[Dubious]

I have a friend in the Portland area who needs a great pain management doc. Any tips?

Thanks!

[Jomar]

No first hand info but here's the superpages - pain management results.
http://www.superpages.com/yellowpage...OR/T-Portland/


I would start by calling the phys therapy places and asking if they can give some names of good PM docs. They should have an idea of who is doing a good job by the patients they treat with phys therapy.
Some might be in uncontrolled pain quite often and some might be having better controlled pain.
When you see a PT you usually have lots of time to talk and they probably know who has what dr, or the client/patient will mention names and if good or not...
You might even get further/better info if you can talk to the PT's in person..
If I had to go that route that's what I would do, then see who comes out at the top of the list.

[loretta]

Originally Posted by Dubious

I have a friend in the Portland area who needs a great pain management doc. Any tips?

Thanks!

Hi Dubious, I think that is some very good information, getting to a good Dr. backward, so to speak. I knew I had a wrong diagnosis in Arizona, so flew to Eugene, Oregon where there was a good sports injury group. I had been to the knee Dr. when we lived there. Eugene is a huge center for track and field, University town. So I made an appointment with the hand doc, and within 1 minute of him walking into my room, he said RSD. Sent me to nuclear med test at hospital, and ordered a tens unit for my hand and got me into pt next day-they were good and experienced with rsd. When I came back to Phoenix, I found a good neuro and he referred me to good hand doc who also had a pt. He knew right away too, I had RSD. The pt people were very good with rsd and not overly tough.
When my current Dr retires, I will see the founder of Arizona Pain Mang.
We had the RSDSA meeting this year at his hospital. Some that I talked to at the meeting used him for pain mang.
My current Dr. is a neuro, psych. & pharmacologist. But I also have an internist, as I'm unstable in my blood pressure. I also have a holistic Dr. that has treated RSD before, infact the internist has also.
Portland has a lot of great Drs. We traveled there for an operation in our family. I think that really is a good way to find a good pain doc. take care, loretta

[fmichael]

Don't know if this would suit your friend's needs, but one of the great pediatric pain specialists in the country is in Portland:

Jeffrey Koh, MD
Chief, Division of Pediatric Anesthesia
Director, Pediatric Pain Management Center
Oregon Health Sciences University
3181 SW Sam Jackson Park Rd
Portland, OR 97201
Office Phone: (503)494-8811

PubMed lists 11 publications for Dr. Koh in total, including:

Use of oxcarbazepine to treat a pediatric patient with resistant complex regional pain syndrome, Lalwani K, Shoham A, Koh JL, McGraw T, J Pain 2005 Oct;6(10):704-6.

Department of Anesthesiology, Oregon Health and Science University, Portland, Oregon 97239, USA. lalwanik@ohsu.edu

We describe a 12-year-old patient with severe, protracted complex regional pain syndrome type I. His pain did not respond to gabapentin, amitriptyline, physical therapy, opioids, or nonsteroidal drugs. Sympathetic or regional block was not attempted because of persistent bacteremia and severe local sepsis. His pain responded dramatically to the addition of oxcarbazepine, with rapid improvement in his symptoms and functional status. We suggest that oxcarbazepine might be a useful adjunct in the treatment of gabapentin-resistant complex regional pain syndrome type I in children and should be considered. PERSPECTIVE: Oxcarbazepine's antinociceptive effect is mediated via sodium channel inhibition in neuropathic models and by inhibition of substance P and prostaglandins in anti-inflammatory models. The efficacy of oxcarbazepine in this patient might be attributable to these mechanisms or possibly to synergism with either gabapentin or the anti-inflammatory effects produced by amitriptyline.

http://www.ncbi.nlm.nih.gov/sites/entrez

The adult chronic pain program at OHSH is known as the OHSU Comprehensive Pain Center, with two locations, "South Waterfront and Westside." http://www.ohsu.edu/xd/health/services/pain-center/ However, going to the departmental list of physicians, those listed with a subspecialty in Pain Medicine who actually complete a Pain Medicine Fellowship are few and far between.

Among those meeting that criteria, is Kim Kaplan, MD, who, after completing an anesthesia residency at the University of Kansas in 2003, did a fellowship in pain management at Stanford, during which time she participated in the following study:

Reduced cold pain tolerance in chronic pain patients following opioid detoxification, Younger J, Barelka P, Carroll I, Kaplan K, Chu L, Prasad R, Gaeta R, Mackey S, Pain Med. 2008 Nov;9(8):1158-63. Epub 2008 Jun 18, free full text at http://www.ncbi.nlm.nih.gov/pmc/arti...ihms140159.pdf

Stanford University School of Medicine, Department of Anesthesia, Division of Pain Management, Palo Alto, California 94304-1573, USA. Jarred.Younger@stanford.edu

OBJECTIVE: One potential consequence of chronic opioid analgesic administration is a paradoxical increase of pain sensitivity over time. Little scientific attention has been given to how cessation of opioid medication affects the hyperalgesic state. In this study, we examined the effects of opioid tapering on pain sensitivity in chronic pain patients. DESIGN: Twelve chronic pain patients on long-term opioid analgesic treatment were observed in a 7- to 14-day inpatient pain rehabilitation program, with cold pain tolerance assessed at admission and discharge. The majority of participants were completely withdrawn from their opioids during their stay. OUTCOME MEASURES: We hypothesized that those patients with the greatest reduction in daily opioid use would show the greatest increases in pain tolerance, as assessed by a cold pressor task. RESULTS: A linear regression revealed that the amount of opioid medication withdrawn was a significant predictor of pain tolerance changes, but not in the direction hypothesized. Greater opioid reduction was associated with decreased pain tolerance. This reduction of pain tolerance was not associated with opioid withdrawal symptoms or changes in general pain. CONCLUSIONS: These findings suggest that the withdrawal of opioids in a chronic pain sample leads to an acute increase in pain sensitivity.

PMID: 18564998 [PubMed - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/sites/entrez

That said, I don't really have any more information, except for the not insignificant fact that she did train (although perhaps not always directly) under Sean Mackey, M.D., PhD, Chief, Division of Pain Management at Stanford Medical School, who clearly knows at great deal when it comes to CRPS, and co-authored the impressive Pharmacologic Therapies for Complex Regional Pain Syndrome, Mackey S, Feinberg S, Curr Pain Headache Rep. 2007; 11:38-43, full text at http://www.rsds.org/2/library/articl...harma_crps.pdf so she might be worth a shot.

Their are two more senior members of the OHSU Comprehensive Pain Center who also "fit the profile," Brett R. Stacey, M.D. and David M Sibell, M.D. However, I can't get too excited about either of them. Dr. Sibell is a specialist in low back pain, has 3 PubMed titles to his name (none directly related to CRPS but serious papers nonetheless) and is the co-editor of a monograph entitled The 5-Minute Pain Management Consult (part of The 5-Minute Consult Series): not sure how to feel about that one.

Dr. Stacey is the most interesting of the group, with 14 articles appearing on PubMed. He's clearly an expert in neuropathic pain. Yet each of the three studies in which he is listed as the lead investigator concern the use of Lyrica (Pregabalin) and their abstracts read as though they could have been commissioned by its manufacturer. And oddly his one published article on CRPS written in 2006, Interventional therapies in the management of complex regional pain syndrome, Nelson DV, Stacey BR, Clin J Pain 2006 Jun;22(5):438-42, discusses "chemical and surgical sympathectomies, and deep brain stimulation," but not low-dose ketamine:

Department of Anesthesiology & Peri-Operative Medicine, Oregon Health & Science University, Portland, OR, USA.

Invasive procedures have long held a place in the therapeutic armamentarium for the management of complex regional pain syndrome (CRPS). However, this has evolved considerably, particularly as research into the mechanisms of CRPS has called into question long-held presumptions about the key role of sympathetic dysfunction in the syndrome. This review summarizes some of the key information currently available about interventional treatments, including nerve blocks, spinal cord and peripheral nerve stimulation, chemical and surgical sympathectomies, and deep brain stimulation. The potential roles for these procedures in facilitating functional rehabilitation goals that are primary to the treatment of CRPS are emphasized.

http://www.ncbi.nlm.nih.gov/pubmed/1...m&ordinalpos=6

In short, Dr. Stacey comes across as fairly "traditionalist" and I'm not sure how comfortable I would be in recommending him.

I have the names of five more physicians in Portland (not directly affiliated with OHSU) who are anesthesiologists with board certification in pain management by the American Board of Pain Medicine, meaning that they completed a formal fellowship in pain medicine and passed an 8 hour written exam, but none have any publication credits I can find, and one of whom appears to work almost exclusively as an examiner for insurance companies. Finally, there also appears to be a decent pain management practice group in Eugene. I'll be happy to pass that information along if you wish.

Mike

[Dubious]

Thanks Mike, whatever you have for a PM doc. It's for a friend with a failed shoulder surgery, not CRPS (thankfully!)

[rsdwife]

my husband goes to a "sports injury" clinic in Eugene as well. A great group of docs. Pm if you would like the name. Maybe they could refer you to a portland Doc.

[achoth]

Try Dr. Heros. He recently moved () to the Portland area. I saw him here in the Salem area and he's really GREAT!