Nadeem Ahsan, MD, is director of the Einstein Pain Institute and clinical assistant professor of Anesthesiology and Interventional Pain at Jefferson Medical College. He is responsible for overseeing the development and implementation of evidence-based, guideline-driven patient care plans, which includes utilizing advanced treatment approaches for a wide range of chronic pain conditions, including axial-spine pain (localized pain) and radicular pain (pain that radiates into a lower extremity), repetitive stress disorders, headaches, neuropathies and complex regional pain syndromes. He is a five-time Philadelphia Magazine Top Doc.
What is interventional pain management? A lot of people might assume the approach just consists of medication.
Dr. Ahsan: Typically it’s for patients whose pain hasn’t been brought under control with conventional treatment options, such as medications, physical therapy and surgery, who are referred to an interventional pain specialist.
Interventional pain management is devoted to the diagnosis and treatment of pain-related disorders, principally with interventional techniques in managing sub-acute, chronic, persistent, and intractable (severe and constant) pain, independently or in conjunction with other types of treatment.
Interventional pain management techniques consist of X-ray-guided minimally invasive procedures with placement of drugs in targeted areas or removal of targeted nerves. We also use state-of-the-art surgical techniques such as laser or endoscopic discectomy (surgical removal of part or all of a disc), intrathecal infusion pumps (injection of pain-killing drugs into the space surrounding the spinal cord) and spinal cord stimulators (which send a mild electrical current to the spinal cord, blocking the pain), for the diagnosis and management of chronic, persistent, or intractable pain.
What types of pain do you treat?
Dr. Ahsan: Most of our patients tend to be people suffering from spine-related ailments. Their pain syndromes include pain, weakness and numbness as a result of nerve-injury based mechanisms. Other conditions that we routinely tend to include post-shingles pain, failed back syndrome (pain following failed back surgeries), RSD (reflex sympathetic dystrophy) or CRDS (complex regional pain syndrome), and cancer pain.
"One of the most gratifying aspects of being a pain interventionist is the happiness our pain-free patients express after previously having resigned themselves to a pain-filled existence."
By the time patients come to you, is it fair to assume they've exhausted other possibilities? Are they finding approaches and care plans that perhaps they might not have known about?
Dr. Ahsan: Interventional pain medicine is a relatively new specialty, so the full scope of what it offers is not well known to people. But awareness is growing. Generally our patients have failed therapy with conservative or conventional treatments prior to being referred to us. With awareness growing, however, we are seeing patients earlier in the course of their illness and as a result we are being able to provide effective treatment prior to the condition becoming permanently untreatable.
Do patients express surprise about the level of pain control they can achieve—that perhaps they might have resigned themselves to a life of poorly controlled pain?
Dr. Ahsan: Indeed. This in fact is a recurring theme for us. One of the most gratifying aspects of being a pain interventionist is the happiness our pain-free patients express after previously having resigned themselves to a pain-filled existence.
Does safe, effective pain management require the level of expertise patients receive from you and others within your specialty? In other words, might patients be receiving treatment from physicians at less specialized levels that isn’t as effective or perhaps even as safe as what they receive under your care?
Dr. Ahsan: Without going into too much detail, my advice to referring physicians and patients seeking treatment for complex pain syndromes would be to seek help from only those pain interventionists who have undergone anesthesiology and interventional pain fellowship training at an accredited institution and have the requisite board certification. All of the physicians at the Einstein Pain Institute fulfill these criteria and are considered leaders in their field.
How much has the science of pain management evolved since you entered the specialty? Some medical specialties change in small ways—for example, a particular surgery might be faster, the incision might be smaller and recovery might be quicker, but the basic surgery hasn't changed. Is pain management the same in this regard, or different?
Dr. Ahsan: Since the early 1990s, which is when I underwent specialized training in interventional pain, the science of this specialty has evolved massively. The advances have to do with improvements in our understanding of pain pathways and the advancements in the fields of radiological imaging, radiofrequency and electronic spinal stimulation devices.
Why did you choose Einstein?
Dr. Ahsan: Mostly because Einstein has a good reputation in the community, offers opportunity for teaching and research, is technologically advanced and caters to patients from all strata of society.
What is your favorite movie?
Dr. Ahsan: I have little time for cinema any more, but such movies as "One Flew Over the Cuckoo’s Nest," "To Kill a Mockingbird," and "Braveheart" come to mind as ones that left a lasting impression.
What is your favorite book?
Dr. Ahsan: I am a compulsive reader and it’s hard to pick just one book. That said, I would probably pick a novella by John Steinbeck called Of Mice and Men as my favorite, followed closely by Milan Kundera’s Unbearable Lightness of Being. Among non-fiction works, Bertrand Russell’s Pursuit of Happiness and Baruch Spinoza’s Ethics would top my list of admired texts. Much of my reading time now is devoted to keeping up with scientific literature. Whatever’s left over goes to books on philosophy and history.
When patients come to you, what might they not know about you? We hear you’re something of a Renaissance man.
Dr. Ahsan: I suppose that would be my hobbies. I am a photographer and my work gets exhibited often at solo and collective exhibitions and in the hallways at Einstein. (Sample photos below.) I am also an avid oarsman, play guitar, cook and shoot clay-pigeons competitively. And when the opportunity presents itself I contribute op-ed articles to various publications.