Caitlin Whyte (Host): Welcome to another exciting episode of Flourish brought to you by PRISMA Health. I'm your host, Caitlin Whyte. Today we're embarking on an exploration of pain management with our esteemed guest, Dr. Sankeerth Challagundla. He is a Board Certified Neurologist and Interventional Pain Specialist at PRISMA Health Neurology. Well, Doctor, we are so glad to have you here on the show today. My first question for you is, is pain just a natural part of getting older?

Sankeerth Challagundla, MD: No. Pain is not a natural part of aging, but we cannot deny the fact that the risk of developing pain increases with age, but with the right care and attention, it's possible to age without experiencing significant amount of pain. There are many adult, older adults who live a vibrant life, pain-free life well into their later years.

The key lies understanding the factors contributing to pain, like arthritis, et cetera, and taking proactive steps to manage and mitigate it.

Host: Gotcha. Well, what are some ways that we can manage chronic pain that don't involve opioids?

Sankeerth Challagundla, MD: The key to managing pain is maintaining an active lifestyle, and also promoting overall health. And depending on the cause of the pain, there are multiple things we can do. What I call, like, managing chronic pain, it's a multi modal treatment, because not just one thing that helps with the chronic pain.

So starting with aerobic exercises, strength training, aquatic therapy, physical therapy, occupational therapy, all those things basically strengthens your body and helps it to alleviate the pain and some body mind techniques like acupuncture, tai chi, yoga also helps with that. And in some cases, situations where cognitive behavioral therapy, mindfulness and biofeedback helps.

These are all like non-medications and other things. But when we come to medications, there are a bunch of medications we can try, starting with just acetaminophen, some antidepressants, non-steroidal anti inflammatory medications, some medications like gabapentinoids, steroids, some topical creams, and in the field of interventional pain, we do a lot of injections for this pain, ranging from epidural steroid injections, radiofrequency ablations and some advanced techniques like spinal cord stimulators and peripheral stimulators.

Host: Well, doctor, can you tell us about this new pain medication called JOURNAVX that was just FDA approved? How does that work and is it available now?

Sankeerth Challagundla, MD: This is an exciting new field. This is a whole new class of medication that has been recently FDA approved. So this medication is approved only recently. And this is approved for acute moderate to severe pain, but not for chronic pain. And this acts by basically blocking nerves from sending pain signals to the brain and this happens by blocking one of the sodium channels in the nerves.

And the good thing about this medication is they specifically block certain sodium channels on the nerves which are activated by pain. It's available now but I did not have a chance to use it yet. So hopefully it will be in the market by end of March, that's what I heard.

Host: Wow, that is so soon. Thank you for letting us know. On that note, are there any other pain medications that you know about on the horizon?

Sankeerth Challagundla, MD: So, as I said, this medication is currently approved only for acute, but they're also studying this for chronic pain, so hopefully that get approved soon. And also, what I recently learned is the same company who developed this medication are also developing a newer medication for diabetic pain, which can be used for neuropathic pain.

Host: Wonderful. Well, you mentioned some options earlier, but can pain be managed without medication at all?

Sankeerth Challagundla, MD: Yes, there are a lot of individuals who really manage their chronic pain without any medications. So they use like healthy lifestyle and then as I said before, like exercises like including aerobic exercise, strength training, flexibility exercises, aquatic therapy, and other integrative practices like acupuncture, tai chi, yoga and sometimes like injections like epidural steroid injections or radio frequency ablations and spinal cord stimulators or peripheral nerve stimulators.

So depending on the cause of the pain, there are different things we can use in addition without even using medications. 

Host: Mm, so it sounds like diet, exercise, and lifestyle certainly can help that pain management. But is it okay to exercise when you're in a lot of pain? How do you balance those two?

Sankeerth Challagundla, MD: So when you have like a really bad pain, like an acute pain, sometimes exercise can worsen it. So these are the cases you need some guided exercise programs like with physical therapy or occupational therapy. But overall, maintaining an active lifestyle is a key strategy for managing pain. So regular physical activity helps keep muscles and joints flexible and reduce inflammation, but also it releases endorphins, which are regarded as like a natural pain relievers that improve your mood, discomfort, and everything.

And also just like a healthy diet helps with the overall health with indirectly helps for a patient to have more physical activity that indirectly helps with the pain.

Host: Well, I'd love to also talk about acupuncture as an option here. What is acupuncture and how does it help manage pain?

Sankeerth Challagundla, MD: So acupuncture actually involves insertion of very tiny needles through your skin at strategic points on your body. This is basically a Chinese, CBD, there is a lot of research on it, which suggests that it really helps with the brain relief, particularly for chronic pain conditions like arthritis and neuropathic pain. But the evidence is still developing, and we need more high quality studies to fully understand the effectiveness and mainly what is the optimal dosage.

Host: Hmm, okay. And if you are currently taking opioid pain relief, how can you safely transition to non-opioid options?

Sankeerth Challagundla, MD: Medical technique where they believe that by using this, they believe there is a flow through the pathways in your body that balances the energy, but the modern take on it is this helps by stimulating nerves and muscles and connective tissue, which can help.

There is definitely some evidence on it, but we need more evidence for that. 

Caitlin Whyte (Host): And what about CBD? How does that help with pain management?

Sankeerth Challagundla, MD: So, CBD, there is a lot of research on it, which suggests that it really helps with the brain relief, particularly for chronic pain conditions like arthritis and neuropathic pain. But the evidence is still developing, and we need more high quality studies to fully understand the effectiveness and mainly what is the optimal dosage.

Host: Hmm, okay. And if you are currently taking opioid pain relief, how can you safely transition to non-opioid options?

Sankeerth Challagundla, MD: So we can safely transition any patient. But how we transition depends on what is the dose of opioid medication you're on or what kind of opioid medication you're on and how long the patient has been on this. So what, what is the best strategy is cutting down a little bit on the medication and trying different non-opioid strategies like medications and

injections or procedures and non opioid or non-medication or injection techniques like yoga, tai chi, physical activity and stuff and we can slowly transition it and in very, very rare cases sometimes we even have to hospitalize patients and slowly transition too.

Host: Great. Well, wrapping up here, Doctor, do you have any tips on speaking about the need for pain management with your doctor?

Sankeerth Challagundla, MD: I think the best thing is to be open and honest with your doctor about your pain giving specific details about its location, how severe is it, and how is it affecting your daily life and what are your treatment goals and where do you want to get to with this. And also preparing for your visit to a pain doctor is also very helpful like maintaining your pain diary and keeping a list of all the medications or procedures you have tried and the imaging results and the labs you already got. 

Host: Well, thank you for this eye opening discussion on pain management, Doctor. And if you want to learn more about managing chronic pain and discover more holistic solutions, head over to prismahealth.org/flourish. Don't forget to subscribe, share, and join in on the conversation. This has been Flourish, brought to you by PRISMA Health.