The truth about managing pain — Part 2

Note from the Mamas: This is a continuation of last week’s interview of Dr. Solomon Pearce of the Mercy Pain Center about managing chronic pain. (Click here to read the first post.)

The stress of parenthood coupled with untreated daily pain can be an overwhelming situation for anyone. That’s why we asked an expert at the Mercy Pain Center to give us some insight about the field of Pain Management as well as the latest advancements in the field and what every patient needs to know before she lets someone treat her pain. We learned a lot from his answers below.

What are the most common mistakes patients make when trying to manage chronic pain? What do you wish more people understood about this field of medicine?

Having the wrong attitude when it comes to any chronic condition is a pivotal mistake. In particular, a number of chronic pain patients fall into the trap of taking a completely passive role in their own condition. They constantly look for others to do something, give them something, make them feel better, but some patients are unwilling to do anything for themselves.

It’s often hard to realize that your pain is your own. Despite the best intentions of others, ultimately it is your responsibility to get better. What this means is sad depressiontaking an active role in your health.  If you have weak muscles, do your physical therapy. If you’re overweight, lose weight. If you have diabetes, keep tight control of your condition. If you use tobacco products, stop. If you have a stressful life, meditate or do yoga or a hundred other things that you can do to get better.

Some of the most difficult things to do are some of the most beneficial. I strongly encourage all my patients to take a hard look at why they might be suffering so much, when someone else with the same physical problem is functioning fine. Often times these patients realize that they have never dealt with past traumas like physical or sexual abuse. Some realize that they hate their job or are really unhappy in their relationship. Once these issues are dealt with, their pain often gets dramatically better.

I wish people understood that healthcare has become a business and that you have to be careful where you shop. There are a lot of unscrupulous people out there selling hope in the form of medication, supplements, surgeries, or the newest device or procedure. All these can have unwanted effects, and all of them drain your bank account.

If a provider’s treatment doesn’t pass a “common sense test,” and especially if they don’t physically examine you or don’t have the time to explain things in terms you understand, look elsewhere for your care.

What are some of the most recent advancements in the treatment of pain?

The three most promising areas in Pain Management are the advances being made in neuromodulation (spinal cord stimulators), genetically targeted medications, and advances in peripheral nerve radiofrequency ablation.

Neuromodulation uses electrical impulses to change the nerve signals from areas generating pain before they reach the brain. These are implanted devices that are similar to pacemakers, but instead of changing the heart rhythm they change the pain signals. These do really well for patients with chronic pain in their arms or legs.

pills2We have learned a lot about how our bodies process medication, and companies are now making genetically targeted medications that are specifically targeted to how individuals metabolize different drugs. In the future you will not have as much trial and error with medications. You will take a blood test, which will show which designer medication will work the best for you.

Radiofrequency ablation is an old technique where we use electrical energy to create heat, most often to drastically reduce pain along the spine itself. This technique is great in that, unlike most medications that reduce pain for a few hours, this works for six months or more. I have been using this successfully for years to help patients with low back and neck pain, but recent advances in the technology are allowing this to be used in other areas of the body as well. Knee and shoulder pain patients who have wanted to put off a replacement or were told by their orthopedic surgeon that they were not a good candidate can now achieve substantial long-lasting relief with radiofrequency ablation.

What kind of specialized training do pain management physicians have that my general or primary care physician might not have?

Pain Medicine is a subspecialty. It requires four years of medical school, four years of residency, and then a year of fellowship in an Accreditation Council for Graduate Medical Education approved program (this is all after grade school, high school and college, and thus requires 25 years of school/training at a minimum). During this training, pain management physicians learn how to safely and accurately perform a number of pain relieving procedures, extensive instruction in the use of medications, and exposure to a plethora of adjuvant modalities.

Any real Pain Management physician according to the American Board of Medical Specialties should have Board Certification first in one of four specialties (Anesthesiology, Physical Medicine and Rehabilitation, Psychiatry or Neurology), plus an additional Board Certification in Pain Medicine.

Unfortunately, Pain Management has one of the highest rates of non-trained imposters of any field in medicine. For some reason, physicians in multiple specialties often claim they do Pain Management, but they do not have the real training or they stopped short from going all the way through a Pain Medicine fellowship.

I don’t perform C-sections, even though I did 30 or so during my medical school/internship training because I know I don’t have the full training to do it safely. If you need a C-section, go to an OB-GYN. For some reason, that same, simple logic doesn’t seem to sink in with some physicians or some patients when it comes to pain management. Some seem to think, “Since the DEA says I can write for opioids, then I must be trained well enough to do chronic pain management.” This is not true. There are even online companies popping up selling “board certifications” from fake boards to help fraudulent providers trick patients. (These are like the internet ordinations for fake ministers.)

This is a definite “buyer beware” situation because some people are pedaling medications that are addictive and can be deadly if prescribed or used improperly. Same thing goes with doing injections. Just because you played an interventional pain doctor on TV, or stayed at a Holiday Inn last night, doesn’t mean you can safely place a needle inside the spinal canal without injuring the spinal cord.  I hope patients spend a little time to make sure they are going to a reputable physician with all the proper training.

Our thanks to Dr. Solomon Pearce at the Mercy Pain Center for taking the time to answer our questions. Dr. Pearce is Double Board Certified in Pain Medicine and Physical Medicine and Rehabilitation. Before coming to Arkansas, Dr. Pearce was a Naval Flight Surgeon who served in multiple overseas deployments. For more information or to schedule a consultation with Dr. Pearce or his colleague Dr. Green at the Mercy Pain Center, call (479) 986-6199 or click HERE for more clinic info.

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Healthy Mama: The truth about managing pain

Most of us know at least one person who deals with pain on a daily basis. You might even be that person. Pain management is such an important part of medicine, so we went to an expert at the Mercy Pain Centerto get more in-depth answers about this complex issue.

Dr. Solomon Pearce of the Mercy Pain Center gave us some thoughtful answers to our questions, so we’re featuring them in this two-part series of posts about managing pain. (Read the second installment next week.) If you or someone you know is dealing with chronic pain, we hope you’ll seek the advice of a qualified pain management specialist. (Pain management physicians receive specialized training in this area, so be sure to find the right doctor!)

What types of situations and/or conditions cause patients to seek the help of pain management physicians?

Patients who come to me are always seeking relief from some sort of suffering. This suffering comes in a variety of forms, sometimes very obvious (e.g. I have a herniated disc in my back), sometimes very complicated (e.g. I’ve had pain for years all over my body; I’m tired all the time, and I can’t sleep) and sometimes very dangerous (e.g. I’ve had pain for years, all that works is Dilaudid with oxycodone, and hydrocodone, and you HAVE to give me medication).

Does pain management mostly involve medication? Are there additional therapies that are effective at managing pain? 

Real chronic pain management never involves just one treatment modality. Acute pain, sure… my son scrapes his elbow, I put a Band-aid on it and we’re done. My wife’s knee hurts after a run, so she uses some Ibuprofen — all better.  However pain that has lasted more than three to six months, day in and day out, has pills-384846_640 (2)become chronic; it has changed the person. It has affected their emotions, how they move in certain circumstances and what they do on a day to day basis. It truly changes how they live their life.

Thinking that all this damage can be repaired with one magic pill is silly. A good pain management physician should investigate all the areas that may have been effected and prescribe an individualized treatment program. This can include getting the person into physical therapy to work on body mechanics and strengthening exercises, occupational therapy to work on improving their function, cognitive behavioral therapy and biofeedback to help with coping and pain relieving strategies, acupuncture, prolotherapy, massage, aqua therapy, exercise programs, osteopathic manipulation etc.

Some patients need interventions with injections or radiofrequency ablation, spinal cord stimulators, or surgeries. Some need medications, and some need diet modifications. Each patient is different and I find a therapeutic approach which uses a combination addressing all their concerns in order to provide substantial improvement.

Addiction to pain medication has become a much bigger problem in our country in recent years. How do you counsel patients to help prevent these addiction issues?

I agree that our country has a significant problem with opioids. I think that the recent increase is a societal problem that can be partly attributed to physicians and to patients. Some physicians have forgotten how to say “no.” There are certain conditions and certain patient risk factors that make prescribing opioids the wrong choice of therapy.

Way too often I see patients being prescribed opioids for years that never should have been started on them in the first place. It’s hard to tell someone who is suffering “no,” but when addictive drugs may make their problem worse, it’s the right thing to do.

Some patients have becoming increasingly fixated on finding a magic pill that takes away all their pain. The media is constantly telling them there’s a quick fix around the corner and that they can just lay back and everything will be perfect. That’s not reality, but that doesn’t stop some people from seeking that end and getting themselves into trouble.

I avoid addiction problems for my patients in a number of ways. First I thoroughly evaluate each patient’s history, physical exam and diagnostic testing to find the appropriate treatment modalities for that specific patient. I screen all patients for signs of pre-existing tendencies which may indicate they could have addiction problems later on or reasons why opioid pain medication would be contraindicated for them prior to starting any treatment plan.

I strictly control access to prescription medication and monitor for compliance with my instructions through drug screening, prescription monitoring programs, and random pill counts. I always use the lowest possible dose to control their symptoms enough so patients can improve their function. This works very well to reduce the risks of addiction or drug diversion.

Are all pain medications habit forming? How would a patient know if he or she has developed an addiction?

No, not all substances that have pain relieving properties are habit-forming. I have a number of opportunities to interfere with pain signals during their transduction, transmission, modulation and perception. I use a variety of medication classes from topical agents, local anesthetics, anti-inflammatories, blood pressure medications, antidepressants and vitamin supplements which all have no habit-forming traits.

I also use some muscle relaxants, anxiolytics, anticonvulsants, and opioids that can be habit-forming (but not all of them are habit-forming.) If taken appropriately, these medications are very safe.

There’s a big misunderstanding in the general population about the difference between physical dependence and addiction.

Addiction is the inappropriate chronic use of a substance with impaired control of one’s ability to stop using it, feeling as though you have to use it, using that substance even though it causes you harm, and getting cravings for that substance. Medications can do this, alcohol can do this, gambling, sex and even food can become an addiction.

Physical dependence on the other hand simply means that your body comes to depend on a substance to function properly. Examples for this would be how some people are dependent on their coffee to wake up in the morning. A diabetic who uses insulin is dependent on their insulin to control their blood sugar. And some pain patients become dependent on a medication to be able to function throughout their day. This is normal. These people are not going from doctor’s office to doctor’s office seeking more meds or buying them on the street or smoking, snorting, or injecting medication. They are just patients living their normal lives, taking a medication every day, like people do for blood pressure or birth control.

Craving is usually one of the first signs a patient would notice if they were developing an addiction — that feeling that you just have to have something. It becomes all you think about. A person developing an addiction might start using more medication than directed, running out early, or trying to find other places to get medication from.

We’ll continue Dr. Solomon’s answers to our questions about pain management in an upcoming post next week.

Our thanks to Dr. Solomon Pearce at the Mercy Pain Center for taking the time to answer our questions. Dr. Pearce is Double Board Certified in Pain Medicine and Physical Medicine and Rehabilitation. Before coming to Arkansas, Dr. Pearce was a Naval Flight Surgeon who served in multiple overseas deployments. For more information or to schedule a consultation with Dr. Pearce or his colleague Dr. Green at the Mercy Pain Center, call (479) 986-6199 or click HERE for more clinic info. 

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The Need to Breathe: May is Asthma Awareness Month

We can all agree that — out of the thousands of different things that can go wrong with the human body — problems with breathing rank right up there at the top. If you can’t breathe, you’ve got a serious problem. That’s why the science of pulmonology and the experts who practice in this field are so important to our overall health.

Jason_McKinney_1679668925We interviewed Dr. Jason McKinney, a pulmonologist practicing at Mercy, and Staci Hopper, an advanced practice registered nurse (APRN), to get insight on what a typical “day in the life” is like for experts who specialize in keeping Hopper,Stacipatients breathing easy.

What types of conditions and problems do pulmonologists treat?

Pulmonologists most commonly treat COPD (chronic bronchitis, emphysema), Asthma, Bronchiectasis, Interstitial lung disease, Occupational lung disease, Pulmonary Hypertension, Complex Lung Infections, Pulmonary fibrosis, and Sarcoidosis. They often are part of the team diagnosing lung cancer and they help manage its complications.

What are the tests pulmonologists use to diagnose the problem?

Common diagnostic testing includes pulmonary function tests, chest x-rays, CT scans, blood work and sometimes using a bronchoscope to look inside the airways.

Asthma can be a scary condition for kids and parents. What are the red flags parents should watch for that might indicate a problem?

Some red flags parents should watch for include: Shortness of breath that worsens during physical activity, cough, chest tightness, reduced exercise tolerance or prolonged recovery time following exercise, excessive fatigue, and/or wheezing.

asthma-156094_640 (2)What are the latest advancements in the treatment of asthma in kids and adults?

There have been several new inhaled medicines useful in asthma over recent years. There is also some newer injection therapies available for more resistant cases.

What is COPD and who does it usually affect?

COPD stands for Chronic Obstructive Pulmonary Disease and is often a mix of chronic bronchitis and emphysema. In chronic bronchitis, the airways get inflamed and make a lot of mucus. This can narrow or block the airways, making it hard to breathe.

In emphysema, the air sacs are damaged and lose their stretch and ability to absorb oxygen as well. Less air gets in and out of the lungs, which makes the patient feel short of breath.

By far, the most common cause of COPD is smoking. Other causes include secondhand smoke, pollution and fumes, genetics, and asthma. Because COPD develops slowly, it is frequently diagnosed in people aged 40 or older.

What can patients do to prevent the likelihood of developing COPD?

The number one way to prevent COPD, or slow it down if you already have it, is to STOP SMOKING. If you have serious lung symptoms with no clear cause smoking-44467_640 (2)(like smoking) you might need testing for “Alpha one antitrypsin deficiency.”

What do you wish more people understood about lung health?

The biggest thing people need to know is that prevention and early intervention is key. Many lung diseases can be prevented by making good lifestyle choices like not smoking, maintaining a healthy weight and routine exercise and wearing protective equipment when dealing with particles or fumes. If someone is having respiratory symptoms, they need to discuss them with their primary care physician. Many pulmonary problems can be very effectively managed by their primary care physician but for some resistant, complicated, severe or unusual cases, a person may need to see a pulmonologist.

Our thanks to Dr. Jason McKinney for answering our questions about breathing problems, prevention and treatment. To schedule an appointment with Dr. McKinney, call his office at 479-338-3080 or click here for more info on the clinic.

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Healthy Mama: March is Colon Cancer Awareness Month

We know this isn’t always an easy topic to discuss, but it’s an important one and this month is the perfect time to talk about it. March is Colon Cancer Awareness Month which means it’s time to march yourself to the clinic for this important screening test, if you haven’t done it already. Why is it such a big deal? Because colon cancer is the SECOND LEADING CAUSE OF CANCER DEATHS in the United States.

We interviewed Dr. Natasha Nathan, a gastroenterology specialist with Mercy, to find out what we all need to know about the risks of colon cancer and about colonoscopies.

What factors increase a person’s risk of colon cancer?

The factors that increase your risk for colon cancer are:

  • Age
  • Diet
  • Lifestyle
  • Family History

colon cancer posterWhat types of lifestyle changes can lower a person’s risk of developing colon cancer?

There are several good things you can do to lower your risk of developing colon cancer, but these three are the most important:

  • Eat foods high in fiber
  • Eat less red meat
  • Exercise MORE

What are the symptoms that might indicate a person has colon cancer?  (Are noticeable symptoms always present in someone with colon cancer?)

The symptoms you might notice include seeing blood in your stool, having an unexplained weight loss or seeing a change in stool size. Some patients might also have abdominal pain.

But it’s very important to know that some patients may not have ANY symptoms. That’s one of the reasons why testing is so important.

When should a person have her first screening test for colon cancer?  How often is it necessary to repeat the screening tests? 

Have your first test when you turn 50 years old, unless you have a family history of colon cancer OR you have had polyps or cancer in the past. If there’s past cancer or a history of it in your family, start having screenings at age 40.

What are the latest advancements in the detection of and/or treatment of colon cancer?

Some of the latest advancements in this field of medicine include improved stool tests as well as genetic tests. The great news here is that, with early detection, people with colon cancer live longer lives.

What do you say to patients who are fearful about getting a colonoscopy?  What information helps them overcome the natural tendency to procrastinate doing something that seems so unpleasant?

I let them know that our sedation methods have improved over the years which means there is much less pain associated with this test.

It’s also good to know that the preparation method required the night before the test has also improved. Some patients found it difficult to drink all of the prep liquids the night before their scheduled colonoscopy. There’s a new “split dose preparation” method that lets patients drink part of the liquid the night before and then the remainder the next morning. Ask your doctor about the split dose preparation method to see if this would be a good fit for you.

The most important thing I can tell patients about this test is that colon cancer is a PREVENTABLE cancer, and this test is the best tool we have that helps us Thusha_Nathan_1295718211prevent this cancer from taking a patient’s life. It’s as simple as that.

We want to give our thanks to Dr. Nathan for taking the time to answer our questions. For more info on Dr. Nathan or to schedule an appointment with her, call the Mercy Gastroenterology Clinic at 479-338-3030 or click here for more info. The clinic is located in the Physician Plaza at 2708 S. Rife Medical Lane (Suite 300) in Rogers.

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Three Northwest Arkansas doctors in ONE family: Meet the Weathers

weathers doctor group2It’s not uncommon to feel like you’re being treated “like family” when you’re at Mercy, but there are three doctors in Northwest Arkansas who take that “family” thing pretty literally.

Meet Dr. Larry Weathers, Dr. Lance Weathers and Dr. Tiffany Weathers — a father/son/daughter team of specialists at Mercy whose bonds are not only biological but professional, too.

Since it’s so unusual to find three doctors in one family working for the same health provider, today we’re taking a look at the family dynamics in this trio of specialists in Northwest Arkansas.

larry weathers dad graphicWhat is it like to have your kids turn into work colleagues?

It is fun watching them be great physicians!

Did anything in their childhood make you think that your kids might be destined for a career in medicine?

No, other than they were exposed to medicine as little children. They were in the clinic after school and they made rounds with me in hospital on the weekends.

flexibilityWhat’s the one thing you wish more people knew that would help them improve their heart health or keep it healthy long-term?

Medical studies have found that there’s a link between how flexible you are and your risk of heart disease. So stay as flexible as a 2, 3, 4, 5, 6, and 7-year-old child.

lance weathers son graphicHow did your dad’s career influence your decision to go into medicine? What was it about his work that fascinated you?

heart modelI was always with him as a kid. I used to wake up on Saturdays and go sit in his truck while he made rounds.  I spent a lot of time playing with echo machines, heart models, and stethoscopes — probably not normal toys for a kid. :-) I know those experiences probably had to influence my fascination.

What are family dinners like at your house with 3 doctors at the table? Do you “talk shop” or do you leave the medicine at the clinic?

razorback logoMom doesn’t like cell phones or “doctor talk” at the table. We usually talk sports (Razorbacks, of course) or we talk about the grand-kids.

My office is on the same hall as my dad’s office, which is a very unique situation in cardiology. There are not many father and son combinations in this field of medicine.

What would an ideal day at work look like for you?

Make a difference with one person. It’s the starfish approach. But you never know which one it’s going to be!

What new medical advancements in cardiology do you get most excited about?

That’s what drew me to cardiology — the ever-changing technology. And cardiology really does change daily.

tiffany weathers daughter graphicHow did your dad’s career influence your decision to go into medicine? What was it about his work that interested you?

Basically, if I wanted to spend time with my Dad growing up, I went to make rounds or went to the Cath lab with him. I met the families when he would make rounds and I saw that he was making a difference. He has the most amazing work ethic I’ve ever seen, and his bedside manner with patients is so kind and calming.

With a father and a brother in cardiology, what was it about gynecology and obstetrics that drew you into that specialty versus cardiology?

I think that with Cardiology, people either have poor genetics and/or poor habits that cause them to have heart disease. Most of the time when my Dad was called to see them, they were dying. It was difficult for me to cope with people dying everyday. No matter what you do, people die from heart attacks. I have the newborn babyutmost respect for my father and brother. They both have amazing hands in the Cath lab.

Obstetrics and gynecology drew me in because I was able to assist with bringing life into the world. It’s such an amazing honor.

What do you wish more pregnant women understood about pregnancy and/or childbirth?

I wish more women would discuss questions with their doctors and not believe all of the information they see on blogs on the Internet.

pregnancyBeing pregnant is actually a 9-month “adaptation period” where your body is expected to perform and develop another human with major hemodynamic changes. You have an increase in cardiac output, sodium and water retention, leading to blood volume expansion, with reductions in systemic vascular resistance and systemic blood pressure. This enables optimal growth for the fetus and protects the mother from hemorrhage, complications and death.

Young healthy women without any medical problems usually do well. The problem is that there are diseases of pregnancy such as pre-eclammpsia, for example, that we as doctors still don’t fully understand. Pre-eclampsia can happen to anyone and has major complications that can lead to seizures, stroke and ultimately death. It’s also a disease that can happen within the “blink of an eye.”

What are the advantages of having three doctors in the family? Would your other family members say that there are any drawbacks of having three doctors in the family?

It’s an honor to work together at Mercy because we often share patients and we can discuss difficult clinical cases.

It’s also beneficial to have people that understand how difficult it is to practice medicine and try to maintain a healthy work-life balance. We sacrifice a great deal of things for this profession and many times our own families do not come first. This is probably why I don’t know many families that have three physicians who are all currently still practicing medicine.

Our thanks to Drs. Larry, Lance and Tiffany Weathers for answering our questions and for their continued service to patients throughout Northwest Arkansas.

To contact Dr. Larry Weathers or Dr. Lance Weathers, call the Cardiology clinic at 479-338-4400. To contact Dr. Tiffany Weathers, call the Women’s Clinic at 479-338-4000. Click HERE to visit the Mercy website.

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