HJAR Jan/Feb 2021

HEALTHCARE JOURNAL OF ARKANSAS I  JAN / FEB 2021 21 the few medical conditions where a patient’s motive is questioned. Do you think that is a reasonable thing for a practitioner to do, and how do you handle this? GOREE: Pain is very complicated, because it is a subjective state. Unlike blood pressure and pulse, we don’t have a device that can measure a patient’s pain. Because of this, we have to trust our patients. Pain should be treated whenever it is reported, but it should be treated appropriately. For a large major- ity of chronic pain conditions, opioids are not the first-line treatment. Unfortunately, for a number of reasons, opioids have been used this way in the past. Hopefully, as our community continues to educate ourselves, we will be able to aggressively and compas- sionately treat pain while avoiding many of these unfortunate side effects. OLAYA: Yes, it is important for the practitio- ner to make sure that the patient is in pain and being truthful regarding the pain level that they are suffering. We need to make sure that the patient is taking the opiates the way they have been prescribed, through ran- dom drug screens, pill counts and review- ing the electronic prescribing monitoring programs (making sure the patient is not “doctor shopping”) andmaking sure that the patient is respecting the pain contract that they signed on the first visit as a new patient. Unfortunately, there are patients who lie to get these pain killers to later divert them to sell them or exchange them for other kinds of drugs like cocaine, THC, methamphet- amine, etc. What treatments have you found most successful in targeting pa- tients’ specific conditions? GOREE: Two treatments that have really changed my practice are radiofrequency ablation and neuromodulation. Radiofre- quency ablation is the use of heat to elimi- nate the nerves that provide sensation to a painful area. Neuromodulation is the use of electricity to block or change nerve signals to decrease pain. The advances in these two fields have been staggering over the past five years. I am excited to be a part of a com- munity that is able to offer cutting-edge treatments for chronic pain for my patients. OLAYA: Every patient is different; there- fore, we will encounter different levels of success regarding the spine intervention procedures that we offer to our patients. It also will depend on the age of the patient, physical fitness, level of activity, motivation, health status, etc. But I have noticed that radiofrequency ablation, spinal cord stimu- lation and Superion, a new technique used to treat spinal stenosis, have been effective. What do you see on the horizon for pain management practitioners? GOREE: Really, two things: 1. Continued research in the development of new technology to treat chronic pain without medications, including regen- erative medicine, neuromodulation and radiofrequency ablation; 2. The use of more holistic approaches to improve quality of life for patients with chronic pain, including nutri- tion, movement, acupuncture, physi- cal therapy, massage and mind-body techniques. OLAYA: We are living in exciting times with the development of new techniques that are minimally invasive, and which have been proven to be very effective at treating lower back pain. One technique that I have had much success with is called the Superion procedure. It is a spacer placed between the spinal processes of the lumbar spine. It is helpful in the treatment of neurogenic claudication and spinal stenosis. We had the privilege of bringing this procedure to the state of Arkansas on April 13, 2018. As of the day I am writing this, I have placed 93 Superions. Adding up the ones the other doctors of our clinic have placed, we have placed around 110 Superions in total. Us- ing layman’s terms, it works as a carjack, preserving the space the nerves need to transmit sensation andmobility to the lower extremities, correcting the stenosis in the foramens and relieving the neuropathic pain that can be very incapacitating and pain- ful in the lumbar spine. When we age, the intervertebral discs lose hydration and be- come flatter, making the foramens, where the nerve roots pass through, smaller. The nerves will be pressed and pinched, causing severe pain, which makes the patient hunch down to open up the foramens and diminish the pain. I believe somuch in this procedure that I had it done tomyself byAmir Qureshi, MD, which relieved my sciatic pain almost immediately with minimal downtime. It’s also worth mentioning that I put two spac- ers to my 84-year-old father, which allowed him to walk erect and without a cane. n “Central pain like the one that can trigger fibromyalgia or peripheral sensitization like myofascial pain can be aggravated by states of stress, anxiety, depression, the need for attentionandsecondaryvalidation among others.” —Julio Olaya, MD