Interventional strategies a key to pain management

When people have joint or spine pain, they’ll likely come to MCH ProCare Interventional Pain Medicine with physician assistant Chineme Chima-Nlewem and nurse practitioner Hanah Bleimes.

They start with a physical exam to see how bad the joint is, X-rays will be taken and some MRIs are given.

“If the X-ray doesn’t show a lot going on and the patient is still in pain then we know that some ligaments are involved,” Chima-Nlewem said.

“Most of our patients come in with joint pain, spine pain and pain that they’ve had for a while,” Chima-Nlewem added. “For us, pain management is a model of intervention. It’s not just treating pain with medication. We treat pain with procedures to relieve the pain.”

How they intervene depends on the patient. If it’s beyond intervention, it will likely mean surgery.

Many times, though corticosteroid injections work and patients come back feeling a lot better, Chima-Nlewem said.

Another treatment, among several others, is platelet rich plasma where they take blood from the patient, put it in a spinner that will spin it and generate a lot of platelets. The platelets are put back into the knee and that helps the healing process of the knee.

If the cartilage is gone and there is no healing, surgery is next on the list.

There are more therapies now than there used to be that are non-invasive. The platelet rich plasma can be done for knees, backs and shoulders. Dr. Mandeep Othee, who Chima-Nlewem and Bleimes practice with does that.

Along with knees, they also treat the lumbar spine and the cervical spine.

Common causes for knee pain or arthritis is the degeneration of the cartilage between the knees.

“Also some people tear the meniscus; too much playing; too much exercise. That’s most of the stuff that we see with the knees. Some people come with fractures and those are the ones we send to orthopedics,” Chima-Nlewem said.

People of all ages can suffer with joint problems. Bleimes said kids who play contact sports and sports with repetitive motion can suffer a torn meniscus and ACLs.

Chima-Nlewem said a lot of people expect to come in and get a prescription for pain medication.

“I just told one of my patients today … if I write pain medication for everybody that comes through, I’ll have a line from here to Midland. We have to always educate our patients. We are interventional pain management,” Chima-Nlewem said.

Most people don’t understand that they are not there to write the pain medications people want. They treat the pain while giving them medication and then titrate them off it.

According to Oxford Academic, “opioid titration is the process whereby the dose of opioid analgesic is altered until the minimum dose which controls an individual’s pain is reached or intolerable toxicity develops.”

“Once we treat the pain,” Chima-Nlewem said, “our intention is not to keep patients on narcotics for the rest of their lives because these narcotics can be addictive.”

They are looking for the root of the pain.

“The major thing that we do here is the intervention. We find what the problem is and we fix it,” so the patient doesn’t need the medication, Chima-Nlewem said.

“But we give you medication as we are fixing it because we know you’re in pain. We also encourage people to do physical therapy, too, because the physical therapy has to fix the pain. When we’ve done all of that and you’re feeling better, we will gradually titrate the patient off of the medication,” she added.

Patients are told when they go to pain management that they can’t be on marijuana or cocaine.

“Most of them get angry because in other states it is allowed. They can take it and take their narcotics. Unfortunately, if you have to be on narcotics from this office, you cannot take those. We do drug test,” Chima-Nlewem said.

Bleimes said patients sign a narcotic agreement. Chima-Nlewem added that they also sign an agreement where the patient won’t doctor shop for opioids.

There is a prescription drug monitoring program so when a patient is looking for pain medication, the doctor can tell they have already gotten it elsewhere.

“When they sign a narcotic agreement with us, they’re not going to do that. If they do it, that’s a breach of the contract and we have the right to stop seeing them. We let them know up front that you can do this; we’re going to drug test you,” Chima-Nlewem said.

They also test for other substances.

“If we see that, that’s also grounds for termination,” she added.

Most of their patients are compliant.

“They understand what it is. They want their pain to be fixed, so they follow the rules and everything goes well,” Chima-Nlewem said.

Patients need referrals to come to the pain management clinic.

Chima-Nlewem and Bleimes drive to work from Midland every day.

Chima-Nlewem said her satisfaction comes from seeing her patients come back and tell her their pain level is zero.

“I’ve seen some patients walk in here with a walking stick and I give them injections. We do the knee injections here in the office. And you give that patient knee injections and he comes back a month later without walking stick. I get a lot of hugs from these people telling me thank you so much. I feel so good. I feel better. That is my satisfaction,” Chima-Nlewem said.

Bleimes said she likes the teamwork at the clinic and her boss. She has good preceptors and the clinical staff are very friendly.

“Good teamwork probably is one of the reasons why I’m here as well, aside from making sure I’m treating my patients very well and I always tell myself if I can learn, I don’t care about the drive,” Bleimes said.