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Assessment and Treatment of Pain
Shaberra Rauther, MD, discusses the assessment and treatment of chronic pain, with discussion regarding best practices for the use of opioids.
Featuring:
Learn more about Shaberra Rauther, MD
Shabeera Rauther, MD
Shabeera Rauther, MD is a board certified anesthesiologist in Champaign, Illinois. She is affiliated with Carle Foundation Hospital.Learn more about Shaberra Rauther, MD
Transcription:
Melanie Cole (Host): Expert Insights is an ongoing medical education podcast. The Carle Division of Continuing Education designates that each episode of the enduring material is worth a maximum of 0.25 AMA PRA category one credit. To collect credit, please click on the link and complete the episode’s post test.
If your patients suffer from chronic pain, you know how hard it can be to manage that pain so your patient can get back to the activities they enjoy. My guests today is Dr. Shaberra Rather. She’s a pain management physician at neuroscience at Carle Foundation Hospital. Dr. Rather, what are the basic types of pain? Describe for other providers how you differentiate chronic pain and acute pain, and since they’re somewhat subjective, how do you measure it?
Dr. Shaberra Rather (Guest): It would be very, very difficult to measure pain. Pain is largely a subjective sensation and what we are looking for is objective evidence of pain. So if somebody complains of pain in their knee, for example, why do they have that knee pain so you want to make sure you objectively know what their anatomy looks like; what is causing their pain because pain, once again, can be very subjective. Acute and chronic pain, generally it depends on the duration of the pain that has bothered the patient. So typically patients if they complain of pain for more than six months or so, then you tend to believe it could be a chronic entity. Sometimes recurring pain in the same location can also be considered as a chronic pain entity.
Melanie: The field of pain management is really a burgeoning field right now. Tell other providers what you’d like them to know about this field and your multifaceted approach to painful disorders.
Dr. Rather: Yes pain is an emerging field right now also for all the wrong reasons I would say because there’s been a lot of stress on the opioid epidemic and we have to realize that opioids are only one modality of treatment for pain management. There are several different modalities for treatment. You have to look at any pain disorder and treat it with different modalities, whether it is physical therapy, whether it is pharmacological management, which includes both opioids and nonopioids. You want to also use behavioral medicine techniques to help with pain whether it’s biofeedback technique, cognitive behavioral therapy. You want to look at interventional options that can help patients with their pain. You want to involve your surgical colleagues to see if they would be candidates for any surgical intervention, so on and so forth. So it has to be a multi departmental approach, a multi-dimensional approach to treating any pain condition.
Melanie: So there might be many providers involved, doctor, that would be involved in pain management and as you’re speaking about some of the other modalities and nonsurgical approaches and possibly surgical approaches to pain management, and you mentioned just a few of them, where do other providers fit into that picture where injection procedures or nerve blocks or even acupuncture might fit into this whole modality and way of looking at pain?
Dr. Rather: So when the patient complains of pain they usually start off with their primary care provider. That’s where usually they complain of pain and then the primary care provider has to figure out where to send this patient. So again they can either refer this patient to us or they could based on the patient’s complaints, do a few investigations whether it’s lab work or imaging studies and figure out where to send them. Does this patient have considerable pain that limiting their every day activities. Does this patient have the endurance enough to go through sessions of physical therapy or is this something that needs to be quickly taken care of by an injection or by surgical means, and if nonoperative options have to be considered, for example in a patient with postherpetic neuralgia or shingles pain, can they just quickly treat them with good medications options. If conventional options are not helping this patient enough, they will have to refer this patient out to more of the experts, that would be us, that would be pain management providers over here.
Melanie: And you mentioned cognitive and behavioral therapy and some of these other sort of complimentary techniques in dealing with pain and speak about how you explain to patients about some of these things whether its exercise or meditation or even biofeedback to deal with some of the pain disorders.
Dr. Rather: So patients have to understand first of all that the minute you suggest for them to see a psychologist the first question is do you think I’m crazy, do you think I’m making this up? That’s not really the case. They have to understand that there’s a lot of power of the mind over your body so learning coping techniques with the psychologist, learning breathing techniques, learning distraction techniques can be very effective. Also never discount the ability of therapy and exercises to help you. A lot and lot of studies are coming out that show that aerobic style exercises, that will release endorphins, which are feel good chemicals within your body have the tendency to dampen your pain signals and can help you considerably, whether it’s yoga, whether it’s meditation, whether it’s mindful breathing; all of these things can help with controlling your pain as well as anxiety to some extent. So these things are all clumped together, pain, anxiety, depression, sometimes they’re all clumped together because the more the pain or more recurrent or chronic the pain entity, you can also have chronic depression associated with it, a lot of anxiety associated with it, so you have to treat everything with behavioral techniques.
Melanie: It’s so important. Really what an interesting field that you are in these days. Wrap it up for us, what you would like other providers to know about the field of pain management, when you feel that it’s right for them to refer a patient to a pain management specialist and what you’d like them to know about some of these other techniques outside of opioids to help with pain management?
Dr. Rather: Well I think the whole thing depends on where the pain is, how long they’ve been suffering with pain, what kind of pain that they’re suffering with, etc. So yes there’s a lot of different modalities that can be utilized so I would ask providers to look beyond just routine opioid treatment and consider other nonopioid options. There are a ton of medications that are nonopioid and will help with pain, especially nerve pain. You know I want them to think about sending patients to us earlier and not too late, but at the same time, I want them to do basic investigation. At least try and figure out to some extent where this pain is coming from. That I think will streamline things better for us when we have all the investigations available, when we have all the studies available, so we quickly know what the problem is and we can go on to the next step. When it comes to the point that primary care providers have exhausted simpler modalities; before they write their first prescription for opioids I think they need to run it by us, make sure that they are heading in the right direction.
Melanie: So important. Thank you so much for joining us today and explaining and sharing your expertise about pain management and the alternatives to opioids and other ways that providers can look to a pain management specialist to help with their patients. Thank you again. You’re listening to Expert Insights with Carle Foundation Hospital. For a listing of Carle providers and to view Carle sponsored education activities, please visit carleconnect.com, that’s carleconnect.com. We hope the information gained will be applicable to your work and life. This is Melanie Cole, thanks for listening.
Melanie Cole (Host): Expert Insights is an ongoing medical education podcast. The Carle Division of Continuing Education designates that each episode of the enduring material is worth a maximum of 0.25 AMA PRA category one credit. To collect credit, please click on the link and complete the episode’s post test.
If your patients suffer from chronic pain, you know how hard it can be to manage that pain so your patient can get back to the activities they enjoy. My guests today is Dr. Shaberra Rather. She’s a pain management physician at neuroscience at Carle Foundation Hospital. Dr. Rather, what are the basic types of pain? Describe for other providers how you differentiate chronic pain and acute pain, and since they’re somewhat subjective, how do you measure it?
Dr. Shaberra Rather (Guest): It would be very, very difficult to measure pain. Pain is largely a subjective sensation and what we are looking for is objective evidence of pain. So if somebody complains of pain in their knee, for example, why do they have that knee pain so you want to make sure you objectively know what their anatomy looks like; what is causing their pain because pain, once again, can be very subjective. Acute and chronic pain, generally it depends on the duration of the pain that has bothered the patient. So typically patients if they complain of pain for more than six months or so, then you tend to believe it could be a chronic entity. Sometimes recurring pain in the same location can also be considered as a chronic pain entity.
Melanie: The field of pain management is really a burgeoning field right now. Tell other providers what you’d like them to know about this field and your multifaceted approach to painful disorders.
Dr. Rather: Yes pain is an emerging field right now also for all the wrong reasons I would say because there’s been a lot of stress on the opioid epidemic and we have to realize that opioids are only one modality of treatment for pain management. There are several different modalities for treatment. You have to look at any pain disorder and treat it with different modalities, whether it is physical therapy, whether it is pharmacological management, which includes both opioids and nonopioids. You want to also use behavioral medicine techniques to help with pain whether it’s biofeedback technique, cognitive behavioral therapy. You want to look at interventional options that can help patients with their pain. You want to involve your surgical colleagues to see if they would be candidates for any surgical intervention, so on and so forth. So it has to be a multi departmental approach, a multi-dimensional approach to treating any pain condition.
Melanie: So there might be many providers involved, doctor, that would be involved in pain management and as you’re speaking about some of the other modalities and nonsurgical approaches and possibly surgical approaches to pain management, and you mentioned just a few of them, where do other providers fit into that picture where injection procedures or nerve blocks or even acupuncture might fit into this whole modality and way of looking at pain?
Dr. Rather: So when the patient complains of pain they usually start off with their primary care provider. That’s where usually they complain of pain and then the primary care provider has to figure out where to send this patient. So again they can either refer this patient to us or they could based on the patient’s complaints, do a few investigations whether it’s lab work or imaging studies and figure out where to send them. Does this patient have considerable pain that limiting their every day activities. Does this patient have the endurance enough to go through sessions of physical therapy or is this something that needs to be quickly taken care of by an injection or by surgical means, and if nonoperative options have to be considered, for example in a patient with postherpetic neuralgia or shingles pain, can they just quickly treat them with good medications options. If conventional options are not helping this patient enough, they will have to refer this patient out to more of the experts, that would be us, that would be pain management providers over here.
Melanie: And you mentioned cognitive and behavioral therapy and some of these other sort of complimentary techniques in dealing with pain and speak about how you explain to patients about some of these things whether its exercise or meditation or even biofeedback to deal with some of the pain disorders.
Dr. Rather: So patients have to understand first of all that the minute you suggest for them to see a psychologist the first question is do you think I’m crazy, do you think I’m making this up? That’s not really the case. They have to understand that there’s a lot of power of the mind over your body so learning coping techniques with the psychologist, learning breathing techniques, learning distraction techniques can be very effective. Also never discount the ability of therapy and exercises to help you. A lot and lot of studies are coming out that show that aerobic style exercises, that will release endorphins, which are feel good chemicals within your body have the tendency to dampen your pain signals and can help you considerably, whether it’s yoga, whether it’s meditation, whether it’s mindful breathing; all of these things can help with controlling your pain as well as anxiety to some extent. So these things are all clumped together, pain, anxiety, depression, sometimes they’re all clumped together because the more the pain or more recurrent or chronic the pain entity, you can also have chronic depression associated with it, a lot of anxiety associated with it, so you have to treat everything with behavioral techniques.
Melanie: It’s so important. Really what an interesting field that you are in these days. Wrap it up for us, what you would like other providers to know about the field of pain management, when you feel that it’s right for them to refer a patient to a pain management specialist and what you’d like them to know about some of these other techniques outside of opioids to help with pain management?
Dr. Rather: Well I think the whole thing depends on where the pain is, how long they’ve been suffering with pain, what kind of pain that they’re suffering with, etc. So yes there’s a lot of different modalities that can be utilized so I would ask providers to look beyond just routine opioid treatment and consider other nonopioid options. There are a ton of medications that are nonopioid and will help with pain, especially nerve pain. You know I want them to think about sending patients to us earlier and not too late, but at the same time, I want them to do basic investigation. At least try and figure out to some extent where this pain is coming from. That I think will streamline things better for us when we have all the investigations available, when we have all the studies available, so we quickly know what the problem is and we can go on to the next step. When it comes to the point that primary care providers have exhausted simpler modalities; before they write their first prescription for opioids I think they need to run it by us, make sure that they are heading in the right direction.
Melanie: So important. Thank you so much for joining us today and explaining and sharing your expertise about pain management and the alternatives to opioids and other ways that providers can look to a pain management specialist to help with their patients. Thank you again. You’re listening to Expert Insights with Carle Foundation Hospital. For a listing of Carle providers and to view Carle sponsored education activities, please visit carleconnect.com, that’s carleconnect.com. We hope the information gained will be applicable to your work and life. This is Melanie Cole, thanks for listening.