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How to Know When You Should See a Pain Specialist

Chronic pain is in an extremely complex and poorly understood medical problem that can have profound effects on one’s physical and mental wellbeing. Uncontrolled pain impacts all aspects of daily activities. But how do you when it's time to see a pain specialist?

Dr. James Liadis, physiatrist in the Dean Stroud Spine and Pain Institute at Shepherd Center, explains in this podcast.
How to Know When You Should See a Pain Specialist
Featured Speaker:
James Liadis, MD
James G. Liadis, M.D., is a physiatrist in the Dean Stroud Spine and Pain Institute at Shepherd Center. After earning a bachelor of science degree in neuroscience from the University of Michigan, Dr. Liadis earned his medical degree from The Ohio State University College of Medicine. Dr. Liadis completed his training in physical medicine and rehabilitation at MedStar National Rehabilitation Hospital in Washington, D.C., and he is fellowship-trained in pain management through the University of Virginia in Charlottesville.

Melanie Cole (Host):  Chronic pain is such an extremely complex and poorly understood medical problem that can have such profound effects on your physical and mental wellbeing. Uncontrolled pain can impact all the aspects of your daily activities but how do you know when it’s time to see a pain specialist? My guest today is Dr. James Liadis. He’s a physiatrist in the Dean Stroud Spine and Pain Institute at Shepherd Center. Dr. Liadis, I’m so glad to have you with us as this is such a huge problem in this country today is uncontrolled pain and pain management. Tell us a little bit about pain itself, chronic, acute, what’s the difference and because pain is somewhat subjective; how do you even measure it? How do you know how much pain someone is in?

James Liadis, MD (Guest):  Those are all great questions. Let me get to your first one. Most of the kind of governing bodies in terms of managing pain say that chronic pain starts when the pain has been present for more than six months. Some of the other aspects of it are kind of some of the same things you have already touched on is that really it becomes chronic pain when it starts to affect the other aspects of your life. So, once it’s starting to become something that’s affecting the way you are sleeping or limiting you from your activities; that’s when either it’s made that six month mark, or it is affecting enough other portions of your life that it starts to become something that is chronic and really to the point where it needs to have something done about it.

The other question that you asked me about was how we measure pain. And that’s a very challenging thing because it is somewhat subjective. And so, everyone has different levels of pain scores and so we rely somewhat on the patient’s story saying what their pains are and we use different scales for that. There is a visual analog scale or various other scales that try and look at both pain and function. But oftentimes, we will also use some of the larger measurement tools like the BTI and a few other scales that look at how pain is affecting the aspects of your life and so that gives us a little bit more of a trackable number as opposed to just whether your pain is an 8 out of 10 or a 5 out of 10.

Host:  Well thanks for clearing that up for us. So, someone knows that it’s time to see a pain specialist when it starts affecting their daily life and their function. So, tell us what it’s like. How do you work with a patient? Discuss for us your multifaceted approach to pain disorders. What are some of the first things that you do Doctor when someone comes to you at the Spine and Pain Institute?

Dr. Liadis:  So, one of the first things that we work on is trying to figure out what the diagnosis is because that’s going to really drive a lot of the treatment options that are available to them. Once we’ve honed down on it, and oftentimes, for people that are coming to us, they’ve already kind of gotten an idea of what the issue is, but not always. So, some of that first meeting that we have with the patient is understanding what’s causing their pain and figuring out if we need to do additional testing to try and answer that question.

Once we have a diagnosis established, then we start working on the various modalities that we can offer them to try and help with their pain. And as you touched on earlier, some of that is medications. There certainly are a lot of other medications outside of the world of opioids. Opioids are one option but not the only option. So, one option is medications. We are very focused on physical function here. and so a big portion is getting back to those activities. So, we have a physical therapist here in our office who works with the majority of our patients that are at least here locally that can be able to come frequently enough to see him. We also work on some of the other affects that pain has on individuals lives like the psychological factors and for that reason, we also have a pain psychologist that works in our office that many of our patients will see to try and work on some of the other ways that we can manage and control pain outside of medications.

And then the other arm that we have available to us is procedures. And so, depending on what’s causing the pain, there are various techniques that we can utilize trying to help with it.

Host:  How interesting that you mentioned a pain psychologist and all of these options. Let’s talk about some of those. If medication or if someone has a question about opioids, they don’t really want to use that as their choice. Tell us some of those procedural type approaches to pain management. Because there are so many on the Shepherd Spine and Pain Institute website. My goodness. Tell us about some of these and what are they intended to do?

Dr. Liadis:  Yes absolutely. So, there is a ton of different options in terms of injections or procedures that can be done, and it really depends on what your complaint is. Probably the largest chronic pain complaint is chronic low back pain. And for that one, it really depends on the type of pain you have. So, some potential options would be epidural steroid injections, sometimes targeted injections to work on what are called the facet joints which is really more of a technique done for pain that’s just in the back whereas the epidurals are done more for back and leg pain.

And then it can be more advanced that that. So, we also look at implantable devices such as intrathecal pumps where a medication is put directly into the spinal fluid or a spinal cord simulator where electricity is directed to the posterior aspect of the spinal cord to be able to decrease pain signaling.

Host:  Wow. It really is amazing what you can do for people today. So, to touch back Dr. Liadis, on some of the cognitive and behavioral things that you can try with people. Tell us a little bit about where that fits in, whether it’s meditation, relaxation, exercise, and I’m sure people have questions about some of the herbal supplements or stem cells, some of the alternative therapies. Touch on some of those for us if you would.

Dr. Liadis:  Yeah, absolutely. So, those are kind of all of the other parts that I think make us a really well-rounded center is that we have access to a lot of those things you are mentioning. So, none of these – the pain complaint typically when it’s acute pain; is really just pain. When it starts to become more chronic; it starts to affect a lot of other parts of live. And so that’s when mobility starts to decrease. We know that in patients that have had chronic pain even looking at controlled samples before they had pain and afterwards; they have a significantly higher risk for having depression and anxiety as a result of that pain.

And so, we know that pain on a chronic standpoint starts to affect multiple aspects of patients’ lives and so that’s why we have those other tools available to us. As we start getting people feeling better with procedures, medications; oftentimes we will get them involved in physical therapy so they can start getting back to the level of mobility and function that they want to be at. And for many people, that’s challenging to do on their own so having someone guide them through that process is extremely helpful. But sometimes that is also an early step where we start that before we even consider some of the procedural aspects. So, it really depends on what someone has been through from the standpoint of how their pain treatment has gone.

Not every one of our patients see a pain psychologist, but it is a very good opportunity to have an access to that. Our pain psychologist does work on a lot of those things you mentioned. So, working on patients, working on biofeedback which is a technique to try and decrease your body’s response to painful stimulus. Working on things like meditation and relaxation which can be very helpful with helping to reduce pain in ways that don’t involve medications, don’t involve procedures and are things that people can have access to at any time that they need it.

Host:  Wow. Such great information and so many choices and ways to approach pain. Tell us about your team at the Dean Stroud Spine and Pain Institute at Shepherd Center.

Dr. Liadis:  Absolutely, so, our team is quite big. It’s currently pain month so we had our big group picture today. We have nurses and medical assistants as kind of the frontline staffing of our team. After that as we mentioned, we have a pain psychologist and a physical therapist that work directly in our department and work closely with us. And then we also have myself and my partner Eric Shaw as the two physicians in the team.

Host:  As we wrap up, Dr. Liadis, give us your best advice. So many people as we said suffer from pain. They can’t always quite describe it. It may not be exactly in the place they think it is. It’s so subjective and confusing. Tell us what you’d like us to know about pain management and the options available at Shepherd Center.

Dr. Liadis:  Yeah, absolutely. What I would say is that there are quite a few options available. A lot of people shy away from asking their Primary Care physician or for even coming in for self-referrals because they are concerned that they may not want to be on these types of medications like opioids that they don’t want to have procedures done and there are a lot more things available to them than just those things.

And so what I would say is to someone who is out there having pain; to reach out to talk with your Family Practitioner or to look at our website and see if you can depending on how your insurance plan works; self-refer to see us here in our clinic. Because I think there are a lot of good options that we can do, and I don’t think people should have to live with the pain that they are having.

Host:  Great information. Thanks you so much Dr. Liadis for coming on and sharing your expertise. Thank you again and that wraps up this episode of Shepherd Center Radio. Head on over to our website at for more information and to get connected with one of our providers. If you found this podcast as informative and helpful as I did, please share with friends and family. I’m sure you know people that are suffering from chronic pain and there are so many options to help them so that they don’t have to suffer, and their daily activities can resume the way that they would like them to. And don’t miss all the other interesting podcasts in the Shepherd Center library. Until next time, I’m Melanie Cole.