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What is Pain Management

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Featured Speaker

Kris Ferguson, MD

Kris Ferguson, MD

Kris Ferguson, MD is a highly-skilled, dedicated physician trained in pain management. He received his medical degree from Wayne State University School of Medicine in Detroit, Michigan and is board certified in anesthesiology and pain management. Dr. Ferguson and his wife have a baby boy and three darling Pomeranians. Outside of work, Dr. Ferguson enjoys time with his family. He LOVES listening to podcasts.


About this Podcast

Dr. Kris Ferguson, Physician at the Pain Clinic at Aspirus Langlade Hospital, discusses the field of pain management and how treatment options can range from exercise, medication assisted treatment, physical therapy, injection procedures to surgical interventions if necessary.

Transcription

Melanie Cole (Host): If you’re someone who suffers from chronic pain, you know how debilitating it can be, and it can keep you from taking part in the activities that you really enjoy. When that pain begins to interfere with your daily life, it might be time to see a physician to assess your pain and look at treatment options. My guest today is Dr. Kris Ferguson. He’s a physician specializing in pain management at the Pain Clinic Aspirus Langlade Hospital. Dr. Ferguson first tell us about this burgeoning field of pain management. It’s relatively new and there are so many tools in your toolbox now. Tell us about the field.

Kris Ferguson, MD (Guest): Well thank you. I think that’s a great question. To be a pain physician, you go to medical school and then you go to a residency typically a four-year residency program and then you go on to do subspecialty training to be a pain doctor. And really to call yourself a pain physician, you should be board-certified by the American Academy of Physicians. A lot of new technologies have come out in the last few years. But really, that doesn’t replace sitting down, speaking to the person that’s coming into the office and seeing you, and figuring out where the pain is coming from.

Host: Then let’s talk about pain. What are the basic types of pain? If we are talking about a chronic pain or an acute pain and since pain, Dr. Ferguson is somewhat subjective; how do you even measure it?

Dr. Ferguson: So, pain – you’re correct is a very subjective thing and there are a lot of things that will influence someone’s pain. There’s an emotional component, there’s a physical component, there’s often a spiritual component. If people have lack of meaning in life, what they find day to day doesn’t really bring them joy; a small pain, a small physical pain can quickly become very painful. Emotional pain is real, and it affects people. For example, often you will see say if a husband and wife have been married for a very long time and one of them passes; the other person will then die shortly thereafter. So, it’s called heartbreak heart. So, with that emotional pain can actually cause changes in the person’s heart. You can see on imaging and that’s strictly due to the emotional pain. And then of course there’s physical pain that can be brought on by a host of genetic diseases or it could be due to trauma or things that happen to you in life.

Host: Tell us how you work with someone who comes to you in pain, about your multifaceted approach. What are the first things you do when someone comes to you and tells you they have back pain, or joint pain or generalized systemic pain? What do you do?

Dr. Ferguson: The first thing I would do is sit down and listen to them very carefully to sort out how long they’ve had pain and the things that make the pain better, what makes the pain worse and really get a sense of what’s causing the pain. And until you really figure out what’s causing the pain; it’s very, very difficult to treat. Once the cause of the pain is sorted out; then typically we will try the least invasive things first.

If someone say has posttraumatic stress disorder or PTSD; then seeing a psychologist or a psychiatrist would be an appropriate referral. If someone has trauma in their background or childhood trauma, again seeing a psychologist is very helpful. If they have physical pain, musculoskeletal pain, I would refer them to the appropriate physical therapist for them to treat that. If those more conservative things don’t work; then I would often try nonnarcotic medications. The less medication is always better. Failing that, I would – if there’s a localized source of pain, there are a variety of interventional pain procedures that we can do to specifically help the pain.

For example, if someone has whiplash pain. If someone got in a car accident and they still have pain in the back of their neck, it’s causing headaches and they have tried these things and it’s persisting for more than three months; then there are procedures we can do to put the nerves to sleep that are causing their pain. If the pain is so severe that it’s having a pinched nerve or say they have severe osteoarthritis of their hips or knees; I’d refer them to the appropriate specialist to treat that. If they have generalized pain, they may need to see a rheumatologist if they need to treat say rheumatoid arthritis or osteoarthritis or a whole host of other rheumatologic conditions.

Host: You mentioned nonnarcotic medications as something you would try first. What are some of the parameters? People hear about opioids and how they can help with pain and yet, such an epidemic in this country. Tell us a little bit about opioid stewardship and why that is not your first option for treatment.

Dr. Ferguson: Well opioids and people may know them by other names such as morphine, Vicodin, Percocet; they may work well for short-term pain like if someone were to say break their knee; it would be very appropriate to treat that person for their severe pain. However, long-term narcotics don’t help because your body tends to get used to them. They are almost like a crutch and just like if you used a crutch every day; your muscles would just weaken, and they wouldn’t work as well. It’s the same thing with the narcotics. Nonnarcotic medication also has issues. For example, if someone has persistent say migraines and they are taking ibuprofen every single day; there’s a condition called medication overuse headache where even if they are taking nonnarcotic medication every single day; it can actually cause pain versus take away pain. So, the long-term strategy is ideally to reduce all types of medications.

As another example, there are some people that are on drugs called statins that will reduce their cholesterol, but these cholesterol lowering medications can also cause body aches and pains. By going on an appropriate diet program and in working in concert with their cardiologist; we’ve had several patients be able to come off their statin medications because their cholesterol profile was so good with specific diet counseling. So, what I’m saying is the take home message is really to try to minimize the amount of time a patient has to see their physician and minimize the amount of medications someone has to take.

Host: And what are some of the other treatments? And you mentioned some of the minimally invasive procedures or interventions that you might try, whether it’s nerve blocks or radiofrequency denervation or even acupuncture, biofeedback. Speak about some of those types of procedures you might consider with somebody.

Dr. Ferguson: So, I would refer out for say acupuncture or I would refer out to physical therapists to do deep tissue massage, Graston Technique which is a very deep – a specific type of very deep tissue massage and they can get a lot more – they can apply a lot more pressure than say a massage therapist can do so that way it can really get to those deep tissue muscle knots. The things that I would do if those more conservative things don’t work and the fancy names are fine, but another way to say it is if say someone has chronic knee pain and maybe they are too young and they want to delay having a knee surgery, what I can do is use these needles that will go by the nerves in the knee and it will put those nerves to sleep for six months to a year. The procedure takes about ten minutes. They go home, maybe a little bandage and that’s it. And that should significantly decrease their pain in their knee, allowing for more function, allowing them to exercise and use less medications.

Host: As long as you mentioned it doctor, where does exercise fit into this picture?

Dr. Ferguson: Everything that I do is really meant to minimize medications and facilitate people being active. The more people are active; it builds up their musculoskeletal system, it helps with their immune response, it helps with their generalized mood and sometimes when people haven’t been active for a long time; seeing say a qualified physical therapist is appropriate so that way they are able to be more physically active and exercise without injuring themselves. Especially if they’ve recently had a surgery of some sort.

Host: What about alternative approaches. People try herbal supplements and we’re hearing more about stem cells. Do any of these have an effect on generalized pain or even specific pain?

Dr. Ferguson: So, everything works for someone and nothing will work for everyone. I think there’s a place for all of these treatments. The only downside with the herbal therapies is that they are not regulated so if someone is buying an herb from one company or a person; it may be a totally different herb that they are getting from someone else or a different concentration. Stem cell therapy is very promising, but the studies are very new so if someone wants to try stem cell therapy; they can, but again, it’s just a very new therapy with the risks and benefits of that therapy are just unknown at this time.

Host: Dr. Ferguson wrap it up for us. Give us your best advice as a pain management specialist, if someone comes to you in pain or for the listeners out there, what would you like them to know about first line of defense and things that they can try to work on their pain before they would have to try some other types of treatments?

Dr. Ferguson: I would say the first thing that someone should try and what I would advocate if I saw them in the office is really try conservative things first. Often pain will go away on its own. If you say have a low back strain at work; if you just rest it for a couple of days, it will probably go away. If it’s not going away; then what I would recommend doing is speaking to your primary care provider or patients can often self-refer as well depending on where the pain clinic is, and I’d highly recommend seeing a board-certified pain physician.

Host: That’s great information and what a big field that you are in now Dr. Ferguson. Thank you so much for coming on and explaining about the field of pain management and some of the options that people that are suffering from pain and chronic pain can try. Thank you again for joining us. This is Aspirus Health Talk. For more information please visit www.aspirus.org, that’s www.aspirus.org. I’m Melanie Cole. Thanks so much for joining us today.

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