05-15-23 Interventional Pain Management with Dr. Ali Esfahani

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Episode Transcript

(00:00):
Mix when I was six to five. Good morning, it's Christina Woolford.
Welcome to Lady Parts with doctor RichardVillarreal of Adina Women's Health. Good morning,
doctor Villarreal, Good morning to you. How are you. I'm doing
great, How are you doing well? Thank you very much. So it's
time for another show. We alwaysfocus on women's health and what is our
topic and our guest today, Well, today we're going to talk about something

(00:20):
interesting and it's something that's been affectingthe country more and more and more.
And we're very fortunate to have providersnow at Adina that take care of these
problems. So we're talking about pain. We're gonna talk about pain management,
how you deal with it, whatyou do. It's not something that you
have to just deal with on yourown. We knew how people now that

(00:42):
can help you. And I'm veryexcited today to introduce doctor Sahani, who
is with us now at Adina.He went to a regular school to college
at Ohio State University. He wentto medical school at the University of Toledo,
It's where I went. And hedid as reside and see at the
Cleveland Clinic and he did this fellowshipthere so very happy to have him here

(01:03):
today, and we're going to hopefullyenlighten everyone about some of the things with
pain and what can be done forit. So we'll get started. Thank
you so much for being here todaywith us. We're very excited to have
you here because I know a lotof people have questions on this. So

(01:23):
what we're going to start talking aboutis pain. So let's just start there
first. Let's talk about there's differenttypes of pain. Yeah, go ahead.
So, I know we have everythingfrom chronic pain, there's injury pain,
there's fibrom aalogya. I mean,I deal with a lot of post
operative pain. I have you know, enemy Rosa's pain, type of things
like that, my facial pain.There's kids in sports pain, knee pain,

(01:46):
back pain, and you deal witha lot of that. So how
do we how do we sort ofencompass, sort of think these things and
what do we do about them?Yeah, that's that's a great question.
Yeah, first off, I wantto say thank you for having me.
I appreciate you being willing to hearme out and hear my opinions on these
things. So m Yeah, that'sa great question. And so pain is

(02:09):
a very heterogeneous population, as youkind of alluded to. There there's a
lot of different types of pain.Acute pain, which usually is less than
three months versus chronic which is morethan three months, are often thought as
like different animals or apples versus oranges. So it is hard. I mean,

(02:30):
I will admit the year of twentytwenty three. When it comes to
chronic pain, there's a lot ofunknown still about what are the mechanisms behind
it, what are the most effectiveways to treat it. But I think
we are chipping away with the researchand kind of our our treatment medalities here
and so I know, mean andthe rest of the group. When when

(02:53):
we meet someone for the first timeand they're telling us about pain, a
lot of it is just kind ofgetting to know them, because saying the
kind of the chronic pain arena,chances are we're going to be working with
each other for at least a fewa few visits, a few times getting
to know each other, and alot of that is just trying to get
to know them and try to understandthem. It sounds very vague, we

(03:14):
try to understand them as a person. Because pain was often thought of as
purely like a mechanical condition where kindof like a car, where this is
rusty and therefore we need to changeit out, we need to oil it
up a little bit. But probablyin the last twenty fifteen years, we're
starting to understand there's a lot morebehind it and kind of underneath the surface.

(03:37):
So there can be psychosocial factors,there can be other things that kind
of drive into pain. So Iguess what I'm trying to say is we
try to simplify that into what timewe have in the clinic to try to
get to know them. And Ifeel like once I get to know the
patient a little better, I cankind of start to dig at maybe what
is driving their pain and what canI do about it personally. That's awesome,

(04:00):
Yeah, I mean because I rememberway back when I started. I
mean, it's you know, youhave pain. What you know, did
something break and something tear? Yeah, the thing, And I like the
fact that you're dealing with more issues, you know. Do they have depression,
do they have sleep issues, dothey have social issues? Uh?
And that's that's great because I think, uh, particularly chronic pain involves all
of those things, yes, verymuch, and all of those have to

(04:24):
be a part of the healing process. So that's great. So let's start,
well, let's just pick one andlet's just start down the road and
say what we can do. Solet's let's probably let's start with an easy
one. Let's just start with likepost operative pain. Okay. So post
operative pain, I will say,is um a little simpler compared to chronic
pain because we're still in the acutestage. UM. A lot of times

(04:45):
are acute pain. UM you candiscern it on imaging or you can point
to the cause of it easily,and so a lot of times uh.
And and from my experience and fromat least the research and the studies I've
seen, UM, it does respondpretty well to our modalities, whether it
be medications, injections, other modalities. UM. Post thought pain, you

(05:06):
do treat it um uh. Andthe medications again are fairly effective towards them.
UM. So you kind of treatit to the point where the patient
UM can feel comfortable. So Ihave a little bit of a rehab background,
So I did a rehab residency,okay, And so a lot of
times we were dealing with people withpost thout pain, whether it be from
a spinal fusion or UM. Youknow, like a hip replacement, and

(05:30):
so UM, we were telling thesepeople to rehab and participate in therapy,
and you can imagine that pain iskind of a barrier towards that. I
just come a hip replaced. Um, doing therapy is not the most fun
thing to think of right now.So UM, we would treat them symptomatically
and they would do pretty well inthat way, and so I will save
all the pains. That's probably oneof the simpler UM. And uh,

(05:53):
yeah, if if that makes sense, and I feel like I answered the
question there, Yeah, so thenhow about well then you talk don't you
talked about spined and the same thing, what about knee or back pain?
Yeah? Otherwise do you mean likein the in the acute postop or just
run chic they hurt themselves. Sothat definitely with chronic it's UM, it's

(06:14):
much more complex and so UM onceyou start getting past and again it's not
hard and set rule of like threemonths, but once you start getting past
a few months of the pain umpersisting, UM, then we need to
start kind of looking at the personas a whole. UM. So there
are times where especially in the spineor the knee, it is as simple
as Um, you do a ne x ray or you're do an m

(06:35):
rin. It's very it's clear asday that, um, they have severe
arthritis. UM. It kind ofwalks like it, it talks like it,
and you can treat it um withwithout other you know, are many
modalities, UM. But then thereare also sometimes where UM, we're finding
more and more that imaging doesn't alwayscorrespond to how much pain the patient is

(06:56):
in. And I'm sure you seethis on your side, UM, and
that's when you kind of I've gotto dig a little bit deeper into like
you said, UM, how arethey sleeping, what's their mental health,
like, their social factors involved,even nutrition? UM. I do try,
I granted it, and you probablyknow, well it's we're a limited,
uh a little bit on our timein the setting of healthcare. But
I do try to dig into thatbecause I feel like the human condition,

(07:21):
especially with chronic pain, is hardto simplify, and so I try to
touch on a lot of those thingsand see what could be the factor among
those that is driving their pain.That makes sense because I mean a lot
of these people have tried to dealwith this at home, you know,
for a long time and how howwould somebody know or what would you recommend

(07:42):
as somebody you know who does havechronic pain, this is just pain they've
been trying to deal with. Oh, you know, I'm just getting older,
or I can't move around like Iused to, or they say,
oh, I'm fifty years old,I can't do what I used to do
because it hurts. And what wouldyou say to somebody like that? Yeah,
and that's a great question because wesee that a lot. And what

(08:05):
I would say is I do specificallyhere at Adina, I have a lot
of trust in our primary care doctors, and I think initially it's it's not
wrong at all to seek help fromthe primary care doctors. I think they
do a great job of evaluating thepatients, making sure a lot of times
when it is chronic, we wantto make sure that there's nothing scary going

(08:26):
on, so goodness forbid, infectionor cancer, something that I could be
driving the pain that you know,you want to kind of find earlier than
later. And a lot of timesthey'll see the primary care doctors, and
if the primary care doctor doesn't feelcomfortable with it, they are more than
willing, you know, more thanable to send them our way and we
can do an evaluation. But atleast for me personally, and I have

(08:50):
lived with chronic pain, that wasthat was a big reason why I kind
of got into this field. Iwent to my primary care doctor first,
and I think that's not a wrongplace to start. We do take people
here in our group. We calllike off the street where they can make
an appointment if they need it.They don't need a referral. But I
think that's a fine place to startwith your primary care doctor and get an

(09:11):
initial work up and see how thingsare going, and we can always take
it to the next step with aspecialist if needed. I think that's awesome.
Okay, So you know, ifsomebody has been just sitting there and
just saying I get through, Ican do this, I can do this,
you'd recommend them following with the primarycare doctor or they can even call
you guys and get in right.Yeah, and certainly neither is wrong.
I think it's kind of nuanced intoyou know, who feels comfortable with seeing

(09:33):
what, but it's it's certainly Ithink it's a it's a good kind of
gateway to see the primary care andif they feel like that, it's something
that they would benefit from, sayingone of us here, they certainly can.
And likewise, if if the patientreally thinks that they want to see
a pain provider, they're more thanwilling to. I wish I had more
of a said answer for you,but that's what I was gonna say,

(09:54):
because we were sort of going aroundthe point, but sort of like,
who would benefit from a pain managementfirst? That's a great question, I
would say, truly, Like,let's assume that they have seen a primary
care doctor, okay, and they'vebeen at this for a while. They've
tried a few things, medications,conservative treatment like physical therapy. And let's
say they haven't done physical therapy,and the doctor has done the xtray and

(10:16):
ruled out something scary or other imaging, and they've done you know, they've
tried medications and they just feel likethey're not really make it picky much headway.
Then I feel like it's really reasonableto send them towards us and say,
hey, can we get your opinionand see what's going on? Yeah,
okay, that makes sense, Solet's talk about something. I mean,
we can just jump back and forth. There there's so much to talk
about in your field, but let'stalk about some of the therapies that you

(10:39):
use. Let's let's start with somereally simple ones, and let's sort of
work our way towards you know,like the pain medications well way up.
Um. Yeah, so there's definitelym I often tell my patients it's it's
kind of like my buffet of optionsthat I can I can offer you.
And I say that in a waybecause I'm trying to kind of empower the
patients to kind of make this decisionwith me as to what do they what

(11:01):
is something they think is reasonable totry, and I can of course advise
them. So first we kind ofstart off with a lot of times because
I see a lot of spine issuesand other muscular scale to issues. UM.
Therapy is often we rely on ourtherapy teams a lot because a lot
of times we're just trying to getthese people to our patients to strengthen things

(11:22):
that maybe haven't been strengthened for awhile, improve range emotion. UM.
Also, this is getting a littlebit deeper into like pain neurology, but
kind of a lot of what wedo in pain management, especially with the
therapy, is kind of trying toshow the body if you think of it
as like a volume on the radio. We're here at a station with volume

(11:43):
on the radio is on a ten. We're trying to find ways and therapies,
one of them to kind of turndown the dial a little bit for
lack of a better way. Sothat's the therapy. Medications is another arm
of it. We have a lotof medications at our disposal and and a
lot of times it's kind of doingthe dance of um, you know,
what medication, what medications are they'realready on, What is the condition at

(12:05):
hand, what medical like conditions theyhave that might prevent it from being safe
to be on the medication, becauseit's kind of factoring all that together.
UM. Certainly there's an interventional side, which is more of our you know,
we're all trained in that in ourin our in our floor and the
interventional pain management team. So kindof break it down into there are diagnostic

(12:26):
injections, UM. Those are morewith the numbing medicine. There are UM
therapeutic and injections with steroid UM.There are oblations UM, and then we
start getting slowly towards the more advancedprocedures. So I think doctor Porter came
on here talking about pelvic pain,and he talked about the stimulators and that's
kind of the more nearer and excitingum feature of pain management nowadays. Um.

(12:50):
So there are spinal cords stimulators,there are peripheral nerve stimulators, um,
and there are that's probably i'd saythe gambit of of a lot of
what we do. I'm sure I'mmissing something along there, but yeah,
there's a lot and kind of alongthe way. One last thing is a
lot of times I phone a friendand I do refer for if if they
feel like their mental health is notdoing well, I'm going to refer them.

(13:11):
Same with nutrition and also even sleepmedicine, just to see it because
I do I personally believe and Ithink the studies back that that all these
things can contribute to your chronic painpicture. That's awesome. Okay, so
you mentioned interventional pain management. Sowhat's the difference between just pain management and
an interventionalist. Yeah, and Ithink the answer you we get would very

(13:33):
un who you talk to, tobe very honest, but if you ask
me, I think intervention interventionalist isa person person who has the tools or
the capabilities and they've learned it alongthe way to use injections or other means
to try to identify the problem orthe pain and also alleviate it. Among

(13:56):
the many other things that we use, interventions are certainly a focus, especially
in like the spine world UM orthe muscle, the scale of the world
for UM, things that can helpus. But yeah, I think pain
management. And we have UM providersup there UM who don't do interventions,
but they certainly are great pain managementand providers UM, and they can help

(14:16):
the They can either help figure outthe patient is UM eligible or someone who
would be a good candidate for theintervention UM or kind of manage them with
the other therapies that we have ata hand. Okay, so let's let's
talk about some of the therapies you'dmentioned, you know, a number of
them. So let's let's start withyou know, when you start with somebody
coming in and say they have backpaint or whatever. So let's let's start.

(14:37):
Let's talk about some of these therapiesso people understand what they have to
you know, what you offer,and so they're not gonna be afraid of
it. Yeah, and that's that'sa great question. And UM, when
you say therapies do you mean morelike the objections, Yes, yeah,
and I will admit, um,I don't think the human human the human
condition is is predisposed to wanting andneedle, you know, stuff conside you

(15:00):
so immediately there's a lot of anxietyand kind of trepidation behind it. But
behind that but um yeah, sothey're the gambit. There's a lot of
them, and I'm sure I'm gonnabe missing them. But um so,
if we think that the facete joints, which are little joints within the spiner,
are possibly causing the condition we have, we can do like a facete
joint injection. That's a little bitless common now versus like medial branch blocks.

(15:24):
Those are more diagnostic. So trulywe try to identify which of these
joints is causing the pain, andif we're able to identify it successfully,
then we can do an oblation,which involves um kind of burning that nerve
purposefull. You're trying to cause somedamage to that nerve because the thought is,
I tell people, it's it's kindof the security system. Um,

(15:46):
so it's not able to communicate tothe brain, then you won't feel as
much pain. Yeah, and thenmore commonly. I'm sure most people have
heard of the epidurals um. That'scertainly the thought is with the the steroid.
There's there's theories on how that works. The most prevailing theories it can
decrease inflammation if there was a herniadisc especially UM. It can also decrease

(16:07):
pain signals to the brain. UM. It can also decrease swelling of nerves
that are irritated. Those are kindof the predominant theories. We also do
injections for all kinds of other joints, so like hip joints, s,
high joints. I kind of havea lot of my niches, a lot
of muscular skettle of medicine, soI kind of do a lot of those
other things and other joints to whetherit be a knee, shoulder. And

(16:30):
then lastly, the more advanced andagain the newer therapies are kind of this
um the stimulators and so UM.Again, I kind of describe to people
that the best way we can understandin nowadays with the stimulators is if there's
like a radio wavey. I keepcoming back to this analogy of radio and
radio stations, But if the painconnection between the brain and the bodies a

(16:55):
radio wave. They essentially scramble them. Um, they bring in signals to
the kind of scramble, so you'renot perceiving the pain as much. Um
and uh again, I'm sure I'mmissing something, but that kind of is
the broad on the interventional side.That's I mean, that's awesome. That's
it's it's so advanced, so muchfarther advanced than you know when I started,
and what you guys are doing nowis amazing. So yeah, I

(17:17):
mean anywhere from the injections, becauseI know my wife was having some knee
problems, so she came in andshe saw one of the one of your
guys and they did the injections toher knee, and I was like,
didn't that hurt? She goes,She says for a second, she says,
but my pain is going. Yeah, She's like, it was so
worth it, you know. Andyeah, that's the thought I tell people.
And then again, I've been throughthese injections myself, and I think

(17:40):
I'd like to think that gives mesome perspective, and I think that helps
the patients know that, um,yeah, you might might in my poke
or burned for a little bit.But her thought is maybe we can give
you some longer term relief. Andmost people were pretty happy with that.
If we can do that for them, that's all. Yeah, especially they
get up and be mobile again anddo what they want to do without pain.
Yeah, exactly, yes, Andwhy wouldn't you do this? So

(18:00):
so there are other things, solike, UM, we talked injections,
we talked about some of the others. What about like some other therapies as
or like about a feedback or didwe do any type of physical therapies or
I don't know. Yeah, that'sa great question, so UM kind of
going to the physical therapy. UM. You know, I think we have
the luxury here. We have agreat UM therapy team that we can lean

(18:23):
on. UM. And I willadmit, given my rehab background and the
way I was trained, I'm abig believer in therapy UM. And I've
met with the team and they're great, And we have this feedback where I've
met with them and tried to seewhat are things from my end that would
be helpful to make sure that whenyou get the patient and you start working

(18:45):
with them, that you both areset up for success. But certainly we
rely on them a lot. Andagain I want to emphasize in that therapists
are uniquely trained and so I don'thave that training, and that I know
it's I can identify a problem thatI think would respond well to therapy or
do well, but I can't tellthem the nuances of what specific exercises.

(19:11):
I might be able to have anidea, but I think the therapist themselves,
that's why they go through this trainingand they're very good at figuring out
does the patient have a directional preference, so they have certain exercise they respond
better to. And I do relyon them in that way in regards to
like biofeedback or cognitive behavioral therapy.I am also a big believer in that

(19:34):
for some of these chronic pain conditions. I will say in a lot of
healthcare systems it's more of a luxury. I know that we are trying to
work towards that possibly, but moreof these tertiary, large academic centers have
them, and certainly there is largevalue in those things too. Okay,

(19:55):
well, see that's awesome. Imean, you guys have such a broad
spectrum of things that you can forand that's wonderful. Um, let's talk
about some more of that I wantto come back to some more of these
chronic pain issues though, um solike the the arthritic pain, you know,
arthritic changes, some of the backpain some of you know. Is

(20:15):
there anything that can be done forsome of these issues? Yeah, no,
certainly, um I will say,like a lot of our interventions,
if if if it's someone who trulyhas this mechanical often I call it mechanical,
where um, if you think mechanical, like it's a rusty knob on
the door, or I guess Ishould say rusty hinge, and it truly

(20:36):
is kind of walking and talking likethat. We can certainly do a lot
of interventions, whether it be kindof this oblation of those the nerves that
provide sensation to those little arthritic jointsin the back, or also kind of
steroid injections. They actually respond prettywell to it. I do tell people
a lot of times the thought isa lot of these do provide long term

(20:57):
relief, but it's also hard toknow truly how long. Um. I
think everybody's a little different. Everyoneis a little different. And again this
is kind of the nuance of chronicpain is we're just not there at that
point too to accurately predict um,how long is it going to respond for?
But they do, they do workpretty well for a lot of these
conditions. And UM, yeah,I guess that's a that's the best of

(21:18):
way I can make service. Thatmakes sense. What about Are you a
believering fiberm aalgia? Am I believer? Yeah? Yeah, I will say
I am. I am a believerin fiber malagia. UM. I think
I think fibermalagi is a very UM. I tell people very generic or like
umbrella term for UM, kind oflike chronic pain of unknown origin. They

(21:40):
just can't figure out. Yeah,they hurt. I mean I believe I
have a lot of women they evenknow they're diagnosed with it, and I
believe because they hurt. Yeah,and they hurt. And that's been often
historically UM with patients providers. Itkind of causes a lot of times like
a strained relationship because the provider mightget frustrated because we don't have a great
test for it. You know,we don't have a lab test. We

(22:00):
don't have UM like a seriological orblood test. We don't have an imaging
for it. UM. But it'svery real, I mean, at least
from my experience and what I've readand then what I see on a daily
basis. Um, it's very real. And UM, I think the studies
have shown that like, um,the amount of reduction and quality of life

(22:21):
is almost sometimes compared to like peoplewho have cancer. It's pretty significant and
UM, and I will admit Itry to hit it from all angles with
what the referrals out to these placesthat are these specialties we've talked about.
There's not always an easy fix,excuse me, and there's not always an
easy fix for it. But youknow, one hundred percent, I'm a
big believer and I think it healthcare. It's a little frustrating for providers because

(22:42):
again, I think we're all kindof in a way concrete thinkers that we
want to see it on an imaging. I want to see it on m
R. I want to see onsomething. But UM, it's it's a
little unsatisfying that way. You're notgoing to see it in that way.
But UM, yeah, no,one mostly big. It's there, and
it's just like you know, howyou could you know, wrap your arms
around it and trying to figure outhow to fix the mixture that they can

(23:03):
have a productive life. Yes,exactly, and I think, you know,
the thought is maybe that's the nextstep in chronic pain, is maybe
we'll be able to capture with somekind of imaging. I know there's this
is kind of getting into the littlebit of details here, but there are
some really advanced like functional MRIs thatcan sometimes capture like what part of the
brain is being lit up, especiallypeople who have chronic pain. Um,

(23:23):
I just don't think it's ready forshowtime yet. You know, for us
that we're using our clinics, butthere is evidence that you know that there
are areas of the body that arelighting up or active and people who have
chronic pain, and it's very real. Yeah, that's awesome. Okay,
So okay, so so let's getback to since this is a women's show,

(23:44):
is pain different in women than men? And are there different things that
cause pain to be different? Yeah? Can you answer that one. That's
a little difficult. I'm sorry.I will try my best. Um,
I will say a lot of times, at least from my view, I
think I really try to whether itbe a man or a woman, I

(24:04):
try to make it very personalized ina lot of their factors. So how
old are they, what medical conditions, they have UM, you know what
other associated things they have that mightbe driving their pain. So I will
say gender is probably down the listfor me, I think specifically. That
being said, there are things thatexcuse me that, let's say, females

(24:27):
may be predisposed to. And soin my training and what I've learned and
seen as a thought as sometimes femalesespecially who have who have given birth to
children, might be predisposed to likea sacreliac joint pathology or orthopathy or DYSFUNCTIONUM.
Similarly like UM, at least fromwhat I've seen and read and tree,

(24:48):
they're a little more predisposed to likeM potelo femoral pain of the knee.
So there is that, and Iwill say, I'm going to put
a plug in for our group hereis we have providers who are a little
more I would say experts, uh, treating pelvic pain. I know doctor
Porter would talk to you about that. And so I would say, of
all the things that I treat orsee, I would say, I probably

(25:08):
feel UM, my knowledge base isn'tas strong when it comes to pelvic pain.
But that's the beauty of our groupis we kind of cover the breath
of pain management and our group thatUM. Even though I might not be
the strongest at it or treating ordiagnosing it, I know doctor Porter feels
pretty comfortable with it and and heoffers a ride of modalities and treatments for

(25:29):
it. And so I think that'ssomething I think we take pride in that
we cover, you know, thethe breath of chronic pain between all of
us with our strengths. So,so what do you like to do?
Yeah, that's a great question.You know, I'm find out. I
mean, you're easy to talk toand you're you're very personal, So just
what do you like? UM?I like, so I like to I

(25:52):
will say there's there's both like andwhat I what I'm confident, identify and
treat. Yeah, I like helpingpeople. I guess that's the most basic
way. But I will say witha little bit more detail, I feel
like my niche or what I whatI feel like I can bring to the
table is more spine and then alsojoke with people kind of like the neck

(26:17):
down with the muscular scale system.So whether it be a risk, shoulder,
elbow, knees. I've always hadinterest in that UM and and that's
kind of what my focus was intraining and that kind of stems again for
me having my own issues with chronicpain. And so I would say that's
kind of my kind of niche inthis group that I'm trying to carve out

(26:38):
a little bit because I get intolike old sports injuries, things like that,
that type of nature. Yeah,not just that, I mean by
no means I mean I I reallydo enjoy treating the elderly population too.
Um, but I in all chronicpain conditions, honestly, I will take,
um, you know, I'll takea run at it and see if
I can bring something to the tablewhen I have a patient. Um.

(27:00):
But when if you were to askme what what conditions or what what kind
of realm of chronic pain do Ifeel like I'm the most confident in,
it would be definitely a spine.And then also kind of like muscular scale
medicine. We refer to it assports medicine, but I like to term
it as muscular scale medicine. Thatmakes that's a big it's a huge area.

(27:21):
I mean, you have a hugembetarian for it, So I mean
that's awesome. So what else doyou guys offer in your group? So
you have that we talked about doctorPorter with public pain. What else Yeah,
yeah, so I'll try to UMthink what else do our providers offer?
So UM Regina Tolliver's our nurse practitioner. UM. She's very specialized in

(27:42):
that she can UM, she canmanage and she can manage pain pumps,
which is very much a niche andpain and pain management that every pain group
has. That that's very valuable.UM. And then I know Doctor's Young
he does a lot of spinal cordstimulation UM and that we can also uh

(28:03):
use and not only for our backconditions and and and uh you know pain
conditions that haven't responded to surgery orthey're just persistent, but also UM even
for like diabetic neuropathy that UM doesn'trespond well to medications. UM I do
also it's there is pain associated ifI do like botox um for people who

(28:23):
have spasticity UM and that can bepainful. But in a lot of these
like conditions is just strokes spinal cornergythat have spasticity. UM. I know
doctors Young also does botox um UHfor like uh muscular pain. I think
we also do we have I believedoctor Porter, and I want to say
doctors young and even doctor John Ithink, uh, they also do um

(28:45):
injections for like occipital neuralgia UM.And then again I like to I like
a lot of the interventions with ultrasoundand kind of the muscular scala system.
UM. I guess I'm gonna gonnarun through and just talk about everyone here.
So doctor doctor Temperado um, sheher focus is more interventional spine or
treating the spine in itself, similarwith doctor Santiago UM. And I'm not

(29:10):
trying to sell them short at all. That they're very good and they kind
of that's what they focus on inthat way, that they're very good at
diagnosing and treating the spine. UM. And then yeah, I guess I'll
leave it at that. That's ahuge group. Yeah, and it's a
wide range of you know, youcoverage about everything, I hope. So
yeah, yeah, I'm sure I'mmissing something, but yeah, no,
but that's wonderful. But I meanthat gives all the listeners at least they

(29:33):
understand I mean, just about anytype of pain you guys can take care
of. Yeah, and you know, there again is a very very heterogeneous
population or chronic pain. So therethere are you know there are patients out
there that we may not be expertson or have the modalities for, but
Ellis most of us are able toEli's you know, evaluate them and figure

(29:56):
out if this is something here atAdena most of the time that we can
help take care of um or isit or will they be better suited at
another institution. That's very rare,but it does happen occasionally. But you
know what, that's nice to hearbecause I think you know, I'm a
firm believer. He said, youknow what, I don't know everything,
and if I can't take care ofit, I'm going to find you the
best person. But I think that'sa sign of a good physician. Yeah,
no, I appreciate, and that'sthe type of a physician that I

(30:18):
think people would want because if thisis what you guys do for them,
saying if I can't do it,I will find you somebody who can.
I think it's fabulous. So nowwhere are you guys located? Yes,
I'm gonna I'm gonna cheat and pullout myself phone for this. So um,
we all we all see patients here? Um in chel coffee okay?
Yes? Um, So starting inJune, I will be going out to

(30:40):
Jackson okay UM one time every singleweek. UM, and then Regina Tolliver
is already in Jackson. UM.I'm going to include our spine surgeons in
this too. Doctor Fleming will alsobe going out to Jackson. UM.
When it comes to Circleville, whichis our north region, doctor Porter goes
there UM and doctor Jean also goesthere. And then doctor Walker again who's

(31:02):
one of our spine surgeons, seespatients. Awesome. UM, I'm going
to continue reading, keep going soUM. Also in Pike, doctor John
sees patients that are currently in ReginaTolliver sees patients in Pike. UM.
Lastly in Greenfield UM, doctor SantiagoUM sees patients and I believe he does
procedures in Greenfield. And then doctorTemperado will be going out to Washington cor

(31:25):
House UM coming June. And thendoctor Fleming at least in my list,
UM, we'll be going out towashingtonor House coming June. Also. That's
awesome. So in North, North, Southeast and West yeah, yeah you're
there, so that's good. SoI mean everybody can get to you,
it can be close to home,yeah, which is awesome. So yeah,
So I mean, this has beena great conversation. That's you know,

(31:45):
a lot of information. I hopepeople understand that you know, what
great, great personality you have,what you bring to the table, and
actually what your whole team brings tothe boy. Thank you. Yes,
so I think that's great. Andnow how can they get ahold of you?
Yeah? UM, so I willsay I don't I don't have the
phone number on me directly, butI will say, UM, you can

(32:07):
reach out to whether it be theUM operator or nurse triage, and they
can get a hold of us.UM. But honestly, I believe,
at least the way I've been informed, UM, is it if you call
and you ask for an appointment withpain management, we'll see you and we'll
try get you. She don't necessarilyneed to referral. You can call in
and get in like you said earlier. Yeah, and that's what UM.

(32:29):
And I'll put another plug in.Ashley Flannery is our is our manager here
and she does a great job ofmaking sure that patients can can see someone
who UM we feel like it's wellsuited to help them. And then also
as soon as possible. That's abig deal because we know that you know,
living with chronic pain is not somethingfun and we want to help you
as soon as we can, andyour friends and Adana are here to take

(32:49):
care of you. Yeah, sowe appreciate it very much. It's right,
all right, Thank you very much, and thank you doctor Esfahani for
coming in here with aDNA. Andof course I like you said, you
can call the main Adena number.Also, Adina dot org has everything you
need, just look it up there. So again, thanks for being with
us today. This has been LadyParts with Doctor Richard Villarreal. It airs
the third Monday of every month atten am on Mix one oh six five

(33:12):
and Chilaicalthee. You can also catchthe podcast on the free iHeartRadio app.
Just open the app up, clickon podcasts, and then do a search
for Lady Parts with Doctor Richard Villarreal.