Steven R. Galper, M.D., Pain Medicine Physician, Psychiatrist and Neurologist at YRMC PhysicianCare, taps into this as he works with people experiencing chronic pain. Getting to know the patient and his or her journey is critical to addressing chronic pain, according to Dr. Galper. He draws on the advice of the founding father of modern medicine, Sir William Osler, who encouraged physicians to “Just listen to your patient; he is telling you the diagnosis.”
During their first appointment, Galper listens as patients describe their pain, its cause and how it has been addressed in the past.
“Pain management improves lives by giving structure to a treatment plan,” said Galper. “I ask new patients, ‘What is the pain stopping you from doing?’ The patient could respond, ‘I want to ride my horses, but I can’t tolerate it because sitting kills my back.’ Okay, let’s get to work on that.”
Together, Galper and the patient identify an objective, functional goal that will assist in measuring progress. For example, returning to horseback riding three times a week, for one hour per ride, in six months. Galper also conducts a full neurologic physical examination. Many people who suffer from chronic pain have never undergone such an examination. Depending on what he learns from the neurologic exam, Galper may recommend blood work and magnetic resonance imaging (MRI) for the patient. With all of the information in hand, Galper collaborates with the patient – and his or her primary care provider – to create a comprehensive treatment plan. While they are individualized to each patient, all of Galper’s care plans include three important components:
- Mind-Body Work – Cognitive behavior therapy – a short-term, goal-oriented psychotherapy treatment – takes a hands-on, practical approach to problem solving. The goal of cognitive behavior therapy is to change patterns of thinking or behavior that are behind an individual’s difficulties.
- Movement – Building strength is important to managing pain. Depending on the patient’s resources and other factors, Galper recommends physical therapy or provides exercises for patients to pursue on their own.
- Medicine – To address a patient’s medical needs, Galper may prescribe a non-steroidal anti-inflammatory for inflammation; a neuropathic medication for nerve pain; and a muscle relaxant for spasm prevention. Galper does not prescribe opiates as a first-line medication for patients with non-cancer pain.
“If you think about pain, it is biology, environment, nature and nurture,” said Galper. “You live at this intersection of what’s going on in people’s bodies and what’s going on in their minds. Some pain starts in your body and some pain is caused by what’s happening to you emotionally. It feels the same, but the thing is emotional pain should not be treated with opiates.”
While this is a challenging fork in the road, it suits Galper and his multidisciplinary background as a board certified pain medicine physician, psychiatrist and neurologist. It also suits the many patients he’s helped overcome chronic pain during his career.
“You’ve got to meet people where they are and work with them,” he said. “Because, their pain is very real.” QCBN
By Bridget O’Gara
For an appointment with Dr. Galper, speak to your primary care provider or other physician. If you would like more information, contact Dr. Galper’s office at 928-445-1232.