Dr. Corey Hunter, MD, an interventional pain specialist and founder of The Ainsworth Institute of Pain Management and assistant clinical professor at Mount Sinai Hospital in New York, talks about why he started The Ainsworth Institute and alternative treatment options for opioids.
The Ainsworth Institute was founded by Dr. Corey Hunter as part of his vision to create the premier center for those suffering from pain. Dr. Hunter completed his residency in Physical Medicine & Rehabilitation the New York University Langone Medical Center and his Interventional Pain Management fellowship at the prestigious Weill Cornell Medical Center – New York Presbyterian Hospital. In a short time, Dr. Hunter has gained national recognition for his many publications and contributions to the study and treatment of pain. His steadfast dedication to furthering the field, particularly pain syndromes that are the most difficult to manage, has resulted in his appointment to advisory committees and the like.
Dr. Hunter is an active member of professional organizations including the North American Neuromodulation Society, International Neuromodulation Society, American Society of Interventional Pain Physicians and American Society of Regional Anesthesia. He is considered to be a rising star and key opinion leader in the field of pain management. He lectures all over the country on the latest breakthroughs and has numerous publications to his credit, including a number of contributions to textbooks on treating pain and several articles published in peer-reviewed journals. In addition, he is a consultant and instructor for several companies who research and develop treatments for chronic pain including Abbott.
Currently, Dr. Hunter maintains privileges at Lenox Hill Hospital and Beth Israel Medical Center. He is licensed in New York, New Jersey and Florida.
Neal Howard: Hello and welcome to Health Professional Radio. I’m your host Neal Howard, thank you for joining us. Our guest today is Dr. Corey Hunter, he’s an interventional pain specialist, also founder of the Ainsworth Institute of Pain Management and he’s joining us on the program today to talk about why he started the institute and alternative treatment options for opioids. Thanks for joining us on the program today Dr. Hunter, how are you?
Dr. Corey Hunter: Good, thank you so much for having me.
Neal: Now I did mention to our listeners that you’re an interventional pain specialist, also the founder of the Ainsworth Institute of Pain Management. A bit of background.
Dr Hunter: Sure. I’m actually a little bit of teaching here too, I am an Assistant Clinical Professor at Mount Sinai and I work with residents here. But my general background is years ago before I went to medical school, I did a lot of research on stem cell therapy, using it for Parkinson’s, paralysis and pain before I even know I wanted to go into it and then pretty much I guess like halfway through my residency, I basically decided that I actually wanted to go into pain management, just all the research I did and wanted. My mother was a prescription drug addict and so kind of I liked the field I’d done so much research on it and just on a more personal note I wanted to have an impact in other people’s lives and try to prevent what had happened to my mother and just it all seemed to fit in place and then here I am now.
Neal: Is it true or is it a myth that many or most of the people that are addicted to opioids start because of an injury or surgery, something like that and next thing in a couple weeks, a couple months, they’re totally addicted and off from there?
Dr Hunter: It’s not a miss at all. I mean you really hit the nail on the head there. It’s really quite common, it can start off as a toothache, a simple soccer injury, broken bone, ingrown toenail. I mean it’s not the case in everybody but I mean what you described is really commonplace. In my mother’s case, she just started off with having migraine headaches in the 80s and doctors are very comfortable with opioids, we’ve been comfortable with opioids for a long time and in medical school there’s really no training in it. We’ll spend a lot of time learning about heart attacks and like what to do and how to treat a broken bone or a stroke but when it comes to opioids, it’s literally like a one day lecture and it barely goes over any of the dangers and the concept of addiction or overdose or misuse and that’s basically our training and then we all go into our respective specialties having only had that one lecture. And what happens is ER doctors or primary care doctors, they don’t know any different and they start the patients on it and they come back and they need another refill and another month and one month, two months, three months becomes two-three years. The next thing you know, the patient started off with just a migraine headache or just a broken bone and just a minor backache and now they’re addicted.
Neal: Now with all of that going on, this exponential growth, how many people are actually suffering from chronic pain and how many of those people are dealing with the opioid epidemic?
Dr Hunter: That’s a great question. I think people when they hear the numbers, they’re really always surprised so right now currently United States there’s about a hundred million Americans that are suffering from chronic pain and the direct and indirect costs of pain and chronic pain in this country are 635 billion per year. And now when you take that, you have all those people and then now you take everything that we know that we’re mismanaging and not properly managing pain, opioids this was just a perfect storm and then you take things like the introduction of oxycontin and more and more opiates come to the market. So now currently, opioids have now surpassed motor vehicle accidents as a leading cause of death in the United States. So it’s not slowing down, in the last year alone, deaths from fentanyl and synthetic opioids went up to 72 percent and heroin made a huge comeback because of opioids. And now between 2010 and 2015m the deaths from heroin use increased 328 percent. This is all because people, they start off on the opioids, they start off and then oxycodone they’re getting from their doctor and then they go to get it on the street and it costs about anywhere from $1 to $5 per milligram. And eventually becomes too expensive to take oxycodone and then they go to heroin and eventually one thing leads to another and then they die of an overdose from heroin. So it’s as long as pain is still a problem and as long as opioids are still accessible, these two have a perfect match and they’re going to keep going.
Neal: Aside from the pain, I mean obviously the pain is a challenge and it’s chronic pain. It’s not like “The inflammation will go away on Thursday and I’ll be okay by the weekend.” This is ongoing chronic pain. Aside from that and aside from the very real danger of becoming addicted, what are some of the other unique challenges that a person facing chronic pain is dealing with?
Dr Hunter: In some of the more interesting cases with chronic pain, it’s something that the people around them can’t see or understand. So it’s really a challenge for people to kind of get their loved ones or their friends to kind of buy into what’s going on. They think that maybe they’re just being dramatic so one of the things I treat a lot is like facial pain and pelvic pain and it’s not something you can see or feel and family members just think that they’re crazy. They think “Look, there’s nothing wrong with you. Why can’t you just get over it?” So they’re dealing with this intense pain, they can’t do the things in their life that they normally want to do and then now their family is kind of shunning them and they don’t even get support so that’s probably the most challenging thing is the psycho-social aspect of it. They can’t work, they can’t play with their kids, their loved ones think they’re crazy and on top of that, they’re just an excruciating pain.
Neal: You say family members and friends, all politicians are someone’s family, someone’s friend – what about legislation? I mean do some of these more personal aspects seem to creep in when it comes to legislation directed toward the opioid epidemic?
Dr Hunter: We wish it would. Right now the Surgeon General is a pain doctor which is great. One of the Heads of Human Health and Services is a former graduate of where I did my fellowship at Cornell … and we’re kind of all hoping that this is stuff that’s going to help us having people to understand our specialty at the top but what’s happening is that pharmaceutical companies have a lot of lobbying power and doctors don’t. So as much as, I’m the head of a couple major medical societies and board of directors and we get asked to help chime in on things for CMS which is the Center for Medicare Medicaid Services and they ask for opinions and we write letters but we’re a small voice compared to lobbying firms and things like that so they listen to some of the things that we’re doing, trying to limit the amount of opioids that a person can get from a primary care doctor. And we’re trying to really create this legislation limit on how much a primary care or a dentist can dispense but these are things that are really hard because then there’s a lot of other people that say “Well we can minimize pain. We need to make sure that patients have access to opioids.” And that’s really the problem, is that we’re not trying to decrease people’s access to opioids, we just want to make sure that if they do really need it, it’s being evaluated and dispensed by the proper person. No one would ever let me dispense a chemotherapy for a cancer patient, for a person who has pancreatic cancer so why is it any different to let someone whose only training is treating root canals write a prescription for percocet? So we just want it to kind of like apples to be apples here, just for what we’re doing. Other specialties in medicine for the same to be done here.
Neal: What are some of the options to opioid use? Non-opioid pain relief, is it all medicine? Is it physical therapy? Is it shockwaves? What are some of the alternatives to treat some of this chronic pain?
Dr Hunter: I’m really glad you asked that. So this is something that people when they hear I’m a pain management doctor, the first thing I think is what you’re kind of alluding to is that medication. And what we specialize as pain management doctors is we specialize in alternatives to medications and more specifically alternatives to surgery. So we usually don’t start out in pain management until a person is exhausted on like six to eight sometimes, twelve group of conservative therapy which is physical therapy, chiropractic, acupuncture, anti-inflammatories, things of that nature. We let them basic things go to work first and the statistics show that if a person does like a multidisciplinary conservative care that over ninety percent of the time, the person’s pain will get better. It’s when the patients don’t respond to the conservative therapy is when we come in. So we’ll try things like nerve blocks, epidural injections, something called radiofrequency ablation where we can apply radio waves to certain nerves and basically kind of prevent their ability to transmit chronic pain. When patients get into the chronic pain realm, it becomes really a lot more challenging because the nervous system becomes hardwired to want to transmit pain so the injury has probably long healed at this point but it’s still transmitting pain. One of the things that we do in pain management for these patients is something called spinal cord stimulation and this is something that’s really existed and a huge growing segment and the pain management and it’s just kind of seemed like a second renaissance over the last couple of years isn’t has been around since like 1967 but people only really heard about it in the last say ten years and it’s just been like I said it’s an explosion of innovation but a really short way of describing it is everybody’s familiar with a pacemaker for the heart this is very similar to that. Instead of us trying to manipulate the electrical signal of let’s say the heart, we’re doing it for the spine and for the nervous system and we can actually really effectively treat and reverse some types of chronic pain by sending the … signal to the right part of the nervous system and we can get these patients the care that they need. In some studies, we’ve actually shown that we can get patients off opioids by doing it so it’s really a good therapy.
Neal: Where can our listeners go online and get some more information, much more information about the Ainsworth Institute of Pain Management and some of these alternatives to opioids that we’ve been discussing this morning?
Dr Hunter: I have a really robust website where I actually just kind of list all the conditions that are out there, all these treatments, it’s ainsworthinstitute.com and I have a listing of just pretty much just about every major condition out there, every major treatment that you can think of and then if people are particularly interested in things like the spinal cord stimulation and things of that nature, you can go to a website called aboutyourpain.com. It’s sponsored by a company called Abbott who actually happens to manufacture a few of these stimulator devices and one that I think are very very effective and you can find, read more about the therapies and find a doctor in your area that’s trained and prescribes them and see if it’s right for you.
Neal: Dr. Hunter, thank you so much for joining us on the program today. It’s been a pleasure, hoping we’ll talk again.
Dr Hunter: Thank you so much Sir, thank you very much.
Neal: You’ve been listening to Health Professional Radio I’m your host Neal Howard. Transcripts and audio of this program are available at hpr.fm and healthprofessionalradio.com.au. You can also subscribe to this podcast on iTunes, listen in and download at SoundCloud and be sure to visit our Affiliate Page at hpr.fm and healthprofessionalradio.com.au