Dr. Ramis Gheith is one of the United States’ leading pain management physicians, and an expert in the field of interventional pain management and neuromodulation. He founded the Interventional Pain Institute in Saint Louis, Missouri, and serves as its medical director. Motivated by fighting the opioid crisis and realizing how detrimental the side effects to opioids can be for chronic pain patients, he has been researching and implementing alternative treatments to successfully manage and relieve chronic pain. He was kind enough to speak with me recently to tell me more about his work, and here’s what he had to say.
Name: Dr. Ramis Gheith (above)
Date: December 15, 2017
Occupation: anesthesiologist and interventional pain management specialist, for the past ten years. I’m focused on using sophisticated technology to combat pain and conquer the opioid epidemic.
Hometown: Raised in the State of Ohio and trained in Chicago at one of the nations’ top ranked medical centers, Rush University Medical Center, then started practicing in Missouri.
Current town: St. Louis, Missouri; I have three office locations in the region for convenient access for patients.
What’s your “elevator pitch”? How can you briefly describe your specialty? What is interventional pain management?
I would say that pain management is the practice of reducing someone’s pain to the point that they become functional in day to day living with improved quality of life and without the use, or with minimal use, of opioid therapy. We help people get their lives back!
So, you do you think that there is or should be some role for opioids in pain management?
Yes, there is some role. Just like diabetes or high blood pressure, chronic pain is a disease and has a specific pathophysiology. It involves different neural circuits in the spinal cord and brain. There can be a significant disorder there that may be treated by targeting very specific nerves or the spinal cord, to modify or eliminate the pain signals, so the patient has a significant reduction in pain and an improvement in their quality of life.
I know that we currently do have a serious problem with opioid addiction in this country. Do you blame the pharmaceutical industry? Doctors? Drug seeking patients? How did we get here?
It’s been a complicated process. The entire system of the opioid epidemic really took of in the 1990s. Pharmaceutical companies told doctors they could use these drugs with minimal chances of addiction, citing an old report showing only a five percent addiction rate, from the 1980s. That’s been debunked. In addition, pain is considered a vital sign. In the late 1990s and early 2000s pain became the “fifth vital sign” and was used to monitor “good care” and “good outcomes” in the hospitals, and is now considered an important part of patient care…the hospital system was pushing that initiative, and the physicians were being taught to provide pain relief, under the belief that they would do no harm to the patient by addressing the patients’ pain complaints. In addition to that, doctors were reprimanded by hospital administrators if patients complained that their pain was not being addressed.
As the decades have gone by, the prescribing habits have quadrupled and now 90 people a day die of overdoses, and it’s become a very significant issue. Truly an epidemic that is engulfing our nation. We now have a better understanding of the neural circuits and the pain pathways, and we are more knowledgeable about how to effectively apply different highly advanced therapies to control pain. We are able to identify the nerves involved, treat the nerves, and reduce pain levels, by blocking nerves, injecting medication to allow a nerve to heal, ablating a nerve, or by stimulating the nerves. The stimulation technology is similar to pacemakers, but in this case for the spinal cord and spinal nerves. Spinal cord stimulation therapy has significantly evolved since 1967 and is now a highly advanced sophisticated way to conquer pain .
I know a law professor, Ekow Yankah, who has written about the difference in attitude that the US public has now toward opioid addicts than we generally had toward people who were addicted to crack back in the 1980s, and how our impression of addiction largely depends on the race of the people who are addicted. What are your thoughts on that?
Historically, there has been an unfortunate discrepancy in how the media, politics, and law enforcement portrayed drug abuse in America. The public image of minority communities being “plagued” by drug abuse, coupled with the significant rise of prescribing habits of opioids has in effect given us a new fact of life. It is now more apparent than ever that addiction has no socio-economic boundaries and is prevalent in all communities regardless of race, religion, or status. It is hard to ignore the fact that more funding is now available to combat this epidemic, given the increased attention it has garnered by affecting more non-minority communities.
If we have developed more compassion towards people suffering from addiction, has that translated into better policies? It seems like it has got to be better to treat addiction as a public health matter than as a criminal matter, as in Portugal, where the government decriminalized drug use…are we there yet? Or can we get there?
We are going to get there, but it will be slow. In the United States, the topic itself has been very politicized and I believe more focus needs to be placed on patients receiving the health care they need to overcome the disease of addiction. This is a medical condition, not a crime. These folks need high quality treatment by improving access to care, ongoing improvement of pain relieving therapies, and education of patients and prescribers. With that said, there has been more allocation of funds for the treatment of opioid overdose by making naloxone more accessible, and improved funding of addiction treatment centers in some regions. Education of the physician is an ongoing process and is also very important in this fight.
So, you are helping patients locally…is this something that you or other physicians are able to take to other places, other parts of the country?
That is our hope. This is an absolute nightmare for this country. People are dying every day when they don’t need to be. It’s a preventable and treatable issue. We can start by speaking out, we can educate communities and physicians, and we can make sure that patients seeking treatment have access to it.
What can people do, who are not physicians, or in the health industry, to help fight the opioid crisis? Are there laws and policies that we should be implementing, locally or nationally?
I think the first thing most people can do is recognize the fact that addiction has no boundaries and affects all communities. In most states, including Missouri, you can find community support and therapy groups. In addition, treatment centers are becoming more popular as funding by local, state, and federal agencies has increased. As more funding reaches treatment centers, more patients can be helped. However, we must understand that recognition and diagnosis of the problem in a patient is number one–then, the patient has to be receptive to undergo treatment after they recognize the addiction. They should always be provided with the proper resources to seek the treatment.
What are some things people do not understand about opioid addiction? What do we get wrong?
The terminology of addiction vs. opioid dependence are mixed interchangeably when they are two very different conditions. I think one issue is understanding the difference. Almost everyone who takes an opioid develops a physical dependence after taking it for some time; however, not everyone gets an addictive disorder. A dependence issue is when you take the medication, because you know if you don’t, you’ll have an adverse reaction physiologically such as diarrhea, nausea, vomiting, stomach ache, sweats–which occurs with the withdrawal from opioids. This also needs treatment; however, this is not the same as addiction.
Addiction, on the other hand, manifests as compulsive use of the pain medications with inability to control your cravings and use of the medication, despite the fact you know it will cause harm to you or others. There are 90 million Americans on opioids and according to the CDC in 2014, almost two million Americans are struggling with addiction. Combine those numbers with the number of patients who misuse and are dependent on opioids, and it’s a huge number. It’s got the attention of the hospitals, physicians, politicians, and certainly, the media. It’s a serious issue, and people like myself are fighting it every day, patient by patient.
Is there anything you would recommend to read for people who want to learn more?
The good news about today is that we have the internet. The National Institute on Drug Abuse website has a lot of data about addiction. Also the Centers for Disease Control website has lots of data on this topic that is easily accessible.
How about a work of fiction or a movie to put more of a human face on this problem?
Traffic, a movie with Michael Douglas in 2000. It’s a movie about the drug trade and Douglas is the drug czar of the United States, and his daughter was a drug addict. That was a good movie that really puts a face on it. It illustrates the lack of boundaries this disease has. Opioids, illicit drugs including heroin and synthetic fentanyl are flooding our communities. They are having a devastating effect on our community. Sicario is a more recent movie which illustrates the rampant nature of the drug trade across borders as well.
What led you to this specialty?
I want to help patients stop suffering from chronic pain and have a better quality of life. Prior to medical school, I was a nurse, and when you have that close contact with the patient, you feel them and know them in a close environment with their families, and I believe it makes you more compassionate. I love the field of anesthesiology, but the patients are asleep and I like to talk to my patients and develop a deeper rapport. Interventional pain management grew out of anesthesiology, and it was an area I saw myself going into for this reason. It was an easy transition for me because of the deep knowledge of the neural anatomy I learned in my specialty. Anesthesiology is uniquely positioned to treat central and peripheral nervous system pain disorders, given the close contact we have with the spinal cord and brain on a daily basis.
We are frequently in the epidural space to control pain signals in obstetrics and in a variety of surgeries–with that being said, anesthesiologists are intimately knowledgeable about nerves and their pathways, and how to stop pain signals, stimulate, modulate, and alter what the patient feels.
Through the use of our medical procedures, skills, and techniques, we can fight pain using the nervous system, targeting pathways, easier than other specialties. Our field is uniquely positioned to combat this epidemic.
Is there a book everyone should read?
Blink, by Malcolm Gladwell. Almost everyone who enjoys the human side of social interaction would love that book.
How about a movie?
Interestingly enough, the movies I like are in the genre of drama, dramatic movies, but I have no particular favorite.
What is the best advice that you have been given?
I remember one of my mentors once said, if you listen to your patients long enough, they will diagnose themselves. Having empathy and compassion for your patients ,and having determination and perseverance will get you through almost every situation.
If you could go back in time and do one thing over, what would it be?
Well, that’s a tough question. I frequently think about this. Would I do something differently? I always come to the same conclusion, and the answer is no. I can’t identify anything I’d do again differently. I’ve been blessed with great fortune and good luck, which has taken me down this path which I absolutely love.
Thank you for your time…we wish you the very best and great success helping your patients!
ABOUT LAURA LaVELLE
Laura LaVelle is an attorney and writer who lives in Connecticut, in a not quite 100-year-old house, along with her husband, two daughters, and a cockatiel.
Laura can be contacted at firstname.lastname@example.org
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