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It Never Hurts to Care

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DANVILLE When you’re dealing with chronic pain patients, the patients want treatment, of course. They want relief from the symptoms. And sometimes they just want someone who understands.

It’s that third element, says Dr. Anjum Bux that sets apart the Ephraim McDowell Pain Management Center, operated by father Madar Bux, MD, and son Anjum Bux, MD, from many other pain management clinics.

“What makes our practice unique is that we treat our patients like family,” Anjum says. “They come in here and not only are they receiving care, but it’s also a social visit. They come in and we talk about kids and the family. They feel well taken care of here because it’s more of a family-type atmosphere.”

He continues, “That’s part of the treatment as well. It’s a form of psychological treatment where they want to feel somebody is listening to them and understands that they have pain. So in addition to treating them pharmacologically or with injections, we’re also treating them psychologically.”

The Journey to Danville

Madar graduated from medical school in India in 1962; then moved to England in 1963, where he performed surgery for three years. He was not fully satisfied with the practice of surgery and eventually changed to emergency medicine.

“I ended up doing anesthesia because I was in the ER and there was a young female patient with facial injuries, and I didn’t know how to intubate,” Madar says. “So I did a tracheotomy, and it saved her life. But after that I went from learning intubation to learning anesthesiology. I liked it, and they offered me a job. That was in 1969. Here I am still doing anesthesia and have never regretted a day. I love it.”

Madar accepted a position at the University of Louisville in 1973 before moving to Danville in 1977 as only the second anesthesiologist at the Danville Anesthesia Associates. The program grew over the years, and in 2002 it was ready for a fifth anesthesiologist. Anjum, who attended Centre College and graduated from St. George’s University School of Medicine in St. George’s, Grenada, in 1998, completed his residency at the University of Kentucky in 2002 and joined the Danville Anesthesia Associates team as its fifth physician.

“My father at that time stopped doing anesthesiology and went just to pain management,” says Anjum, who is the managing partner for Danville Anesthesia Associates. “At that point the pain management part was separated from Danville Anesthesia Associates and has operated as Bux and Bux Pain Clinic at Ephraim McDowell Pain Management Center.”

Madar continues to work at the age of 79, despite undergoing a complicated heart surgery just three years ago. “There was a 98 percent chance that I was going to die,” Madar says, noting that the opportunity to work with his son is what motivates him to continue to practice. “That’s the reason I decided to continue to work. Otherwise I could have retired, but it was fun to work with my son. It’s just a different feeling when you’re working together.”

A Multidiscipline Approach to Pain

It should come as no surprise that father and son have developed a symbiotic relationship in their practice, complementing each other’s skills and expertise to the maximum benefit of their patients. Madar’s time is completely devoted to pain management, primarily through epidural injections and joint injections. In cases in which those injections are not enough, they are referred to Anjum.

“I’m doing more of the invasive procedures, the intrathecal pain pumps and the spinal cord stimulators,” Anjum says. “My practice is made up of some of the patients that he’s already seen and done injections on, and they need more interventional pain management, including implanted pain pumps or spinal cord stimulators or rhizotomies.”

A large part of their practice is patients with intrathecal pain pumps and spinal cord stimulators. According to Anjum, “These treatments are reserved for patients who have failed all conservative therapies, including physical therapy, medications, injections, and are not candidates for surgery or have failed previous surgery.” They have one of the largest intrathecal pump practices in the state with over 400 pumps under management. In addition, they are one of the few practices that utilize a spinal cord stimulator system that is MRI compatible and has adaptive stimulation, which is described as stimulation that automatically adjusts with different positions. Anjum says that, “With this system, patients love not having to worry about getting an MRI in the future and having their stimulator automatically adjust itself to different positions from lying down to sitting to walking.”

As expected, the Buxes treat many patients suffering from back pain, neck pain, or arthritis. Recently, they have also become a leader in treatment of shingles. Anjum says their strategy is to take a very aggressive approach, employing the use of nerve blocks, oral medications, antiviral pain cream, and injections.

Utilizing these various procedures and techniques demonstrates the growing diversity and expertise present in the field of pain management. Employing these different strategies is slowly helping change a once negative perception that many had of pain clinics.

“Pain clinics have always had a bad connotation because people think that a chronic pain clinic means narcotics,” Anjum says. “But it’s much more than that. We have a multidisciplinary way of treating patients. It involves physical therapy, occupational therapy, psychological treatment with Dr. Johnathan Cole in Lexington, oral medications other than narcotics, and injections. I think people just don’t understand everything that is involved in chronic pain treatment.”

Anjum himself had much to learn — even after his formal education ended. Working with his father, Anjum received top-notch instruction every day. “I couldn’t ask for better training,” he says. “It was good to have him nearby. He would let me try things my way, and he would always tell me, ‘you will see.’ And he was right. I’d try it my way, and inevitably I changed.”

One thing that hasn’t changed from the early days of the Danville Anesthesia Associates to today is the family atmosphere that makes patients so loyal and satisfied with the care they receive. That level of compassion and understanding is a trait that runs through both father and son, who might soon welcome a third family member to the practice. Anjum’s wife Faezah is in her second year of residency in anesthesia at UK. There’s little doubt she’s already immersed in the social, family-friendly atmosphere that sets the Ephraim McDowell Pain Management Center apart.

“Often we cannot eliminate the source of the pain,” Anjum summarizes. “We cannot cure degenerative disk disease or degenerative arthritis. So we basically are treating patients to decrease their symptoms and pain level so they can learn to manage and live with their pain. It’s basically treating them psychologically to validate, ‘Yes, you have pain, but here’s how we can help you can live with this pain and go on with your daily life.’”