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Center for Interventional Pain Management

For Physicians

Dear Colleague,

As a new graduate of a nationally and internationally recognized interventional pain fellowship program, I am excited about the revolutionary improvements in pain management options in the past few years. My intention is to bring state of the art techniques and knowledge to the specialty practice of pain medicine in the Effingham area.

Ease of Access
We are committed to providing rapid assessment and comprehensive management services for those that need our help. Our goal is to accommodate new patients within 24-48 hours. We are able to do this through a team approach, utilizing well-trained and experienced nurses to assist with the care of patients within the clinic. We have a dedicated contact hotline to facilitate your referral process. That number is 347-6702. We do require current medical records to guarantee the best possible evaluation, so your speedy delivery of these documents is appreciated.

Multidisciplinary Approach
As you know, people suffering from chronic painful conditions often have co-morbidities including depression and anxiety, possible addiction, obesity, sleep apnea, osteoporosis, etc. They commonly have many social stressors as well. A comprehensive treatment plan is necessary to optimize outcomes. The multidisciplinary approach includes pharmacologic management, interventional injections, physical modalities, counseling, and spiritual support. These offerings are individualized to the patients needs.

Opioid Management
As we all know, chronic opioid therapy can be challenging. After ‘’recognition’’ of pain as the fifth vital sign and the need for it to be treated in the 1990s we have come a long way. This revolutionary extension of chronic opioid therapy to chronic non-cancer pain patients seemed the only option to help these patients at the beginning and coincided by a big push by pharmaceutical companies for high dose opioid therapy in chronic non-cancer pain conditions. After more than a decade, we are now learning more about the risks of such a therapy including not only tolerance and dependence, but also opioid induced hyperalgesia (OIH) (1,2,3). Some authors have now suggested that patient’s pain scores will actually decrease after detoxification from high-dose chronic opioid therapy(4). Furthermore, no outcome study has shown improvement of the function and even pain score from chronic opioid therapy. Having said that, many, including myself, believe that with careful patient selection and monitoring, a subgroup of patients will still receive benefit from chronic opioid therapy when combined with other aspects of a multidisciplinary approach to pain management. We will provide consultative guidance for medical management of painful conditions. We will screen the patient prior to initiation of chronic opioid therapy to see whether or not they are a candidate for it. Also, for patients who are already on opioid therapy, we will be able to gauge their response and to see whether or not they are ‘opioid sensitive’. We will provide recommendations for modification of the regimen, and if needed, for tapering off opioids while suggesting alternative non-opioid pharmacotherapy. Unfortunately, our clinic is not be able to take over management. This needs to happen to allow efficient delivery of care for the next series of patients that need assistance. It is a known fact that there simply are not enough pain specialists to chronically maintain monthly visits for all those needing medications for pain. A conservative estimate is that at any given time, 20% of a population has pain severe enough to need pain clinic level care. This number shows the epidemic proportions of this problem. We are here to help, if we can. I will personally answer all your concerns/ questions regarding chronic opioid management of the patients.

Avoid ‘’Avoidable’’ Spine Surgeries
Not all spine conditions necessitate surgery and surgery doesn’t always alleviate the symptoms. When minimally invasive spine interventions are combined with other components of multidisciplinary pain management, including medical management, physical therapy, and if indicated acupuncture, cognitive, etc. the majority of patients would be able to avoid surgery. There has been a breakthrough of options in the past few years of numerous, less invasive techniques to treat painful spine conditions. I have listed a summary of these procedures for the patients on the website, and I would be more than happy to chat with you about them and send you the published studies that support them. I partner closely with our excellent spine surgeon colleagues, so that when the more conservative measures fail, I will provide valuable diagnostic information to them. Some of these information include response to selective spinal injections and provocative discography, so that only the symptomatic levels will be targeted during the surgery.

Feedbacks Welcome
Over the next few months, I will be surveying you to determine how we can better meet your needs and expectations. We want to develop profiles on the healthcare providers that refer to us, so that we can know you better and perform a better service. Part of our initiative to improve service will include e-mail communications and medical updates. The survey will request your permission to utilize electronic communication modalities. As a ‘new kid on the block’ we welcome your feedback regarding problems and/or appreciation regarding our program.

Thank you for your support. We look forward to working with you and I would like to thank you for allowing me the privilege to participate in the care of your patients.

Sincerely,

Omid Ghalambor, MD, DABA, FIPP
217-347-6702

References:

  1. Mao, J, Opioid-induced abnormal pain sensitivity : implications in clinical opioid therapy. Pain 2002 ; 100 :213-217
  2. Angst MS, Clark JD. Opioid-induced hyprealgesia : a qualitative systematic review. Aneshesiology 2006 ; 104 :570-587
  3. Ballantyne J, Mao J. Opioid therapy for chronic pain. New Engl J Med 2003 ; 349 :1943-1953.
  4. Baron MJ, McDonald PW. Significant pain reduction in chronic pain patients after detoxification from high dose opioids. J Opioid Manag 2006 ; 2 :277-282.