Joey Wahler (Host): It's something that affects quality of life for many of us. So we're discussing pain management. Our guest is Christine Skilliter. She's a Nurse Practitioner at the Center for Pain and Spine Management at Wood County Hospital. This is Health Matters, Insights from WCH Medical Experts. Thanks for joining us. I'm Joey Wahler. Hi there, Christine. Welcome.

Christine Skilliter, CNP: Hi, Joey.

Host: So first, what do we mean exactly by the term pain management?

Christine Skilliter, CNP: Pain management is much more complex than it sounds, obviously. We primarily treat chronic pain. So, sometimes someone will tell me, this feels like a band aid, we're not fixing the problem. That's absolutely correct. We find ways to manage pain and keep you doing the activities that you want to do.

We want to improve your quality of life. So, you know, unlike a surgeon who's going to fix something, we're going to manage your problem and keep you at the activity level you want to be at.

Host: Gotcha. So what are some of the most common conditions you treat?

Christine Skilliter, CNP: The most common are back pain, probably number one, neck pain, joint pain, headaches and migraines would be you know, the common conditions.

Host: And how about some of the more complex conditions you see?

Christine Skilliter, CNP: So, we treat different types of cancer pain. One common one we do is pancreatic cancer. We do something called CRPS, which is complex regional pain syndrome. We treat pain in the abdomen, male and female chronic pelvic pain, pain in people who have had multiple surgeries, you know, to one area of their body, they're now having nerve pain, diabetic peripheral neuropathy is something we treat. So really there's not an area of the body that we don't treat chronic pain in.

Host: So you mentioned back pain, neck pain as two of the most common. What are some of the typical causes of that?

Christine Skilliter, CNP: The number one cause would be just wear and tear, chronic degenerative changes. Some people are genetically more prone to that. Some people have had really active lives, you know, hard manual labor, athletics. We treat you know, college athletes, high school athletes, it's honestly rarely an acute injury.

We see that maybe in a car accident or a work related injury, heavy lifting,but much more commonly, we just see just chronic degenerative changes that, for whatever reason, one day you wake up and they're bothering you. Very few people have a great story to go with it.

Host: How often would you say chronic pain occurring in one area of the body is caused by an issue in another part since so many things are connected?

Christine Skilliter, CNP: So very commonly. We often have, more so than not, you know, when a patient has hip pain or buttock pain or leg pain and they may say, it's not coming from my back, I don't have any back pain. Very commonly, more so than not, the pain is coming from their back.

We use different tools like maps, dermatomal maps. We can show patients, okay, this pain in your leg or your foot is actually coming from this level in your spine. Same with hands and arms. Oftentimes people have abdominal pain that once everything else is ruled out, they're just left with this chronic pain. It could be coming from issues in their thoracic spine or their middle back. We treat a lot of headache patients that deny any neck pain, but that headaches are coming from the neck.

Host: Interesting. So what can patients expect during an initial visit to the Center for Pain and Spine?

Christine Skilliter, CNP: So at your initial visit, more times than not, you'll see one of the nurse practitioners. There's three of us. We've worked with Dr. Atallah for a long time now and we take your initial history, which starts from square one. You know, when did this pain start? Where is it located? Where does it travel? What does it feel like? What makes it better? What makes it worse? Oftentimes people get really annoyed with these questions. You know, why are you asking me this? But that's how we figure out, you know, what your main pain generator is. And technically this is chronic pain. So you've been going through this for a while and you're kind of tired of all of our questions, but they are important. So the number one thing we do is take your history of, a lot of questions about where'd this pain come from and then we do a physical exam. Oftentimes patients already have some form of imaging that we review, but they may not. We get some self-referrals that we're kind of started from scratch with, but if we need to, we'll order more imaging. X-rays, MRIs.

More importantly though, oftentimes, you need physical therapy before we can do some of these more advanced images. You need to have had at least six weeks of conservative care. So, rest, ice, anti-inflammatories, things like that. So we figure out everything that you've tried.

So, when we're asking, you know, have you tried anti-inflammatories or Tylenol, people say, of course I have. You know, well, we have to document all of this. So the initial evaluation is a lot of documentation. A lot of getting the story, and then if we have all the imaging, you've done your physical therapy; we come up with a plan, and we can order procedures or interventions that day. Otherwise, we'll either refer you to physical therapy, to get images, and then we see you back in a few weeks to go over everything.

Host: And so you mentioned typically physical therapy precedes imaging. Why is that?

Christine Skilliter, CNP: So, physical therapy does help. I mean, it can provide significant relief, especially if the pain is relatively acute, meaning it's just started within the last six months. It is the best thing for you to try physical therapy because, like I said, more times than not, it really does help.

And then that prevents further injury in the future. It's something you can do at home and keep up with. And we don't want to do invasive procedures. Everything comes with a risk. If something like physical therapy for six weeks solves your problem or gets it to a manageable point. And then another complicating factor is, you know, insurance companies want to know that you've tried everything you can before they'll think about, you know, paying for images and injections when it could simply be fixed with some therapy.

Host: Okay, so you mentioned physical therapy, you mentioned medication, anti inflammatories, over the counter, if that stuff doesn't work, what are the other options?

Christine Skilliter, CNP: That's when we need to figure out what's the main issue here. We match up what your pain pattern is with what the images are showing. They don't always correlate as closely as we would like. So at that point we figure out what kind of procedures we're gonna do to help this or diagnose the pain.

The procedures can be as much diagnostic as they are therapeutic. So one thing we do are epidural steroid injections, which is a type of steroid injection that's done in the neck or the spine, and that's done by Dr. Atallah, under live x-ray, and those can help the back pain, nerve pain, disc issues in the spine.

We treat arthritis in different areas of the body, primarily the neck and low back, with something called a radiofrequency ablation, or often it's called a nerve burn. That sounds a little bit more invasive than it is, but it is heating up the nerve and deadening it. There are joint injections, a type of gel injection we can do in the knees.

 There's specific nerve blocks, maybe you have pain after a hernia surgery, we can do like an, something called an ileoinguinal nerve block. And then often, you know, depending on the type of nerve, if this doesn't give you long term relief, we're able to do something called the radiofrequency ablation, but we can do that in more areas than just the spine.

Host: Wow, so that's a lot of options.

Christine Skilliter, CNP: It is a lot of options.

Host: Which is great it sounds like, but then, if there are more than one option for a given case, how do you get together with a patient and how do you and yours determine what's going to be the best route to go?

Christine Skilliter, CNP: So that's when all these obnoxious questions we asked you over and over again come from. Is the pain staying in your back? Is it radiating anywhere? Do you have any numbness or tingling? What does it feel like? Is it aching? Is it stabbing? One big question we ask is when you're in a grocery store, do you lean forward over a shopping cart? Does that take away your pain? And people will look at us like, how do you know I walk like that? You know, it's do you have pain with sitting or is your pain primarily with walking? If you're walking and you sit down, does the pain go away? You know, does it keep you up at night? Is it in the morning?

So, more of our treatment plan comes from our actual history and our physical exam than it does the imaging. Often the images rule out something serious, something that needs treated now. Something we weren't necessarily looking for, but our main treatment plan comes from the exam itself. We may have somebody that comes in with leg pain and hip pain, thinking it's actually the back, because they also have back pain, and it turns out it's all coming from the hip joint itself.

You we do a hip injection. If that fixes it, diagnostically, that's your hip. Even though your MRI looks bad, your back is not the problem.

And we talk about, you know, there are certain procedures that patients are fearful of and scared of and they just won't do so then we give some other options for that, what will you do, you know, what can we do to help you make your decision?

Host: Absolutely. So, a few other things, how about general tips from your experience for people to try lessening or preventing or prolonging certain types of pain.

Christine Skilliter, CNP: Yeah, absolutely. One is, you hear all these things about, lifting correctly and, and, you know, learning just basic body mechanics does help. Thinking about what you're doing, obviously, when people are younger, you don't think about the consequences when you get older, but even at a young age, you need to be aware of how you're using your back.

Letting pain be your guide, you know, there's a long time, no pain, no gain. That's not typically the case, you know, with exercising, sure, you want to stop, it's not fun, it's painful, but, if something is worsening your pain, listening to your body is really important. You know, weight management, an extra 10 pounds, that's a lot.

If you, if you pick up 10 pounds and feel it, that's a lot on your joints, your low back. All of us now have posture issues because we're looking down at phones constantly. We're all guilty of that. That can really affect the neck, the shoulders, the entire back. So posture is a big thing.

Regular exercise, you know, if your muscles aren't strong, your spine and joints are not going to be stabilized. Just generally staying healthy. Things like diabetes, it can cause pain. It can make treating pain significantly worse. So can cardiac issues, you know, we're limited on what we can do.

So overall, you know, your general health plays into all of your pain.

Host: Sure. And when we talk about exercise, as you just mentioned, how about Christine, the importance of tailoring your workout routine when you have chronic pain and realizing that you can't necessarily, or shouldn't necessarily, even if you can, do the same things you did before you had that pain, right? You gotta, you gotta put the ego aside, don't you?

Christine Skilliter, CNP: Yes, that is, that's that whole, you know, no pain, no gain thing. It's, realistic expectations are huge. That's a lot about what we do. And when I say, you know, we don't fix things, we may see a young patient who's lifted 500 pounds before, now they have a back surgery and you know, in an injury, it's like, look you can still exercise, you can modify things, but you're probably not going to go back to doing what you were doing.

Like I said, realistic expectations are a lot of it, telling people, we may improve your pain, you know, you may feel 80 percent better. We want you to be active. However, you need to listen to your body. If something you're doing is repeatedly causing pain, we're gonna try to keep you doing that. You know, we're the last place that's gonna tell you, just forget it. You can't do that anymore. But, realistically, you may have to modify things to work for you or you'll be in this cycle of constantly injuring yourself.

Host: And then finally, Christine, in summary here, having just mentioned the importance of realistic expectations, when people come to you and yours, how about the chances, generally speaking, obviously every patient, every case is different; the chances of effectively addressing someone's pain to where it can in fact be managed provided they have those realistic expectations.

Christine Skilliter, CNP: Our practice varies so much in every patient that we see, you know. We see everything from I've had a minor pain for six weeks to I have had 11 back surgeries. So, very rarely, very, very rarely do we have patients that don't make any improvement. More times than not though, you will feel better and you will get lasting relief.

 We don't see the patients back who are doing great, but we have a constant influx of new patients because people are feeling better and they don't need to come back. And we're very honest with people, you know, they want to know is this injection gonna help? How much relief am I gonna get and how long is it gonna last?

We can't typically give you that answer you know. You really have to try and see. Things like something we do called a spinal cord stimulator that we have. You try it for a week, but I can say, you know, Dr. Atallah's overall success rate is 88 percent of patients are happy with the spinal cord stimulator.

Those percentages are difficult to give because everybody has a different level of what they'll be happy with. Some patients come back, you know, I just had a patient, they said, my pain's a 7 out of 10. I said, Are you comfortable with that? And they were so happy with where they were at. They were sleeping through their night. Their life was improved. They were happy to go out the door that day. You know, I have other patients who we can get them from a level of an 8 down to a 2, and just that's not where they want to be. You know, they want no pain. So, I can tell you zero pain is not what we are going for in pain management, but the vast majority of our patients do feel better.

 And our goal is, with everything we do, we want at least 50 percent relief of your pain, if not more like 80 percent relief of your pain, which is kind of where we want to be at. But a hundred percent relief, we don't often get.

Host: All right, well I'm sure those joining us appreciate you giving it to them straight. Sounds like you have a lot of success stories. Folks, we trust you're now more familiar with pain management. Christine Skilliter, keep up the great work. Thanks so much again.

Christine Skilliter, CNP: Thank you.

Host: And for an appointment at the Center for Pain and Spine Management, please call 419-373-7696. If you found this podcast helpful, please do share it on your social media. I'm Joey Wahler, and thanks again for being part of Health Matters, Insights from WCH Medical Experts.