Pain management outreach now available in Madison

Posted on Wednesday, September 22, 2010

By ELISA SAND, Staff Reporter

Lake County residents who suffer with chronic pain and dread the idea of driving to Sioux Falls or Pipestone, Minn., to get relief have a new option at home.

Madison Community Hospital has contracted with Certified Registered Nurse Anesthetist Jerry Zwak to provide a local pain management outreach clinic. Zwak said he is currently scheduled to come to Madison every two weeks.

Hospital Administrator Tammy Miller said the proposal for the outreach clinic came from one of the hospital physicians. As the hospital explored the idea for the clinic, Miller said, Zwak was chosen because he was presently working with a number of physicians.

Until this point, the nearest pain management clinics were in Sioux Falls or Pipestone and, Zwak said, he's heard of patients who've had to wait a significant amount of time for an appointment.

Miller said appointments with Zwak are coordinated through referrals from physicians who have determined that the pain management technique would be beneficial.

"He can't do anything without a referral from a physician," Miller said.

By the time a patient arrives in his office, Zwak said, they've already had an MRI and other tests to determine the source of their problem.

Zwak said about 90 percent of his patients suffer from lower back pain, which is usually caused by herniated discs. He also sees a fair amount of neck injuries. To manage their pain, Zwak administers epidural injections with local anesthetic.

Sometimes the epidural shots provide relief for the patient and eliminate the need for surgery, he said. Sometimes the relief is temporary.

"The goal is to prevent surgery or make sure surgery is at the appropriate area," he said.

Looking at an MRI, Zwak said that a patient could have three herniated discs, and a doctor could conclude that the disc which is herniated the most is the problem. Sometimes, he said, that's not the case and the results of the epidural injections can help pinpoint the problem, which might be the disc that causes the least amount of concern.

Depending on the person and the severity of the injury, the injections can help manage the pain after the first injection, or it might require a couple more, he said.

While anyone can have bulging discs, not all cause pain. Pain occurs, he said, when the bulging disc starts to irritate the nerves and the nerves get inflamed.

"I'm trying to break the cycle of inflammation," he said.

Administration of the injections takes about 10 minutes.

Miller said the Madison hospital invested in a new piece of radiology equipment called a C-Arm for Zwak's office.

"It was an update to ours and support to the clinic as well," she said.

While providing the pain management clinic locally is somewhat unique, Miller said, it's a trend that other hospitals of comparable size are offering. Hospitals in both Marshall and Pipestone now offer this service, and demand has exceeded expectations.

"We're happy to offer this service in the community, making it easier for people to access pain relief without having to drive out of town," Miller said.

Zwak provides pain management outreach in several communities in South Dakota, North Dakota and Minnesota. He is from Pipestone.

©Madison Daily Leader 2010