Host Dr. James Flowers and VIP Guest Dr. David Lee educate Co-Host Robin French and the listening audience on the subject of chronic pain and the various treatments. Dr. Lee discusses his role as a spine specialist and how he spends the bulk of his day managing his patients with chronic pain. Dr. Lee also discusses recent projects with patents for spinal devices and how he works with companies on the cutting edge of cellular therapy and concussion treatment.
—
Listen to the podcast here
Chronic Pain Treatment With Dr. David Lee [Episode 19]
I’m super excited. My good friend, Dr. David Lee from Hattiesburg, Mississippi. Dr. David Lee is a distinguished ABNS Board Certified Neurosurgeon in Hattiesburg, Mississippi with several years of experience in working with patients. He is a fellowship trained spine specialist with Southern Bone and Joint Specialist. He is very active in the management of chronic pain, which is how I know Dr. Lee and is a consultant for several companies who manufacture devices that treat this condition. Dr. Lee also has several patents. Dr. Lee, welcome to the show.
Thank you.
Chronic Pain Treatment
I had a question for Dr. Lee about one of those patents. How many patents do you have, Dr. Lee?
I’ve got one. We’re rotting up a nurse. I think five other ones are all spawned devices.
There was one that I was reading about. It’s a machine that provides spine surgeons with the test that 79% more accurate than the typical MRI machines. It also reduces cancer causing radiation exposure but that was something from a few years back.
Most of the things that we’re developing now are mechanical type implants and things of that nature. I spend all my day treating spine patients now. I quit doing cranial surgery a few years back, but I did my fellowship in spine after doing my residency in neurosurgery. We focus all our time and energy on spine. I’ve got some physician assistants and nurse practitioners who work with me. I’m in a big Orthopedic group in town where there’s 14 or 15 orthopedic spine surgeons in our group. We have neurology, physiatry and all the insulated services as well. It’s a big surgery center. We try to provide comprehensive bone and joint care, so to speak, but my focus is entirely on spine.
Neurosurgeon
In the event, there’s someone reading who doesn’t know what a neurosurgeon is or does. Can you explain that to the audience?
Neurosurgery is as a field of medicine where we’re focused on both operative and non-operative treatment of the conditions related to the brain, spinal cord, spine, and peripheral nerves. It may be something as simple as a carpal tunnel release that we do routinely versus taking a ruptured disc out of your back or fixing a neck fracture. Those are things we do routinely. Once again, a majority of people who do it are still practicing cranial surgery.
Again, if you have a brain tumor or if you had a stroke or things like that, we deal with diagnosis and treatment of those conditions as well. It’s a pretty broad field. There are people who specialize in movement disorders that treat Parkinson patience for tremors. You can get very specific into some specialty areas of neurosurgery.
There are certain doctors who are only pediatric neurosurgeons and ones who do the spine and ones who do tumor and vascular surgery like aneurysms and things like that. It’s just a broad field as opposed to neurology. Neurology is more of the treatment of headaches and seizures. It’s a different spin off, but we do a lot of operative things. We also see a lot of non-operative things as well.
Sports Medicine
You do a lot in sports medicine. Can you talk a little bit more about that, too?
We’ve got some things that we’re working on as far as products related to like a pre-concussion cream that you would apply topically to the carotid arteries. You do it before any type of context in sport. In case you took a head, either concussive or some concussive blood to the head. It’s like an anti-inflammatory effect to lessen the entry to the brain.
I’m also involved with a company that’s producing a neuropeptide that you would inhale it like a nasal spray that would help treat concussion. Bret and I are involved in those two companies. Reps from Hattiesburg as well or lives here in town and we’ll probably have him on his subsequent visit. He and I work with these two companies. They’re related companies but separate in other ways. We’re on their advisory board for those type products.
Psychology
You and I worked together in how to multidisciplinary chronic pain program. For patients that you were seeing, a lot of your patients with spine difficulties and the work that you do on the spine. A lot of patients have chronic pain prior to coming to see you and sometimes, come in with severe depression or severe anxiety or fear or grief or avoidance or somewhat of a poor attitude saying, “I’ll never be able to accomplish anything again.” How do you think psychology fits into your practice and in the world of chronic pain treating a chronic pain patient?
This is something I see every day. Every day of the week, I have to deal with chronic pain. In my practice in particular, I do most of this area’s spinal cord stimulation. I’m seeing the worst of the worst when it comes to the chronic pain patients. As you said, take a typical like an injury of any type. It didn’t have to be a work comp injury. It could be any type of injury. If you look at the pathology and then what happens afterwards for the psychology of it. Initially, to get not too technical, a stimulus is applied to a nociceptor. A nociceptor is just a cell or a receptor on your body that registers whether it’s pressure or temperature or something that’s a noxious stimulus.
Those signals transmitted from the nerve through the autonomic the spinal cord to dorsal columns. That information is related to thalamus of your brain, which is part of deep brain and then it sent to several areas, including the limbic system. The limbic system is the emotional center of your brain. All these areas timed together. There’s the physical contact that calls this a simulation, but then there’s all this cascade of things that get set an emotion and then take the typical person who gets hurt. They hurt their back on working offshore.
They get sent home and they can’t go back to work within two weeks. They get an MRI scan. They’re put on narcotics, given anti-inflammatories and ice packs and then they don’t get better. They’re getting paid not to work. There’s a secondary gain issue right there that they have off the bat and because they’re hurt, their wife or husband says, “You can’t mow the yard. You can’t take the kids to school. I’ll do that.” They become less involved. The less active they get, you don’t get an endorphin release because they’re not exercising. A little bit of depression builds up, then you have to get a lawyer because you can’t go back to work. There’s so much emotional component to it.
You no longer have just that physical stimulus that causes the receptor to be activated, but you’ve got this entire cascade of psychological things. Whether its secondary gain. Secondary gain is not just intentional. It’s subconscious. You can’t help but get depressed, withdrawn and then you focus on your pain at that point. You could testify. You feel like everything is magnified because you have nothing else to do.
On top of that, you throw the opiates. The more you take, the more the receptors get blocked and you have to take more of them. It’s just this vicious cycle. You have to intervene at some level, which is what we try to do. With some of these people, you have to get them in a psychiatric program or psychology program just to break the pain cycle, so you can start to heal.
With some people, you have to get them to a psychology program just to break the pain cycle so you can actually start to heal.
That’s exactly right, and that’s that program that he and I did together. Patients would come 8 hours a day, 5 days a week for 20 to 30 days at a time. When they came in, take the back depression inventory and the back anxiety inventory. People would score severe, severe depression, severe anxiety, and severe avoidance. A lot of secondary gain issues as well and as Dr. Lee said, not all of it is intentional. A lot of it is behavioral, or the wife or the husband says, “Let me do the dishes,” or, “Let me do this for you.” It becomes a habit.
All of a sudden, their body begins to atrophy their mind. It begins to atrophy because they’re not having to work and not doing anything. They get in the cycle and their life just starts to spin out of control. They think that an opiate or a surgery is going to help them. Knowing Dr. Lee, for as long as I’ve known him, he’s not going to do surgery unless it’s necessary. He did surgery on my father-in-law and then saw him again.
He came in. I think he had an L4-L5 disc herniation. Dr. Lee ended up doing a fusion, I believe. He’s doing well now. He had foot drop. He’s exercising and going to physical therapy but here’s someone that has worked in the forest cutting down trees for 60 years of his life and worked outside and then he had this chronic pain. It’s someone that isn’t depressed, but pain will make you depressed. You think, “I have to have surgery.” Many times, surgery is appropriate but it’s not always appropriate.
For the patients who you and I both see and we’ve seen for years and we’re in the middle of this opiate epidemic in the country. All a part, take apart COVID that we’re going through, we have this other huge epidemic that we see and that’s opiate crisis. People who have experienced hyperalgesia need more and more to have the same effect on them. Part of my luxury around the country when I’m talking about chronic pain and culture, there is an cultural difference between different parts of the world. I always ask my audience I practice and mostly in Houston, Texas.
Houston and the three counties that surround us, have about 8 million people in it. I’ve been practicing here for about 29 years. I always ask the audience, “How many Asian patients do you think that I’ve seen in my practice?” They’re like, “Hundreds.” Houston has a huge Asian community. I’ve treated less than five. You are right. It is, “I need it now.” “I need it fixed now.” “I want to know how to fix it.” “You’re a physician. I need you to fix it for me.” “I need to feel better today.”
Many times that first answer is, “You guys are so busy in your jobs and these patients come back and they come back.” Around the country, what happened is, Joint Commission said to hospitals, “If you don’t treat pain adequately, we’re going to take your joint commission accreditation away.” That open Pandora’s box and said, “We have to prescribe medication.” It opened this whole epidemic up when Joint Commission did that.
After, not to be political here at all, but with good intentions. President Bill Clinton in the ‘90s named the ‘90s the decade of pain. He signed into law that you must treat pain adequately. Not you should, but you must. When that becomes part of Joint commission then and then it becomes part of the law. Your patients are like, “I’m on that scale of 1 to 10. I’m at 10. Write me a prescription.” That’s what happened in the hospital systems.
Post-surgery now, speaking of my father-in-law, over in Mississippi. My mother-in-law had a quadruple bypass surgery. I think it was 2 hours or maybe 3 hours after surgery, she was walking loops around her floor. They were making her get up, walk and hold a pillow. She did it but years ago, it was like, “Let’s stay in bed. Your back is hurt.” Dr. Lee, my grandfather was a surgeon. When I was growing up, he would tell patients with back pain, “Lay down and rest. It’ll get better in a week or two.” That’s the worst advice you would give now. We need to move and we need to oil our backs, keep busy, and keep moving.
It’s funny though that in the Clinton years and the Joint Commission putting out that you had to treat pain and you had this pendulum shift, where everything swapped over to you. You got opiate for anything. I’ve seen people that are smiling saying, “They have a 12 out of 10 pain.” They come in and they’re on 30 milligram oxycodone tablets four times a day. They walk in smiling and don’t have a limp. All of a sudden, everything shifts to where, I hate to say it, but now pain is probably under treated because opinion always going back the other direction.
You’re almost criminalized if you ask for pain medication now, particularly the ones that get harmed or the ones who have been so long. They need to rehab to get off of it rather than cold turkey. You have to be careful what you wish for because it’s that paradigm shift. Over that rapid of a period can be dangerous, too. You can be under treated to some degree.
Now, pain is probably undertreated because the opioid is going back the other direction and you’re almost criminalized if you ask for pain medication.
Advice To Chronic Pain Patients
That’s right. The pendulum that you’re talking about, I always talk about in my lecture. Many physicians went from opaphilia to opiophobia and saying, “I’m not going to prescribe these medications. I will not do it.” What advice would you give chronic pain patients? I spoke with a woman in Dallas, Texas. She has a herniation at L4-L5 and I forget what was wrong with S1. She asked who the best neurosurgeon in the country was and I said, “If you’re able to travel to Mississippi, you need to go see David Lee.” What advice would you give someone that has ongoing chronic pain and hasn’t felt that relief yet?
It depends upon the problem because if you’ve got a deficit of some type. Say, you’ve got a pinched nerve and developing a foot drop like your father-in-law did. You probably need to have that fixed and work those things up. Figure out where you are on the scale of needing surgery based on an MRI, myelogram, and an EMG. A nerve conduction test for somebody just with chronic pain, I see people in my practice every day, we’ve had hip surgery, knee surgery, ankle surgery, and back surgery and they’re just not better. They’re not asking for narcotics or want to get off the narcotics.
There are options for people that have those conditions. Typically, you’re diagnosed with, it’s called a complex regional pain syndrome. We see a lot of those people that have it. We offer spinal cord stimulation. There are still are some people who place opiate pumps in place so you don’t get the euphoria and you can still function, but those aren’t near as common. The spinal cord stimulators are good option for people that have minimal invasive.
You try them first. You don’t just implant that $18,000 battery. It looks like a pacemaker battery, and you’ll go in and do a trial. There’s certainly options for people with chronic pain, whether it’s from joint pain, back pain, or some type of nervous condition or nerve conditions. Those are certainly options and you find a reputable, either a neurosurgeon or orthopedic spine surgeon who deals with chronic pain patients. At least get an evaluation.
I can’t believe this, but we’ve been the two minute warning, unfortunately.
I was beating my hand on my head trying to think what CRPS. It was RSD, reflex sympathetic dystrophy then they moved it over to CRPS, complex regional pain syndrome. You’re amazing as always. I can’t wait to get over to Hattiesburg.
I could be reached at Southern Bone and Joint Specialist, PA here in Hattiesburg, Mississippi. We’ve got a website. You can look up appointments online.
That’s great, and we will put that information on our website at JFlowersHealth.com. You can reach us at J. Flowers Health at (713) 783-6655.
