Anesthesiology subspecialty: Pain management
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- čas přidán 24. 06. 2024
- Pain management is unlike all other subspecialties of anesthesiology, for example pain management physicians don't even work in operating rooms. In this video, I take you inside Mt. Sinai Hospital's pain management fluoroscopy suite where program director Dr. Mourad Shehebar shows us what pain management is all about.
📷 On Instagram: @MountSinaiPainFellowship
🔗 Online: www.mountsinai.org/care/pain-...
0:00 Start
0:42 What is pain management?
1:05 Radiofrequency ablation
3:40 Conditions treated
4:18 Pain management vs. OR anesthesia
5:41 For residents
7:13 For patients
The information in this video is not intended nor implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images, and information, contained in this video is for general information purposes only and does not replace a consultation with your own doctor/health professional.
#Anesthesiology #Residency #MedicalSchool - Věda a technologie
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Hi Max. I’m a board certified anesthesiologist but haven’t practiced anesthesia since 1991. I am now a retired primary care physicians and plan to volunteer with Doctors Without Borders and give anesthesia in Africa. I very much enjoy your videos and realize how much anesthesia has changed in 30 years, especially with regard to monitoring. I plan to spend a few months as an observer in a modern OR to prepare for my trip. Please keep up the excellent videos and best wishes.
As someone who's not involved in medicine, I love hearing about the different subspecialties of anesthesiology. There are so many different subspecialties, or aspects to the subspecialties, that I never would have thought of as being their own thing.
I certainly appreciate your videos. I have a lot in common with this one in particular. I have intractable back pain and had to have both hips replaced in the last year. I'm 47 and spent 217 days in the hospital in the last 2.5 years. I'm getting my caudal epidural injection on the 9th, and do ot every 4 months. Life-saver! Thanks for what you do, Max. It's GREATLY APPRECIATED
@Michael_Wood<
you have a good story, man... I will have, this year, in 6 months, almost 60 days in hospital and rehab.. for 4 different conditions, on top of existing 'issues'
I feel your pain !
this doctor seems to care, a lot, would that there were more departments like his!
I have adhesive arachnoiditis, which is an intractable pain condition. I've had many of the procedures discussed in the video and your approach to (and attitude toward) pain management is spot on. If only more physicians were as dedicated to their profession and patients, there would be less misery and disability. Thanks for another great video, Max 🙂
I am a benefactor of this type of pain management. I had sciatica that almost had me crippled. Two sessions and things have been good for 11 years. Thanks Dr. Chapman.
I adore CZcams channels such as this one. Your profession is an extremely complicated one, and to hear it explained in such a calm, rational way is a breath of fresh air. I wish you the best of luck in all future endeavors!
Holy crap you’re just pumping out the videos. I love it !
You are so Informative and humble.
Thank you for doing this one. Pain is something that so many people have to live with---and doing something to reduce that continual pain is life changing. It sounds like their department is extremely popular---guessing in part or to a big extent due to success.
Wow! That was really cool and amazing! If I was a anesthesiologist I would want to do pain management too, I would went to also be a travel, Anesthesiologist, I really enjoy donating to the anesthesiologist Foundation, since it was hard for me to go to college because of my cerebral palsy, I really wanted to be a anesthesiologist physician!
Thank you for sharing! I’ve been in the fluoro suite once to assist during a PRP, I’ve never seen anything spine related. This was great!
Protect this man at all costs
I recently had an injection in the right SI joint and feel so much better.
Another excellent video by Max.
Thank you for sharing!! My anesthesiologist wants me to have RFA in my lumbar spine & SI joints, but I have been too afraid to even consider it. Even though I am in a high level of pain 24/7. Watching this video really helped me understand the procedure, and I feel less terrified by the idea of it.
I have heard it can really help. I hope your pain gets better. Don't give up.
I have had several (unfortunately they can wear off) and have helped me tremendously. Before I couldn’t sit long enough to eat a meal and now can sit though do have flares and long car rides are a struggle but they aren’t impossible like they were before.
They help me some in the lumbar region. I had pretty good results in my thoracic. I have a curvature in thoracic that makes it where I can’t stand or sit for too long. The results are off and on for me. They don’t last very long in my case anyway. Still need pain meds unfortunately. I’d love to not need those again. Gets old relying on them being treated like a child with compliance. Pill counts and drug tests. Never failed one ever, but feel like a person on probation or something. lol
Thanks for this video. It gives me some insight into my dad's treatments.
I've had my lumbar facet joint nerve endings abladed (rhizotomy) two and a half times. The first one held for an amazing two years, while the second treatment lasted one-and-a-half years. After a move out-of-state, I found a local anesthesiologist who did the procedure, but only one side at a time, and my insurance didn't want to pay much, so I held off on having the other side done. The nerve endings have grown back and it affects how long I can stand or walk, and where I can and cannot go. My insurance has changed again, and as soon as I finish chemo I'm going to try to get the procedures done again. The previous procedures made such a difference in the quality of my life!!
I have the lower back pain that goes down the legs. It is so painful! I have had about 30 epidurals over the years. Now my doctor says I need to have screws put in my lower back and hip. I have so many other problems I haven’t scheduled it yet. I was in the hospital in July for emergency operation because of blood clots and one major one in a artery. (6 hr surgery) I could really tell that I was very forgetful after the anesthesia. Thanks for your videos, I have seen them all!!! I started having clots after two Covid vaccine shots and am on blood thinners for life…..
As someone applying to medical school now, your videos have single-handedly made me way more interested in anesthesiology and I’m hoping to have some anesthesia rotations later in med school. Awesome videos!!
Research CRNA, American Association of Nurse Anesthesiology (AANA), and the fact things are getting less invasive over more invasive before considering anesthesia. Your welcome.
Excellent video ❤
I know pain management well. I have nerve damage from complications with Crohn's disease and after 2 years of trying everything, I did an in-patient interthecal pump trial which was super effective. I had my first pump installed in 2012 (Medtronic) and I had a Flowonix pump placed in 2019 as the battery runs out in about 7 to 9 years depending on the pump model and pump settings. The fact this pump can run for 7 to 9 years without charging blows my mind.
I feel lucky that I've had amazing care from top pain clinics like UCLA, and USC. You should do a video about nerve stimulation implants and interthecal pumps. It would make people aware of the technology and the solutions that go along with them.
I have severe pain with Crohn's and I can barely walk, move my shoulders, neck, etc. I get radio frequency ablations, trigger point injections, Entyvio, Imuran, and pain medication but the pain don't stop. It has reduced, but it's still really painful. I am mid 40's and I have to use a cane just to function.
e1986 so sorry to hear that mate. Did it start slow for you or was it more sudden? I feel like I am losing more and mobility over time. It's such a horrible thing most can t understand. It's hard to stand in the kitchen to make a pizza. I have to sit down 3 or 4 times or my legs and hips give up and I can fall over....
Love your videos! A good friend of mine received radiofrequency ablation. It helped him so much! He called it "dry needling". He is a very active 70+. He is doing well! Are those procedures the same thing?
My herniated disc gives me constant pain, but the thought of sticking needles in there just makes my balls retract into my stomach.
Thank you!
I love learning from you. Whete ate you practicing
Dr. Feinstein man really saved the internet economy. 🙏🙏🙏
Hey Max, I don't know if you'll see this, but as someone who has had life-long health issues, I just wanted to say thank you to you and to all of the kind anesthesiologists I've met over the years. You guys and the RNs have always been the shining light in my darkness of health. Even if it's something like helping with a stick (full on i'm 10/10 on the hard stick scale, and have had a few anesthesiologists give a helping hand when there's been a newer RN. I've since picked up a few things to suggest to them which helps before they call like the double top/bottom tourniquet, be careful of that false flash, etc , but when I was younger whoof, 8 attempts minimum.)
I know that I'll see another anesthesiologist sooner rather than later, so I'm just putting every ounce of positivity I have towards all of you in the field. I also like to offer game suggestions to y'all to play on your tablets/phones while I'm under, and that usually goes over pretty great hahah. I think a lot of people freak out when they hear about it being common, or doing crossword puzzles, but honestly I get it - it's keeping your brain active while in a waiting posture rather than staring off at a wall for a long period of time and slowly losing track of things or being caught off guard.
PS - My number one suggestion for a long time was a game called Bookworm. Think tetris + scrabble.
Take care, and I wish you the best on your peds fellowship!
As someone who has had many RFA procedures since 2014 it is refreshing to hear some places do try to get you in soon. I have SI joints ablation and bilateral l4-s1 ablation. I get usually about 7 months of great pain relief. I know that is what seems to work best. Insurance will only cover when at least 6 months plus in each location. I just wish from when I call after 6 months I did not have to wait another 5 months before I could get in. I wish I could just schedule each area 8 months after as would be willing to deal with that pain. Just not the way my local healthcare system works.
For some asking, the patient is awake for ablation procedures. You do have conscious sedation so are relaxed so you do not move. The doctor needs the patient to be able to answer when they do motor testing so can varify correct placement of electrodes.
Thanks for the content warning
Wow!
"Pain cannot wait.."
That would certainly be a refreshing attitude around my location, where we wait 6 months, have a 15 page questionnaire to fill out...and, sadly, a couple of specialists who "don't believe in breakthrough pain.."...And, many specialists don't seem to be able to grasp the situation where a patient has *many pain sources*... Imagine that you might have:
- Bilateral knee total arthroplasty
- SSP surgery failure
- 2nd SSP tear
- impingement syndrome
- arthritis in shoulder
- 2x lumbar surgeries
- Monteggia fracture long-term joint and bone problems
- cervical spine issues
- CSF leak
oh, and, genetic hyper-tolerance (think "no significant side-effects to 1000 μg fentanyl IV) to opioids...
Sounds to me like a patient needing Dr. Shehebar!
if only he wasn't 4000 km away!
Great video, and a great idea to have more pain specialists in practice!
I am a pain epidemiologist as a second specialty (primary is infectious disease), and have been involved in pain research and treatment at a major medical school and school of public health for 30+ years. Outcome data for interventional pain procedures have yielded contradictory results that have been unimpressive, even as the techniques have grown increasingly more sophisticated. Numbers needed to treat for epidural steroids, for example, have been 3-4 or greater, with small effect sizes. It’s worth a try for refractory radicular pain, but this is more likely to not work rather than to work even for well selected patients. Interventional procedures are big money makers for all involved.
All pain is in the brain-that does not mean “it’s all in your head”-but the most promising treatment involves a combination of movement, mindfulness meditation and other such techniques, some medications, and most importantly, tincture of time.
Abstractly I'm sure that's true.
Concretely though it's really missing the point as a patient looking at a very limited suite of poor treatment options. The pain might be bad enough that literally anything is worth trying to fix it as long as it's reasonably safe even if the efficacy is not the best.
Pain from various conditions or injuries can be so debilitating that you're unable to exercise, or lose weight, or do PT, or any other of a series of the usual measures to combat it. The medications can help acutely but used chronically often cause addictions or side effects or liver / kidney problems from the metabolism thereof.
A life of continuous severe pain can be exhausting and miserable and not worth living without some form of interventions.
Obviously having a wider variety of lower risk and more targeted interventions with excellent NNT figures is the holy grail. But that doesn't exist in this part of medicine. So we only have what we have.
Make sure your pain doctor is fellowship trained
Hi Max, I have a question regarding to general anesthesia and opioid addiction substitution therapy with Suboxone (buprenorphine / naloxone; sublingual) treated patients?
As opioids are used by general anesthesia and (partially opioid) buprenorphine is more potent to opioid receptors than most other opioids, what is the protocol in these cases?
Does it is a danger to general anesthesia or does it give a chance that general anesthesia does not work well?
❤❤❤
One pain management specialist described the patients he mainly sees, as having suffered a back injury at work, they get a payout and they spend it within a few years. So then they have no money, and a back that stops them from working.
hi, i have a question, is it possible to remove all the pain during the operation keeping the patient Conscious?
Can i ask you professional opinion? A friend has heard a sleeve gastrectomy (VSG) may be possible using an epidural anaesthesia only. This sounds far fetched to me and i want to be sure she isnt having her leg pulled. She has health issues that mean surgeons are wary of ooerating under general anaesthesia.
Technically that may be feasible depending on the surgical approach, however oftentimes these surgeries require a device be placed down the esophagus. Even if that’s not the case, it would be incredibly uncomfortable because the patient would need to be breathing on their own, but their abdomen would be full of CO2 so that the surgery can happen. Basically it would be like breathing while a person is sitting on your abdomen. Also, it’s very unlikely that most surgeons (or anesthesiologists) would be comfortable with this plan.
@@MaxFeinsteinMD exactly what I thought. I am 17 weeks post OAGB (59lbs lost!) And those were all the things I thought of, the pouch guide, the gas etc. Thanks
This guy probably makes over a million each year :0
trust he buys gold bullion as our dollar weakens by the day
If you are looking foward to a procedure it doesn't hurt much. I had to freeze my own wart on my heel with liquid argon during corona. It hurt so bad to walk the actual freezing was enjoyable. I tried liquid helium first but it kept boiling as soon as it hit that Styrofoam cup then my manager started yelling at me "You wasted 500$ of helium!"
As someone with trigeminal nerve pain, I need frequent injections of steroids into the side of my face. I am very grateful to have a pain management specialist who can help me.
Your videos are the best ever! I have 2 questions. 1
During that ablation , the pt was awake. Why? Also when they do caudal block. Where are they injecting and what is the purpose? Sorry I think that's more then 2 questions. Great to see you! ❤❤❤❤❤😊
Some drs sedate some dont. Also depends if insurance will pay
wanted to ask , i did colonscopy (chrone's disease) , and i was given some kind of anesthesia im not sure which.
and couple seconds later , i began hearing a super loud White-noise kind of sound , and suddenly i told it to my doctor and heared him saying :"its because you are going to sleep now" and then the word "now" started looping so many times i heared "now , now ,now ,now ,now ,now ,now ,now ,now" for like 30 seconds , and then i was out and couldnt remember anything else.
is that normal? to hear and expirence all that?
I have had probably 20 surgeries and I have had that effect twice.
i did some service work for this senior dentist we were talking and I asked him how he deals with drug addicted patients pressuring him for pain management, he said " we have eliminated all but a few and they are in our crosshairs"
Can CRNA's go in this type of speciality too?
CRNAs are trash
CRNAS should not be doing anything independently
@@Propofol1234yikes, guess we should shut down all those independent crna rural hospitals and surgery centers...
@@ALousySavage Yes we should. Or we could, you know, employ more anaesthesiologists instead of wannabees...
I meant to say under an Anesthesiologist supervision.
Do they train Nurse anesthetist who want to go to pain management?
interesting! i have painful peripheral neuropathyn and am dealing with it via an electrical spinal stimulator
How has that worked for you? Has the stimulator helped?
@@DudeWhoSaysDeez i am on test mode for the last two days. two more to go before a decision is masde to go permanent
Does the age of the patient matter? I do not experience pain the same way I did when I was a kid. I feel the sharp ouch! but that is just a hurt. I shoved a titanium chip between the bones in my big toe it was in my shoe. I felt something on my toe and though it was a blister. Then I felt hot and sick I took my shoe off and felt the end of the chip and yanked. It hurt so bad I almost threw up. I don't experience the throbbing aching pain.
Man, TACK should sponsor you, I bet you've sold them thousands.
Ketamine is my favorite anesthetic because it's fun and it's also a very powerful antidepressant.
Tell CDC MDH assumed that you have back or neck pain and the doctor examine the back and neck for medication only for a long term life 💕🧬🙏🧬🙏 in my back and neck is fine. Both knees hurt so badly and needs to go through a knee replacement surgery on both knees and back disk and fractured spine that are nonunion giving me a lot of anxiety and pain all the time.
if your pain is not well controlled during your office visit you can't communicate your problems and the interventional anesthesiologist will be brain dead
I have gone through the ringer with these guys quite a few times. They are absolute quacks and they exist solely to bill your insurance for expensive treatments that are VERY expensive, are VERY repetitive, and are clinically shown to work in less than 1/3rd of patients treated.
As a pain patient I can say confidently that these guys are a chronic pain patients absolute worst nightmare. Fixing you means less income for them and that is the focus of their treatments CASH.
I guess that’s appealing for potential doctors unless you actually care about helping your patients. Or even speaking to them at all ever.
I do not agree with these treatments being only for billing insurance at all!
I have had these kinds of treatments for both my cervical spine and my lumbar spine.
Before surgery, I was in a great deal of pain from compressed nerves. Even narcotic medication did not touch the pain.
When my neurosurgeon referred me to these kinds of doctors, he was very clear about. It might not work, it might buy me a bit of time, the goal was to try treatments that are less invasive than major surgery.
My neurosurgeon only wanted to operate only as a last resort.
I have had a wonderful experience with my dr. He does these procedures but doesn’t force anyone to do any treatment or med they don’t want to do
doctors should be banned nurses