Mercy Washington's Spine Center and Pain Management

As an RN, Judy Tobben has more than just empathy for the patients she sees at the Mercy Washington’s Spine Center and Pain Management. She has complete understanding.

It wasn’t so long ago that she was a patient there herself.

“Pain can make a person so tired and it can take the joy out of your life,” said Tobben, Washington. “It actually makes you very depressed.”

After recovering from knee surgery in January 2018, Tobben found herself experiencing severe low back, hip and leg pain from her thigh all the way down to her toes.

“The longer the pain went on the weaker and more numb my legs and feet became,” she said. “My back and hips were so stiff I had a hard time getting out of bed. If I rode in the car for more than 10 minutes, I had difficulty standing and walking.

“I was honestly afraid I was developing an auto-immune disease like multiple sclerosis.”

She made an appointment with her internist who ordered labs and a nerve conduction test. She also began receiving physical therapy several times a week.

That helped alleviate some of the pain, she said, but it did not give her enough relief, strength or function. She still couldn’t walk down steps without tripping.

She had an MRI and from there was referred to Dr. Kenneth Justin Naylor at the Mercy Pain Management Center.

“I had several epidural steroid injections, and I felt like a new person,” said Tobben. “Within a week or two, my back and legs were strong again. The pain and stiffness were gone in my back, and I could sleep without pain.”

Stephen Enger, who lives in Hope, Mo., in Osage County, tells a similar story of finding pain relief.

He lived with back pain for about a year and a half before it got so bad that he knew he had to do something about it.

He came to Mercy Washington for an MRI that showed he had stenosis, which is a narrowing of the spaces, in his lower spine. He was referred to Dr. Naylor, who said Enger was a perfect candidate for MILD, which stands for minimally invasive lumbar decompression.

A nonsurgical outpatient procedure that takes less than an hour to perform, MILD has been something of a miracle cure for the 30 or so patients that have had it done in Washington, said Bill Hellebusch, director of support services at Mercy Hospital Washington.

“Lumbar decompression used to be a very involved spinal surgery that involved overnight stay and a long recovery,” said Hellebusch. “These patients walk out of our procedure center the same day, and they’re getting back to doing functional things they used to do.

“Through the size of a hole punch, doctors are doing this with a catheter,” Hellebusch explained. “They are actually removing ligament that becomes thickened, creating less space for patients on their lumbar. (They) even remove some bone to allow the spinal cord to move, and these patients have incredible results.”

Enger said his pain relief after MILD “was immediate . . . It was tremendous!”

New Procedure Center

Mercy Hospital Washington has been offering pain management services for about 10 years now, but for much of that time the procedures were performed in the surgery center, which required a level of overhead, in terms of cost and care, that the patients just didn’t need, said Hellebusch.

“They were going through pre-op and then going to the OR (operating room) for the procedure and then going through recovery,” he said, noting that was a lot for patients who were mostly receiving smaller percutaneous procedures that didn’t require an incision.

“You’re doing things with catheters, so you didn’t need to be in the surgery center,” he commented.

Then about a year and a half ago, Mercy opened a new pain management procedure center on the second floor of the North Doctors Building, with an office space located just down the hallway.

“This has allowed us to be so much more efficient,” Hellebusch remarked, noting patients are cared for by the same team from initial visit through post-treatment follow-up.

“In a footprint the size of a doctor’s office, we see pre-op patients, take them back for their procedure and discharge them. It all happens very seamlessly,” he said.

The staff — which includes two full-time physicians, Dr. Naylor and Dr. Matthew Rahrig, and one nurse practitioner, Jessica Latham, ANP — is able to see as many as 40 to 45 office patients per day and do as many as 30 to 34 procedures a day.

Mercy Pain Management also recently opened a office second location at the Mercy facility at Clayton and Clarkson in West St. Louis county. They have office hours there once a week and then those patients travel to Washington to have their procedure, said Hellebusch.

Treating All Types of Pain

Patients who come to Mercy Pain Management have all different kinds of pain, including:

Back pain, cancer pain, chronic knee pain, complex regional pain syndrome (RSD), degenerative disc disease, diabetic peripheral neuropathy, failed back surgery syndrome (FBSS), head and neck pain, hip pain, myofascial pain, neuopathic pain, osteoporotic and malignant compression fractures of vertebrae, post-amputation pain, sacroiliitis, sciatica, shingles and spinal stenosis.

“The big things are all spine and osteoarthritis,” said Hellebusch. “Our pain management practice is almost exclusively interventional.

“We do very little of pain medication. If we do it’s in combination with a procedural intervention, and it would be something like Gabapentin. Not an opioid.”

There is actually a sign at the pain management center that reads, “No narcotics given here,” said Enger.

As a patient, he was more than fine with that. He had been given an opioid in the past to treat acute pain, and while it helped in the short term, he hated the side affects.

“It made me itchy and cantankerous,” said Enger, who was given an opioid after he had knee surgery. “It killed the pain, but the side affects were intolerable. I quit taking them.”

Hellebusch isn’t surprised by that.

“The research is very definitive on this,” he said. “No opioid is successful at treating chronic pain.”

“Interventional pain management through epidural steroid injection, transforaminal procedures, radiofrequency ablation . . . where we actually isolate nerves that are inflamed and burn them. These are things that are going to take care of the problem, where the opioid really didn’t,” said Hellebusch.

Mercy Pain Management doesn’t just want to treat a patient’s pain, but also to understand what is causing the pain and how it is affecting the patient’s life.

The goal, said Hellebusch, is not just to improve pain but to restore function and quality of life.

Types of Procedures

Mercy Pain Management offers a variety of treatments.

That includes epidural steroid injections for neck and back pain, vertebroplasty/kyphoplasty for spinal fractures and spinal cord stimulation for chronic pain.

There also are a number of procedures done using X-ray to be sure the medicine is placed in the ideal location, said Hellebusch.

For some patients, a treatment may be only needed one time, said Hellebusch. For others, they may be recurring.

“Interventional pain management isn’t going to structurally change things within the spine, if someone has advanced stage osteoarthritis,” Hellebusch explained. “It is going to treat the symptoms associated with that and reduce inflammation.

“Through a catheter, they can do a procedure called an epidural steroid injection, and they deliver a high-dose steroid into the spinal cord and reduce inflammation of the bones, ligaments, nerves, which then alleviates the pain,” he said, but for those types of cases, the patient will have to come back for future treatments. “It’s a recurring relationship.”

Since having the MILD procedure done more than a year ago, Enger has returned to Mercy Pain Management, but to treat other pain, including arthritis in his spine. Each time he has been pleased with the results. 
“This is like a new lease on life,” Enger remarked.

For more information on Mercy Pain Management, call 636-239-8097 or go to