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Intro: Riverside Healthcare puts the health and wellness information you need well within reach.

Terry Streetman (Host): Welcome back to Well Within Reach, presented by Riverside Healthcare. I'm Terry Streetman from Marketing. We're here with Dr. Mohammad Issa, interventional pain specialist, to discuss interventional pain medicine and chronic pain. Thank you for joining us.

Dr. Mohammad Issa: Oh, thank you for hosting me, and thank you for our listeners too.

Host: Absolutely. Well, before we jump into our questions, we will take a quick break for a message about myChart.

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Host: Okay. We're back. Dr. Issa, can you remind our listeners, because you've been on the podcast before, about your background and your role?

Dr. Mohammad Issa: Absolutely. So, I am an interventional pain physician. I've been treating patients in the community at Riverside for the past six years. I've specialized in physical medicine and rehab at Baylor College of Medicine in Houston. And then, I did a sub-specialization in interventional pain treatment at Johns Hopkins Hospital in Baltimore.

Host: Okay. Well, yeah, that's a great background. We're glad to have your expertise here in the community. So, we're focusing on chronic pain today. So, how common is chronic pain and who does it tend to affect the

Dr. Mohammad Issa: Absolutely. So, let's start by defining chronic pain. So, chronic pain is pain that lasts beyond three months, or pain that lasts beyond the normal healing time, and it's pretty prevalent and common worldwide. Some of the statistics that I can share with you are it's approximated that one in five adults globally suffer from chronic pain. Also, the most common type of chronic pain is low back pain, and it's the leading cause of disability worldwide. Okay? So in specific, in the U.S., we have about 20% of our U.S. adults, which is about 50 million people that report chronic pain. And about 7% report high-impact chronic pain, which is pain that significantly impact their daily activities of life.

Host: So, who does chronic pain tend to affect the most then?

Dr. Mohammad Issa: So, it tends to affect mostly older adults, which is defined as individual above the age of 65. And it's about 50% of older adults above the age of 65 suffer from some form of chronic pain. In addition to the elderly population, we have patients that undergo surgeries in the past, injuries, individuals with occupations that require repetitive strain and heavy physical labor. In addition to that, you know, lifestyle habits can impact the prevalence of chronic pain, such as smoking, lack of activity, as well as mental health conditions like depression and anxiety.

Host: Okay. Well, it's interesting to know that kind of prevalence too, because I think people sometimes, you know, it can be one of those invisible disability kind of things where it has that impact and you might not know.

Dr. Mohammad Issa: Absolutely. I couldn't agree more. Yup.

Host: So, you talked about then common causes, the main things being the lower back pain and some of those occupational things. Are there other common causes of chronic pain that you want to talk about?

Dr. Mohammad Issa: Absolutely. So, chronic pain stems from a wide range of causes. Sometimes it's clear cut, sometimes it's a bit more complex. And the most common cause of chronic pain tends to be musculoskeletal causes such as arthritis with its forms. What I mean by forms, osteoarthritis, which is basically wear and tear over time. You have also rheumatoid arthritis, which is an autoimmune disease. In addition to that, there are conditions that affect the spine such as herniated disc; spinal stenosis, which is narrowing of the spinal canal where the nerves live; and also disc disease or what we call degenerative disc disease. In addition to that, fibromyalgia, which is a kind of a widespread muscle pain syndrome.

Other causes of chronic pain could be nerve related, such as nerve injury or damage. Examples of that, diabetic neuropathy, sciatica or what we call a pinched nerve in the spine; postherpetic neurology, which can develop after infection with shingles.

Host: Well, thank you for that. I know that's a lot of issues that affect a lot of people in our community. And I think it's another reason why it's so great to have our orthopedic and spine center because so many of those things that you mentioned are treated by various providers that we have here. So, that's great. When it comes to the patients then that you see, how does chronic pain affect the lives of your patients?

Dr. Mohammad Issa: So, chronic pain can deeply affect nearly every part of a person's life, including physically, emotionally, socially, and even economically. Let's start talking about the physical effects for example. That includes fatigue, which is, you know, because of the pain that can drain someone's energy, being in constant pain, which can also lead to limited mobility, which affects walking, bending, lifting. In addition to that, sleep disturbances because it's hard to fall asleep when you're in constant pain.

Other effects are mental and emotional effects, such as depression, anxiety, irritability, mood swings, cognitive issues such as brain fog. Patients with chronic pain can experience difficulty in concentrating or memory problems.

Other effects such as social effects, people with chronic pain tend to be a bit socially isolated and that comes down to the fact that they're not enjoying social activities because of that constant pain. In addition to strained relationships with the other members in the family or friends, because of, again, the lack of ability to enjoy the activities with other people in their circle.

Other effects can be work and economic effects, such as reduced ability to work, especially in physically demanding jobs; job loss or early retirement because of their chronic pain as well as financial stress. There's something we call the cycle of suffering that can be caused by chronic pain, where chronic pain can cause a vicious cycle. It starts with pain, it leads to poor sleep, which leads to fatigue and depression, and that can lead to reduced activity and eventually more pain.

Host: Okay. So, that snowball effect then. I would be curious then, when you're seeing all that effect on people, what does it look like then when patients come here, like the relief that you see?

Dr. Mohammad Issa: It's life-changing for some of our patients and it's very gratifying for me as a physician to witness that and be part of that journey with our patients and help them during that difficult time and eventually see the results at the end of that journey and the improvement they achieve and the impact on their lifestyle and quality of life.

Host: That's great. Yeah. I'm sure a lot of folks, you know, getting back to the things they love, that's huge. Before we get to our next question, we're going to take a quick moment to talk about the importance of primary care.

Consistency is being able to count on someone to be there when you need them. At Riverside Healthcare, your primary care provider is dedicated to being in your corner, helping you and your family stay healthy and thrive. Find the right primary care provider for you at myrhc.net/acceptingnew. From annual screenings to well checks and everything in between, having a primary care provider that you can trust makes all the difference.

Okay. We're back. And our next question here, you talked about chronic pain being pain that lasts longer than typical healing or more than three months. As people are going through that, I'm sure a lot of them start with over-the-counter treatments because they think, "Oh, this is just a nagging pain." At what point does that go beyond over-the-counter treatments to needing to come see you or your team?

Dr. Mohammad Issa: You know, knowing when to go beyond over-the-counter remedies is key to managing pain early and preventing it from becoming chronic in nature. And some of the advices that I can share with our listeners is that if your pain lasts more than three months, you want to seek medical attention. If the pain is not responding to over-the-counter medications, such as, you know, Tylenol, ibuprofen, topical creams, then you want to seek medical attention.

In addition to that, if the pain comes with concerning symptoms such as numbness, tingling, muscle weakness, fever or unexplained weight loss, bowel or bladder issues, swelling or redness in one of the extremities, as well as chest pain, shortness of breath, that could be sometimes an indication of a more serious underlying condition.

Host: Okay. So in that case then, if somebody says, "Okay, this is beyond what I can do with over-the-counter treatments," what kinds of treatments does your team offer for these kinds of chronic pain?

Dr. Mohammad Issa: So, interventional pain medicine in specific focuses on treating chronic pain using targeted, minimally invasive procedures, often when other treatments such as medications or physical therapy haven't provided, you know, for relief. And there are multiple treatments, that fall under the umbrella of interventional procedures such as nerve blocks or what we call cortisone injections that can target the spine, whether it's a neck, mid-back, low back. We can target pinched nerves. If someone is having nerve pain that shoots down the arm or shoots down the leg, we can do injections to help with that pain.

In addition to that, if there's pain coming from the joints in the body, such as spine joints. Including what we call facet joint, which is they are joints that allow us mobility in the neck, back, mid back, low back. In addition, we can do SI joint injections. The sacroiliac joint is a joint that connects the spine to the hip, and it can get inflamed or it can develop arthritis with time, wear and tear. And that can be also debilitating in nature and can be targeted with injections.

Other types of injections can be simple trigger point injections that we do in office, and those target muscle knots or areas of muscle that are tense and causing a lot of pain. And other treatments are radiofrequency ablation, which is very commonly used treatment to target pain that stays in the spine and caused by the joints of the spine, where we basically introduce a needle and we apply heat at the tip of the needle to cauterize the nerves that innervate, or the nerves that actually send the pain signal from the joints of the back.

And last but not least, we do offer treatments such as spinal cord stimulation therapy, which is an advanced modality of treatment that can treat pains stemming from the spine that have been resistant to other traditional methods. Spinal cord stimulation is basically a wire connected to a battery, and it affects or modulate or decrease the intensity of the pain signal that goes through the spine. And it interrupts it from getting to the brain and provides our patients with relief. Usually, it starts with a trial period where we place a temporarily wire in the spine and it would be connected externally to a battery, and we leave it there for about five days or so. And if the patient gets a lot of relief, we move to the implant stage where the battery and the wire are implanted under the skin. And the recovery from that is usually pretty fast. Within a few weeks, the patient has recovered and ready to enjoy their life activities.

Host: Awesome. Well, it's great to have so many options and it sounds like a really thorough process to make sure people have that personalized care. So, you've talked about this a little bit. Is there more that you can share kind of about what that treatment process looks like? And if there's anything, like any treatments that you're particularly excited about that are coming down the line, can you share some of that?

Dr. Mohammad Issa: It would really be back to the spinal cord stimulation part that I discussed, because we have a newer, generation of devices that we're actually excited to have at Riverside that can adjust the signal based on patient position and physiologic activity, such as sneezing or coughing. The device has the ability to adjust based on that.

So once the patient is referred to us by their primary care physician or one of the other specialists, we do perform a very thorough physical exam and we formulate a comprehensive plan of treatment, which is put in place to focus on improving the patient's function and quality of life. If the decision is made to proceed with an interventional procedure, such as a nerve block, for example, an authorization and scheduling team starts the process almost immediately. And within few days, the patient is contacted and given a date for their procedure.

Host: Okay. So, that sounds great. So, if they go through that process, I think that helps people take some of the mystery out of it, make it a little less intimidating. And then, I think another great thing with Riverside's system is if there's rehabilitation or other treatment needed, they've got all of that right within the same system and the same myChart records and everything.

Dr. Mohammad Issa: Absolutely. Which makes a massive difference because you are getting all of your care in one place where you have access to multiple specialties, physical therapy, your imaging can be done within the same facility. So, it's great for our patients.

Host: Well, we're getting towards the end here. So, I guess my last question for you is what would you say is the biggest takeaway that our listeners should have from this episode?

Dr. Mohammad Issa: So, you don't have to live in constant pain. If you're struggling with chronic pain that's affecting your daily life, know that effective personalized treatments are available and that you're not alone. At our clinic, we specialize in advanced interventional pain therapies designed to reduce your pain, restore your function, and improve your quality of life. Please allow us to help you take the next step towards relief and a better quality of life.

Host: All right. Well, thank you for that. I think that's really big for a lot of people because they have been dealing with this pain for a long time. They might just think there's nothing they can do. And knowing that there's treatment here and a whole team behind them as they go through this process, I think, is really huge. So, thank you for joining us. Thank you for the great information.

Dr. Mohammad Issa: Thank you you so much for hosting.

Host: To learn more about Riverside's Interventional Pain Medicine Specialist, you can visit myrhc.net/painmedicine, or you can call 815-802-7090. Thank you for tuning into Well Within Reach, presented by Riverside Healthcare. Please take a moment to rate and leave a review for Well Within Reach on Apple, Spotify, or wherever you get your podcasts. To learn more about Riverside, visit riversidehealthcare.org.