In modern medicine, pain management is something approaching a multidisciplinary art form. one of the specialty’s most ardent practitioners at New York Methodist Hospital explains the latest advances in this critical field of care

by Megan Schade • Photos By amessé photography

Pain. Everyone experiences it, yet no two people experience it in the same way. A mother in the throes of childbirth; a construction worker injured on the job; a cancer patient fighting her disease—all in extreme discomfort, each needing unique pain treatment. Ancient Greeks believed pain was divine retribution for human errors, and tried to appease the angry gods through ritual and sacrifice. Incans drilled a small hole in the skull so as to allow the pain a means of release.

Such courses of action may have indeed provided a distraction from the pain, but actual relief didn’t occur until herbal and medicinal remedies were employed, specifically those derived from the opium poppy, drugs known as opioids.

Cultivation of the opium poppy and its seed pod for euphoria-inducing qualities is recorded through antiquity, and so are tales of opioid addiction. “Opioids like oxycodone, morphine, codeine, and other pain medicines work by binding to certain receptors in nerve cells, blunting the pain sensation,” says Soheila Jafari, M.D., chief of the Division of Pain Management at New York Methodist Hospital. “They are very potent and very effective as pain relievers. However, in addition to their potential for creating dependency, opioids often have other side-effects–such as shallow breathing, confusion, dizziness, sleepiness, lightheadedness, nausea–that can hinder a patient’s ability to recover from surgery or other procedures, and can require a patient to stay in bed when he or she should be up and moving to avoid postoperative complications.”

While opioids and other pain medications have long had—and still have—a very important role in pain management, significant research is underway to find pain management alternatives that provide the pain relief of opioids without the side effects and addictive qualities. One of these solutions is interventional pain management. Interventional pain management involves procedures, such as nerve blocks and electrical nerve stimulation, that eliminate pain at its source— the nerves themselves. These procedures are not only highly effective, they can also dramatically reduce the role of opioids in the treatment of certain types of acute or chronic pain.

“The goal” continues Dr. Jafari, “is to use multi modal techniques to control the pain and one mode is to find the specific nerves that are responsible for patient’s pain and turn only those nerves off—and that’s exactly what these interventional techniques allow us to do.”

From the time that she finished medical school in the early 1990s, Dr. Jafari knew that she wanted to specialize in anesthesiology and pain management. “I was drawn to the intellectual challenge of anesthesiology. You need to have a vast knowledge of physiology, anatomy, pharmacology, biochemistry, radiology, technology and even physics to practice.” She was chief resident in the Department of Anesthesiology at New York Methodist Hospital, completed her fellowship training in anesthesiology at New York University (NYU Langone Medical Center), and returned to practice anesthesiology and pain management at NYM.

“I was also attracted to the humane aspect of the specialty, to be able to guide people, and their families, through one of the most stressful experiences of life, and to provide them with relief before, during and after a procedure,” Dr. Jafari continues.

One exciting development in the field of interventional pain management is treatment using nerve blockades. Nerve blockades are performed using a portable ultrasound machine that allows the doctor to guide a thin tube (catheter) to the site of the nerve. The tube delivers a local anesthetic (pain reliever) that blocks the nerve and stops the patient’s pain. Eighty percent of inpatients who undergo an interventional nerve blockade find that the need for IV pain medication is significantly reduced.

Another interventional technique, electrical nerve stimulation (ELS), uses an electrical current to treat pain. There are two types of ELS: peripheral nerve stimulation, in which electric pulses are sent through the peripheral nerves; and spinal cord stimulation, in which the electrical pulses are sent through the spinal cord. These pulses interfere with the nerve impulses that cause a person to feel pain.

“Pain can have many causes: physical, psychological, spiritual,” explained Dr. Jafari. “So its treatment must be multi-disciplinary. Anesthesiology does not work in isolation.”

“At NYM, we believe in staying ahead of the pain and providing preemptive treatment. We do not wait until the symptoms are overwhelming and the patient is unable to participate in the very activities he or she needs to perform in order to heal,” says Joseph Schianodicola, M.D., chairman of anesthesiology. “Dr. Jafari brings a keen intellect and deep compassion to each patient she works with. She is committed to providing maximum relief with a minimum of side effects, and is constantly searching for the perfect formula. That approach informs all that we do in the Division of Pain Management.”

“NYM is also very adeptin the field of palliative care. Too often, when people think of palliative care, they equate it with end of life care,” says Dr. Jafari. “My main concern at any time is the comfort of my patients, and having a staff dedicated to palliative care here at the Hospital means that I can trust that all of their needs can be met.” Louis Mudannayake, M.D., chief of the Division of Geriatric and Palliative Medicine, continues, “Palliative medicine provides relief of symptoms associated with advanced and chronic disease, including pain. Managing physical, psychosocial and spiritual pain is key to proper palliative care, and our Division works with multiple disciplines to optimize symptom management.” “Pain can have many causes: physical, psychological, spiritual, so its treatment must be multi-disciplinary.

Anesthesiology does not work in isolation. All of the members of the pain management team, from the chairman to all of my colleagues—Mehrdad Hedayatnia, M.D., who is in charge of outpatient pain management (and is also my husband of 20 years!), Rajammal Jayakumar, M.D., Abdulquader Khan, M.D, Gary Thomas, M.D., Joel Yarmush, M.D., Chaim Mandlebaum, M.D., work in concert with a patient’s primary physician and surgeon, as well as with our colleagues in neurology, pharmacy, neurosurgery, orthopedics, psychiatry, rehabilitation medicine, and pastoral care to treat the patient as comprehensively as possible,” says Dr. Jafari.

“As an anesthesiologist, you have to work closely with many types of physicians: a surgeon or internist while giving anesthesia to an adult, a neonatologist when working on a newborn infant, a pediatrician when working with a child, a geriatrician when giving anesthesia to an elderly patient. The goal is the best outcome for the patient with the least amount of discomfort, and we work very hard to meet that goal 100 percent of the time.”

“We are lucky to have an increasing number of options for pain treatment at our fingertips, but I believe the true secret to relieving pain lies in being able to understand its source. That understanding can lead us to finding the best treatment. We aren’t just treating the pain, we are treating the person.”

New York Methodist Hospital
506 Sixth St. / 718.780.3000 / nym.org