ANNISSA JOBB first limped into the office of Dr Riam Shammaa, a sports medicine and pain specialist in Toronto, Canada, in 2017. The personal support worker in long-term care homes was desperate for help after a decade of back pain due to an undiagnosed herniated disc.
“It’s my calling in life, taking care of people,” says Jobb, now 54. But working with frail seniors involves a lot of lifting, bending, and pulling. It wasn’t an option to rest. So she gritted her teeth through the pain. “I had a drawer full of pain medication. None of it was working. I’d snap. My husband and I came close to getting divorced.” By November 2016, Jobb could scarcely walk 200 metres. “My family doctor finally said, ‘You will end up in a wheelchair if you don’t stop working there.’”
Jobb was referred to Dr Shammaa, who began by administering nerve-block injections, similar to an epidural, every few weeks. They held the pain at bay for anywhere from a few days to a few weeks, but then it always returned.
Historically, the treatment of complex, chronic back pain has been less than ideal, sometimes resulting in patients becoming addicted to opioids, or involving major—often unsuccessful—spinal-fusion surgery, which is suitable for only about
