Melanie Cole, MS (Host): Welcome to Back to Health, your source for the latest in health, wellness, and medical care, keeping you informed so you can make informed healthcare choices for yourself and your whole family. Back to Health features conversations about trending health topics and medical breakthroughs from our team of world-renowned physicians at Weill Cornell Medicine.

I'm Melanie Cole. And joining me today is Dr. Rohan Jotwani. He's an Assistant Professor of Clinical Anesthesiology at Weill Cornell Medical College - Cornell University, and he's here to help us managing pain or discomfort while working from home. Such an interesting topic. Dr. Jotwani, thank you for joining us again today.

Before we get into this topic, because so many of us are working from home now, and since COVID, it's really changed this shift. Can you tell us a little bit about the field of Pain Management and the services that you provide at Weill Cornell Medicine?

Rohan Jotwani, MD: Sure. Thank you for having me. I'm a pain doctor. It's kind of an unusual profession in medicine because you never see like an entire medical specialty based around one symptom, you go to a brain doctor or you go to a heart doctor, but you don't go to like a gastric reflux doctor. So, it's kind of interesting that we have an entire specialty of medicine around a single symptom. But that's because pain is just that complicated, that it kind of needs its own specialty. One in five Americans lives in chronic pain, and part of what we specialize in is thinking about pain not only as a consequence of another disease process, but also as the disease in and of itself. This idea that the body becomes acclimated to a signal, a signal that exists in the body or evolutionarily exists in the body as some kind of defense mechanism, but now no longer serves that purpose. In fact, it does the opposite. Instead of helping you survive, actually, a lot of patients who live in chronic pain aren't surviving, they're not thriving. That's sort of where I do my sort of medical battles, so to speak. I live in that world of trying to understand patients, their lives, how pain has affected that life, and how we get them back to the life they once had. And we do that in a lot of different ways.

You know, I sort of think of one of the benefits of being a pain doctor is that we can be exceedingly creative with how we approach pain. We can do everything from medication management to procedures. Sometimes those procedures can be very simple procedures. Maybe Botox for headaches and Botox for muscle pain, all the way to very complicated procedures like surgical implants, and electrical therapies. So, we kind of do a lot of interventional management as well. You know, I advise patients sometimes on lifestyle changes, right? Things like vitamins, I advise them on physical therapy. I advise them on things like acupuncture, and integrative approaches. I have a personal sort of stake or, I guess, stake is the wrong word, but a personal research interest in virtual reality therapy and embodiment therapy. So really, there's not a lot we don't do in terms of pain management, in terms of how we help people sort of restore their function and get back to the life that we have. I often tell my patients, "I'm going to search under every rock until we find the right answer for you."

Melanie Cole, MS: Dr. Jotwani, you're such a great guest and I love that you said it's one of the few professions where you're just dealing with one symptom. And going off of that, to do your practice and your clinical expertise, that is so interesting. I've never heard that before, but it is a burgeoning field, Pain Management. And there's so many, as you say, approaches with the Pain Management services that you provide. And we're looking more toward multimodal now, you know, as opposed to opioids and certain things that used to be so common in your field, but now is really going in so many directions. And thank you for sharing all those services with us.

Now, common related issues that people that work from home experience, what are some of the most common that you see? And I think, as an exercise physiologist, I think along the lines of ergonomics and necks and backs and thumbs and wrists and from our mouse. And what do you see, doctor, every day?

Rohan Jotwani, MD: I see it from head to toe. I'll start by saying, you know, before I was talking about, evolutionarily, pain was designed to be something helpful for us, you know, when we were out there on the savannas, being hunter gatherers. I'll go so far as to say, you know, for most of human history, we have not been confined to corporate offices or confined to our houses as our mode of working for, you know, eight hours a day every day. But society changes and the world changes. And here we are, more people now than ever are spending time very sedentary for many, many hours of the day confined to a space, which is new for us as a species. And so, there are no shortage of problems that people come to me with. And the root cause tends to be in how they spend a lot of their working hours of the day when they work.

So, I see very commonly low back issues. I see a lot of what we call tech neck, which is our musculature of the cervical spine sort of hurting because of the way that we're interacting with the this new technology, mobile phones, where we're bending our heads all day long. So, I see sort of both those things very frequently. I also see a fair bit of carpal tunnel syndrome and, you know, not to mention migraines that come from staring at a computer screen for many hours of the day. So, it's a real head-to-toe business when it comes to home-based or home office-based pain issues.

Melanie Cole, MS: Dr. Jotwani, as people describe their symptoms to you, whether it's headaches or neck pain, as you've described, or whatever it is, how do you figure out that it is something ergonomic? I mean, you take a detailed history, yes. Are there any imaging tests and things that help you along this route?

Rohan Jotwani, MD: I think the first thing that we do is kind of central to pain medicine, is finding pain in the body is kind of like a needle-in-a-haystack kind of situation. But people have the clues, right? They'll give you the clues if you're sitting there and actually listening. So, in order to understand somebody's chronic pain, you have to understand who they are. So, yes, imaging helps. Sometimes imaging will show me, "Oh, okay, I can see arthritis in this certain portion of the back," or sometimes, you know, a scan will show me, like an MRI scan will show me, "Oh, it's this pinched nerve," and this pinched nerve kind of correlates with the exam.

But the first and foremost thing is you just have to understand the person. What is their work-life balance like? What is their work life like? Usually, if I find out, oh, okay, the patient has a job where, say, they're a computer programmer, so they're spending their day kind of hunched over for, you know, maybe six, seven hours, you know, during a coding stretch that they may do. I then ask about, like, "Hey, what chair are you using?" And, you know, if they work from home, the answer is usually, "Well, the chair I had at home." And that will start to clue me into like, "Oh, is this chair actually designed for you to sit in it for like, you know, hours and hours and hours on end?" And usually, the answer to that is no, depending on the person's work situation.

So, I think you got to be a little bit of a detective when it comes to being a good Pain Medicine doctor. And you have to be willing to ask certain questions that may be seen, you know, unusual for a doctor to ask. And then, you kind of figure it out. I could probably tell most of the patients that I have my practice, I actually do know what they do quite well, because I'm always curious as to whether or not that plays into why they have their pain syndrome.

Melanie Cole, MS: So then, what do we do about it? Can you speak to some strategies that you give your patients every day for optimizing those ergonomics so that they don't have those pains before they have to look to interventions. I'd like you to also speak about some of the interventions because those have changed over the years as well, yes?

Rohan Jotwani, MD: Oh, yeah, definitely. Okay. Well, let's start about how we fix the root cause of the problem, If the root cause of the problem was there is a behavior that is being done that is leading to the generation of the human body or is leading to muscle issues or sort of arthritis or really a nerve issue, we got to identify it and then we got to correct the behavior. So, I think it starts with understanding simple things, right? Like, so for example, when you sit, do you slump when you sit, right? So, sitting, as a chronic activity that we do for hours and hours, needs to be balanced between how your core and your back function. No one part of your body should be working harder than the others because it's in those imbalances that things like arthritis or muscle pain tends to develop. So usually, the first step starts with an analysis of that and then creating exercises or opportunities through the workday to correct for these misbehaviors. So, a lot of patients will go to physical therapy, right? And the whole point of physical therapy is to work on a home exercise program such that these things don't happen in the future.

Now, sometimes we end up in sort of a little bit of a situation where it hurts too much to do physical therapy. And patients, you know, will often come to me and say, "I tried physical therapy, but I can't get to that point where it's helpful because I'm in just too much pain to have a home exercise program right now." To which I say, "It's always great to still try and get into that process earlier rather than later. But that's usually at the time when I start thinking about an intervention, when I'm like, okay, the intervention could be not only the therapy to treat the pain, but also a means to prevent future pains from happening, right? Insofar as it helps you get in line with your physical therapy home exercise program. When it comes to stuff like that, the interventions can be very simple. They could be something like a trigger point injection, where we simply help a muscle that's in trouble get back to where it once was and stop spasming, and deal with these areas of trigger points where there can be some issues with how the muscle is behaving due to spasms.

There are also other things that we can do, for migraines, if a patient has gone through a certain number of treatments, we can offer them sort of more advanced pain therapy like Botox injections for migraines. And we can sort of keep going down the line for various types of injections for various etiologies until we find the right combination of things for that person.

Melanie Cole, MS: Thank you for such a comprehensive answer and it's such an interesting field. As we get ready to wrap up, I'd like you to give us your best advice, the importance of taking breaks, physical activity. As you mentioned, you give this kind of advice while you're helping people and shared decision-making and deciding what kinds of interventions are available in the field of pain management. So, I'd like your best advice, Dr. Jotwani, what you want people to know every day to hopefully avoid injuries when they're working from home.

Rohan Jotwani, MD: My best advice is aging is coming for everyone. To the best of my knowledge, we haven't yet found the fountain of youth. So, your body is going to age, as much as you try not to, some of that process is going to happen. But you don't want your work life to accelerate that process of aging. And it's kind of unfortunate that part of modern society for most people means working. And you're going to spend a lot of your life working. So, a lot of people will say, "Well, listen, when pain becomes a part of my life, or when there is a problem, I will fix it." My advice to you is prevent yourself from having that issue, right? Build good habits into your work-life balance, or into your work-day balance, that prevent you from getting chronic pain. And sure, this may mean I see less patients, but I'm totally fine with that. I'm totally fine with the idea that we have less people suffering from chronic pain in the world.

The way that you do that is you think about what we are as a species and where we've been as a species. So, we were not designed to sit for hours and hours and hours of time in chairs. So, stand, stretch, incorporate things like yoga or exercise into your morning before you get onto that computer. If you have the ability to have a treadmill desk, try it out. You don't have to do the treadmill for all day long. But even if you did one or two meetings a day on the treadmill and a few meetings off the treadmill, that could be great. Develop a plan so that way you're checking in with yourself every time you may be slumped over. So that way, if you don't have the right chair, say, that keeps your core strong, find a way to check in with yourself ever so often so that you can remember, "Oh, I'm not supposed to be slumped over."

If you find yourself spending a lot of your day looking at your phone, maybe it's time to set an alarm, because your neck shouldn't be bent over all day long, looking at your phone. That's a very, very easy recipe for neck issues down the line. If you find yourself having headaches, looking at a screen all day, maybe it's time to consider sometimes there are these light screens that you can have to prevent that, but it may also be time to consider taking breaks every so often, so that way you get out there and, you know, maybe look at some sunlight instead. There are all these different things that we can do, but we have to plan for it. The default is that we won't do these things and we will end up being chronic pain patients. But if we plan to prevent ourselves from being chronic pain patients, that's great, that's the ideal.

Melanie Cole, MS: It certainly is. So beautifully said, Dr. Jotwani. What a great guest you are. Thank you so much for all that good advice and telling us about the services that you offer for pain management at Weill Cornell Medicine. Thank you again. And Weill Cornell Medicine continues to see our patients in person as well as through video visits, and you can be confident of the safety of your appointments at Weill Cornell Medicine.

That concludes today's episode of Back to Health. We'd like to invite our audience to download, subscribe, rate, and review Back to Health on Apple Podcast, iHeart, Spotify, and Pandora. For more health tips, please visit weillcornell.org and search podcasts. And parents, don't forget to check out Kids Health Cast. I'm Melanie Cole. Thanks so much for joining us today.

Promo: Listen now to On the Mind, the new podcast from Weill Cornell Medicine, discussing the latest hot topics in psychiatry, psychology, and mental health. Join Dr. Daniel Knoepflmacher as he explores recent research in cutting-edge clinical care with leading scientists and providers. Learn new initiatives in community wellness and how to process your mental health journey while exploring everything on the mind. Subscribe wherever you listen to podcasts.

Disclaimer: All information contained in this podcast is intended for informational and educational purposes. The information is not intended nor suited to be a replacement or substitute for professional medical treatment or for professional medical advice relative to a specific medical question or condition. We urge you to always seek the advice of your physician or medical professional with respect to your medical condition or questions. Weill Cornell Medicine makes no warranty, guarantee, or representation as to the accuracy or sufficiency of the information featured in this podcast. And any reliance on such information is done at your own risk.

Participants may have consulting, equity, board membership, or other relationships with pharmaceutical, biotech, or device companies unrelated to their role in this podcast. No payments have been made by any company to endorse any treatments, devices, or procedures. And Weill Cornell Medicine does not endorse, approve, or recommend any product, service, or entity mentioned in this podcast.

Opinions expressed in this podcast are those of the speaker and do not represent the perspectives of Weill Cornell Medicine as an institution.