Jonathan M. Simhaee, MD, is board-certified in physical medicine and rehabilitation, and fellowship trained in spine and interventional pain management. He joined the Center for Pain Management in August 2014 and as the practice grows, Dr. Simhaee continues to showcase himself and the team. The following Q&A session with the doctor seeks to answer a variety of questions related to the practice, and his specialty of interventional pain management. Additional questions or comments are most certainly welcomed by contacting the office numbers listed below.
Dr. Simhaee, how did you come to join The Center for Pain Management?
Coming out of fellowship, I was ready to join a practice that was not only thriving, but that was focused on continued growth. When I was introduced to the group, I immediately felt welcomed. We continue to share common interests and goals in making our team the “go-to” specialists in the area. Since I joined, our team has grown tremendously. We have great support in the community and a new state-of-the-art facility which is second to none. The Center for Pain Management is now a division of The Center for Musculoskeletal Disorders and comprises other spine, peripheral joint, as well as hand surgeons. Having the support of different specialists is vital for proper patient diagnosis and treatment plans as we are constantly in contact with each other and remain strong advocates for our patients. I think that was a main reason why I joined.
What is the biggest change in treating back and neck pain that you’ve seen?
I think patients are more educated and knowledgeable regarding their pain than in the past. Through what they read on the internet and what they view on YouTube, many times patients think they know what I may recommend. I am pleased that patients feel empowered with this information. Having said that, a saying we have here is “No two spines are alike!” Further, nothing beats a thorough history taking and an exhaustive physical exam as they remain key for a proper diagnosis and subsequent treatment plan. Patients need an advocate and that’s what we’re here for.
In that regard, do you think the accessibility of medical literature for laymen make your task as a doctor more challenging?
Firstly, one should never confuse a Google search with a medical degree! Patients who are in pain, many times attempt to diagnose themselves. Some are even connected to group blogs and forums for discussion with other sufferers. I see this often in regards to migraines and other forms of headaches. I do cautiously embrace this phenomenon as I, too, grew up in this age where knowledge is literally at your fingertips! Having said that, it remains a challenge trying to help a patient better understand their pain—especially if they were misinformed or misguided. It’s my job to make things more clear and, together, to come up with a treatment plan that’s feasible and empowering.
What do you do differently when treating acute versus chronic pain?
The majority of acute lower back pain, for example, will resolve on its own given time and conservative care. My goal in treating patients with acute pain is to decrease the pain and other symptoms that started abruptly, hopefully to enable a comprehensive physical therapy program. However, in patients with ongoing issues, we may have more time to try and incorporate a range of pain-management modalities. The chronic-pain patients are the most challenging as we have to attempt to break the cycle of pain as well as subsequent feelings of hopelessness. Some patients do require surgery to treat their symptomatic conditions—or they have exhausted their nonsurgical treatment options without much long-term improvement. In those cases, I may suggest a referral to my surgical colleagues.
What’s the difference between the various types of pain-relieving injections?
If a patient has failed conservative care, which may include physical or occupational therapy, acupuncture and other modalities, I may step in with more targeted and interventional techniques. Medial branch blocks and epidural injections are the “bread and butter” in our field. They involve injecting a mixture of a steroid with a numbing medication directed at specific joints and nerves in the spine. These injections, in skilled hands, are very low risk, quick and efficient. Some injections may have to be repeated. Certain times, however, the relief is sufficient enough and may even delay or help to completely avoid surgery.
How can you know if your pain is serious enough to warrant a visit to your doctor?
Great question. I have given lectures on this topic. The long answer: The Mayo Clinic recommends you visit your doctor if:
• Your back pain is constant or intense, especially in the evening or when you lie down.
• It spreads down one or both legs, especially below the knee, and it causes weakness, numbness or tingling in both legs.
• You experience weight loss you can’t explain, or there’s swelling or redness on your back.
Back pain remains a major reason for visits to one’s primary care doctor. But when should your primary care doctor refer you to a pain specialist, such as myself?
Since my training and background is in physical medicine and rehabilitation, I am skilled in nonsurgical techniques and therapies for neck, back, shoulder, knee, hip and elbow pain. I also take pride in being the “team leader” in regards to your pain. MY answer: when your pain limits you in any way, see a specialist. It does not mean you’re getting the fanciest treatment options right away, or that we will take out the “big guns” on our first encounter. It just means you’re in the right hands from the start!
Is there any hope for low back pain sufferers?
YES! In the majority of cases, there are things you can do to improve your situation. But one needs “skin in the game”! Advocate for yourself. Take charge and be an active participant in not only finding a solution to your acute pain, but to realize that through education and effort you will be empowered and you can then be part of your own back-pain solution. This is a game changer!
What are some things I can do to help alleviate back pain now and in the future?
Education is power. Learn as much as you can about your back and how it functions. Realize that what you’re dealing with is more than just the pain signals. Your mind and body work together. Take the initiative and do not hesitate to see a specialist, such as myself, for further encouragement and/or other treatment options.
At the Center for Pain Management, WE HAVE YOUR BACK!!!
