President-elect of Monroe County Medical Society, an interventional pain medicine doctor, discusses managing pain using a holistic approach, and some of his plans as the head of the local medical society
By Chris Motola
Q: What is interventional pain medicine?
A: Interventional pain medicine is a discipline that primarily includes diagnosis and treatment of pain disorders. It principally involves the application of interventional techniques in managing acute and chronic pain. We use evidence-based, minimally invasive approaches to identify individualized pain generators so that we can tailor our therapies towards those pain generators so we can improve the patient’s pain and quality of life.
Q: Pain management got something of a bad name in recent years and is often cited as one of the main causes of the ongoing opioid epidemic. How has the contemporary approach changed and how it is addressing these issues?
A: We take a comprehensive approach towards underlying disease processes, which are contributing to the development of chronic pain. It’s a holistic approach where we not only utilize medications, but also highly advanced, precise, image-guided interventions to target those potential pain generators. In addition, an individualized functional rehabilitation plan is the key in developing comprehensive pain management plans for patients.
Q: Can you give me an example of what these interventions might look like from a patient’s perspective?
A: So let’s take a common complaint: lower back and leg pain. Let’s say a patient has a disc herniation that is compressing one of the nerve roots. So a patient might present with lower back and leg pain, after a thorough patient history and a physical examination, we will determine the acuity of the problem and start with conservative options like NSAID medications, maybe some nerve pain medicines and a physical therapy program. About 75% of disc herniation cases will improve with these conservative options. A certain percentage will require additional interventions. We’ll proceed with advanced imaging to precisely identify pain generators and then target the specific pain generators we’ve identified. Most of the cases will respond. The ones that don’t will usually require surgery. A small percentage of those may experience chronic pain even after surgery. For those patients, we can use some advanced treatment options. For example, a spinal cord stimulator, peripheral nerve stimulator which you can think of as a pain pacemakers. The goal is to block the pain signals, which are coming from damaged nerves. The success rate of that ranges from 70% to 80% in the long run.
Q: You’re also a cancer rehabilitation specialist. How does that overlap with pain management?
A: Cancer pain management is a dying art. Over the years oncologic treatments of cancer have evolved, so the survival rate of cancer has improved significantly. We have a lot more cancer survivors now. But they may be struggling either with cancer-related or cancer treatment-related functional impairments.. We develop comprehensive plans for these patients to not only manage their pain, but improve their functioning and quality of life. In addition to helping cancer survivors, there’s also a significant role for cancer rehabilitation in the early stages of cancer. It’s the concept of prehabilitation. Based on the specific type of cancer a prehabilitation plan can be developed to minimize long term functional impairments.
Q: How can both of these disciplines help address the opioid crisis?
A: This is a very good question. We are still in the middle of an opioid epidemic. It’s recently been overshadowed by the pandemic, but as the COVID-19 numbers are coming down; it’s starting to become more visible again. Our approach is comprehensive and holistic. We try to focus on the pain generators and use of safer, non-opioid pain medications as well as advanced opioid-sparing treatment options like implanted devices..
Q: You’re also president-elect of the Monroe County Medical Society. What duties will you be taking on?
A: Monroe County Medical Society is a 200-year-old nonprofit organization in our community which advocates for physicians and patients and the improvement of health in the community. The job of the president is to be the face of the medical society, and interact with the state society, Medical Society of the State of New York, and to be the voice of our local physicians at the state level. We also work very closely with our peers in the region, as well as regional health systems. We have a lot of educational initiatives and also provide one of the oldest medical scholarships funds in the county. Advancing these issues is the key role of the president.
Q: Do you have any projects in particular that you’re looking to advance?
A: Quite a few projects, actually. The main one is to develop and maintain the value proposition of the medical society for its members. Making sure that we’re not only retaining, but are increasing our membership. Secondly, we’re working on quality improvement projects within the community. It’s focus is on adolescent mental health with a grant through Excellus BlueCross BlueShield. We’re also working on a physician wellness program and continuing our advocacy efforts at the state level, primarily focusing on reducing physician burnout rates.
Name: Hemant Kalia, MD, MPH, FIPP, FAAPMR
Specialty: Interventional pain management and cancer rehabilitation
Position: Program director, interventional spine and pain fellowship; president-elect of the Monroe County Medical Society; clinical assistant professor, physical medicine and rehabilitation/neurology/pain medicine, Lake Erie College of Osteopathic Medicine (LECOM); secretary, NY Society of Interventional Pain Physicians; editor-in-chief, Advances in Clinical Medical Research & Healthcare Delivery
Hometown: Chandigarh, India
Education: MGM Medical College, India
Affiliations: Rochester Regional Health System
Organizations: Monroe County Medical Society; New York Society of Interventional Pain Physicians; American Society of Pain and Neuroscience, North American Neuromodulation Society
Family: Wife, daughter
Hobbies: Traveling, music