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Table of Contents
anesthesiologist - a doctor who specializes in giving drugs that
block, prevent, or relieve pain, especially during surgery
central nervous system - the brain and spinal cord
central pain - pain associated with an injury to the central nervous
system
dermatology - medical specialty focused on problems with the skin
ER - emergency room
MRI - Magnetic Resonance Imaging; diagnostic device which uses a
strong magnetic field to create images of the body's internal parts
modality - a method of treatment
nanotechnology - the science of making devices that are extremely
small, about the size of a molecule
narcotic - class of drugs derived from the opium plant -
or created synthetically for the same effect; used as pain-killers
Nash syndrome - disorder of the liver
neuropathic - abnormal pain caused by damage to the nervous system
nociceptive - normal response to pain
opioid - narcotic
orthopedics - branch of medicine that deals with the muscular and
skeletal systems
pulmonary sarcoidosis - a rare disease involving inflammation,
stiffening, and sometimes scarring of the lungs
syringomyelia - neurological condition where a fluid filled cyst
forms in the spinal cord
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Pain. Everyone feels it - especially people with Chiari and
syringomyelia - and everyone has their own views on it. One person
with a very unique view is Dr. Mark Gorchesky. Dr. Gorchesky spent
years as a anesthesiologist and pain medicine specialist, treating over
100,000 patients before his career was cut short by a chronic, debilitating,
and painful condition. After treating pain patients for so many years,
Dr. Gorchesky got a first-hand look at what it's like to navigate today's
healthcare system.
Although his health problems may have knocked him around a little bit, he
did not let them knock him down. A man of tremendous passion and
spirit, he decided to use his experiences to help people in a different way,
by starting the PAIN Foundation of Western Pennsylvania.
As a pain specialist, pain patient, and pain advocate, he offers unique
insights into the world of pain. Dr. Gorchesky agreed to share
his thoughts, feelings, and knowledge with us, In The Spotlight...
Let’s start by talking about your experience as a pain practitioner. How
do you define pain?
G: Pain is defined by the International Association for the Study of
Pain, of which I am a member. It’s the unpleasant sensory and emotional
experience associated with actual or potential tissue damage. The key
phrase here is the unpleasant sensory and emotional experience, one
doesn’t happen without the other. Being a chronic pain sufferer myself, I
define it in simple terms, you know it when you feel it.
How and why
did you become interested in treating pain?
G: At a very young age in the early 1960’s, a number of my family
members were quite ill in hospitals and suffered from pain and cancer. I
always remember their struggles and how there were very few things available
for them. As I went through college and medical school both pharmacology
and the use of medications was very interesting to me and I loved to read
and understand how these things work both in the spinal cord and in the
brain and in the peripheral mechanisms. As an anesthesiologist, it is a
natural process for us to treat pain in the preoperative period,
postoperative period and even in the long term chronic setting with both
acute pain and chronic pain in cancer patients. It became a natural
transition for me, with my love of interventional procedures, and love for
the knowledge of pharmacology and mechanisms to graduate into the wonderful
field of pain medicine.
Should
anyone with chronic pain seek treatment from experts?
G: Resoundingly YES! In medicine today we’ve graduated into very
significant and highly technical and specialized areas and fields. We all
see and are treated by primary medical doctors, but if things don’t tend to
go well, we’re often referred to other doctors. For example, if you have a
rash, you are seen by a specialist in dermatology. If you have
bone disorders you are seen by doctors of orthopedics and bone specialists.
So, if someone were suffering with pain for longer than six weeks to six
months, it would be a natural progression to be seen by experts in the
field, and those are pain medicine physicians.
What is a
pain clinic?
G: There are a number of different types of centers the word pain
clinic has been used to describe. Sometimes it refers to a single
modality-like place where either it’s a doctor practicing and using shots or
blocks or injections; or a chiropractor just using manipulation. A pain
center may have one or two different modalities but the ideal setting is a
multidisciplinary pain management center or institute where the individuals
are board certified in pain medicine, they use multiple modalities including
physical medicine, physical therapy, psychology, biofeedback, pharmacology,
regional anesthetics and a whole combination of alternative and
complementary means. Treating the mind, body and spirit appears to be the
best approach in the long-term with the best long-term plausible results.
What should a patient expect at a Pain Center?
G: When one enters a multidisciplinary pain evaluation center, one
should expect a very thorough evaluation towards finding an accurate and
correct diagnosis. If you don’t have an accurate diagnosis, treatment plans
will fail. In the beginning, the most important thing is supplying your
medical records. They would also want to see if there are legal issues,
scenes of accidents and anything written about that. They will also look at
the objective data that you have had taken before, such as x-rays, CT scans,
MRIs, previous procedures and surgeries, and medicines you have used. A
very thorough history will be taken on all of your general medical issues,
then a particular pain history will be taken about when your particular pain
started, how did it get started, what makes it worse, what makes it better,
does the timing of it appear to be in relation to anything, do meds make it
better or worse, and your own particular opinion of why you think this is
going on. Looking and reading about all of the things that have been done
in the past and creating an opinion is very important. Ninety-nine percent
of the decision-making in a diagnosis is often made with a very specific and
thorough history. After that’s completed, a very thorough physical
examination will be used, a broad physical examination of all of the systems
and then a focused exam on your particular problems. They should look very
carefully at how you walk, how you sit, the duration of your ability to sit
or stand or move if there are limb disorders. If there are problems with
moving or musculature, they may look at different lengths of your legs and
pelvis, the length of your legs to the length of your arms, your spine and
if there are any curvatures, muscle spasms, nervous disorders, movement
disorders, even reflex changes or neurosensory changes. Once there is an
accurate diagnosis, the doctor should impart a plan and a program for you in
a multidisciplinary way. He should use additional disciplines to his own to
help improve your situation. Goals should be to improve your function, aid
in your coping through this disorder, decreasing your need and dependence on
the health care system, reducing your need and dependence on habitual
medications, and lastly to reduce your pain and pain perceptions. He should
reassess with each visit, whether or not these goals are being reached.
Some pain experts point out that treatment – and even research – is
complicated by the fact that many patients are experiencing several discrete
types of pain at the same time. Do you agree with this, are there
fundamentally different kinds of pain?
G: Several different types of pain can overlap or appear separately.
Nociceptive pain is specifically focused in the area where you feel pain.
If you stub your toe, that’s where you feel the pain. Visceral pain is a
vague, diffuse type of pain and is harder to diagnose and treat.
Neuropathic pain is also difficult to treat due to the overlap of nerves and
their functions. Central pain – due to stroke or abnormality in the brain –
is also difficult to diagnose. Combinations of these types of pain exist as
well.
Do you think the current pain scales and measurement techniques are
adequate for both clinical use and research?
G: No particular scale is perfect, especially for humans given the
male-female and cross-cultural differences. However we are getting better.
Pain centers should be using particular scales to assess pain on a 0-10
number scale or pointing to faces to measure pain. Also using other
assessments such as mood, functioning, and daily activity in combination to
make judgments is important.
In your clinical experience, did you favor some types of therapies more
than others? If so, which ones?
G: Everything is individualized per patient. The pain specialist
treats each patient individually. There is always some specific nature that
comes out in a case that may preclude using something, or favor one thing
over another. I like the KISS method, keep it simple stupid, because the
less medicines and tests and even doctors involved the better.
Do you think there are any effective treatments for people with
neuropathic pain due to syringomyelia?
G: Very difficult disorder to treat. I want to underscore the
importance of the correct diagnosis. There may be secondary issues in the
spine, such as cysts, so it’s important to have a clear and specific
diagnosis. Once that is made, the neuropathic nature of the pain is
difficult, because we’re looking at central and peripheral mechanisms. Some
medicines, such as anti-seizure drugs like Neurontin have been helpful as
well as some anti-depressants. Local anesthetics and narcotic spinal
infusions have been helpful in severe cases. Even some electro-stimulating
procedures have been helpful. All have been used, but none have been 100%
effective in this difficult disorder.
What are your views on the use of narcotics to treat pain? Should
patients and/or doctors be concerned about addiction?
G: The use of narcotics is quite controversial but does have a role in
pain management. Overall, narcotic analgesics are quite safe. Thousands
upon thousands of patients die every year with non-steroidal
anti-inflammatory complications. Those types of cases are not reported with
opioids. It is unfounded to believe that addiction is quite common. As a
matter of fact in the chronic pain population, the incidence of addiction is
no greater than among the general population. When seen by pain experts,
and managed and followed and reasonably screened, the risks of addiction are
quite low and the rewards are quite high. Again, going back to the
functional goals: are the patients functioning, are they coping, are they
reducing their dependence on the medications and the healthcare system?
Meaning they’re not doctor shopping or going from ER to ER. Also is their
pain and pain perception improving? Those are valuable; improving the
quality of life is significant. You can’t put a measure on someone’s
qualify of life. And there is an unfounded fear among those practitioners
who are not experienced with these medicines in their reluctance to use
them. Often the medicines are given to the wrong patients. Patients need
to be screened, especially for prior alcohol abuse, and other social
factors. A pain expert does this and follows the patients closely.
Choosing the proper patient is critical in opioid treatment.
As a clinician, how did you view your patients? Do you feel you were
empathetic?
G: One of the deepest, most treasured things any physician can have is
empathy and a deep trust in your patients. I certainly tried in every
possible way to treat every person with dignity, respect and empathy. I
would often tell residents and med students to put a small stone in their
shoe and walk the halls that way and realize how far it is to walk from
registration to your office and back. Go to the pharmacy and listen to the
inappropriate treatment and costs patients face. In every angle and every
aspect of patient’s lives I tried to experience what they experienced. It
was often a very emotional day for me on a regular basis.
Let’s move on to your experience as a pain patient. Could you describe
your own medical situation?
G: I’ve been diagnosed with pulmonary sarcoidosis with systemic
manifestations including problems with my eyes, sinuses, trouble breathing,
cough, and pain in the back. As a result of some of the medicines I used
for treatment I have liver disease. I have Nash syndrome and spinal
osteoporosis due to steroid use. Sometimes I have memory problems and
depression. There’s not a day that goes by that I’m not reminded of the
profound effect this disease has on my life and the life of my wife, my son
and my family. Not a day. Some days I wake up and wonder why? Some days I
think of patients who are suffering more and I shouldn’t consider myself
unlucky. I try to embrace it as something I need to focus on to improve
myself rather than lie around and feel sorry for myself. I can get up and
feel the same symptoms, but I can be productive and maybe make a difference
in the lives of others.
What was it like going through the system as a patient after being an
integral part of the system for so long?
G: It’s interesting, now the doctor becomes the patient. I’d been sick
before and gone to the ER for things, but never on a chronic basis where you
have to keep going back to your doctors and getting blood drawn and getting
constant scans – like many of the SM patients. I have to tell you, I’m not
very happy with the overall system. We’ve made major strides in medicine,
science, and tests, but we’ve lost the human hand and human touch. I, like
many other patients, have worn the fancy gowns and had my rear end hang out
as I walked the hallway, or had to turn on my side and throw up into my bed,
or been so weak I needed multiple nurses to help me move. I have a profound
increased sense of the special nature of what a person goes through: the
loss of humanity, dignity, and particularly control, when you enter the
medical system.
How has it effected your views on treating pain and pain patients?
G: I no longer clinically treat patients. Running the foundation give
me a reason to get up in the morning and allows me to interact with patients
and their needs and questions, and to teach and educate them through our
pain support group lecture series here in Johnstown [Pennsylvania]. It has
made me a better person; it allows me to see the inside of what patients are
going through, because I’m the same person who has to wait in waiting rooms
or gets an appointment miss-scheduled. Many of those things happen. The
most important thing for patients is to not give up, not to feel hopeless
and helpless, to feel that there is someone to talk to, and to use their own
God given mind to get out of situations and better themselves.
Can you talk about the organization you founded? What is its mission?
G: The PAIN Foundation of Western Pennsylvania. PAIN is an acronym for
Pain Awareness and Investigation Network. The acronym speaks to the
mission. The mission is to help improve the quality of life of severe
chronic pain patients and cancer pain patients through efforts in research,
education, and advocacy. We were founded in Western PA in 2002 out of my
need and my significant disorder; suffering and seeing the significant loss
of my energy, health, and my life. I felt there was very little out there
to find in ways of help, people with ideas similar to mine or problems
similar to mine. I wanted to create a place where people could view
literature in the area as well as find help for some of their questions,
concerns, and problems.
What has the response been so far?
G: The response has been growing. Our website is viewed by over 25,000
people a month from 25 different countries. It’s very difficult to for me
to imagine the success so far and we are slowly accomplishing our goals.
What do you hope to accomplish over the next 1-2 years?
G: I hope to accomplish further alliances and partnerships with groups,
hospitals and non-profits to bring in and assimilate information and to
streamline the information and deliver it on a regular basis to patients,
families, and even medical professionals. We would like to improve our
website and include a regional resources network where people can click and
add on and find different doctors in the area for their needs. I want
people to be able to find what they need quickly.
Where would you like to see the organization be in 10 years?
G: In ten years I would hope to have a significant endowment of money
that will perpetuate the organization and its employees and can generously
give to those in need of education and training, and to develop a network
wide support group system.
What motivates you?
G: Several things: my faith, my family, and the patients that call
daily. The faces of pain and the faces of help. Seeing people cry when
they are finally helped and realize they are not alone. It’s a very
powerful motivator. Realizing that I don’t need to feel sorry for myself, I
need to do this and this is probably what was meant for me all along. And
I’ve had to travel all these years through school and education and disease
to get here. It’s a wonderful journey and it continues to be a journey for
me. It will not be a destination.
As both a clinician and a patient, what research really excites you?
G: Novel compounds like carbohydrates being considered as analgesics.
Sucrose and glucose and fructose have been known to be analgesics; that’s
why chronic pain patients enjoy sweets or binge on sweets from time to
time. But engineering new forms of carbohydrates are going to be
potentially on the forefront as analgesics with minimal side effects. Also
genetic engineering is exciting. Using common viruses or viral splicing to
cause viruses to be released in your body to actually secrete or produce
different chemicals or molecules to fight pain. Also nanotechnology is a
very impressive process on the forefront of research which may improve the
wellbeing of all of us.
What advice do you have for someone facing a lifetime of chronic pain?
G: This is simply what I say to myself everyday; you must be your own
best advocate. You must believe in the doctors that are treating you and
have a strong diagnosis you believe in from leaders in the field. Once this
occurs you should come up with an easy, but specific multi-disciplinary
plan. Reduce the overwhelming amount of medicines and procedures and
improve your life through hope, happiness, health, and exercise. Try water
aerobics, or alternative measures such as Tai Chi and Yoga. Healthy dieting
including whole grains, vegetables, and low fat is important. Three simple
things I live for are find someone to love, find something to do, and find
something to hope for.
Return To Table Of Contents |
In the Spotlight:
Mark Gorchesky, M.D., DABPM
Founder and Executive Director of the PAIN Foundation of Western
Pennsylvania
Qualifications:
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Volunteer Clinical
Assistant Professor of Anesthesiology, University of Pittsburgh Medical
Center
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Former Director,
Center for Pain Management Shands Jacksonville, University of Florida
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Former Director,
Center for Pain Management, Altoona Hospital (Pennsylvania)
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Former Medical
Director of Pain Management Services, Georgetown University Medical Center
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Board Certified in
Pain Management
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Diplomate of the
American Board of Pain Medicine
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Diplomate of the
American Board of Anesthesiology
Education:
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Indiana University
of Pennsylvania, BS Biology
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Ross University
School of Medicine, MD
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Western
Pennsylvania Hospital, Internship, Anesthesiology Residency
PAIN Foundation
of Western Pennsylvania
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