New techniques focus on pain so patients can forget about it.
Written by John Ferrari
We’ve all experienced pain. It’s part of being human. And while
no one likes to think about pain, it is remarkably complex. Individuals
perceive pain differently. What one person may experience as very painful
may feel only mildly painful to another.
We’ve all experienced pain. It’s part of being human. And while
no one likes to think about pain, it is remarkably complex. Individuals
perceive pain differently. What one person may experience as very painful
may feel only mildly painful to another.
There are many types and causes of pain—from the sudden, acute pain
of an injury to the chronic shooting pain of sciatica to the dull ache
of an overworked muscle. (And let’s not even mention toothaches. Ouch!)
Despite these differences, when most of us think of pain relief we think
of one thing: medication—either pills or injections. Pain management,
though, is much more than that. Pulse spoke with
Sina Samie, MD, to understand some of the newest techniques and procedures Torrance Memorial
is using to manage pain—and to get a few tips on how to avoid chronic
pain in the first place. Dr. Samie earned his medical degree at the Saint
Louis University School of Medicine and completed his anesthesiology and
interventional pain management training at the University of Southern
California.
You are an interventional pain medicine physician. What is that?
SS: It’s an offshoot of older, more traditional pain medicine. We
use advanced techniques, including injections and nerve blocks, with or
without steroids.
Are there pain management techniques that are not based on the use of medications?
SS: Yes! For example, we can use heat to disable nerves that are causing
pain. This is a technique used to manage pain caused by arthritis in the
spine. We use radio frequency heat to ablate the nerves that are causing
pain. This therapy usually brings six to eight months of relief. More
than 50% of pain complaints in the U.S. are due to arthritis in the spine,
so this is a big deal.
Besides medication and heat, another technique is neuromodulation, which
uses electricity. Basically, if there are damaged nerves, you can implant
electrodes by those nerves and use electricity to stimulate them, which
helps modulate the pain signals they are transmitting. It’s almost
like a pacemaker for the spine.
These techniques fall in between medication and surgery. They can help
reduce long-term or chronic pain and the need for oral medication.
You use a multidisciplinary approach to pain management. What does that entail?
SS: I take the patient’s condition and all the different options
for pain management into consideration. We can use different combinations
of pain management techniques, including physical therapy, yoga, chiropractic
care or acupuncture and procedures including injections, ablation or neuromodulation.
We’ll try surgery if those don’t work, but our approach depends
on what the patient’s pathology is. We have a lot of different options
to consider.
Is that similar to a holistic approach?
SS: That’s more associated with homeopathic medicine, which can include
chiropractic care or acupuncture. Some people don’t want to take
medication or injections, and I am willing to send them to see a chiropractor
or acupuncturist. I work with my patients and recommend what I think will
help them the most.
Can holistic or non-Western approaches to pain management work?
SS: To an extent, pain is a psychological phenomenon. If you can convince
somebody they feel better, then they do feel better. I’ve seen people
scheduled for surgery just decide they feel better. Suddenly the pain
is gone, and they feel better. As long as they’re feeling better,
that’s what matters because they’re the ones feeling the pain.
An improvement is an improvement. And a lot of my patients do find relief
with some of these techniques.
Managing pain is good, but avoiding it is even better. What can people
do to avoid chronic pain?
SS: A lot of issues that cause chronic pain are lifestyle-related. Spinal
pain is the No. 1 issue. It’s usually related to arthritis, but
there are a variety of causes including compression of the discs between
the vertebrae.
If you’re younger, don’t ignore issues you may have—they
can lead to bigger issues later on. There are simple steps people can
take like stretching and maintaining good posture, which will help prevent
problems over time. Obesity can contribute to a lot of issues too. Keep
your body light and nimble.
At any age, people who keep doing the same physical activities despite
back problems should start doing more sustainable exercises. A lot of
people are remaining active until later in life. Their bodies are lasting
longer, but even then their bodies aren’t keeping up with their
minds. They want to continue playing sports and exercising, and they should
adjust their activity to their age and their body’s abilities. •
New Protocols for Breast Cancer Post-Op Pain Management
"Traditionally, narcotics—or opiates—have been the mainstay
of treating perioperative pain,” says Torrance Memorial anesthesiologist
Zak Rangwala, MD. “That has been the go-to for dealing with surgical
pain, but because of the undesirable side effects and the dangers associated
with misuse and abuse, we’re constantly seeking other methods to
achieve pain control and reduce the amount of opiates used.”
For breast cancer and other surgeries, Torrance Memorial has adopted a
concept called Enhanced Recovery After Surgery. The intent is to help
patients recover quickly and safely so they feel comfortable returning
home. Naturally, controlling pain is a big part of that.
“We want to send patients home safely and comfortably, which includes
being able to control their postoperative pain with a safe amount of medication
at home,” Dr. Rangwala explains.
The pain management protocol treats pain using different classes of medications
that attack the transmission of pain via different mechanisms. “By
attacking pain transmission at different points in the sensory pathway,
we achieve a synergistic effect, reducing the amount of each individual
medication,” Dr. Rangwala says.
In practice, that means using smaller amounts of medications before, during
and after breast cancer surgery. These medications include more well-known
pain medications like Tylenol and nonsteroidal anti-inflammatory drugs,
as well as medications traditionally used for muscle spasms, seizures
or even depression.
The application of regional anesthesia during surgery also reduces—and
sometimes even eliminates—the need for post-op narcotics. In the
case of breast cancer surgery, regional anesthesia involves identifying
the nerves that sense pain in the breast and injecting a local anesthetic
into those areas. It’s similar to the technique used by dentists
to numb a tooth but much more precise. The analgesic effect can last up
to 72 hours, depending on the medication used—reducing pain levels
during the most painful, immediate postoperative period and decreasing
the need for narcotics.
“Research shows this approach reduces the need for opiates,”
Dr. Rangwala says. Patients report less pain and a greater ability to
move on to the next phase of their recovery.
Sina Samie, MD is a pain specialist at Torrance Memorial Physician Network in Torrance
at 23550 Hawthorne Blvd., Ste. 120, and 23560 Crenshaw Blvd., Ste. 102.
He can be reached at (310) 891-6795.