Relief for a Teen’s Severe Back Pain
Erica Medina will never forget the feeling of waking up pain-free for the first time in six years."It was heaven," Erica said with a bit of a laugh. "The clouds opened up. I thought, 'There really is something out there that can help me.'"
The 17-year-old high school senior was awakening from a procedure at Lucile Packard Children's Hospital to inject anesthetic and steroid medications into joints in her back that were affected by juvenile idiopathic arthritis. Before the injections, "Erica was in a really bad place," said her mother, Stephanie. Erica's arthritis, which goes through periods of remission and active disease, had flared in the months before her injections, causing severe pain.
"Her rheumatologists at Packard Children's were really concerned because her demeanor changed," Stephanie said. "They told her, 'You're getting used to the level of pain you're in, and that's not OK.'" So they referred Erica to the hospital's Pain Management program.
Six years earlier …
One morning when she was 11, Erica woke with her hands excruciatingly swollen. Physicians in her home town of Reno, Nevada soon diagnosed juvenile idiopathic arthritis, one of the many forms of childhood arthritis that, in total, affect 300,000 U.S. children. Over the next few months, arthritis spread to Erica's wrists, arms and back.
"It was definitely scary," Stephanie said. Suddenly, her sixth-grader couldn't perform basic tasks. "I had to tie her shoes for her. That was really hard."
Juvenile idiopathic arthritis, which is caused by an immune system attack on the body's own tissues, causes joint pain and swelling. When arthritis began to affect her back, Erica was also diagnosed with ankylosing spondylitis, a form of inflammatory arthritis of the spine. Because the state of Nevada has no pediatric rheumatologists, she was referred to Packard Children's, where pediatric specialists manage her care in cooperation with an adult rheumatologist in Nevada.
 Pediatric rheumatologist Joyce Hsu, MD |
Medications quieted the arthritis in Erica's hands, wrists and arms, but her back was a different story. Back pain made it taxing to sit through lectures at school, go on field trips or walk through the mall with friends. It wasn't just the pain that bothered her: "When I was younger I hated taking my meds," Erica said, adding that it felt like "giving up" to take pain medicine. "I didn't want to be different from any normal kid."
Stephanie was glad Erica's doctors tackled this issue head-on. "They were able to convince her that treating pain has nothing to do with weakness," she said.
Such patient-care challenges are one reason children with arthritis should see a pediatric rheumatologist, said Hsu: "I'm a pediatrician first: We really keep track of school and physical and emotional development, and understand the issues that come with that."
With her doctors' support, Erica did as many ordinary activities as possible. She loved playing volleyball and basketball. But it could still be hard to acknowledge her limits, as she realized when she earned a spot on her high school's championship basketball team. The grueling workouts were too hard on her body, and she made the difficult choice not to play.
"The pain was the first obstacle that stopped me from doing what I really loved," she said.
In the summer of 2010, Erica's back pain worsened. That was why her rheumatologists referred her to the Packard Children's Pain Management team. In cooperation with Erica's rheumatologists, they tackled her pain from every angle, prescribing physical therapy, acupuncture, melatonin supplements for sleep, orthotic shoe inserts and other treatments.
 Pain management specialist Meredith Brooks, MD |
However, when other approaches didn't give Erica enough relief, Brooks suggested a therapy she reserves for particularly intractable arthritis pain – the joint injections that gave Erica her first complete pain relief since her diagnosis six years earlier. The injected mixture of anesthetic and steroids numbs the nerves and reduces joint inflammation for three to four months. Erica now receives injections a few times per year. After she turns 18 and transitions to adult care, Erica may switch to an alternate therapy with similar effects, called radiofrequency ablation of the nerves, to avoid undesirable side effects from repeated injections of steroids, Brooks said.
Being free of back pain has made a huge difference in Erica's life. She has a job she loves at a frozen-yogurt shop. Nearly set to graduate from high school, she can concentrate during her favorite science classes – preparation for the career she's planning as a research geneticist. And she's able to enjoy everyday teenage fun.
"I hang out with my friends more often," she said. "If we go out walking, I always go now instead of never going. It is so nice to relax and finally be happy."