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Taking Great Pains

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LEXINGTON Regardless of the source, frequency, or intensity, one thing all pain sufferers can agree upon is they just want it to go away.

“Pain doesn’t discriminate,” says Lexington Clinic’s Joshua C. Bailey, MD, MS, addressing the scope of his patient population. “It appears at all ages.” And Bailey treats all ages, with the exception of pediatric patients.

The Mount Vernon, Ky. native began his education with an interest in pediatric oncology, but a rotation in anesthesiology piqued his interest in patient comfort. After earning his medical degree from the University of Louisville School of Medicine, he completed a fellowship in pain medicine and a residency in anesthesiology at the Mayo Clinic in Jacksonville, Fla.

Bailey, who joined Lexington Clinic in August of 2015, hopes to bring the “Mayo model” of pain medicine to Kentucky and to offer alternatives to the high-dose narcotic-based pain treatments prevalent in the state.

“One of the reasons I came back to Kentucky is that it is one of the states that suffered most from the popularization of narcotics in the early 90s,” Bailey says. “I want to be a balancing force for Kentucky. I combine low-dose opiate management with other interventional and behavioral treatments, and I avoid high-dose narcotic management unless the patient has cancer. My goal is to bring new approaches to pain medicine that individuals haven’t utilized before and try to get away from treating pain with opiate medications only, or altogether.”

That is where the Mayo Clinic model comes into play. Bailey describes a program that was designed to take a more comprehensive look at a patient’s pain. The Mayo Clinic’s three-week program began with taking fibromyalgia and central sensitization patients off of their opiate medications, combined with a cognitive, behavioral, and comprehensive approach to pain medicine.

The 15-person program saw one patient graduate each day while a new patient joined the group, giving them an opportunity to see how they would transition through the program. The “Boot Camp for Pain,” as Bailey describes it, consisted of physical therapy, occupational therapy, biofeedback, and cognitive behavioral therapy as the primary components of the class-based program.

“The biggest component was cognitive behavioral therapy, teaching the body what normal feels like again, retraining your normal pain pathways,” Bailey says. “When patients left, they were off all opiate medications with improved pain scores after this three-week program.”

Bailey is working to duplicate that model at Lexington Clinic and he has already begun to implement many of the same components and philosophies. He is referring patients to cognitive behavioral therapy, physical therapy, and occupational therapy.

A major component in Bailey’s approach is to work with the referring physicians to determine the underlying cause of the pain. That is one of the things that drew him to Lexington Clinic, where he found that collaborative spirit already alive and well. “With neurosurgery and orthopedics, we are all part of one provider. It’s a close collaboration,” Bailey says. “That’s one of the biggest benefits of the Mayo model – collaboration with consultants. That’s what I saw when I came here. Everything was already in place. They were just missing a pain department.”

With the pain department in place, Bailey can now work closely with neurosurgery, for example, to determine the underlying cause of a patient’s back pain, be it nerve entrapment, arthritis, or fractures. “In medicine we have a tendency to treat all back pain as equal, but it’s not,” Bailey says.

With more treatment options available and patients asking for alternatives to narcotics, determining the underlying cause of pain is central to restoring a patient’s comfort level and functionality. “My goal is to keep patients functioning and to minimize the systemic and psychological effects they are having from their pain,” Bailey says, citing some of the newer treatments that allow him to do so without relying on narcotics. “The future is in neuromodulation, radiofrequency ablation of nerves, and spinal cord stimulators. We are able to mask the pain by controlling how the brain perceives it.”

Perception is also key to Bailey’s goals about pain medication in general. He wants to put an end to misconceptions that all pain treatment centers are “pill mills” and help both patients and physicians see that there are alternatives that offer better long-term results.

“The newer data is showing an exponentially higher risk of deaths when you increase narcotic dosage,” Bailey says. “My goal is to provide patients with alternatives to narcotics. I don’t want patients to feel like they’re coming to a pain clinic, but are coming to find answers.”

The future is in neuromodulation, radiofrequency ablation of nerves, and spinal cord stimulators. We are now able to mask the pain by controlling how the brain perceives it.— Dr. Joshua Bailey