Eastern Virginia Medical School
Lydia Meyer Endowed Chair and
Associate Professor of Physical Medicine and Rehabilitation
In 2004, when then-Department Chair Dr. Jean Shelton recognized the need to establish a spine center at EVMS, it was Dr. Antonio Quidgley-Nevares whom she recruited to accomplish that task – although he is quick to point out that Dr. Jennifer Reed had already begun making connections and starting referral patterns. “The first building blocks were there,” Dr. Quidgley-Nevares says, “and that made things easier.” Thirteen years later, Dr. Quidgley-Nevares is directing a center that boasts seven physicians, one psychologist, a residency program and a pain management fellowship.
He completed medical school at the University of Puerto Rico School of Medicine, and did his residency training in Physical Medicine and Rehabilitation at the University of Virginia. In 2003, he completed a fellowship in Pain Management from Medical College of Virginia/VCU.
Dr. Quidgley-Nevares founded and serves as director of the Pain Fellowship Program at EVMS, and as Medical Director of the Pain Consult Service at Sentara Norfolk General Hospital, Medical Director of Lake Taylor Transitional Care Hospital and Medical Director for @Heart Hospice Care.
As a physician dealing with all aspects of pain management in addition to the spine, Dr. Quidgley-Nevares is keenly aware of the opioid crisis in the Hampton Roads, and co-developed the Opioid Agreement Protocol that has become widely adopted for use throughout EVMS.
“The way we approach spine pain has changed,” he says. “Over the years, we’ve been trying to prescribe more things like physical therapy, staying away from opiates as much as possible. The role for opiates is now considered more for function, rather than pain relief. Most of what we’re doing now focuses on non-opiate alternatives.”
Among those alternatives are epidural injections as well as spinal cord stimulators, implanted devices that block pain signals from the spinal or peripheral nerve injury, delivering an electrical current to the spinal cord. And with more than 200 patients being actively treated with intrathecal pain pumps, Dr. Quidgley-Nevares has considerable expertise in that means of controlling chronic spine pain in patients who have failed conservative treatment and would not benefit from additional surgery. He explains: “The surgeon implants a device about the size of a hockey puck in the abdomen, underneath the skin but above the muscle. The device has a catheter that goes underneath the skin and inside the spine in the intrathecal space. Medication is slowly dispersed around the spinal cord and the brain.”
The surgery is image-guided, and performed under fluoroscopy, avoiding the respiratory centers. The benefits of the intrathecal pain pump, in addition to effective pain relief, include providing greater ability to function normally and reducing side effects associated with oral medications. “In the case of morphine, for every 300 mg a patient would need to take by mouth, the pump only needs to deliver one mg,” Dr. Quidgley-Nevares explains. “There’s still the risk because it’s still an opiate, but it’s much less of an opiate load to the patient.”
Because compliance is vital to the success of any modality dealing with chronic pain, Dr. Quidgley-Nevares considers patient selection crucial. “Despite being safer, these treatments aren’t totally without risk,” he says. “Thus every pain patient undergoes a psychological evaluation before embarking on the therapy, to avoid the consequences of not following the prescribed regimen.”
Dr. Quidgley-Nevares continues to research and publish articles on a wide variety of topics in Pain Evaluation and Management, and serves on several committees at EVMS, including Resident Education, Clinical Advisory/Quality Assurance, Pain Management and Rehabilitation Research, and the Dean’s Council of Chairs.