By the time most patients come to see Dr. Rames Gheith, they have often been facing pain for months or even years. Gheith, a physician at Interventional Pain Institute, says it’s so common for people dealing with chronic pain to wait before addressing it, that a new diagnosis has developed. “Chronic pain syndrome is a diagnosis that develops on top of the pain, both psychologically and emotionally. There’s severe anxiety that these patients are dealing with, and often they’re taking pain medicine, antidepressants and mood-stabilizing treatments that could have been avoided or minimized if the treatment was timely.”

Gheith, whose practice focuses on chronic pain, often with complex, neurological causes, says, “The problems often go unrecognized for years before the patient walks into my office. We’re playing catch-up with treatment to reintroduce them to social norms and working activities. Often, they’re already in significant distress emotionally and financially. But the patients do well the vast majority of the time with treatment, once we identify the correct diagnosis.” Untreated chronic pain can lead to psychological distress and insomnia, leading some patients to apply for disability because their pain keeps them from being able to work. “It’s a very rewarding aspect of my job to see patients recover from painful conditions and regain their life back,” he says.

When Gheith sees a patient for the first time, he first does an extensive history to identify the source of pain, then advises treatment options that range from physical therapy to pain medication and more advanced interventional treatments. “My clinic is not a management center where people get pain pills; they get the appropriate workup, we identify the cause of the pain, and treat the cause of pain—we don’t just mask it. We utilize multiple modalities to meet that goal.”

For patients who have intractable pain despite trying many types of treatment or multiple surgeries, more advanced treatment may be required, Gheith notes. For these patients, options might include nerve-ablation treatment, which destroys the nerves causing pain with a heat source, or neuromodulation. “The best example of this is spinal-cord stimulation therapy,” he says, which is most frequently used on patients who have severe, intractable neuropathic pain or have undergone multiple unsuccessful back surgeries. “The beauty of neuromodulaton therapy is that before it gets implanted into the body, you get to try it and see if it works,” he says.

During the trial simulation, the patient comes in for a minor procedure, where wires are introduced into the region experiencing pain, usually the trunk or limbs. “The patient can go home and experience it in their home environment, doing their normal activities. The goal is to have 50-percent pain relief or better, to reduce consumption of pain medications, and to improve the patient’s function and quality of life. If we can achieve those goals with the trial simulation, the patient might be offered permanent implantation of the device.” Gheith notes that for patients with intractable chronic pain, this treatment can be more cost-effective than repeated surgeries, and is currently being used by more than 150,000 patients worldwide.

Neuromodulation therapy is designated as an advanced interventional treatment with Class 1A evidence showing efficacy. “It’s the highest level of evidence to show that they’re effective,” Gheith notes. “They give the best outcomes, improve the patient’s quality of life and give them more functionality so they can be involved with their family and loved ones again.”

On the Cover: Interventional Pain Institute, with locations at 1045 Truman Blvd. in Festus, and 10435 Clayton Road, Ste. 120 in Frontenac, is a comprehensive pain management center. For more information, call 636-933-ACHE (2243) or visit