects people of all ages with chronic low back pain.

[00:07:46] Yeah, it's very real.

[00:07:48] And I love, by the way, Kristen, the three goals, just because it's like, what do I want to do?

[00:07:53] You know, and the treatment becomes very personal.

[00:07:55] And then when you start doing those things, you're like, wow, like this is why you could feel the progress.

[00:08:01] Right. It goes beyond the clinic, but it goes into daily life.

[00:08:05] Absolutely.

[00:08:06] I love that.

[00:08:06] And it's rewarding to see as a provider.

[00:08:09] Oh, big time.

[00:08:09] That's what makes us keep getting up in the morning and keep loving what we get to do.

[00:08:13] And some days are hard, but these wins are what makes coming back to work again feel great.

[00:08:19] That's awesome.

[00:08:19] And this goes for patients and providers, right?

[00:08:22] I mean, you got into this business to care for patients, to make people better.

[00:08:27] And, you know, it could be a grind out there.

[00:08:29] It could be a grind.

[00:08:30] It could be burnout.

[00:08:31] And when you get these types of wins, it's very rewarding.

[00:08:35] Specific outcomes, anything rise to the top for you as, you know, improvements that patients have experienced following this type of therapy?

[00:08:42] Yes.

[00:08:42] There's one patient that I still see.

[00:08:45] I just actually treated her for shoulder pain yesterday.

[00:08:48] So she was one of our first implants a couple of years ago.

[00:08:52] She's a middle-aged woman, commutes to work.

[00:08:55] So we live on the island.

[00:08:57] Her canoe was probably about 30, 45 minutes.

[00:09:00] Had a desk job.

[00:09:01] And she was in chronic pain for decades.

[00:09:04] I would say 15, 20 years.

[00:09:06] Wow.

[00:09:07] And she had seen other pain physicians, underwent epidural injections, radiofrequency ablation of the medial branch nerves surgery, and other things to kind of try to help her pain.

[00:09:19] Physical therapy, chiropractor care, medications, you name it.

[00:09:22] She's done it all.

[00:09:23] So she was our patient the past couple of years and still complained of this back pain, this kind of fatigue plateauing with physical therapy.

[00:09:33] It's just little transitions would cause her pain, sitting at her desk, sitting in the car on the way to work.

[00:09:38] And it was still debilitating to her on a daily basis, despite doing all those interventions for years.

[00:09:43] So we implanted her.

[00:09:45] And it's been about, I would say, a year and a half since she's had the implant.

[00:09:49] And it's completely changed her life.

[00:09:51] Wow.

[00:09:52] She is back to commuting.

[00:09:53] Desk job, doesn't have to get up and walk around every, whatever, 15, 20 minutes.

[00:09:59] She has no further back pain.

[00:10:01] And I've been following her for other things like her neck and her shoulders.

[00:10:03] But her back pain still stays great.

[00:10:06] She actually says the device helps her fall asleep because it kind of massages her back at night.

[00:10:10] So it's completely changed her life with her back pain.

[00:10:13] And she couldn't be happier.

[00:10:14] What a great story.

[00:10:15] And the going to sleep thing I heard from a couple of the other patients that we interviewed.

[00:10:19] So amazing.

[00:10:20] Thank you for sharing that.

[00:10:22] And there's so many of us with pain.

[00:10:25] And we don't have to live with it.

[00:10:27] And oftentimes, we don't know what the options are.

[00:10:30] And that goes for patients and also providers.

[00:10:33] So for any providers out there, Kristen, that are considering to incorporate restorative neurostimulation, or maybe they don't know about it yet into their practice.

[00:10:44] Like, what advice would you give them for the management of this multifidus dysfunction and chronic low back pain?

[00:10:49] There are so many tools to use for educational purposes for advanced practice providers, physicians, whomever.

[00:10:58] I would say first go on to the website, right?

[00:11:00] So Mainstay's website is a great source.

[00:11:03] It has everything from, like I said before, the clinical cues, what to expect with the patients, physical exam testing with video demonstrations, things about reimbursement in the procedure itself.

[00:11:14] So it's a great resource to kind of get yourself familiarized.

[00:11:17] And if you reach out to Mainstay, they can coordinate webinars or peer-to-peers with other physicians and nurse practitioners or PAs around the country that have experience with the therapy to be able to educate that particular provider one-on-one.

[00:11:32] Conferences are a great tool.

[00:11:33] They're at many of the conferences with the booth.

[00:11:35] You can learn more about the product, get your hands on some of the battery, the lead, some of the equipment.

[00:11:40] And I would also say their webinars are a great tool for patients and providers to kind of learn, okay, what am I looking for on this patient?

[00:11:49] What do they typically complain of?

[00:11:50] And how do we follow and treat these patients after implantation?

[00:11:54] What does that follow-up look like over the months following?

[00:11:57] So there's tons of resources out there.

[00:12:00] Just reaching out and kind of getting involved would be a great start.

[00:12:03] And when you're going to incorporate this into your practice, and this is true for any therapy, I would say, make sure your whole team is on board.

[00:12:11] So that goes to the people at the reception, your medical assistants, your nurse practitioners, your physician assistants, your physicians.

[00:12:19] And get everyone on board.

[00:12:21] Let them know what this therapy is.

[00:12:22] Teach them a little bit about the therapy.

[00:12:24] And talk to your providers about where is this going to fit in our algorithm when we treat chronic low back pain and how are we going to follow these patients up.

[00:12:32] And when everyone's on the same team and on the same page, it just makes for a more streamlined process and more success for them as providers and for patient outcomes.

[00:12:43] Love that, Kristen.

[00:12:44] What a great and super important point to bring up.

[00:12:47] Involve your team.

[00:12:48] Involve the entire care team.

[00:12:50] The front office team.

[00:12:51] Everybody needs to be on the same page.

[00:12:53] Exactly.

[00:12:54] Yeah, I love that.

[00:12:55] What a great way to close.

[00:12:56] And also, let's not forget the resources that Kristen mentioned.

[00:12:59] The webinars, the website.

[00:13:00] We're going to be linking up all of the resources that she just mentioned in the show notes.

[00:13:06] So hit pause or keep going with it and check those out.

[00:13:09] Now's the time for you to make a difference for your patients, your practice.

[00:13:14] Now's the time to transform your particular practice.

[00:13:19] And Kristen, I want to thank you for your time spending with us today and sharing what you've seen and the success with this therapy.

[00:13:26] Thank you so much for having me.

[00:13:28] Thank you.