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UPMC Pain Management physicians help people manage chronic pain.
Phil’s Story: Moving on from Chronic Pain
As a longtime deck hockey player, 32-year-old Phil Berube was used to an athlete’s active lifestyle. But when the COVID-19 pandemic hit in 2020 and put a stop to group events, he suddenly found himself at home and not moving as much.
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“I was sitting around a lot,” he says. After months of reduced activity, his lower back started to hurt. Two and half years later, the pain was still with him, and it was affecting his quality of life.
“I was miserable sitting around, but I was more miserable when I was doing things,” he says. “It was a constant pain I couldn’t escape.”
When his pain started, Phil was in his late 20s and in good health. Since his mother and fiancée both work at UPMC, Phil is familiar with navigating health care systems. He sought help from multiple providers to find out what was causing his pain. But because he was young and he had no obvious physical signs of an injury or condition, he felt that getting a diagnosis — and a treatment plan — was difficult.
“I tried basically everything,” he says. “They told me what they thought it was, gave me medicine to try, and recommended physical therapy. Nothing was really working.”
Then Phil’s primary care physician referred him to UPMC Pain Management at UPMC Passavant. “Originally, I thought it was an appointment to get a cortisone shot,” he says. “I went to my first appointment not feeling negative, but neutral. At that point, I had gone to many different doctors.”
Phil’s perspective changed once he met Michael Desciak, MD, pain management specialist at UPMC Passavant.
“From the second I walked in and started talking to Dr. Desciak, it was a different experience,” Phil says.
Dr. Desciak says a big part of UPMC Pain Management’s treatment approach is listening to patients and stressing that the doctor-patient relationship is a collaboration.
“In our first meeting, Phil said something that resonated. He initially was very grateful he had someone to listen to him. Because he’s young and has no other physical problems, he got the sense that people weren’t taking his pain seriously,” Dr. Desciak says.
Phil says Dr. Desciak spent the first part of his appointment talking with him about his pain and how it was affecting his life.
“He wanted to know exactly where the pain was and what it felt like. It was very personalized,” Phil says. “It was, by far, the best personal experience I have ever had with a doctor.”
Getting to the source of the pain
Phil’s pain was caused by arthritis in his lower back. According to Dr. Desciak, reduced physical activity can sometimes lead to back and joint pain.
“The body is like a big support beam. When you’re active, your joints have muscular support,” he says. “During the pandemic, a lot of people were forced into inactivity. When people don’t move as much as they used to, their muscles get weaker and put more strain on their joints.”
In Phil’s case, Dr. Desciak says, the arthritis crept up on him during the pandemic, when he couldn’t play hockey.
“He had been an athlete for a long time and was used to physical activity,” Dr. Desciak says. “It makes complete sense.”
For Phil’s condition, Dr. Desciak recommended a cooled radiofrequency ablation procedure. The procedure involves using x-rays to help guide a needle to the nerves causing pain. The needle directs heat to the nerve to interrupt the pain signal.
“If you have joints that are painful and inflamed, there’s not much we can do to fix them, but we can quiet the nerves,” says Dr. Desciak.
The procedure, called COOLIEF®, differs from traditional radiofrequency ablation because it circulates water through the tip of the needle to counteract the heat used to target the nerves.
“It applies a little energy and stuns the nerves to help treat pain,” Dr. Desciak says. “We first perform a test treatment where we inject local anesthetic, or numbing medicine, around the nerves. If the patient experiences significant pain relief, they return to the office for the cooled radiofrequency ablation. During the procedure, we apply energy to the tip of our probes and thermally deactivate those nerves.”
The procedure can treat arthritis pain in the neck, lower back, and knees. It works best on pain that stays in one area. Because Phil’s pain was concentrated on his lower back, he was a good candidate for this treatment, Dr. Desciak says.
Finding relief
After undergoing the cooled radiofrequency ablation procedure, Phil reports that his pain is about 80 percent gone, enabling him to get back to an exercise routine. “My pain is at a low enough level that I can start doing core-strengthening exercises,” he says.
Dr. Desciak says that while the procedure itself provides pain relief, patients who return to physical activity afterward get the most out of it. “I told Phil, if you don’t change any aspects of your life, you may get a year of pain relief from the procedure. The best way to extend it and make it permanent is to get back to your previous level of activity,” he says.
During his treatment, Phil visited the pain clinic four times over a two-month period. He says he can’t say enough good things about the clinic and everyone he encountered.
“Every single person I dealt with in the pain management clinic was fantastic,” he says. “I thought, these people are here to genuinely talk to me and make me feel more comfortable.”
Pain Management at UPMC Passavant
UPMC Pain Management recently expanded at UPMC Passavant with the addition of its newest providers: Michael Desciak, MD, and Ryan Holden, MD. Both doctors are fellowship-trained in chronic pain management and offer a range of services. They join Edward Heres, MD, in the multidisciplinary program that includes interventional therapies, medicine, physical and occupational therapy, pain psychiatry and psychology, and alternative therapies.
“I’m proud of the fact that we have been able to build a comprehensive pain management program here at UPMC Passavant,” says Dr. Heres, who has been director of the UPMC Passavant pain management program for more than a decade. “In particular, our spinal stimulator program for patients with chronic pain conditions is one of the busiest in the area.”
Dr. Holden says the field of pain management has expanded rapidly in recent years, along with the understanding of how to best treat their patients.
“In the past, we’ve used different treatment approaches, such as injection-based therapy, medication-based treatments, or a physical therapy-based approach,” Dr. Holden says. “The latest research tells us that an effective approach is taking the entire patient into consideration and offering multiple treatment modalities as needed.”
“We value a physician-patient partnership that emphasizes patient education, communication, respect, honesty, and accountability,” says Dr. Desciak. “Our training allows us to identify the specific needs of our patients and tailor our treatment plans.”
Conditions that may benefit from pain management services include:
• Abdominal pain
• Arthritis
• Cervical and lumbar stenosis
• Diabetic neuropathy
• Facial pain
• Fibromyalgia
• Hernia pain
• Knee pain
Pain management is recommended for patients who have been experiencing chronic pain and have not found relief with other treatment.
Technology expands treatment options
UPMC Pain Management at UPMC Passavant recently introduced ultrasound-guided nerve blocks. Ultrasound, an imaging technique that uses sound waves, shows the doctors the nerves they are targeting for treatment. The traditional method, fluoroscopy, uses x-rays instead of ultrasound. However, x-rays can only show bones – not nerves.
Ultrasound-guided nerve blocks can be used to treat conditions like:
• Chronic abdominal pain
• Chronic pelvic pain
• Chronic thoracic pain
• Craniofacial pain
• Large joint inflammation
• Mononeuropathies
• Sciatica
• Spine arthritis
For more information about our pain management services, visit UPMCPassavant.com/PainManagement.
COOLIEF® is a trademark of Avanos Medical, Inc.