Michael Smith, MD (Host): Meaningful Medicine is a Novant Health podcast bringing you access to leading doctors who answer questions they wish you would ask. From routine care to rare conditions, our physicians offer tips to navigate medical decisions and build a healthier future. And today I'm sitting down with Dr. Ankur Patel and we're going to be talking about addressing pain as you age. Now, before we get it started, Dr. Patel, tell us why you got into pain management. How did you make that decision to go down the pain specialist route?

Dr. Ankur Patel: Thank you again for the invitation and for having me here today, Dr. Mike. I would say that I kind of really got interested into pain medicine very early on in my medical training. So I was actually fortunate before going to medical school, I worked with a great neurosurgeon in the spine center.

So I really had a experience firsthand to kind of see patients who have chronic pain, chronic back pain, different conditions. And kind of seeing different surgical and non-surgical options we can offer them. And the really nice thing was that while I was working with these patients, I saw them before and after and how much their function and their quality of life improved.

So I think that was a big thing that kind of really stuck with me throughout my training. I really love neurology and different like musculoskeletal medicine and that kind of really poured my passion. I felt like this was my calling in doing pain medicine throughout my career.

Host: Oh, fantastic. So Dr. Patel, I think I'm a little older than you. I'm just going to say that. And you know, as I get older, I'm kind of getting the aches and pains a little bit here and there, but is experiencing pain as you age inevitable? Is there some hope for an old doctor like me?

Dr. Ankur Patel: Absolutely. I tell patients that we're going to have some impact on our body as we age, right? So as we're like 60 or 70, we're not going to be as fit and mobile as we were when we were 20s and 30s, right? But I think there's a lot of things that we can do as we age to prevent those chronic conditions from developing and to keep ourselves more mobile and functional. So there are a lot of tips and tricks and I hope we can discuss that today regarding those.

Host: Oh, no, I know. We're definitely going to get into that. But you just mentioned right there, acute, chronic. Let's talk about that for a second to make sure the audience understands what we're talking about, right? So there's acute pain, and then we also have the category of chronic pain, right? So what's the difference there to help the audience understand what we're talking about today?

Dr. Ankur Patel: So I usually kind of define this for patients more in timeline base. So that acute pain is typically that sudden onset of pain. So think about if you like sprained your ankle or you kind of fell and you kind of injured your back or that region. Usually that pain will get better with time, kind of some rest as time goes on and really pretty quickly within a couple of days or a couple of weeks, that pain should resolve.

Now, chronic pain is when we get into this realm of when this pain is really not improving and there's kind of going on and off for maybe several months or several years. And it's just taking a toll, not only on you physically, but then it has some emotional components too. And this pain overall kind of really encompasses you throughout your daily routine and really just affects your quality of life.

Host: Yeah. So, if an older person is listening to this, you know, it's kind of like every time you get up out of your seat, if you have some pain or something with that, if that's constant and constantly happens, you would call that chronic pain and they should go see somebody like you.

Dr. Ankur Patel: Yeah, I think that it kind of becomes the more chronic, especially in that timeline course that it becomes, it's not getting better. It's kind of been there throughout their day and it's kind of affecting them multiple times throughout the day and affecting their ability to kind of transition or walk and do things that's affecting their quality of life. So I think absolutely that is more defined on the chronic spectrum.

Host: As you see patients uh, especially on the older side, what's the most common cause of the chronic pain? Are we talking about joints? Are we talking about muscles? Are we like, well, what are we talking about?

Dr. Ankur Patel: Yeah. So I think it's a combination of all of it, but the most common I would say is arthritis, right? So we see arthritis that can form in different joints. So especially in my practice, I see a lot of patients who come in with back and neck symptoms. So a lot of it could be due to arthritis of the joints of the back and the neck.

Sometimes it can be some degenerative disc disease, like a herniation or a bulge that's affecting a nerve, and that's gonna be causing some sciatica or pinched nerve symptoms, pain that's going down the leg. So there's a lot of different factors that kind of cause this chronic symptoms and that's kind of as our bodies age and these are more commonly degenerative processes, but there's things that we can actually do to help decrease the progression of those.

Host: Well, let's talk about that. Let's start off with a more general question about how you manage patients Dr. Patel. What kind of things do you do when a patient comes into your clinic, right, and you meet them and you're talking to them, you took your history, you got your physical exam.

 What are you starting to think? If they have chronic pain, whether it's joints, whatever else, what are the things you're starting to think of right off the bat about prevention?

Dr. Ankur Patel: Yeah. So this is kind of when I really have that conversation and kind of really discuss that with the patient, right? To figure out what the goals are, right? So like one of my jobs I kind of say is not just to improve your pain, right? But to kind of improve your function and quality of life, right?

So I have patients sometimes say that, my pain is okay, it's bearable, but I can't go up and down the steps, right? So how can we help with that? So really figure out what the patient's goals are. And then we take it down and I tell patients that from step by step, right, we can really emphasize like a multi modal treatment approach where we can use different things in our toolbox.

So I like to recommend different areas of sub specialties such as physical therapy, kind of using medications. And what I specialize is a lot of interventions and injections to help patients so we can avoid those more surgical options if not necessary, right?

And in select patients, we may have to go down that surgical route, but if we can kind of really help improve their function and quality of life without that; a lot of my patients prefer that.

Host: So, when you're talking to somebody, I mean, again, you mentioned joints. That's obviously very common. Osteoarthritis, very prevalent. So, when you talk about prevention, it's more about preventing progression, right? So, what are some of the things you specifically talk about? Is there weight training involved in what you suggest? Stretching, flexibility? How important is some of those lifestyle,

suggestions?

Dr. Ankur Patel: I think lifestyle plays a key role in this and when I tell patients, my most common thing I tell patients from day to day is that movement is medicine, right? So really just staying active. So like making good lifestyle decisions in terms of eating healthy, right? Making sure that our weight is well-controlled, working with our primary care physicians regarding our diabetes, hypertension, other things, staying hydrated.

And the biggest thing I tell patients that as much as you can stay active and exercise. And exercise does not need to be that you're doing certain forms of exercises throughout the day or stretches, but things that you enjoy to do. So if you like to play golf or like to play tennis. Go do those things, right, because that's going to be a form of exercise that you're going to be willing to stick with, and you're going to keep moving, and as your body keeps moving, you're just basically going to have good medicine, good health.

So I think those are kind of the crux of what I usually recommend in terms of lifestyle medica- or lifestyle changes for a lot of my patients.

Michael Smith, MD (Host): Dr. Patel, I think you're onto something. I think when we say the word exercise to people, that usually creates this image of a gym and lifting weight, whatever, isn't it more just about being active? Like maybe we need to change the word. Right? Like, let's stay active in our life. What do you think about that?

Dr. Ankur Patel: Absolutely, Dr. Mike. I 100 percent agree with that. Most of my patients are like, I don't want to go to the gym, but it doesn't really have to be going to a physical place, right? Some patients just want to have long walks with their family or be able to go swimming in the pool. I think these are all forms of exercises and just kind of staying active and doing what you love is the key to help decrease those chronic pains and conditions as we develop as we age.

Host: Yeah, listen, doing what you love, you'll keep doing it, right? That's the whole point. That's the key point to a lifestyle change. So let's talk about the kinds of doctors people should see though, because obviously there are people who incorporate some of these lifestyle changes. Maybe they're on some medications as well.

They're not at surgery yet. At what point do you recommend more of a specialist in pain? If I'm experiencing pain, what kind of doctor should I see in this? Is it you, Dr. Patel, or are there other specialties in this?

Dr. Ankur Patel: Yeah, so I think that seeing someone like myself, who's a pain specialist um, is I think at any stage is actually very appropriate, right? So even if you haven't talked to anyone or haven't tried anything, I see patients who are kind of the first time they've had not had any imaging to patients who have already had surgery and still have pain.

So I think the spectrum is quite wide. Oftentimes I see these patients go a lot to their primary care and primary care is usually we will try a lot of conservative therapies and when those don't work, they'll send them over to me to kind of evaluate them. But I tell patients that at any time, right. I think the whole point is to build that plan very early on and we can see that plan grow and develop as we work through that together.

I think specialists like myself, pain specialists, my primary specialty is physical medicine and rehabilitation. So I really look at function and quality of life. I also lean on my neurology colleagues, my neurosurgery colleagues, orthopedics, sports medicine. So there's a lot of us that kind of work together but when patients have pain, they usually typically come to see a pain specialist and we can help them and work with them.

Host: I'm glad you just said what your specialty was, because when you say pain doctor, I don't know if a lot of lay people, patients, understand what that really means. Like, who is a pain doctor? Aren't all doctors helping with pain, like, at the end of the day? So you are in rehabilitation medicine, right? Is that where most of the pain doctors fall under as a specialty?

Dr. Ankur Patel: I would say that probably more it's 50-50 now. So a lot of pain doctors, so there's different routes to become a pain physician. One is through anesthesiology. So a lot of my colleagues are anesthesiologists who also specialize in pain medicine, physical medicine and rehabilitation or physiatrists. We also have neurologists, even psychiatry. Now you see more emerging fields such as emergency medicine, internal medicine. So I think it's many different routes to get there. And the beauty of it is that all these people came from different backgrounds. So really bringing those different primary specialties together and making a multimodal treatment approach for our patients, I think it's key. Because like I said, like pain is not just physical, there's many different components to it. And as we bring these things into our toolbox, we're able to offer patients much more in the treatment plan.

Host: So, what do you think are the biggest misconceptions that you hear about being a pain doctor?

Dr. Ankur Patel: Yeah, I think the biggest thing is that a lot of patients feel that the only thing that we're able to offer really is medications. And I think that a lot of patients are like, I don't want to be on medications. I don't like the side effects especially kind of when we look into different medications such as opioids and the opioid epidemic that we kind of had.

So I tell patients that that's one component, right? Medication has its role for select patients. But there's a lot of different things that we can do, and especially for what I like to specialize in, what I really do is a lot of different interventions. So trying to target different nerves, doing different minimally invasive procedures to kind of help patients to really try to help avoid surgery in the appropriate occasion or to kind of maybe prolong the need for that at that time.

Host: Yeah, but at some point, unfortunately, some people might need surgery for certain things, right? When do you make that recommendation and how do you approach that with the patient?

Dr. Ankur Patel: So I usually tell patients that when we have failed many different conservative therapies and things are not improving; then I say that maybe it's reasonable to talk to our surgeon, right? And I always tell patients, let's have the discussion. It doesn't mean that the surgeon is going to necessarily offer or recommend surgery, but I think let's try to get a second opinion and see what else we can offer.

But for my patients, I typically recommend surgery when there is instability, especially of the spine, or if there's any neurological dysfunction or something that needs to be emergently taken care of. So those are the ones we'll go to surgery right away. But I think that there's a lot of things I think working hand in hand with your surgeons is very important and having that good relationship with them so that way we can really offer great care to our patients I think is key.

Host: If somebody comes in and sees you, let's say they have some chronic pain, whether it's joints, muscles, whatever that pain may be; how successful are pain doctors, rehabilitation doctors, in, in preventing that surgery and doing lifestyle things, doing some of the stuff we've already talked about here, how successful are you in helping somebody maybe they deal with that pain better? It's not as bad and they don't have to go to surgery.

Dr. Ankur Patel: I think overall the success rate is fairly high. I think that over the last 10 years, we've actually seen a lot new therapies come out for our patients and be able to offer things that really wasn't available before. So I think that there's more things in our toolbox that we're able to offer like certain things like we have spinal cord stimulations or patients who have like chronic neuropathic pain or back pain or leg pain doing things like that, stimulators or like different minimally invasive procedures to help with that. So I think we are able to expand what we're able to offer patients. So that's been a big component of that.

Host: Let's talk about your toolbox real quick, right? I love the way you just, you have this toolbox of things you can use to help people. What are you most excited about for the future in that toolbox?

Dr. Ankur Patel: I think what really excites me is in the field of like neuromodulation, which means the form of working on nerves, right? Kind of using either medications or actually using electrical devices. So a lot of my practice and a lot of my partner's practice includes things like spinal cord stimulation or peripheral nerve stimulation.

So one area that I actually really enjoy is kind of both of those. But really be able to target different nerves and really change on how the nerve is like talking to the brain, kind of resetting that pain signal. So I think the research is really developing, especially in this field. And a lot of these things, especially I'll give you the example.

I have a lot of patients who have chronic knee pain who are technically not surgical candidates, right? Either they're too, they're not medically stable or their BMI excludes them from being surgical candidates, but really be able to use a device where you can kind of target a nerve, to help with their pain.

And so that they can go back and start doing more therapy, more rehabilitation, working on that and improving their pain and function I think it's really exciting. And I think that's something that we weren't able to offer patients about five, 10 years ago. And I think that's going to, the technology is going to continue to develop.

So I'm really excited about that as the kind of field continues to shape.

Host: Fantastic. So listen, let's in summary, what is your best advice for somebody listening who currently is experiencing pain, some form of chronic pain? What do you want to tell them?

Dr. Ankur Patel: Yeah. So I want to tell you that you're not alone, right? There's a lot of things that we can offer you. I think the first step is just really connecting with someone that who's able to help you. Really talking to your primary care physician, getting to see a specialist and really discussing your goals and how we can help you.

Like I said, that there is not just one different, one type of treatment. There's multiple different options. So I always tell patients that the same treatment plan is not applicable to the same, to another patient, right? So we like to kind of use a very customized approach and really find what your goals are, try to help you get there and help improve your pain, your function, and your quality of life. Cause I think that's the most important thing.

Host: Quality of life. Yeah. What a great way to end, right? Cause that's the end goal, right? At the end of the day is making sure people have that same or even better quality of life. Dr. Patel, this was fantastic. Thank you for joining me today.

Dr. Ankur Patel: Thank you for having me.

Host: Hey, to find a physician, you can visit NovantHealth.org. For more health and wellness information from our experts, visit HealthyHeadlines.org. I'm Dr. Mike. Thanks for listening.