Relief Options For Chronic Pain
Dr. Damien Tavares
Pain management specialist at Pain Medicine & Rehabilitation
Where did you receive your schooling and training?
I attended UH John A. Burns School of Medicine. Then I did a surgical internship at UH. After that, I did a physical medicine and rehabilitation residency and an anesthesia pain medicine fellowship at the University of California-Irvine.
How long have you been in practice?
I’ve been practicing medicine for about seven years. After my medical training, I worked for the Interdisciplinary Pain Management Center at Tripler Army Medical Center. My wife Deanna, who is a registered nurse, and I opened Pain Medicine & Rehabilitation in October.
How do you determine what is causing a person’s pain?
The majority of the time, I can make a diagnosis based on the patient’s history. I do a thorough history of the patient’s complaints and I proceed with a thorough examination. With pain, the most important examinations are the neurologic and musculoskeletal exams. With the history and exam, I can diagnose the patient’s problem 90 percent of the time, with a high degree of certainty. Imaging and labs are usually ordered to confirm my diagnosis. For further diagnostic clarification, I sometimes perform an electromyography study, which is an extension of the neurologic exam.
What treatments are available?
Depending on the diagnosis, a patient may be a candidate for a personal home exercise and stretching program, orthotics and possibly a short course of topical or oral medications. Other patients require referral to a therapist. Many patients who are referred to me have failed conservative management and benefit from interventional pain procedures. I perform two surgical procedures that are reserved for patients with severe pain conditions. I also offer a new procedure called platelet-rich plasma, which is a natural alternative to steroid injections.
What conditions do you see most often?
Low back pain is very prevalent. Approximately 40 percent of my patients have chronic low back pain, which means that pain has been present for more than three months. There are multiple structures in the lower back that can cause pain. I do several procedures for low back pain that are very safe, minimally invasive and can provide patients with excellent pain relief for three to nine months.
I don’t cure chronic pain. The reality is that if a patient has had pain for more than six months with no evidence of ongoing tissue damage, pain will likely be a part of that person’s life. My main goal as a pain specialist is to provide my patients an alternative to surgery and opioid medications while maintaining their function and quality of life. I do perform minor surgery and prescribe opioids for the right patients, but I try to avoid doing so.
What are opioids?
Opioids are medications such as Vicodin and Oxycodone. They are great for acute pain when they are used for a short period of time. For chronic pain, however, these medications can actually increase a patient’s pain because of a phenomenon known as opioid-induced hyperalgesia. Many patients also develop tolerance, requiring higher doses over time just to feel normal.
Patients I prescribe these medications to have to have a very clear diagnosis that warrants opioid use. They also have to have failed other pain treatments and show evidence that they are doing better functionally on the medication. These medications are highly addictive, and patients subsequently have to be seen regularly. Just as there are people who wouldn’t typically drink a lot of alcohol but do so with life stressors, likewise, someone who normally would not get addicted to opioid medication still has to be monitored. In my opinion, the most invasive thing we can do in pain management is to prescribe opioid medications to patients with chronic non-cancer pain. It is a necessary and often good treatment option for the right patient, but it should be a last resort.
What is the rehabilitation part of your practice?
My philosophy and approach toward pain management is that rehabilitation is the process of transforming a patient with limitations. This often requires getting to the root cause of the problem. I typically start with education and conservative management. I discuss lifestyle modifications that may reduce pain such as weight loss, smoking cessation, stress management and sleep hygiene. I also provide my patients with personalized home-exercise programs. I’m also honest with my patients with my limitations and their expectations. For many patients who have been in pain for several years, they are similar to patients with severe physical disabilities in the sense that I don’t have a magic bullet to “fix” them. I will, however, provide every treatment option to make living with pain more manageable.
How do you decide what to do for different kinds of pain in different parts of the body?
It depends on the diagnosis and type of pain. There are some pain conditions that are neuropathic or nerve-related and others that are nociceptive, which is typical of arthritis. There are some pain conditions that are a combination of both. Knowing the type of pain a patient has is important, because some types of pain respond to different classes of medications and different interventions.
In regard to diagnosis, someone with chronic shoulder pain probably wouldn’t be a good candidate for bracing compared with someone who has acute wrist pain or carpal tunnel. Someone with severe low back or neck pain might be a candidate for interventional procedures. Someone who has leg and back pain and has had previous back surgery might be a candidate for a surgical procedure called a spinal cord stimulator implant.
What do you mean by interventional procedures?
These can be advanced injections guided with ultra-sound and X-ray to provide precision delivery of medications that are both diagnostic and therapeutic. Other procedures include injecting a cement-like substance into a spinal fracture or burning nerves that are causing pain. I also place electrodes under the skin and over the spinal cord to block pain signals.
Anything else you would like to say?
Pain Medicine and Rehabilitation is a specialized pain-management practice with a variety of treatment options, from conservative care to surgery. If you or someone you care about lives with daily pain, we can help.