Pain management treatment and the importance of the patient-provider relationship

An Interview with Dr. Kamyar Assil, M.D.

Kamyar Assil, M.D. is an expert in pain management with more than two decades of experience. He received a Bachelor of Science with honors in psychobiology from the  University of California, Los Angeles (UCLA) and a medical degree from the University of Southern California (USC) Keck School of Medicine. Dr. Assil was one of the first fellowship-trained pain specialists in the Ventura County region, with formal training in pain management from State University of New York Health Science Center in Brooklyn, NY. He also completed a clinical fellowship and advanced training in interventional pain management at the Manhattan Center for Pain Management at Saint Luke’s-Roosevelt Hospital in New York City, NY. A sought-after practitioner with specializations in interventional pain management, Dr. Assil focuses on targeting the source of pain –– treating pain problems acute to chronic, from severe spine and peripheral pain pathologies, headaches, neck pain and nerve damage to herniated disks and lower back pain. A Qualified Medical Examiner (QME), Dr. Assil also practices as medical consultant in legal cases and as an expert witness for interventional medicine and pain management. He also serves as a senior instructor of the Spine Interventional Society (SIS) and as a visiting clinical professor at USC Medical School’s Department of Anesthesiology’s division of pain medicine.

Jeannette Pforr, Director of Marketing:

How do you mitigate the risk of opioid abuse in your practice?

Dr. Kamyar Assil, M.D.: It always starts with a good interview, asking questions regarding the patient’s pain. Certain pain problems do not respond greatly to opiate medications, and there may be many options in order to better diagnose and treat the condition than opioids.

Patients on very large dose opiates would benefit from an addiction medicine or detox expert. However, there are not that many centers that have a multi-disciplinary team to include psychology, biofeedback, P.T., and a medical director in order to appropriately help a patient wean off opiates; and such centers may not be covered by insurance companies or they won’t take insurance coverage.

 

JP: How important is the patient-provider relationship in managing pain?

KA: It’s extremely important. There has to be mutual (two-way) trust between the two. Both sides have to be honest, the patient is trusting in the doctor, and the doctor should appreciate the privilege of having that trust, and clearly explain how they plans to help the patient.

 

JP: Are there any new pain management treatments that you’re particularly impressed by?

KA: There are newer technologies in spinal cord stimulation for nerve damage pain, and with very high frequencies in stimulation (above 1000 Hz) the patient may not even feel any paresthesia and stimulation but the pain is still modulated.

There are new approaches to nerve blocks and also radiofrequency neurotomy for longer term pain relief for certain chronic back pain, neck pain, posterior headaches, and now chronic knee pain. There is also new biological injections for joint or soft tissue chronic inflammatory pain problems such as chronic tendinitis, etc. Instead of steroids, a patient’s own blood, fat, or bone marrow is spun down and a portion of the blood or bone marrow, concentrating either platelets from blood or white cells from bone marrow, is injected. This treatment has shown far more benefit than those from cortisone injections.

 

JP: If opioids are medically indicated, do you prefer those that are abuse deterrent?

KA: Not always, but in certain patients that I may not know as well yet, then yes.

 

JP: What’s the key message you’d like to share with providers?

KA: That the subspecialty of pain management, or pain medicine has come a long way. Many pain conditions can be managed without long term opiates, and long term opiates have many known and probable unknown side effects. In addition, chronic pain patients can be more functional and productive if the right diagnosis and therefore treatment plan is implemented, which may not be easy but would be more effective than depending on opiates long-term.

There may be conditions in chronic pain that require a team of practitioners to help a patient in many fronts, from psychology, to psychopharmacology, occupational and physical therapy, and spine injections if necessary; this is a multi-disciplinary team approach that may be beneficial for some severe or chronic conditions.