PROGRESS OVER PATIENCE

September 2, 2025

172

Article by Ann E. Butenas

C. Lan Fotopoulos, M.D. -Interventional Physiatrist, shares how proactive pain management has replaced the “wait and see” approach.

When interventional physiatrist Dr. C. Lan Fotopoulos looks back at his early days practicing medicine, he remembers patients who had few options and little hope for relief. Today, in his practice with Kansas City Orthopedic Alliance, those same conditions that once seemed insurmountable are routinely treated with precision procedures that would have been unimaginable just 25 years ago.

Q: Dr. Fotopoulos, you’ve been practicing for over 25 years. How has pain management changed during that time, and what impact have these changes had on your patients?

The transformation in pain medicine over the past quarter-century has been almost revolutionary. When I started my career, we were essentially practicing defensive medicine with limited options. Today, we’re able to offer patients targeted, minimally invasive solutions that would have seemed like science fiction back then.
Take vertebral compression fractures, for example. Twenty-five years ago, if an elderly patient came in with a compression fracture from osteoporosis, we had essentially one treatment: bed rest. We’d tell them to lie down for weeks, maybe months, hoping the bone would heal on its own. The problem was that prolonged bed rest often led to muscle atrophy, blood clots, pneumonia, and a downward spiral that was sometimes worse than the original injury.
Now, through procedures like vertebroplasty, I can have that same patient walking out of the clinic within hours, pain-free. We inject medical-grade bone cement directly into the fractured vertebra, essentially creating an internal cast. It’s a 30-minute procedure under light sedation, and the relief is often immediate. This isn’t just about comfort, however; it’s also about preventing the cascade of complications that used to be inevitable with these injuries.

Q: What about conditions that were poorly understood back then?

Sacroiliac joint dysfunction is a perfect example. Twenty-five years ago, SI joint pain was barely on our radar. Patients would come in with lower back pain, we’d look at their spine, maybe do some physical therapy, and when nothing worked, we’d often just shrug our shoulders. We now know that this condition affects roughly 30% of people who suffer from lower back pain, yet it remains largely unknown to the public.
The tricky thing is there’s still no blood test or X-ray that can definitively tell you “Yes, this is SI joint dysfunction.” You must piece it together from the patient’s history and symptoms, develop what we call an index of suspicion. These joints connect your sacrum—that triangular bone at the base of your spine—to your pelvis, and while they don’t move much, they’re crucial for transferring forces between your upper and lower body.
My approach is systematic now. We start with conservative treatment—physical therapy focused on pelvic alignment and core strength, anti-inflammatory medications, maybe some specialized bracing if the joints are too mobile. If that doesn’t provide lasting relief, we move to precisely targeted steroid injections. And for the toughest cases where conservative treatments and steroids only give temporary relief, but diagnostic injections confirm the SI joint is the source, we have percutaneous SI joint fusion. It’s minimally invasive and has largely replaced radiofrequency ablation as our go-to permanent solution.

Q: How has technology changed your most challenging cases?

Diabetic neuropathy was honestly one of the most frustrating conditions I dealt with in my earlier years practicing medicine. I’d see patients come in with this relentless burning and shooting pain in their legs and feet. This was pain so severe they couldn’t sleep through the night or even walk across a room. And what did we have to offer? Medications that worked for maybe half our patients, and even then came with side effects that sometimes felt worse than the original problem. The alternative was opioids, but that just created a whole different set of issues without actually addressing what was causing their pain.
The introduction of high-frequency spinal cord stimulation has been a game-changer. The Nevro system, which is the only FDA-approved device specifically indicated for painful diabetic neuropathy, uses 10 kHz therapy to interrupt pain signals before they reach the brain. What makes this particularly exciting is that we’re seeing not just pain relief, but actual improvement in neurological function. Some patients are regaining sensation they thought was lost forever.
The numbers tell the story: in clinical studies, 86% of patients report greater than 50% pain relief at 12 months. But beyond the statistics, I see patients who were essentially homebound return to active, productive lives. It’s transformed how we think about neuropathic pain management.

Q: What broader changes have you observed in patient care?

The biggest thing I’ve noticed is that we don’t just sit around waiting for things to get worse anymore. Back in the mid to late 90s, for example, our approach was basically “let’s see how bad this gets before we do something about it.”
Now? If I see someone heading toward trouble, we jump on it early. It’s amazing how much suffering you can prevent just by being a little more aggressive upfront instead of letting problems snowball.
The technology has become incredibly sophisticated, but the human element remains paramount. We’re not just treating pain; we’re restoring people’s ability to live the lives they want to live.
The most rewarding part of practicing medicine today is that we can offer hope where there used to be resignation. That’s a profound change, and it’s one that benefits everyone who walks through our doors.