Massachusetts General Hospital

BiographyMy clinical practice focuses on cancer pain, spinal pain, and neuropathic pain. I employ both technological advances and my one-decade of experience of pain management practice to provide effective pain relief for cancer and non-cancer patients. The technologies that I focus on include surgically placed indwelling pumps for spinal drug delivery, neuromodulation therapy with the spinal cord stimulation technique for refractory neuropathic pain and minimally-invasive spinal injections for spine disorders related pain.

Current research and practice indicates that nearly 15% of advanced cancer patients suffer from refractory pain despite conservative therapies. Many of these patients benefit from the placement of an indwelling pump that delivers opioids and other adjuvants adjacent to the spinal cord. Such therapy is effective for pain relief, decreases side effects and can improve survival for advanced cancer patients with pain. I have been surgically implanting this pump for cancer patients for ten years. At the new Advanced Cancer Pain Clinic at the Yawkey Cancer Center, we provide advanced interventional pain therapies, including the indwelling pump, for cancer patients within a multidisciplinary care setting.

Spinal cord stimulation is a non-neurodestructive, neuromodulatory technique that is extremely helpful in treating refractory neuropathic pain. It has been shown to provide excellent analgesia for patients with persistent pain after back surgery, complex regional pain syndrome and other peripheral neuropathic pain conditions.

The most common cause of disability among younger workers is low back, neck, and upper or lower extremity radicular pain. Minimally invasive, fluoroscopy-guided spinal injections provide pain relief for many of these patients. Further, decreased pain facilitates physiotherapy and improves functionality in patients with common spine disorders.

ResearchI am a Clinical Investigator at the MGH Center for Translational Pain Research (CTPR).

Research Areas

• Mechanisms of spinal cord stimulation (SCS) therapy for refractory pain
• How pain transitions from acute pain to chronic.
• Opioid induced hyperalgesia

Description of Research

In 1965 Melzack and Wall proposed that stimulation of large afferent fibers in the dorsal column blocks the transmission of small fibers that carry nociceptive signals at the spinal cord level, also known as the gate control theory. Despite over four decades of spinal cord stimulation (SCS) therapy, few clinical studies have addressed the fundamental issue regarding the mechanistic basis of SCS treatment in chronic pain patients. My research focuses on the effect of SCS on a variety of pain measures related to the mechanism of neuromodulation using quantitative sensory testing (QST). I hope the research will have a direct impact on improving the quality of SCS therapy by suggesting a mechanism-based, individualized patient selection approach.

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