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Bill Klaproth (Host): Well if you're human, then at one point you've probably experienced neck, upper back, and lower back pain. We've all been there but when it becomes chronic, what can you do? Here to talk with us about orthopedic pain is Dr. Hazmer Cassim and Dr. Jeff Smith, board certified physiatrists and pain management physicians at Eisenhower Desert Orthopedic. Dr. Cassim and Smith, thank you for your time. Dr. Cassim, let's start with you. What types of conditions do you normally treat?

Dr. Hazmer Cassim, DO (Guest): Hello, thank you for having us. Pleasure to be here. When it comes pain, there are a variety of different conditions we can treat. We can essentially treat many different parts of the body including neck, upper back, lower back, extremities such as the arms and legs. Treatment areas really depend on the source of pain, but we do work with a multitude of different types of pain conditions, specifically spinal remediated pain like sciatica, facet pain, arthritis, and even neuropathy.

Bill: And those really can be painful for people that are suffering from those conditions. And Dr. Smith, how do you diagnose someone with orthopedic pain?

Dr. Jeff Smith, DO (Guest): Again Bill, like Haz said, thanks for having us. The diagnosis of an orthopedic problem is multi-factorial. First of all, we need to start with the history a patient gives us, which might be the most important thing, which definitely involves the intake forms that people fill out telling us about their history, maybe circling areas on a map of the body of where they hurt, which is maybe one of the most important things as well as the onset of the pain, how long it's been there, what it feels like, and then certain parts of an examination.

We do a focal or a full body examination based on the symptoms and the history, and we take that and decide what kind of testing may be needed, certain imaging, x-rats, CAT scan, MRI. We work alongside neurologists who do nerve conduction, EMG testing. We have other state of the art testing as well that we can perform to help decide what malady we're dealing with.

Some of the intervention we perform, different injections that we perform are actually considered therapeutic to help a person, but they're also diagnostic as well. So again, many different ways to get information to help a patient.

Bill: And you mentioned intervention, and I want to get into that a little bit. Dr. Cassim, when you talk about interventional pain management, can you tell us what that is?

Dr. Cassim: Absolutely. So interventional pain management is part of a treatment program, typically successful if used in a comprehensive treatment program, including muscle mobilization techniques, therapy, and the appropriate medicine.

Interventional therapy is the concept of guiding specific types of treatment which could be steroids, heat, or even electricity in specific areas of the body, particularly in the spine, using some kind of guidance. Usually we use fluoroscopy or x-rays, and using these guidance mechanisms, we can get a steroid, so to speak, or cortisone into the epidural space. We have a lot of different types of epidural injections for sciatic pain, radiculopathy as it's known.

Also we can treat arthritis in the spine.

Now spinal arthritis occurs in very small joints. So unlike hips and knees, you can't really see these joints, which is why we do need the x-rays or fluoroscopy. And using these imaging modalities, we can guide needles in there with heat, and on occasion we ablate or burn nerves around the joint as well.

Now interventional therapy also has a wide spectrum of what can be done including something called neuromodulation or neurostimulation where electrical impulses and electrical currents is placed close to the epidural space. We also have treatment options where we can put pain medicine in the spinal fluid.

And a variety of different treatments fall under the category of interventional techniques, but the idea is to put treatment right at the source of the problem, and making it more effective than if we didn't have these different interventional techniques.

Bill: And if I could follow up on that, Dr. Cassim, and Dr. Smith, feel free to jump in. So basically what you're talking about is non-surgical techniques. Is that right?

Dr. Cassim: Exactly. They're minimally invasive non-surgical techniques. Patients typically come in, and the procedures are anywhere from five to fifteen minutes. They come in the same day, and they're able to go home, and appreciate and enjoy the benefits of the treatment that we can provide with these non-surgical treatments.

Bill: And Dr. Smith, if you could talk about your collaboration with other physicians, particularly spine surgeon, and how that benefits the patient when it comes to treatment.

Dr. Smith: Absolutely. I'll even take that a step forward and mention that we are proud to work in a comprehensive spine center, a multi-disciplinary approach to pain and spinal conditions is what we offer and what we really support in our community to provide the best care. And obviously that means working with other physicians, but we also work closely with acupuncturists, rheumatologists, neurologists, chiropractors, even numerous physical therapists that treat all the different maladies that Dr. Cassim spoke of.

A pain psychology team is what also helps wrap up a multi-disciplinary team. We do work alongside spine surgeons, which is a wonderful way of treating spinal and painful conditions. Most of the painful conditions out there are at least spine related, or they have the spine adding to that chronic type of pain, and therefore having a surgeon on standby just in case somebody is not improving is beneficial.

And our surgeons, and we agree, that most conditions can be treated non-operatively, and that's normally the way that people can get their lives back and get their pain under control. We also work alongside the other types of orthopedic surgeons, hip and knee specialists, et cetera, which also is very beneficial in case a radiating type of pain in the extremities, for example commonly it's coming part from the hip and part from the lumbar spine, and therefore we have close and easy communication with our colleagues.

Dr. Cassim: I completely agree, and I think that's one of the biggest advantages that we have here in treating pain, and that's the access to our surgical specialists. Conservative non-surgical treatments are successful most of the time, but repeating the same failed approach again and again is obviously not the best for patients. And having our surgical colleagues back us up and assess patients from a surgical standpoint really makes that a best option for patients and provides best outcomes, so that's something that we're very lucky to have, and certainly best for patients' care.

Bill: Well that coordination of care is very important. And Dr. Cassim, there are plenty misconceptions about pain treatment. Can you tell us what those are and debunk those for us?

Dr. Cassim: Oh, absolutely. So one of the concerns in treating pain and the concerns out there is that most patients with pain have been dealing with pain for a long period of time. If initial treatments are not successful, patients with chronic pain can certainly have depression and it can affect their lifestyles. And there are a lot of different commercials on TV and newspaper articles talking about a variety of different magnets or braces, and even different treatments that require cash to be paid.

And the concern about this is our patients, we want to make sure that they get the scientific and valid treatments that are offered to them, and a lot of these treatments that are commercialized and advertised don't really have evidence-based scientific proof to them.

And so these are the concerns that we have in terms of patients getting care from non-credentialed facilities. And there are different types of treatments, and I'm certain that many can find them online, or even in newspapers, but the key is to go to an appropriate place, qualified and well-trained facility to get evidence-based treatment rather than non-evidence-based treatment.

Bill: So evidence-based treatment, that is the key, and that is what we need to pay attention to. And Dr. Smith, if you could wrap it up for us. For someone listening who may be suffering from chronic orthopedic pain, what is your message to them? I know that you are able to help people. What would you say to someone who is listening right now who's really struggling with pain?

Dr. Smith: Sure, thank you, Bill. My message would be that a comprehensive approach with a multi-disciplinary system such as our system is the best out there because the pain generator is really what we're talking about here. The different conditions Dr. Cassim spoke of, really finding what is generating a person's pain is our key. It's really what our focus is, to make sure we're treating the right thing. And you know, we're proud to say that our skills go beyond that because we're able to not only find these, but treat them readily, and usually very effectively. And the fact that we work with a full team, normally even if it's not something that's in our hands, then one of our colleagues can definitely help.

Bill: Well finding that pain generator, I love how you put that, Dr. Smith. That just makes it so clear. Well thank you so much for your time today, Dr. Cassim and Dr. Smith. We really appreciate it. And Desert Orthopedic Center's pain management physicians are available at Eisenhower Health Clinics in Palm Springs, Rancho Mirage, and La Quinta. To learn more, call (760) 773-4545 or visit www.EisenhowerHealth.org/EDOC. That's www.EisenhowerHealth.org/EDOC. This is Living Well with Eisenhower Health. I'm Bill Klaproth, thanks for listening.