Let's Talk About: Pain Management with Drs. Butler and Sthalekar
Pain is the most common reason why patients come to see our board-certified and fellowship trained physicians. To address many of the questions most frequently asked by our patients, we held a roundtable discussion with two of our expert pain management specialists, Dr. Sean Butler, DO and Dr. Ninad Sthalekar, MD.
What kind of patients do you see most often?
Sthalekar: We see many different types of patients, both the younger patients ranging from 25-55 years old, who have suffered some type of acute injury caused by their job responsibilities, working around the house, playing with the kids, or they are athletes. All have a common goal to get back to work or their life and athletic endeavors as quickly as possible. The other major group is our older patients, typically 60-80 plus, who have more chronic conditions such as neck and back pain. They have been tolerating their symptoms which have been getting progressively worse. Their goals are typically just achieving a better quality of life and improvement in their activities of daily living. Simple tasks such as walking in a store or getting in and out of car become very difficult and they would like some freedom from their pain.
Butler: Yes, many of our patients have been referred to us from their primary care physician and most have already tried different therapies such as heat, ice, anti-inflammatories, or physical therapy. The reason many of them end up coming to us it that they’re in need of a more specific diagnosis so that a more targeted and effective treatment plan can be developed.
What are the treatment options available for these conditions?
Sthalekar: For most patients, we follow a standard algorithm by trying conservative measures first such as medications, rest and therapy. However, there are cases where a patient has tried conservative treatments prescribed by their primary care physician which have failed and now they are prepared to undergo more aggressive treatment such as spinal injections.
Butler: And of course it always depends on the patient’s symptoms and functions, as well as their current level of pain. We always take a multi-disciplinary approach, combining both external modalities such as bracing, traction, TENS, and physical therapy with internal options such as medications and supplements.
Sthalekar: Most definitely. We’re big proponents of the different modalities that enable us to minimize the amount of medication that the patient needs to take. In fact, we have several specialists on our team whose goal is to help set you up with some of these different therapies such as the TENS units and traction, so that patient can be confident they’re doing it correctly at home.
What are some of the newest treatment options that are available?
Butler: PRP – platelet-rich plasma therapy – is not new, but it’s something that many patients are independently asking for. It’s a great option because it uses your own body’s blood, so there are very few side effects and the pain relief lasts longer. It’s not the best option for all patients, though, based on the published studies, and that’s why I worry when I see these advertisements for “pop-up” PRP clinics that are often offered by practitioners who are not qualified.
Sthalekar: Exactly. I worry when I see the same thing for medical marijuana “clinics”. As a qualified physician, I have been approved by the PA Department of Health to certify patients forCBD (cannabinoids). We have incorporated medical marijuana into our practice to help patients with chronic pain which is defined as pain lasting more than 6 months.
Can you share some patient success stories?
Sthalekar: Over the past year we have certified more than 500 patients for medical marijuana and at least more than 80% of them have reported a reduction in their pain and improvement in their quality of life.
Butler: One story that sticks out for me was a recent patient who had been to many other physicians in the city, but still had significant pain to the point where he could no longer exercise; he was discouraged and depressed. I reviewed all of his records, assessed his symptoms and function, and decided to perform a medial branch nerve block and then radiofrequency ablation in order to pinpoint the exact cause of his pain. From there, I was able to give him a guided cortisone injection right in that very precise spot which provided him enormous relief. In fact, he was able to get back to exercise after having given it up for over a year.
There’s a lot of talk about reducing opioid use: how has that affected your practice? What are some successful strategies you’ve used to minimize opioid use?
Butler: Our goal is always to minimize opioid use, keeping it to the lowest dose that is absolutely needed. Using a multi-modal approach to pain management allows us to do that.
Sthalekar: Interestingly, one of the indications for medical marijuana is opiate use disorder. Patients currently on opiates can significantly reduce their dependence on opiates for pain or eliminate it completely by adding CBD to their treatment plan. Of course, patients must remember that any medication can have disadvantages which is why it is important to have a consultation with your physician to discuss appropriate treatment options.
What percent of your patients are able to avoid surgery?
Butler: We get asked that question all the time! The majority of our patients are able to avoid surgery.
Sthalekar: I would estimate less than 10% of our patients eventually require spine surgery.
What should patients look for when selecting a pain management physician?
Sthalekar: They should look for a physician with experience who offers a multi-modal approach when treating their pain.
- Yes. Patients have many different choices for pain management: physiatrists (doctors trained in physical medicine and rehabilitation – PM&R), neurologists, and anesthesiologists. Dr. Sthalekar and I are both board-certified in PM&R, with additional fellowship training in Interventional Spine/Pain Management. What differentiates us is that PM&R physicians are focused first and foremost on function. Our top goal is your quality of life and ability to function, so that you can do things that you want to do.
If you are struggling with pain, please call (215) 600-4714 to schedule a consultation with one of our pain management specialists.