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Scott Webb (Host):  With so many treatment options available, managing our aches and pains can be confusing and challenging. Let’s talk to Dr. Johnathan Goree, a UAMS Anesthesiologist who specializes in pain management. This is UAMS Health Talk from the University of Arkansas for Medical Sciences. I’m Scott Webb. Dr. Goree, thanks for joining me today. Is it realistic for any of us to expect to be totally pain-free? Is that a thing?

Johnathan Goree, MD (Guest):  Unfortunately, pain is a part of life. And especially when we have surgery or we have any kind of acute event, pain is a part of normal healing. Pain let’s us know that our body is sending messengers and blood cells to kind of make our body back to normal. So, as pain is a part of the normal healing process; when we have acute events, pain is going to get better as our body heals. Now unfortunately, sometimes we develop dysfunction with that healing process and that cause us to develop what’s called chronic pain. And chronic pain is normally pain that’s lasted longer than 30 days or 90 days and it also causes some changes to how our nerves fire and how we sense pain. And while chronic pain is unfortunate, and it’s uncomfortable, I think there are ways that we can try to decrease these symptoms that a chronic pain patient has but I think once those changes have happened; it’s very challenging to get a patient to a point where they are pain-free.

Host:  So, it sounds like what you’re saying is some pain is good and some pain is bad. Some pain lets us know we’re alive and other pain we need to deal with. And on that note, what are some tips you offer patients when dealing with pain management?

Dr. Goree:  I think the most important thing is to prevent patients from going from that functional pain to that dysfunctional pain. And so, when patients have surgery, I think we have to be really aggressive about treating their pain because we don’t want patients to sit with pain for weeks or months and develop some of those changes. That being said, opioids have their risk as we all know. As we are in the middle of an opioid epidemic. And the longer that patients are on opioids especially after an acute event or after a surgery; the higher their risk of developing addiction or tolerance or long-term opioid use.

And so, if you have a surgery, I would say really work with your physician to make sure that you’re as comfortable as possible. You’re probably not going to be pain-free. But also, try to ensure that you get off of those opioids as soon as possible. And don’t continue to take them when you don’t need them. Sometimes, transitioning to something as simple as Tylenol, ibuprofen or even ice or elevation can be equally as effective.

Host:  So, Dr. Goree, talk about some of the frontline treatment options that your clinic offers.

Dr. Goree:  So, whenever we meet patients who have chronic pain; most of the patients who I see have complex chronic pain; we try our best to eliminate pain at that source. And so, we try to use medications and treatments that are specific for that kind of pain. One of the challenges with opioids are they are a general cover up for all types of pain. So, we try to examine a patient and we try to diagnose exactly what’s causing their pain. If their pain is caused by inflammation; then we will try treating with an anti-inflammatory medication. If it’s caused by a nerve dysfunction; then we will treat with what’s called a neuropathic medication or a nerve pain medication. We also do a number of minimally invasive procedures to treat long-term chronic pain.

For example, many of our patients have lumbar spine arthritis or knee arthritis and have failed many of the other treatments that their primary care doctor has prescribed. We have a procedure called radiofrequency ablation where we can take away some of the sensations to that arthritic joint which will allow the patient to continue to move and be active without feeling the pain from that inflammation.

Host:  This is all so fascinating and I’m thinking about that. I’m thinking about my kids and sometimes offering them like Advil or Aleve before a game and my wife’s always like but if you do that, you are really masking the pain and they won’t really know what’s hurting or how much it’s hurting. Do you think people do that too much? Do you think that they take things in advance of something and then they make the injuries even worse because they couldn’t feel kind of how injured they were at the time?

Dr. Goree:  It’s a delicate balance and I think it depends on whether you are taking a pain killer or whether you are taking an anti-inflammatory. So, a pain killer will mask pain and could allow you to cause more pain in the future or cause more dysfunction. When you take something like Advil; you are really decreasing inflammation and so if you have another – a new acute injury, then that actually – your body will still be able to feel the pain from that injury. So, I don’t think that’s as dangerous whereas taking a hydrocodone or oxycodone may cause you to injure yourself further.

When we do these radiofrequency ablation procedures, they are very targeted to the joints that are arthritic. We also know that movement is lubrication for the joints and that’s something that one of my good friends Leah Toby who’s a physical therapist at UAMS always says. So, if someone has knee arthritis, one of the worst things that we can do is make that knee immobile. I’m sure many of our listeners have sat in an airplane for eight to twelve hours before and felt that it’s really hard to move after sitting for a long time and it actually causes you to have pain.

So, we actually when we have a joint that’s arthritic, we actually need to keep it moving. Because keeping it moving is going to keep blood flow into that joint, it’s going to help blood to move out the bad stuff and bring the good stuff and bring forward healing. So, when a joint is really too painful to move; this procedure can actually over the long term, decrease their progression of their arthritis.

Host:  Yeah, I think that movement is key. I know as you say the analogy of flying on planes for long periods or just even when you wake up in the morning when you have been lying in bed for eight or ten hours something like that and then those first five minutes can be a little bit rough especially as we get older. What other ways do patients become pain-free besides what we’ve talked about already?

Dr. Goree:  So, one of the treatments that we offer at our UAMS Pain Clinic is neuromodulation. And it’s a relatively cutting-edge new treatment for complex chronic pain. Mainly for patients who have had a lumbar spine surgery or who have had multiple lumbar spine surgeries without relief of their pain or who have had severe lower limb injuries or upper limb injuries or even newer indications like diabetic peripheral neuropathy. And that’s the placement of an electrical lead in the epidural space, so along the spinal column to help regulate some of the pain signals as they come from that injured limb up to the brain.

So, I think of it almost like a pacemaker for the spine. So, when the heart has dysfunctional rhythms we will often put in a pacemaker to make sure that those rhythms are more functional. When we have chronic pain for a very long time; the rhythms of our nerves or the signals that our nerves send get really dysfunctional. And sometimes, placing what’s called a spinal cord stimulator or a neuromodulation device can help regulate these signals and make them more normal and decrease some of the pain.

Host:  What would you consider to be the most repeated advice you find yourself giving patients at the clinic?

Dr. Goree:  So, I think the most important thing is to make sure that you break the inflammatory cycle. And so, immobility leads to chronic pain and chronic pain leads to immobility. And there’s a lot of things that we do to our bodies that cause us to be proinflammatory or that promote inflammation. And one of the best things we can do is to try to decrease those things. And so one is smoking. So, smoking causes – it brings smoke, it brings fire, it brings inflammation into our body and so, to prevent chronic pain, one of things we can do is stop smoking.

Another is make changes to our diet. So, there’s a lot of things that we eat that are proinflammatory. Some believe that gluten and dairy for example are very proinflammatory and I have given them up myself for that reason. So, and also continuing to move. As I talked about, breaking that cycle and making sure that you push through because lack of movement can also promote inflammation and lastly, sleep. Sleep is very important. It promotes healing. It allows our body to reset. It allows our body to heal and it also prevents inflammation. So, living our life without very much sleep can also increase the amount of chronic pain that we have.

Host:  Dr. Goree, is there anything else that you would listeners to know about pain management and how UAMS and the clinic can help?

Dr. Goree:  I think one of the most unique things about the Chronic Pain Clinic at UAMS is that we’ve assembled a number of experts from different areas of the country who have different expertise in a lot of complex pain diagnoses. Things like complex regional pain syndrome. Things like failed back surgery syndrome. A lot of treatments that are very rarely seen but we’ve assembled a number of physicians who’ve gotten a lot of experience from other centers and so, just because your physician says that there may not be an answer for your disease; we may be able to find a solution in our clinic.

Host:  Dr. Goree, thanks for your time today. for more information on Dr. Goree and Pain Management options at UAMS, visit www.uamshealth.com. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for additional topics that may interest you. This is UAMS Health Talk. Thanks for listening.