Patients do not have to endure pain if they come to the right place at the right time.
“Pain Clinics provide holistic care, possible only in large hospitals where all doctors are on the same page.”
Many people may have heard the term ”Pain Doctor.” A Pain Management Doctor is a physician who specializes in managing chronic pain. In the past, medication was the mainstay of treatment. However, now there are Pain Intervention Specialists who are experts in performing complex procedures to manage pain more effectively and quickly, without the need for medication.
Today, MedPark Stories has the opportunity to chat with Adjunct Assoc.Prof.Dr. Marvin Thepsoparn, an anesthesiologist specializing in pain management at Medpark Hospital, will share his journey to becoming a pain management doctor and bring to light the pain intervention specialist methods for eliminating pain. Stay tuned!
Pain Management Doctor: A not widely known specialist
After graduating from the Faculty of Medicine at Chulalongkorn University, Dr. Marvin continued his training as a resident in anesthesiology at Chulalongkorn Memorial Hospital. His extensive experience treating patients led him to the realization that pain not only affects the patient but also has far-reaching consequences for those around them, impacting both physical and mental well-being. This realization became a driving force behind his decision to pursue further training in Pain Management.
“In the early days of my practice, I felt a deep sense of empathy for my patients. They all came to me suffering with pain. In truth, every doctor wants their patients to recover from their illnesses. While treatment may cause discomfort, no one wants to be in pain. When pain strikes, patients often struggle to seek medical attention on their own, requiring assistance from family members. This caretaking adds to their burden, as they may need to take time off from work, squandering their time and disrupting their lives.”
“Some of my patients are household breadwinners. When their pain becomes so severe they are unable to work, forcing them to quit their jobs for treatment, financial hardship ensues. Others experience irritability and mood swings due to pain, causing marital conflicts that sometimes lead to the brink of separation. These experiences motivated me to pursue specialized training in pain management abroad, a challenging field that required me to start from scratch, hardly utilizing my acquired knowledge in anesthesiology.”
At that time, there were very few pain specialists in Thailand. Even doctors might be oblivious to their existence and unfamiliar with their treatment approaches. This scenario was another significant factor that prompted Dr. Marvin to go all in without hesitation.
Painkillers and morphine may not be the best solutions
Dr. Marvin discusses pain management methods that do not always involve pain medication.
“Normally, doctors prescribe pain medications when patients have pain or morphine for cancer patients under palliative care. However, that is not the treatment approach of a pain intervention specialist. Specialists in this field shy away from using medications. There are alternatives for helping patients rid their pain if they see the right doctor at the right place and time.”
“The common perception is that pain management simply involves prescribing painkillers, or palliative care cancer patients receiving morphine once pain set in. However, this is not the primary focus of pain specialists. With specialized training in this field, we strive to minimize the need for medication by exploring alternative approaches to alleviate suffering and improve patient's quality of life if they come to the right place at the right time.”
Upon completing his overseas pain management training, Dr. Marvin returned to Thailand and embarked on a career as a physician at the Pain Clinic in the Department of Anesthesiology at Chulalongkorn Hospital, Thai Red Cross Society. His dedication to pain management extended beyond clinical practice as he actively engaged in research, publishing numerous research papers. Among his notable contributions is the groundbreaking research on platelet-rich plasma (PRP) injections for torn rotator cuff pain management.
This groundbreaking research compared the effectiveness of steroid versus autologous platelet-rich plasma (PRP) injections for torn rotator cuff pain management. While PRP injection was not then a mainstream treatment, the research findings were remarkable. Patients who received PRP injections experienced significant tissue healing, including the healing of torn tendons, as well as muscle regeneration demonstrated by MRIs. This novel treatment resulted in substantial pain reduction, eliminating long-term pain medication dependency and potentially avoiding the need for surgery.
The research, published in a prestigious medical journal, reaching a broad audience, and extensively cited and discussed on various platforms, has garnered widespread recognition and acclaim propelling him to the forefront of the pain management discipline. This surge in visibility has significantly boosted public awareness of pain specialists and the field of pain intervention.
Pain Intervention Specialists: Targeting the right pain spot
Dr. Marvin said doctors will typically try to identify the underlying cause of pain. However, pain intervention specialists tend not to pay much attention to the cause.
“Regardless of the locations, whether in bones, joints, teeth, cancerous tumor, or headache, pain is never a good sign for patients, especially when it becomes chronic and lasts for three months or more. At our pain management clinic, our doctors typically focus on relieving the pain rather than delving into the underlying cause. Our approach is straightforward: identify the point of pain and disrupt the corresponding nerves, sending a pain signal to the brain to alleviate the discomfort.”
“Among the various pain management techniques, Pain Intervention Specialists excel at 'neurolysis,' a procedure that involves disrupting the nerve signals responsible for transmitting pain perception.”
While 'nerve destruction' might raise concerns about losing mobility, it is crucial to understand that this procedure targets specific pain-signaling nerves, leaving the essential motor and sensory functions intact. He further elaborates,
“Extensive research has revealed that the human nervous system comprises specific nerves dedicated solely to pain perception. Given nerve diversity and numbers, we can selectively target and disrupt the nerves associated with specific pain locations. For instance, in migraine headaches, we can target the nerves in the head, and for knee pain, we can disrupt the nerves supplying the knee joint. This approach effectively eliminates the pain.”
Dr. Marvin shared an example of a cancer patient who experienced pain relief up until the last day of life.
“Cancer therapeutics have advanced significantly, extending cancer patient survival for several years. However, patients often endure debilitating side effects during treatment. In one case, a patient was not in a condition to come to the hospital, prompting his son to record a video. Upon seeing the patient delirious and incoherent, I recommended intrathecal morphine administration, a relatively uncommon procedure at the time.”
“After intrathecal morphine injection, his son sent photos of the patient enjoying meals, strolling through malls with grandchildren, smiling ear to ear, and sleeping soundly like a normal person. The final 1-2 months of his life were pain-free until the peaceful passing without pain and suffering. His son expressed profuse gratitude for this treatment, extending comfort to his father.”
Holistic care at MedPark Hospital Pain Clinic
“Pain management clinics in Thailand are still relatively scarce, primarily concentrated in major public teaching hospitals like Chulalongkorn, Ramathibodi, and Siriraj Hospitals. The limited number of pain specialists often restricts patient access to specialized care. Nevertheless, Dr. Marvin expresses his hope that physicians across all specialties and hospitals grasp the concepts and treatment approaches of the pain management specialists to foster a holistic healthcare approach.”
“Ever since joining the Pain Management Clinic at MedPark Hospital, a newly opened private hospital, I have been impressed with cutting-edge medical equipment, particularly the hybrid operating room equipped with the latest bi-plane X-ray technology. This equipment enables precise identification of even the most specific nerves, facilitating more accurate and targeted treatment. The nurses were also exceptionally attentive and caring, and made telephone follow up to inquire about their well-being.”
Dr. Marvin observed that most referred patients at the Pain Management Clinic at Medpark Hospital come from the Hematology-Oncology and Orthopedic Surgery centers.
“The most common referrals to our Pain Clinic include cancer, back, and spinal pain. These are particularly prevalent among individuals in their 50s and 60s. Some younger patients may also experience pains due to WMSDs (work-related musculoskeletal disorders), which fall under the same category as spinal pain. We also receive walk-in patients, primarily foreigners, who know we offer pain relief without requiring surgery.
“Referring patients to the Pain Clinic facilitates a holistic treatment approach, which only large hospitals, where all physicians share a common understanding, can effectively implement. Each specialist can focus on their fields of expertise, and MedPark's comprehensive range of medical professionals is a significant advantage.”
While the Pain Clinic at Medpark Hospital may not be as busy as other departments, the situation is bound to change within the next two years. Through word-of-mouth touting the Clinic's efficacy and effectiveness, the waiting times for pain specialist appointments could be much longer.