Selected Podcast
Managing Chronic Pain
Strange as it sounds, chronic pain doesn't have to mean chronic suffering. There are ways to diminish chronic pain and increase your wellbeing. Dr. Sam Nia discusses the different methods we can use to manage our chronic pain.
Featured Speaker:
Sam Nia, MD
Dr. Nia is a Harvard-trained double board-certified Interventional Pain Physician. He is triple fellowship trained in acute pain medicine, interventional pain as well as pediatric pain medicine. He is a native Manhattanite and is a US medical school graduate from New York Medical College. He is an expert in ultrasound-guided intervention and is an instructor for the World Academy of Pain Medicine Ultrasonography in which he specializes in teaching neuromodulation and peripheral nerve stimulation implantation surgery. Transcription:
Managing Chronic Pain
Amanda Wilde: Strange as it sounds, chronic pain doesn't have to mean chronic suffering. There are ways to diminish chronic pain and increase wellbeing. Welcome to Jamaica Hospital Med Talk. I'm Amanda Wilde. Dr. Sam Nia is a Harvard-trained double board-certified interventional pain management physician at Jamaica Hospital. Thank you for being here today, Dr. Nia
Dr. Sam Nia: Thank you so much for having me.
Amanda Wilde: Pains, aches, suffering, discomfort. Are those all the same? How exactly should we define pain?
Dr. Sam Nia: That's a great question. And, you know, evolutionarily, the purpose of pain is really a warning system. It's an alarm. It alerts the organism, in this case, the human that, you know, there's something potentially wrong or damage or injury and to be cognizant of it, to allow it to properly heal, so that, you know, function can continue. And ideally, what happens with pain is that while you have the injury, you're having this warning system, it hurts, you guard the area, you allow yourself to heal. And then once the healing happens, the pain goes away. So in the ideal circumstances, pain is a temporary state and it actually serves to help us.
Amanda Wilde: So pain is an important and normal signal that something's wrong. But if it continues and it's not from time to time and it becomes chronic pain, what is the difference there between the pain we all might experience occasionally and chronic pain?
Dr. Sam Nia: Great question. So while we have a normal amount of pain during times of injury and healing, sometimes after the healing has occurred and completed and finished the pain persists, this is what we call chronic pain. There's no good purpose for the pain to continue. There's no more need for this warning system to help us kind of guard the area to allow for healing to happen. Healing is already done. And yet, we still experience this warning system. This alarm is not turning off. That's what we talk about when we talk conceptually about chronic pain.
Amanda Wilde: If chronic pain is pain that is not supposed to be there anymore, what is it that causes that?
Dr. Sam Nia: Most commonly, we talk about things like herniated disks, pinched nerves, arthritis in the back, low back strains, things like that. Essentially, there's some pressure on the nerve, irritation, inflammation around the nerve roots in the low back. They can sometimes cause pain to run down the legs, kind of in the sciatica, as people call it, configuration. And you know, the body does what it can to kind of resorb the disc to decrease the pressure on the nerve roots, yet the pain persists. So now, we're in a chronic pain state. There's really no healing that's taking place, yet we still have this alarm going off. We still have this pain that's not really serving much of a good purpose.
Amanda Wilde: Those conditions all sounded really familiar. And I associated that with taking pain medications. But of course, there's also danger with doing pain meds for any length of time. Are there other treatment strategies that are offered for pain management?
Dr. Sam Nia: Yes, I like to use the analogy of a weight loss surgeon. Of course, there are lots of different methods by which a patient can lose weight, diet, exercise, calorie restriction, nutrition, you name it. However, when a patient goes to a weight loss surgeon, the expectation is for that doctor to use their surgical expertise to treat the patient, to help them lose weight. And that's where I come in as an interventional pain physician. I use interventional or procedural strategies to try to decrease chronic pain for patients. So I come from a completely different perspective in that I'm not trying to give medications or manage pharmacology, but instead do procedures.
Amanda Wilde: So does that mean instead of masking the pain, the way a pain med would, that you might be working toward eliminating the pain entirely?
Dr. Sam Nia: So this is kind of a philosophical question. Again, we go back to the idea of what is pain. Pain itself is kind of an alarm sound. So if we're in a state where, well, we say all the healing has taken place, patient had surgery, let's say for knee replacement, they have continued pain around their knee area. They go back to the orthopedist. All the x-rays look good. The CAT scans look good. None of the hardware is loose. There's no more intervention to be done surgically for that patient, yet they still have pain. So when it comes to the question of masking pain, the real question we should be asking is how do we mitigate the signal of pain itself? There is nothing to turn off the switch. Everything looks good surgically. So how do we decrease the experience of pain or the perception of pain? And that's where we kind of move into a sort of different interventional techniques with neuromodulation.
Amanda Wilde: Oh, so I was just going to ask. It made me think about what are those other forms that are called interventional techniques for pain management? And there's one called neuromodulation.
Dr. Sam Nia: Yes. So neuromodulation is somewhat of a new approach to interventional pain medicine. And again, I like to use the analogy or the thought exercise of, you know, let's all imagine we go to plug our smartphone in under the desk and as we come back, we bonk the back of our head on the bottom of the desk, right? What's the first thing we all do apart from cursing? We rub the back of our head where we hit the back of our head on the desk. And so why are we doing that? And we all do it automatically. And what is the purpose of that? Well, the reason is that we're interfering with that pain by causing a non-painful stimulus to go through a painful area. And whether we realize it or not, it diminishes that perception of pain, because now we have an interfering sensation in that region. And so neuromodulation takes advantage of that interfering with the pain.
Amanda Wilde: How does it work?
Dr. Sam Nia: Great question. So what we actually do is that we use implantable electrical devices. So they're all percutaneously implanted, meaning that they're just done through needles, very small electrical leads similar to wires, and we place them under ultrasound guidance near the nerves that we believe are carrying those painful signals. And then we wirelessly transmit a signal through those wires, similar to how your smartwatch might charge. You put it on a wireless charger and it transmits the electricity to that device. And essentially it's like permanently rubbing the back of your head, but it's permanently stimulating that nerve in a non-painful way to interfere with that painful stimulation that's being sent through that nerve.
Amanda Wilde: Wow. This is really high tech.
Dr. Sam Nia: It's pretty cool stuff.
Amanda Wilde: What have you seen in terms of the benefits of neuromodulation and what kind of results are your patients experiencing?
Dr. Sam Nia: Well, one of the benefits right off the bat is that it's completely opiate-avoiding. There are no potentially habit-forming medications at all in any part of the algorithm. This does not cause any systemic side effects, you know, whereas you could take a medication, even a non-opiate medication, for example, and have some type of side effect in an unrelated body system. I use the example of a non-steroidal anti-inflammatory, ibuprofen, for example. We can take it for aches and pains, but then some people get upset stomach and something that has nothing to do with the pain. Well, this is very focused. It's only affecting that painful area. It's only a wire near the nerve. There's no other systemic side effects with this technique. Patients, again, they do great because the device itself can be controlled by the patient. You can go up, you can go down on the amount of stimulation that you receive. There's different patterns and wave forms. You can choose as a patient once it's implanted what type of stimulation works best for you.
Amanda Wilde: Is neuromodulation something everyone can use?
Dr. Sam Nia: It's not for absolutely everyone. We have to have a consultation, speak to the patients to make sure that this is something that they'll be able to maintain. The device itself does need to be charged. The patient does need to be able to operate, you know, a basic remote control. Some systems use an app on a smart device. So patients need to be able to properly use the equipment, but it is by and large safe for just about the vast majority of patients.
Amanda Wilde: So this is so new. If someone wanted to learn more about neuromodulation treatment or even schedule an appointment, like how should they go about doing that?
Dr. Sam Nia: So they can reach out to my practice at Jamaica Hospital. And they can talk to my practice manager, her name is Rebecca at 718-206-7246. What we can do is schedule a consultation with me and discuss to see if some of these techniques might be amenable to try to help the patient.
Amanda Wilde: Dr Nia, this new technique is fascinating. It's really encouraging to hear about these healthy pain management strategies. Thank you for sharing your expertise.
Dr. Sam Nia: Thank you so much.
Amanda Wilde: To schedule an appointment with an interventional pain management specialist at Jamaica Hospital, please call 718-206-7246. For more information about the services Jamaica Hospital offers, visit our website at jamaicahospital.org/podcasts. I'm Amanda Wilde. Be well.
Managing Chronic Pain
Amanda Wilde: Strange as it sounds, chronic pain doesn't have to mean chronic suffering. There are ways to diminish chronic pain and increase wellbeing. Welcome to Jamaica Hospital Med Talk. I'm Amanda Wilde. Dr. Sam Nia is a Harvard-trained double board-certified interventional pain management physician at Jamaica Hospital. Thank you for being here today, Dr. Nia
Dr. Sam Nia: Thank you so much for having me.
Amanda Wilde: Pains, aches, suffering, discomfort. Are those all the same? How exactly should we define pain?
Dr. Sam Nia: That's a great question. And, you know, evolutionarily, the purpose of pain is really a warning system. It's an alarm. It alerts the organism, in this case, the human that, you know, there's something potentially wrong or damage or injury and to be cognizant of it, to allow it to properly heal, so that, you know, function can continue. And ideally, what happens with pain is that while you have the injury, you're having this warning system, it hurts, you guard the area, you allow yourself to heal. And then once the healing happens, the pain goes away. So in the ideal circumstances, pain is a temporary state and it actually serves to help us.
Amanda Wilde: So pain is an important and normal signal that something's wrong. But if it continues and it's not from time to time and it becomes chronic pain, what is the difference there between the pain we all might experience occasionally and chronic pain?
Dr. Sam Nia: Great question. So while we have a normal amount of pain during times of injury and healing, sometimes after the healing has occurred and completed and finished the pain persists, this is what we call chronic pain. There's no good purpose for the pain to continue. There's no more need for this warning system to help us kind of guard the area to allow for healing to happen. Healing is already done. And yet, we still experience this warning system. This alarm is not turning off. That's what we talk about when we talk conceptually about chronic pain.
Amanda Wilde: If chronic pain is pain that is not supposed to be there anymore, what is it that causes that?
Dr. Sam Nia: Most commonly, we talk about things like herniated disks, pinched nerves, arthritis in the back, low back strains, things like that. Essentially, there's some pressure on the nerve, irritation, inflammation around the nerve roots in the low back. They can sometimes cause pain to run down the legs, kind of in the sciatica, as people call it, configuration. And you know, the body does what it can to kind of resorb the disc to decrease the pressure on the nerve roots, yet the pain persists. So now, we're in a chronic pain state. There's really no healing that's taking place, yet we still have this alarm going off. We still have this pain that's not really serving much of a good purpose.
Amanda Wilde: Those conditions all sounded really familiar. And I associated that with taking pain medications. But of course, there's also danger with doing pain meds for any length of time. Are there other treatment strategies that are offered for pain management?
Dr. Sam Nia: Yes, I like to use the analogy of a weight loss surgeon. Of course, there are lots of different methods by which a patient can lose weight, diet, exercise, calorie restriction, nutrition, you name it. However, when a patient goes to a weight loss surgeon, the expectation is for that doctor to use their surgical expertise to treat the patient, to help them lose weight. And that's where I come in as an interventional pain physician. I use interventional or procedural strategies to try to decrease chronic pain for patients. So I come from a completely different perspective in that I'm not trying to give medications or manage pharmacology, but instead do procedures.
Amanda Wilde: So does that mean instead of masking the pain, the way a pain med would, that you might be working toward eliminating the pain entirely?
Dr. Sam Nia: So this is kind of a philosophical question. Again, we go back to the idea of what is pain. Pain itself is kind of an alarm sound. So if we're in a state where, well, we say all the healing has taken place, patient had surgery, let's say for knee replacement, they have continued pain around their knee area. They go back to the orthopedist. All the x-rays look good. The CAT scans look good. None of the hardware is loose. There's no more intervention to be done surgically for that patient, yet they still have pain. So when it comes to the question of masking pain, the real question we should be asking is how do we mitigate the signal of pain itself? There is nothing to turn off the switch. Everything looks good surgically. So how do we decrease the experience of pain or the perception of pain? And that's where we kind of move into a sort of different interventional techniques with neuromodulation.
Amanda Wilde: Oh, so I was just going to ask. It made me think about what are those other forms that are called interventional techniques for pain management? And there's one called neuromodulation.
Dr. Sam Nia: Yes. So neuromodulation is somewhat of a new approach to interventional pain medicine. And again, I like to use the analogy or the thought exercise of, you know, let's all imagine we go to plug our smartphone in under the desk and as we come back, we bonk the back of our head on the bottom of the desk, right? What's the first thing we all do apart from cursing? We rub the back of our head where we hit the back of our head on the desk. And so why are we doing that? And we all do it automatically. And what is the purpose of that? Well, the reason is that we're interfering with that pain by causing a non-painful stimulus to go through a painful area. And whether we realize it or not, it diminishes that perception of pain, because now we have an interfering sensation in that region. And so neuromodulation takes advantage of that interfering with the pain.
Amanda Wilde: How does it work?
Dr. Sam Nia: Great question. So what we actually do is that we use implantable electrical devices. So they're all percutaneously implanted, meaning that they're just done through needles, very small electrical leads similar to wires, and we place them under ultrasound guidance near the nerves that we believe are carrying those painful signals. And then we wirelessly transmit a signal through those wires, similar to how your smartwatch might charge. You put it on a wireless charger and it transmits the electricity to that device. And essentially it's like permanently rubbing the back of your head, but it's permanently stimulating that nerve in a non-painful way to interfere with that painful stimulation that's being sent through that nerve.
Amanda Wilde: Wow. This is really high tech.
Dr. Sam Nia: It's pretty cool stuff.
Amanda Wilde: What have you seen in terms of the benefits of neuromodulation and what kind of results are your patients experiencing?
Dr. Sam Nia: Well, one of the benefits right off the bat is that it's completely opiate-avoiding. There are no potentially habit-forming medications at all in any part of the algorithm. This does not cause any systemic side effects, you know, whereas you could take a medication, even a non-opiate medication, for example, and have some type of side effect in an unrelated body system. I use the example of a non-steroidal anti-inflammatory, ibuprofen, for example. We can take it for aches and pains, but then some people get upset stomach and something that has nothing to do with the pain. Well, this is very focused. It's only affecting that painful area. It's only a wire near the nerve. There's no other systemic side effects with this technique. Patients, again, they do great because the device itself can be controlled by the patient. You can go up, you can go down on the amount of stimulation that you receive. There's different patterns and wave forms. You can choose as a patient once it's implanted what type of stimulation works best for you.
Amanda Wilde: Is neuromodulation something everyone can use?
Dr. Sam Nia: It's not for absolutely everyone. We have to have a consultation, speak to the patients to make sure that this is something that they'll be able to maintain. The device itself does need to be charged. The patient does need to be able to operate, you know, a basic remote control. Some systems use an app on a smart device. So patients need to be able to properly use the equipment, but it is by and large safe for just about the vast majority of patients.
Amanda Wilde: So this is so new. If someone wanted to learn more about neuromodulation treatment or even schedule an appointment, like how should they go about doing that?
Dr. Sam Nia: So they can reach out to my practice at Jamaica Hospital. And they can talk to my practice manager, her name is Rebecca at 718-206-7246. What we can do is schedule a consultation with me and discuss to see if some of these techniques might be amenable to try to help the patient.
Amanda Wilde: Dr Nia, this new technique is fascinating. It's really encouraging to hear about these healthy pain management strategies. Thank you for sharing your expertise.
Dr. Sam Nia: Thank you so much.
Amanda Wilde: To schedule an appointment with an interventional pain management specialist at Jamaica Hospital, please call 718-206-7246. For more information about the services Jamaica Hospital offers, visit our website at jamaicahospital.org/podcasts. I'm Amanda Wilde. Be well.