EPISODE 31 — Diabetic Neuropathy & Spinal Cord Stimulation: Covered by Insurance!

Episode 31 — Diabetic Neuropathy & Spinal Cord Stimulation: Covered by Insurance!
Guest: Dr. Sean Sills, Touchstone Interventional Pain Center

Diabetic neuropathy affects nearly 40% of people living with diabetes — often resulting in burning pain, numbness, sleep disruption, difficulty walking, infections, and even amputations. But new advancements in spinal cord stimulation are changing everything.

This week, Jamie sits down again with Dr. Sean Sills, anesthesiologist and founder of Touchstone Interventional Pain Center, to uncover a treatment that is giving patients life-changing relief — and yes, it’s covered by insurance.

Dr. Sills explains:
 • What diabetic neuropathy actually is
 • Why nerves misfire and cause burning, stabbing, or numb sensations
 • First-line treatments and why they often fall short
 • How spinal cord stimulation works (it’s like a “pacemaker for the spine”)
 • The 1-week “test drive” trial before implantation
 • Success rates, risks, and real patient outcomes
 • How some patients regain mobility, sleep, and sensation in their feet

If you or someone you love lives with diabetic neuropathy, this episode may be the turning point.
 Learn how this minimally invasive technology is restoring quality of life — even after years of debilitating pain.

Touchstone Interventional Pain Center
Website: touchstonepain.com
Phone: 541-773-1435

At Team Senior™, our mission is to guide you and support you through the maze of Southern Oregon Long-Term Care.

📞 For Team Senior resources, call: 541-295-8230

Or visit our website for more information: https://www.teamsenior.org/

Transcript

EPISISODE 31: Diabetic Neuropathy & Spinal Cord Stimulation - covered by insurance!

Host: Jamie Callahan
Guest: Dr. Sean Sills, Touchstone Interventional Pain Center

JAMIE CALLAHAN: Hi, this is Jamie Callahan with the Team Senior Podcast. Our goal is to simplify aging. Society grooms us to plan for retirement, but what about life beyond retirement, where the rubber meets the road? Perhaps you've had a stroke, or you've been diagnosed with cancer, or maybe you're forgetting things and now you have dementia. That's our area of expertise, and we are here to share our insight.

And now, the Team Senior Podcast.

Hi there. This is Jamie Callahan with the Team Senior Podcast, and I am back in the studio with Dr. Sills from Touchstone Interventional Pain Center. I say that very slowly so that you really know what the name is. It's the Touchstone Interventional Pain Center. Dr. Sills, tell us a little bit about you again. Let's get through what you do at your clinic and why you are so involved and passionate about what you do.

DR. SEAN SILLS: Thank you. Yeah. I'm Dr. Sean Sills. I'm an anesthesiologist, and I specialize in a field called interventional pain management. And so that's a specialty where we use minimally invasive procedures to both diagnose and treat both acute and chronic pain conditions. I founded Touchstone about 12 years ago, really out of a desire to create an institution where I could deliver the care that I wanted to deliver, where I put people first—and not just our patients first, but also our employees.

JAMIE: That's super important in this day and age, when folks usually feel at a doctor's appointment that they're rushed in and rushed out by the Medicare guidelines of eight minutes that you get to see your doc. One thing I have learned about Dr. Sills in the short amount of time that I've known him is that he does genuinely care. He is interested in improving your quality of life.

DR. SILLS: Thank you.

JAMIE: Yeah, you're so welcome. So we're here today to talk specifically about diabetic neuropathy, and there is a certain treatment called a spinal cord stimulation that he's going to talk with you a little bit about. So let's dive right into it. Let's first talk about what is diabetic neuropathy.

DR. SILLS: Yeah. Diabetic neuropathy is a condition that about 40% of patients with diabetes develop. And it's a result of the high blood sugars. So the high blood sugars actually cause what's called glycosylation of proteins, and it damages the nerves. And when it damages the nerves, they can begin to misfire, and it can be just loss of sensation and numbness. Or in about half of these patients, it progresses to severe pain. And the pain is very debilitating. I always like to ask patients with diabetic neuropathy to tell me about their pain, and they get very colorful. For instance, "Tell me about your pain. What do your feet feel like?" "I feel like they're on fire. I feel like I'm walking on coals. I feel like somebody poured gasoline on my feet, or I feel like I'm walking on glass."

JAMIE: Can it also feel numb sometimes?

DR. SILLS: Yes. Numb.

JAMIE: Okay. Yeah.

DR. SILLS: Often numbness, often burning, often pins and needles. Sometimes it feels like your feet are wrapped. Sometimes they feel cold. It's just all sorts of bizarre, debilitating conditions, and it really does affect them. They can't sleep at night. They have trouble walking. Even wearing shoes can be difficult.

JAMIE: I've seen that myself. How common is it that somebody with diabetes has neuropathy?

DR. SILLS: I would say about 40% of diabetics will develop neuropathy, and then again, about 20%—or half of those—will develop painful neuropathy.

JAMIE: So before we talk about presenting a solution to them, let's talk about problems or issues that they face as a result of having diabetic neuropathy.

DR. SILLS: Yeah. So if you can't feel your feet, you don't know if you're injuring yourself. So a lot of these diabetics will cut themselves, not realize it. Later on that day, they look down and they see blood all over their sock or shoe, and they're like, "Oh, what happened?" And these cuts then become ways for the feet to get infected. A lot of the patients with diabetic neuropathy end up with ulcers, toe amputations, all sorts of consequences from their neuropathy.

JAMIE: We see that all the time. And I have to say, I'm very excited to take a deep dive into this with you today, because there are several people in my own inner circle who suffer from this.

DR. SILLS: Yeah.

JAMIE: So let's just talk first about what's the first line of treatments.

DR. SILLS: Yeah, so the first line, usually started by your primary care doctor or a podiatrist, will be medications. So the medications come from two main classes. One is a group of medications that work on nerve pain called gabapentinoids—gabapentin, pregabalin. They were initially developed as anti-seizure medicines, but they work to calm the nerves or slow down nerve conduction. And then another class of meds that can work are some antidepressants—SSRIs, selective serotonin reuptake inhibitors, or TCAs, tricyclic antidepressants. Those two classes of antidepressants also can help nerve pain. So usually your doctor will start you on one or a combination of those medications first.

JAMIE: That is very interesting. I would never in a million years have thought that an antidepressant could help with neuropathy pain.

DR. SILLS: Yeah.

JAMIE: Why is that?

DR. SILLS: I don't think we completely understand it, but part of the pain pathways are transmitted through norepinephrine and serotonin. And so these antidepressants that work on these pathways can indirectly alleviate pain.

JAMIE: Okay, so we've established that the primary care is probably going to prescribe gabapentin in some form of antidepressant, or maybe a combination of the two.

DR. SILLS: Yes.

JAMIE: Your office does something very different. What is spinal cord stimulation?

DR. SILLS: Yeah. This pain syndrome used to be a pain syndrome that I hated to treat because there wasn't much I could offer patients than what their primary care doctor was already offering. But about 10 years ago, there was an advancement in the field of neuromodulation, specifically spinal cord stimulation with high frequency, where we're able to get patients with neuropathy and pain remission. And I define that pain remission as we get their pain less than a two and a half out of 10.

JAMIE: So when I hear "spinal cord stimulation," I immediately think of epidural. I've had a baby. Yeah. So that's the connection that it makes for me. What does the process look like for a patient that's considering this? Is there a trial phase? Do you just go full monty? What do you do?

DR. SILLS: I love that analogy to your epidural, because it actually is an epidural. So instead of placing a catheter like you would do for labor and delivery that's infused with medication into that epidural space, we put an electrode. And so I look at it like a pacemaker for the spinal cord. So we place an electrode with a small battery that's like a pacemaker-size battery, and it sends signals over the spinal cord to interrupt those pain signals going to the brain.

JAMIE: So walk me through what this looks like. Patient shows up to your office. They've already been pre-qualified or assessed, and we know that this is going to work. How do you do this?

DR. SILLS: Yeah, so when they show up, we do our evaluation, look over their medications, and then insurance requires a neuropsychological evaluation screening for major psychopathology. And this is an insurance requirement. It's not my requirement, but basically making sure there's not a delusional disorder, there's not a severe dementia.

JAMIE: Is it because the treatment could cause that or make it worse? Why are they doing that?

DR. SILLS: Years ago, like 30-plus years, pain was looked at as it was just in the head. Oh. And these psychological tests were established like 20, 30 years ago, and they're just still—for whatever reason—when it comes to these interventional pain treatments, they want to rule out this major psychopathology.

JAMIE: Got it. So they get their psych evaluation?

DR. SILLS: Yes.

JAMIE: And then what?

DR. SILLS: Then I get an MRI scan just to make sure that it's safe for me to place the leads. And then once we get the neuropsych and the MRI, then we schedule for the trial. So there's very few procedures in medicine where we actually get to test-drive the procedure. So spinal cord stimulation, we actually get to do that. So we do a trial where, through a needle, I place electrodes. Takes me about a half hour, not very painful. We tape those electrodes with a battery to the skin. You wear that for a week, and you test-drive to see if the system works for you. If you get at least 50% of your pain relief during that week, then we consider you for implantation a few weeks later.

JAMIE: That is fascinating. How many primary cares are referring to you for this service? Is it well known?

DR. SILLS: It is, but it isn't. The technology for spinal cord stimulation has been rapidly advancing. There's just been an explosion of technology. It's hard for me, myself, as a pain specialist—who, this is all, this is my niche, this is all I do—to keep up with the change in technology. So a lot of the primary care docs just don't even know that this is a treatment modality that exists. So we're trying to get the word out, let people know.

JAMIE: This is like the standard in the medical industry, right? I meet with lots of people, and I hear lots of different things, and I'm always left with: How do people not know about this?

DR. SILLS: For sure.

JAMIE: Yeah, absolutely. So let's talk about risks and side effects quickly. What are the risks?

DR. SILLS: Yeah, so the risk that I fear the most is infection. Anytime you put a foreign object in the body, there's a risk it can get infected. It doesn't happen often. Nationally, it's like 3%. In our hands, it's 1% or less. But if you get an infection, we've got to take it out, put you on IV antibiotics. If you get a spinal infection, you can get really sick. So we do a lot of things to try to mitigate that and reduce that. But the chance of that, it's about 1%. The other risk is that it stops working for you. And we don't understand this, but in about 10% of our patients after the implant, over time, it just stops working. Your body gets attenuated to the signal, and then you start to get breakthrough pain, and then the device works less and less.

JAMIE: What's the average amount of time that it takes before somebody stops to see results—or stop seeing results?

DR. SILLS: Usually, if this type of process can start within a couple months to even up to a couple years.

JAMIE: Interesting. I feel like a couple of years of pain relief is huge, especially in late stages of life.

DR. SILLS: Yeah. And it's—again, it doesn't happen to—it happens to a small part of our patients, but it is something that—I always get frustrated. The patient took the risk, we did the procedure, they got good results, and then all of a sudden, for whatever reason, the results go away.

JAMIE: Oh, sure. It has to be frustrating. I know from my own experience, I got an epidural with both of my kids. The first one, it worked brilliant. It was like a lovely experience, actually. And then with my second, it didn't work nearly as well.

DR. SILLS: For sure.

JAMIE: Yeah. So I can see that. That's definitely a thing. Because I know how passionate you are about helping your patients, I would love to hear a story about somebody whose life you've touched, where this significantly improved things for them.

DR. SILLS: Yeah, I got a great story. My story would be the first patient that I actually treated with this technology called high-frequency stimulation about 10 years ago. So the FDA had just approved it. And this patient had painful diabetic neuropathy. I remember seeing him in our office—he was missing a couple toes from amputations. His calves were all atrophied and shrunk because he couldn't walk very well, and just in terrible pain. And then I remember, after the trial and the implant, coming into his office visit, asking him, "How are you doing?" And he's like, "I'm like 90% pain-relieved." He says, "I can walk." He says, "I can dance," which he hadn't done for years. And then, over time, he got sensation to return to his feet. So he's now almost 10 years out and still just doing great.

JAMIE: No kidding?

DR. SILLS: Yeah.

JAMIE: Oh my gosh. Yeah. What a lovely experience. I know that there must be follow-up for patients once they come to see you. So what does that look like? How does your team support them? How often are they checking in with you? Yeah. How do you help them once they get this?

DR. SILLS: Yeah. So what's great about this procedure is often it's a one-and-done procedure where patients come in with terrible, debilitating pain—whether it's the diabetic neuropathy or they've had back surgery, or they've got all sorts of different pain syndromes—and we treat them. And then they're in pain remission. We do the follow-up, and then they just call us if they need us. But other patients, we have a staff dedicated to their care—that's our spinal cord stimulator coordinator—and she tracks our data. She's always reaching out to our patients, seeing how they're at, seeing if they need reprogramming, and then getting them into the office if they need that.

JAMIE: Nice. I know that's comforting for folks to know that they're not just going to be left after they get this implantation. How do people reach out to you?

DR. SILLS: The best way is to just go online to our website, www.touchstonepain.com—touchstonepain.com—or you can call us at 541-773-1435.

JAMIE: All right, Dr. Sills, I'm going to repeat that back for folks, because this is something you definitely want in your repertoire of available services when you need to call on it. The name of the facility that he works at, that he founded, is the Touchstone Interventional Pain Center. Their website is touchstonepain.com, and you can reach them at 541-773-1435. Again, this is Jamie Callahan, and as I always close with, the opportunity for you to reach out to us: If you forget anything about what has happened in this podcast, or you've listened to it and you fast-forward a couple years and you can't remember, call us. We'll do everything in our power to get you connected to Dr. Sills and his team.

DR. SILLS: Thank you. Thank you, Jamie.

JAMIE: Yeah, you're very welcome. Thank you so much for being here today. This is an amazing service that you're providing.

DR. SILLS: Thank you.

JAMIE: You got it.

Thank you for listening to the Team Senior Podcast. We're here every week sharing new and relevant information. Remember that we're just a phone call away. Team Senior can be reached at 541-295-8230. Again, 541-295-8230. Until next time, this is Jamie Callahan.