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Improving Your Quality of Life with Pain Management

Caitlin Whyte (Host): Welcome to Checkup Chat with EvergreenHealth. I'm Caitlin Whyte. And today we're sitting down with Dr. Jennifer Lee, a pain management physician who is here to discuss improving your quality of life with pain management. So Dr. Lee, what are we talking about when we say pain management? What does that mean?

Jennifer Lee, MD (Guest): Well, pain management is a specialty and it's a relatively new specialty in the field of medical science. It's only really about 20 years old. Before the development of this particular specialty, pain management was the purview of primary care doctors or specialists that treated the condition, the pain related to conditions that they were treating otherwise. But as it is now, pain management is a specialty in itself. And a pain management doctor is a doctor that has had special training in order to learn about differentiating or being able to decide and determine the cause of a chronic pain. A chronic pain is a pain that has been present for at least three months and a chronic pain doctor is an expert in treating pains that have been around for three months or longer. So, those might include chronic arthritis pains, spine pain, nerve pain from many different causes, headache pain, but a pain management doctor has skills to treat a broad range of discomfort.

Host: So, who can benefit from pain management?

Dr. Lee: Well, as I alluded, a patient who has had months, three months or longer of a chronic pain, would be someone who should be considered to see and meet with a pain doctor. In the United States, there are an enormous number of people who have chronic pain. It's estimated that between 10 and 20 million people in the US have high impact chronic pain. It's a huge problem. So, we're talking about pain that lasts longer than a typical expected healing time for a known condition. And also what becomes unique and really important about chronic pain, is that when it's present for that long, it really starts to have an impact on the patient's life, in terms of the quality of their sleep and their ability to be mobile and active, or make plans with family and friends. And it's really common as well, for people who have chronic pain to have an impact on their mood and their relationships. So, it's really something that requires a specialized approach.

Host: So when should the conversation around pain management begin?

Dr. Lee: Right. Well, most patients go to their primary care doctor first when they have pain and a primary care doctor will do their best to diagnose that, try to determine the cause of that. And they may do simple first things like order anti-inflammatory medicines or an x-ray or physical therapy. However, if after six to eight weeks time has passed and there is no improvement, it's time for that primary care doctor to consider a referral to another specialist. In many instances may be best to be seen by a pain management doctor because a pain management doctor can pick up where the primary care doctor left off in ordering tests or doing examinations to really determine what is fundamentally the cause of that pain. And then since it's a pain that has been present for a long time now, typically months, also, it's important to start thinking about treatments that will be lasting.

You know, a steroid injection or an anti-inflammatory or a pain medicine prescription, that's a type of a treatment that will last and improve pain for a short period of time. But if this is a pain condition that is long-term, months or longer, then there's different medicines that need to be considered in that circumstance.

Host: Now, what can a patient expect at their appointment?

Dr. Lee: So, the appointment, when you see a pain management doctor is really comprehensive and we'll talk about the condition that you're having that causes pain, the history of when it started, how it's evolved. We'll talk about the medicines that you've tried or injections or therapies that have been attempted. We'll also talk about the way that that pain is affecting your relationships, your activity, your sleep. It's important when you meet with a pain management doctor, especially when you meet with me. I really want to understand what your, what the patient's philosophy of medical care is. Some patients have a strong preference to avoid taking chronic medicines.

Some patients are afraid of needles. Some patients would prefer to talk about more definitive like long-term solutions that would be independent, that they wouldn't need to take medicines or undergo injections on a regular basis. So, it's really about matching the patient's needs and their philosophy of how they wish their medical care to be arranged with options that we have.

Host: Can you dive a bit more into what treatment options are available?

Dr. Lee: Yeah. Pain management is really exciting right now. In the last, I'd say five to 10 years, there's been a real explosion of new technologies and options for some of the most difficult pain conditions to treat. So, I've mentioned medications. In my practice, I really do bend toward non-opioid medications, but some of those newer technologies that I was mentioning are things like neuromodulation or spinal stimulation. There are little spacers now that can be placed in the back of the spine to make space and relieve pain caused by spinal stenosis. There's new procedures such as Relievant, and this procedure is very unique and very up and coming as a way to treat pain from degenerative disc disease. These are just a few of those. There's lots of radio frequency ablation procedures, where a nerve can be cauterized to reduce the pain that it's causing. So, really there's so much, I think that patients don't understand and I'd say very often that even the referring primary care doctors are unaware of.

I think that it's probably very unnecessary the degree of pain that a lot of patients just consider their new baseline. And I've had so many instances when patients come to me and we talk about options and they're really surprised and excited to hear that there were options there that they had no idea had been.

Host: Now, what would you like to say to individuals in our community who could benefit from this pain management?

Dr. Lee: Well, I guess I, I think what I would really like to say is that I believe that patients who are first of all, I think it's really important that we understand the cause of pain. I've met so many patients who they have back pain, but don't have an understanding of what structure in their back is the cause of their pain or similarly knee pain or joint pain that is there. And they don't know specifically why, other than that location hurts. And I think it's really important for people to understand what the cause of their pain is because there's therapeutic value in knowing. It is an emotional relief to know what specifically is the cause of the pain. And it also allows a pain doctor like myself to offer the most specific treatments to relieve that pain.

And I think the other thing is that I would encourage people who have been living with chronic pain for months or years who have written off the hope that there will be something to make an improvement upon that. I would really encourage them to come and investigate with a chronic pain doctor, myself or another, to see if there isn't anything that could make an improvement in their life.

Host: Wonderful. Well, Dr. Lee, is there anything else you'd like to add to this conversation before we wrap up?

Dr. Lee: I just, I have a lot of passion for this specialty, for finding patients who have really complex problems and being creative and very patient centered to find solutions that will improve pain and improve function and allow a lot better quality of life.

Host: Well, we can certainly hear that in your voice, Dr. Lee, just an incredibly important conversation today. Thank you for being with us. If you or someone you know, may benefit from pain management, please call EvergreenHealth Pain Care at (425) 899-2365 to schedule an appointment. That's (425) 899-2365. This has been Checkup Chat with EvergreenHealth. I'm Caitlin Whyte. Stay well.

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