As a medical student, Lexington Clinic’s Michael E. Harned, MD, board-certified in anesthesiology and interventional pain medicine, glimpsed a possible future for pain management. A University of Kentucky mentor was moving away from narcotics as the default treatment for chronic and acute pain, using devices and injections instead. Harned says “He made a big impact on me as far as what a pain physician could actually achieve.”
That impression compelled Harned towards interventional pain management, which relies on a broad range of techniques and abundant communication between consulting physicians. Harned calls it “comprehensive pain management,” where he offers interventional techniques, while caring for the patient’s whole needs. If non-narcotic medications can be used first, he employs those before moving to controlled medications. Harned’s inclinations about pain management have evolved into a modern, collaborative approach that serves patient and Lexington Clinic alike.
Refining the Vision
After a general surgery internship at UT Medical Center in Knoxville and residencies in anesthesiology at UK, Harned took a fellowship in interventional chronic pain at UK. He chose to join Lexington Clinic in December of 2011. Lexington Clinic’s appeal was the opportunity for collaboration that Harned sees as integral to effective comprehensive pain management: “I feel that Lexington Clinic offers an amazing opportunity to care for patients in a model way. You have easy access to their family physicians, their neurologists and surgeons so that everyone is moving in the same direction.”
Harned’s youthful energy- he replaced three outgoing pain physicians– was bolstered by deft usage of clinic-wide EHR. “Within Lexington Clinic,” he says, “I use the EHR to know exactly what the primary care physician for any one of my patients is thinking, so I spend less time on the phone coordinating care. More of my time is spent delivering care.”
And it’s working. Having harnessed the twin attributes of his generation, willingness to collaborate and comfort with technology, Harned’s practice at Lexington Clinic is seeing more patients than ever, and he envisions expanding it.
Modern Pain, Modern Tools
As evidenced by Harned’s patient population, the growth of pain management needs in Central Kentucky is the result of two phenomena: aging boomers who insist on staying active and trauma in athletes in the 16–25 demographic. “Most of my patients come to me for back and leg pain due to lumbar disc herniations, neck and arm pain due to cervical disc herniations, and low back pain due to musculo-skeletal disorders. I see a fair amount of postherpetic neuralgia in our older population,” Harned says.
Increasingly, Harned sees a steady stream of cancer patients, many from Lexington Clinic’s John D. Cronin Cancer Center, who suffer from chronic cancer-related pain. He explains, “cancer treatments have come so far, but while they are more effective in fighting cancer, they oftentimes leave patients with pain.” Complex regional pain syndrome and auto-immune diseases like lupus also contribute to his patient-load.
Only a small percentage of Harned’s treatment plans use narcotics. Instead, he employs interventional treatments such as neuroablation and neurostimulation to manage pain at its point of origin and pain pumps that deliver steroids and opioids where applicable. Harned also uses ultrasound-guided injection when appropriate to reduce the radiation risk of fluoroscopy.
Seeing the Future of Pain Management
Like many pain specialists, Harned looks forward to a more sophisticated approach to dosing and ultimately less dependence on opioids. Pharmacogenetics could be the answer. Practitioners can utilize genetic testing to know what to expect pharmacologically from patients who are reporting higher dosaging needs than are normally expected. Genetic testing is costly and challenging for patients now, but he expects that will change.
A critical advancement in pain management that Harned foresees is the evolution of injected material. He opines that “our injections will be to the same places but will be of platelet rich plasma that has been spun down from the patient’s own blood.” With this, Harned believes “that steroids will be a thing of the past.” He knows that nerve stimulation and drug delivery have room for evolution also.
While Harned is energized about the future of pain medicine, its present is vibrant at Lexington Clinic. For him, “tailored individual therapy is what we need to do” and his interventional approach at Lexington Clinic, with a robust EHR system and family physicians and specialists close at hand, is effectively moving him towards that future he envisioned in medical school.