Pain Management: Getting to the Root of the Problem

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Chronic pain affects millions of people in the United States and is often linked with a variety of issues that can devastate a person’s quality of life. There are common misconceptions about chronic pain and what causes it. Some of these misconceptions center on diet while others focus on exercise and vices. There are also millions of others living with their pain and not seeing a doctor for fear that their pain is the onset of some other major illness or health problem.

Andrew is privileged to discuss the issue of chronic pain and pain management with well-known medical experts, Dr. Michael Roizen and Dr. Teresa Dews. Dr. Roizen is the Chief Wellness Officer for the Cleveland Clinic Foundation, the first such position in a major healthcare institution in the United States. Dr. Roizen also serves as Chairman of the Wellness Institute at Cleveland Clinic. Dr. Teresa Dews is a pain management expert and also the medical director of Pain Management at the Cleveland Clinic Foundation’s Hillcrest Hospital. In this program, both Dr. Roizen and Dr. Dews share their insights on the different types of chronic pain people experience as well as when to seek care and when to get a second opinion.

Depending on the severity of the pain, one can purchase over-the-counter drugs for relief, or take a more holistic approach to relieving and perhaps alleviating the pain. Dr. Roizen and Dr. Dews describe several holistic remedies for different types of chronic pain and reveal the treatment options available if taking the holistic approach, when over-the-counter drugs are not an option. Join Andrew and his guests to learn what causes chronic pain and find out how to get relief for back pain, neck pain, joint pain, or any other type of chronic pain that you or someone you know may be experiencing.

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Produced in association with Cleveland Clinic Foundation

Transcript

Andrew Schorr:

Hello, and thanks for joining us once again on Patient Power. I’m Andrew Schorr broadcasting from Seattle where it’s cold and been rainy, but it’s doing okay. We have mostly been watching a lot of sports this past weekend. Here we are in early October, and we’re not in it at all. The Seattle Seahawks got killed by the Pittsburgh Steelers; pretty embarrassing this weekend if you are a football fan and on the losing end. In baseball all these sweeps going on. The Yankees hanging on against Cleveland, but we’re going to have some Cleveland folks on who obviously have their point of view on that, but I hate the Yankees, so I hope they go down pretty quick.

Of course we’re not here to talk about sports. We’re here to talk about significant medical issues. You know one that often gets overlooked, we talk about this disease or that disease or preventing this or preventing that; all important topics. But what affects so many people day in and day out is chronic pain. People who get terrible headaches and people who have back pain for sure. I’ve got pain now in my heel, plantar fasciitis. My friend at dinner last night has neck pain. He had previously had back surgery, and now he has neck pain, and it’s down his arm and his hand hurts. Is it a hand problem; is it a neck problem; does he need surgery, does he need a shot from a pain management specialist? All kinds of things like this. My kid had a headache yesterday. What is the thing to do? Do you take a bath, or do you take some over-the-counter medicine, or when do you need something more? Is it your diet? Can exercise help? Are you drinking too much coffee?

Well fortunately at one of our leading medical centers, the Cleveland Clinic, they have people who specialize in all that and take a very holistic approach. There are two guests we have today who are closely associated with all that and with helping people with their health issues. One is particularly famous because he has been a co-author on a number of best selling books, and he is also a radio host too, and that is Dr. Michael Roizen who is the Chief Wellness Officer and he is Chairman of the Division of Anesthesiology Critical Care Medicine and Pain Management at the Cleveland Clinic Foundation in Cleveland. Dr. Roizen thanks so much for being with us on Patient Power.

Dr. Roizen:

Andrew, thank you. It is always a privilege. You do so much good work that it’s a pleasure for us to be with you.

Andrew Schorr:

Thank you sir, and also someone who specializes in pain management every day, is Dr. Teresa Dews, also an anesthesiologist. Dr. Dews as we continue we’ll get into some specific suggestions you have, but I mentioned it’s sort of a holistic approach. It’s not always a shot or a pill that makes the difference, right?

Dr. Dews:

No it isn’t. It is usually a combination of things, and I’d just like to take the opportunity to thank you for inviting me to your program.

Andrew Schorr:

Sure, I’m happy to do it. You know one thing that I’ve read is that there are common misconceptions about chronic pain, and that diet can make a difference. So Dr. Dews where does diet come in because we think that we eat what we eat, but that doesn’t cause pain?

Dr. Dews:

Well it doesn’t necessarily cause pain, and there are different philosophies related to that. There is a group of thinking where there are some diets that actually add to inflammation, and so there have been some studies, there has been some work to try to get people to eat a more healthy diet to actually impact inflammation. Where there is inflammation that is an opportunity for pain. So eating a healthy diet is actually important not only for our general health, but may actually help in some instances related to pain.

Andrew Schorr:

Are there a lot of people out there who are just grinning and bearing it, because I’m looking at the statistic that says 75 million Americans, Dr. Roizen, have chronic pain, so it’s a serious public issue, but is it the kind of thing that some people just try to live with?

Dr. Roizen:

Actually a huge number of people try and live with it. Chronic pain is in fact our largest medical cost in the nation. Probably if you include the cost for lost productivity as well as for absent days and medical costs, it’s probably around 300-billion dollars, that is the lost productivity alone is probably someplace in the 150-billion dollar range. So it’s a huge cost and a lot of people with it will, and Teresa will tell you this, you know almost every referral that we get to our pain clinic starts with an apology. That is, ‘You’re not going to like this patient, but . . .’ That’s because the patients, even when they are seen by their family practitioner, their family practitioners often don’t know how refer them, don’t know when to refer them.

Andrew Schorr:

You know Dr. Dews I have a question that came up at dinner last night, and it is sort of like what Dr. Roizen was getting at. There is a desperation that comes with pain, but also depending upon which doctor you get to. You go to this specialist and that one, often not a pain specialist but an orthopedic surgeon, neurologist; I’m thinking of particularly back and neck problems that radiate from there, and you get different opinions on whether you need surgery.

That was my friend’s quandary last night. He had previously had a laminectomy for back problems some years ago, and now he has real bad neck pain again, and it radiates down his arm. I don’t know that he has been to a pain specialist, but his concern previously when he went to neurosurgeons was one says, ‘You definitely need surgery, and I can do that for you next Tuesday.’ Then somebody else says, ‘No, that probably would not be necessary.’ So he is just confused, and I am sure there are a lot of people with pain that, depending on who they consulted with, just throw up their hands and don’t know what to do. Any guidance for them?

Dr. Dews:

You know that is very, very common. Unfortunately, particularly with neck and lower back pain we really don’t have a gold standard as far as when surgery is absolutely necessary unless someone has some very critical signs such as they are losing strength, or the pain is extremely severe, or the pain is mostly in the leg or only in the arm. So patients will get conflicting opinions related to surgery, and so you basically have to defer to going with the best doctors, taking all of that information together, and then kind of deciphering it you know yourself with your primary care doctor as far as what’s the best way to approach it.

In general, in the absence any leg weakness or any arm weakness you do have time to be conservative. So conservative therapy includes exercise, maybe trying different medications to try to decrease the pain, considering the injections or interventional therapies such as epidural or nerve blocks or epidural steroid injections to help decrease the pain and facilitate your physical rehabilitation. There are enough people who will get better with those conservative modalities that surgery is not always necessary.

Andrew Schorr:

We are going to talk about some other modalities too after the break. For instance I have a cousin Jeanne in Charlotte, North Carolina. She has had some kind of ablation to her neck, and I’ll ask you about that. It worked one time, but then she had it another time, and it didn’t work, and so she just suffers. Certainly there are people with migraine who grin and bear it, tried over the counter products, etc. so also how people can advocate for themselves. When you talk about chronic pain there is plenty to talk about, so we’ll be back with our two experts from the Cleveland Clinic, Dr. Michael Roizen, well known on the radio and as an author as well, and Dr. Teresa Dews. It’s all coming up as we continue Patient Power live on HealthRadio Network. Stay with us.

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