The Interventional Pain Program, under the Department of Anesthesia, provides comprehensive pain management for both cancer and non-cancer related pain.
There’s more to cancer care than simply helping patients survive.
Cancer patients should report their pain to their caregivers, and enlist their doctors to help them manage it.
Interventions such as minimally invasive nerve blocks, joint injections, radiofrequency ablation of nerves, intrathecal pain pumps, or neurostimulators are used in conjunction with medications, psychotherapy, physical rehabilitation, and even hypnosis to reduce pain and improve quality of life for each patient.
Andrew T Leitner, MD, an assistant clinical professor of anesthesia and interventional pain, is here to discuss City of Hope's Interventional Pain Program and how City of Hope’s approach to cancer pain treatment is different and leading the way in interventional pain management technology.
Selected Podcast
Interventional Pain Management for Cancer Pain
Featured Speaker:
Board certified in both anesthesiology and pain management, Dr. Leitner is fluent in Spanish, Hebrew and Hungarian. He is an active member in numerous professional associations including the American Society of Anesthesiology, the American Society of Regional Anesthesia, the California Society of Anesthesiologists, and the North American Neuromodulation Society. He has also written several articles and abstracts.
Andrew T Leitner, MD
Dr. Leitner is an assistant clinical professor of anesthesia and interventional pain in the Department of Anesthesiology. He earned his undergraduate degree magna cum laude in biology from Tufts University in Medford, MA. He went on to receive his medical doctorate from the Washington University School of Medicine in St. Louis, MO. He completed his residency in the Department of Anesthesiology at the University of California, Los Angeles (UCLA), where he also pursued a fellowship in interventional pain management.Board certified in both anesthesiology and pain management, Dr. Leitner is fluent in Spanish, Hebrew and Hungarian. He is an active member in numerous professional associations including the American Society of Anesthesiology, the American Society of Regional Anesthesia, the California Society of Anesthesiologists, and the North American Neuromodulation Society. He has also written several articles and abstracts.
Transcription:
Interventional Pain Management for Cancer Pain
Melanie Cole (Host): There’s more to cancer care than simply helping patients survive. There’s more to cancer treatment than simple survival. Constant pain should not be a part of conquering cancer or any quality of life, for that matter. My guest today is Dr. Andrew Leitner. He’s an assistant clinical professor of anesthesia and in interventional pain in the Department of Anesthesiology at City of Hope. Welcome to the show, Dr. Leitner. Tell us a little bit about pain management, this field of pain management, interventional pain management. What is its role in cancer?
Dr. Andrew Leitner (Guest): Thank you, Melanie. It’s good to be here. Pain management is a relatively recent field within medicine and it comes in different flavors, but ultimately, all of its adherents and specialists are looking to approach pain from a symptom standpoint and help patients return to functioning life. The interventional pain specialists have a few extra tools at their disposal, but ultimately, all pain specialists are looking at the most effective ways of treating pain symptoms, whether it’s a combination of medication, physical rehabilitation, nerve blocks or some combination of the above. With an interventional pain specialist, there is extra training in specifically those procedures that can help alleviate pain symptoms both in the short and long term.
Melanie: Is this just for cancer patients, or can this really benefit a whole variety of people suffering from chronic pain?
Dr. Leitner: Well, the field was developed for the treatment of pain of all types, and we typically categorize pain as malignant or non-malignant pain. But as cancer treatment has improved and as patients are surviving longer with cancer, that line becomes blurred. And ultimately, we treat all types of pain. The separation that we typically approach our patients with is is this pain from cancer, is this pain from cancer treatment, or is this pain from a patient who may have cancer, may be in remission, but ultimately develops the types of pains that everybody else does—from aging, arthritis, degeneration, inflammation?
Melanie: Tell us about it. I know it’s certainly specific to each patient and where their pain is located, what they’re suffering from, but tell us a little bit about pain management. What kinds of pain management options are out there?
Dr. Leitner: The options for our patients really depend on what the source of pain is. In many cases, the referral to pain management comes after discussion with a primary treating team. In many cases for our cancer patients, cancer directly from either a physical mass or involvement with nerves becomes referred to an oncologist or a surgeon, where the primary treatment is really directed at the tumor itself. But in cases where treatment has already taken place and pain persists, that tends to be the time when they are referred to a pain specialist. Now, in many cases, we also like to see these patients early on so that we can help guide approach to pain if it develops or if it progresses. And what we have at our disposal, as I have mentioned, are various types of medications, and these are always evolving in addition to a specific guidance on physical rehabilitation, whether it’s working with a physical therapist or other professionals. And then the final one is specifically directed treatment at nerve and the nerve signaling pathway, whether it’s an injection, an ablation technique, or placement of special devices that help decrease the signal through the spinal cord.
Melanie: What’s going on in the world of pain management? What’s exciting on the horizon? What can people look forward to in this burgeoning field?
Dr. Leitner: Ultimately, pain management becomes more effective when teams are built around it. That’s one of the unique attributes here at City of Hope. We’re not working in isolation. We are a strong unit with both our patients’ primary oncologists and other treating services such as radiation oncology or interventional radiology. Each one of these specialties may have special tools specifically to offer for our parents who are suffering from pain, and it would be a disservice to our patients to only offer the tools that we specifically have. So this multidisciplinary model is probably the most effective resource that we have for our patients. Of course, there are always new technologies that are developing and some of them are very exciting, and one of these technologies is neuromodulation, where we can, in a sense, trick the body’s nerve signaling pathways into believing that a pain signal is not transmitting up the spinal cord so that it can be processed in the brain, which is where all pain is experienced ultimately through higher levels and higher channels through the brain. This neuromodulation technology is still in development, but it has been used for a good couple of decades but is evolving, and this includes spinal cord stimulators or peripheral nerve stimulators at the site of either injury or a chronic nerve irritation.
Melanie: What do patients say to you, Dr. Leitner, when you’re discussing treatment and if you’re looking at nerve blocks or spinal cord stimulators? What are some of the questions that they ask you?
Dr. Leitner: The first question most patients ask is how will this affect my current quality of life, my functioning, and then I usually ask the question back. The most important priority for how we approach care is really an honest and open discussion with my patients about what their goals of care are. This is not the same for everybody. Just as cancer is a highly personal and unique experience, pain and other symptoms can be a highly personal and unique circumstance. I have patients for whom maintaining their physical functioning, the activities that they crave and they need to continue to feel whole, that may be their number one priority. For other patients, maintaining their cognitive function, being fully alert so they can interact with loved ones, that is a treatment priority. For other patients, it’s pain relief is most significant so they would be able to tolerate some reduction in either physical function or cognitive function so they would not be in as much suffering. Most patients would like obviously some combination of those. That’s really the first question, they ask, how is my quality of life going to be affected by these different treatment options.
Melanie: That’s a great answer, too, because you think some of the treatments might affect your ability to think clearly and some of them won’t. So that’s a really great answer, good, succinct answer for that. Tell us a little bit how City of Hope’s approach to cancer pain treatment is different from other places and why patients should come to City of Hope for their care.
Dr. Leitner: Well, there are a few ways in which City of Hope stands out. The first is we as pain specialists and as a supportive care team and multidisciplinary team in general is involved early with the care of our patients. This is somewhat unique. As opposed to going through weeks and months of working with a primary oncology team, patients always have the opportunity to see a pain specialist early in their care. And we are working on different methods of making that point of contact even earlier, even if it’s just to provide information for patients that they can use later prior to starting chemotherapy, prior to starting radiation treatments, prior to surgery. And this is well integrated with our various departments. For instance, the anesthesia department will do specific clinic interviews with our patients before they’re undergoing major surgery so that any concerns or questions can be addressed. And if needed, we can put into place a plan for how specifically to address pain after the surgery and weeks and months after that as well. That opportunity to be involved early is one thing that is quite unique about City of Hope. And then of course the other aspect, as patients are well aware, our oncology research here is top of the line, and patients have opportunities to be administered treatments that are developed in our lab bench-side and then administered here in our clinics or in hospital. And the same can go for pain treatment. If we’ve decided that a patient has a unique circumstance and have shown benefit from an experimental treatment, we are able to offer them that treatment earlier, more readily with fewer steps in between, because this is ultimately a smaller institution with great communication between the services and we can get involved early.
Melanie: Thank you so much. It’s great information. You’re listening to City of Hope Radio. For more information, you can go to cityofhope.org. That’s cityofhope.org. This is Melanie Cole. Thanks so much for listening.
Interventional Pain Management for Cancer Pain
Melanie Cole (Host): There’s more to cancer care than simply helping patients survive. There’s more to cancer treatment than simple survival. Constant pain should not be a part of conquering cancer or any quality of life, for that matter. My guest today is Dr. Andrew Leitner. He’s an assistant clinical professor of anesthesia and in interventional pain in the Department of Anesthesiology at City of Hope. Welcome to the show, Dr. Leitner. Tell us a little bit about pain management, this field of pain management, interventional pain management. What is its role in cancer?
Dr. Andrew Leitner (Guest): Thank you, Melanie. It’s good to be here. Pain management is a relatively recent field within medicine and it comes in different flavors, but ultimately, all of its adherents and specialists are looking to approach pain from a symptom standpoint and help patients return to functioning life. The interventional pain specialists have a few extra tools at their disposal, but ultimately, all pain specialists are looking at the most effective ways of treating pain symptoms, whether it’s a combination of medication, physical rehabilitation, nerve blocks or some combination of the above. With an interventional pain specialist, there is extra training in specifically those procedures that can help alleviate pain symptoms both in the short and long term.
Melanie: Is this just for cancer patients, or can this really benefit a whole variety of people suffering from chronic pain?
Dr. Leitner: Well, the field was developed for the treatment of pain of all types, and we typically categorize pain as malignant or non-malignant pain. But as cancer treatment has improved and as patients are surviving longer with cancer, that line becomes blurred. And ultimately, we treat all types of pain. The separation that we typically approach our patients with is is this pain from cancer, is this pain from cancer treatment, or is this pain from a patient who may have cancer, may be in remission, but ultimately develops the types of pains that everybody else does—from aging, arthritis, degeneration, inflammation?
Melanie: Tell us about it. I know it’s certainly specific to each patient and where their pain is located, what they’re suffering from, but tell us a little bit about pain management. What kinds of pain management options are out there?
Dr. Leitner: The options for our patients really depend on what the source of pain is. In many cases, the referral to pain management comes after discussion with a primary treating team. In many cases for our cancer patients, cancer directly from either a physical mass or involvement with nerves becomes referred to an oncologist or a surgeon, where the primary treatment is really directed at the tumor itself. But in cases where treatment has already taken place and pain persists, that tends to be the time when they are referred to a pain specialist. Now, in many cases, we also like to see these patients early on so that we can help guide approach to pain if it develops or if it progresses. And what we have at our disposal, as I have mentioned, are various types of medications, and these are always evolving in addition to a specific guidance on physical rehabilitation, whether it’s working with a physical therapist or other professionals. And then the final one is specifically directed treatment at nerve and the nerve signaling pathway, whether it’s an injection, an ablation technique, or placement of special devices that help decrease the signal through the spinal cord.
Melanie: What’s going on in the world of pain management? What’s exciting on the horizon? What can people look forward to in this burgeoning field?
Dr. Leitner: Ultimately, pain management becomes more effective when teams are built around it. That’s one of the unique attributes here at City of Hope. We’re not working in isolation. We are a strong unit with both our patients’ primary oncologists and other treating services such as radiation oncology or interventional radiology. Each one of these specialties may have special tools specifically to offer for our parents who are suffering from pain, and it would be a disservice to our patients to only offer the tools that we specifically have. So this multidisciplinary model is probably the most effective resource that we have for our patients. Of course, there are always new technologies that are developing and some of them are very exciting, and one of these technologies is neuromodulation, where we can, in a sense, trick the body’s nerve signaling pathways into believing that a pain signal is not transmitting up the spinal cord so that it can be processed in the brain, which is where all pain is experienced ultimately through higher levels and higher channels through the brain. This neuromodulation technology is still in development, but it has been used for a good couple of decades but is evolving, and this includes spinal cord stimulators or peripheral nerve stimulators at the site of either injury or a chronic nerve irritation.
Melanie: What do patients say to you, Dr. Leitner, when you’re discussing treatment and if you’re looking at nerve blocks or spinal cord stimulators? What are some of the questions that they ask you?
Dr. Leitner: The first question most patients ask is how will this affect my current quality of life, my functioning, and then I usually ask the question back. The most important priority for how we approach care is really an honest and open discussion with my patients about what their goals of care are. This is not the same for everybody. Just as cancer is a highly personal and unique experience, pain and other symptoms can be a highly personal and unique circumstance. I have patients for whom maintaining their physical functioning, the activities that they crave and they need to continue to feel whole, that may be their number one priority. For other patients, maintaining their cognitive function, being fully alert so they can interact with loved ones, that is a treatment priority. For other patients, it’s pain relief is most significant so they would be able to tolerate some reduction in either physical function or cognitive function so they would not be in as much suffering. Most patients would like obviously some combination of those. That’s really the first question, they ask, how is my quality of life going to be affected by these different treatment options.
Melanie: That’s a great answer, too, because you think some of the treatments might affect your ability to think clearly and some of them won’t. So that’s a really great answer, good, succinct answer for that. Tell us a little bit how City of Hope’s approach to cancer pain treatment is different from other places and why patients should come to City of Hope for their care.
Dr. Leitner: Well, there are a few ways in which City of Hope stands out. The first is we as pain specialists and as a supportive care team and multidisciplinary team in general is involved early with the care of our patients. This is somewhat unique. As opposed to going through weeks and months of working with a primary oncology team, patients always have the opportunity to see a pain specialist early in their care. And we are working on different methods of making that point of contact even earlier, even if it’s just to provide information for patients that they can use later prior to starting chemotherapy, prior to starting radiation treatments, prior to surgery. And this is well integrated with our various departments. For instance, the anesthesia department will do specific clinic interviews with our patients before they’re undergoing major surgery so that any concerns or questions can be addressed. And if needed, we can put into place a plan for how specifically to address pain after the surgery and weeks and months after that as well. That opportunity to be involved early is one thing that is quite unique about City of Hope. And then of course the other aspect, as patients are well aware, our oncology research here is top of the line, and patients have opportunities to be administered treatments that are developed in our lab bench-side and then administered here in our clinics or in hospital. And the same can go for pain treatment. If we’ve decided that a patient has a unique circumstance and have shown benefit from an experimental treatment, we are able to offer them that treatment earlier, more readily with fewer steps in between, because this is ultimately a smaller institution with great communication between the services and we can get involved early.
Melanie: Thank you so much. It’s great information. You’re listening to City of Hope Radio. For more information, you can go to cityofhope.org. That’s cityofhope.org. This is Melanie Cole. Thanks so much for listening.