To wrap up 2017's Chronic Spotlight Series, we'll learn heaps of new information in this two-parter with Dr. Paul Christo.
Dr. Christo has dedicated his life's work to chronic pain management. What I love about this doctor is his ability to be in constant pursuit of providing hope to his patients who suffer endlessly from chronic pain. Whether through seeking pain management techniques used across the globe, his Sirius XM radio show, or latest book -- both titled, Aches and Gains -- Dr. Christo is never satisfied with the status quo.
I was truly impressed with Dr. Christo, his view on pain management and his ability to relentlessly pursue healing methods for his patients. Some of the cutting edge pain treatments Dr. Christo recommends are new to me, and I can't wait to try them!
Take a moment, to learn and grow in your pain journey from Dr. Paul Christo.
What drew you to pain management as a career? And why is helping people suffering from chronic pain your life's work?
During my internship, I felt helpless when treating patients with chronic back pain, neuropathic pain, or arthritic pain. I realized the significant need for pain treatments and wanted to have the skills to make a difference in the lives of those with pain.
Chronic pain chips away at the foundation of who we are. It limits our drive and leads us to inactivity and isolation. Helping to lift patients out of this condition is very gratifying and the focus of my life’s work. I’ve used clinical care, education and research as the means of working toward this goal.
What changes have you seen in treating pain over the last decade? The last year?
Over the last decade, I feel like physicians and patients have become more open-minded about different pain therapies. We’ve also seen the development or application of non-opioid medicines (pregabalin, duloxetine), injection therapies (nerve blocks, types of radiofrequency procedures), neurostimulation (spinal cord stimulation, peripheral nerve stimulation, topical electrical stimulation), and integrative therapies (acupuncture, yoga, biofeedback) for pain. Also, anesthesiologists and surgeons are placing a greater emphasis on pain control before, during, and after surgery because this can reduce the risk of developing chronic pain. It’s not often that we can completely eliminate chronic pain, but we can usually make it tolerable and manageable.
Over the last several years, the number of opioid-related deaths has increased, and this is a significant public health concern. We’ve seen the CDC issue a guideline limiting the use of opioids for non-cancer pain, and shifting pain treatments toward non-opioid therapies. We need to do our best to curb the non-medical use of opioids while ensuring that they remain available for patients who need them.
I’ve seen an overall enhanced awareness of the need to control pain; yet, patients with cancer pain and non-cancer pain alike continue to suffer, often needlessly. The NIH research budget for pain is surprisingly low given the enormity of the problem.
Tell us about the cutting edge treatments below:
Nerve blocks
Nerve blocks are injections of medications around nerves that include local anesthetics, and steroids. They interrupt the transmission of pain signals from the nerve to the spinal cord and brain. These procedures are minimally-invasive and specific. Procedures may include nerve blocks to control back pain, groin pain, headache pain, or chest wall pain, for example. Certain nerve blocks are used diagnostically or therapeutically. If patients report meaningful pain relief, pain specialists may then offer radiofrequency procedures to lengthen the degree of pain relief.
Injections
Similar to nerve blocks, injections of local anesthetic or steroid into joints, muscles, tendons, or into deeper areas of the body (the sympathetic nervous system) can help control pain. Platelet rich plasma and stem cells are examples of the growing field of regenerative biomedicine. These substances are injected into joints and around damaged tissue for healing and pain reduction.
Implantations
Insertion of a drug delivery system (pain pump), can allow patients to significantly reduce their dose of oral medicines such as opioids by administering those medicines in very small doses to the spinal fluid. They can provide good pain control without the same side effects of oral pain medicines. We use these in patients with cancer pain, but also for patients with bad leg or arm spasticity. Those with non-cancer pain can sometimes benefit too.
Neurostimulation
Neurostimulation therapy is offered as spinal cord stimulation, peripheral nerve stimulation (targeting the nerves in the extremities, groin, chest, for instance), and transcutaneous electrical stimulation (across the skin). It’s the precise delivery of small doses of electricity to targeted nerve sites.
Think of a spinal cord stimulator as a pain pacemaker for the spinal cord. This stimulator sends mild electrical impulses to the spinal cord to disrupt pain signals traveling between the spinal cord and the brain. It can be used to treat several forms of chronic pain including failed back surgery syndrome, neck and shooting arm pain, complex regional pain syndrome, radicular pain, and sometimes chronic shingles pain, groin pain, and visceral pain in the abdominal or pelvis. Innovative modes of stimulation are better targeting pain such as high-frequency stimulation.
More Pain-Relieving Devices
Along with spinal cord stimulation, targeting the peripheral nerves of the arms, shoulder, or groin for instance with electrical stimulation can transform chronic pain. A new therapy called, StimRouter does just that. It uses a short, thin wire along a nerve to reduce the transmission of painful impulses to the spinal cord.
Vagus nerve stimulation places the electrodes of a nerve stimulator on the vagus nerve in the neck. It’s been studied for treating migraine and cluster headaches. A transcutaneous version of this, GammaCore is handheld and placed on one side of the neck to treat migraine and cluster headaches. It’s approved in Europe for both of these headache disorders and recently approved in the U.S. for cluster headaches.
Coming up in part two, find out about Dr. Christo's most impressive results as well as his top three tips for managing chronic pain.