This is part 2 of a 3-part series from Dr. Bilal F. Shanti, MD, an anesthesiologist and an interventional pain physician working in Payson two days per week.

Pain is an ambivalent symptom. It is “great” in a sense because it alarms us there is an underlying issue, but it is evil because it is also annoying, and no normal human being can deal with it.

Nowadays, one of the treatment modalities is pain medication. Initially, it was thought that the more pain medication, such as morphine, is given, the better the pain control. More recently, there is data to suggest that accumulation of metabolites of morphine, or the other pain medications such as Oxycodone or Hydrocodone, can lead to hyperalgesia (increased pain sensitivity) rather than analgesia (pain control).

In today’s pain clinics, we encounter more chronic than acute pain. Chronic pain is becoming more aggressive and resistant to treatment. In part, because acute pain was not well addressed.

By the time a patient makes it to a pain specialist, they have typically tried several methods of treatment (medications, injections, therapies and yes — even surgeries). This complicates the course of pain pathology such that this pain is very difficult to manage. This “wind-up” phenomenon is, for example, typical for fibromyalgia patients and patients with “centralized” pain such as phantom limb pain and post-stroke pain. This stimulation of higher areas is devastating to the patient.

Physicians are not familiar with it and often discount the patient complaints, feel they are “just depressed” and simply prescribe anti-depressants and at the most refer patients to psychiatrists.

I remember I saw a patient several years ago. He was a military veteran and had lost his left arm due to an amputation following a war-related injury. When he came into the exam room, he twisted his body to avoid hitting his left arm, which was amputated. I asked him why he did that, he confirmed he did not want to hit his left arm. The partial explanation is that our brain sends signals to all parts of the body continuously as it should. When he had an earlier surgery to amputate his left arm, he had been placed under general anesthesia. Once he woke up, his left arm was gone. However, the brain continued to perceive it as part of the body, just like before anesthesia. Providing him with a motor nerve block prior to undergoing general anesthesia could have interrupted this “oneness” of the body. The block will let the body know the arm is no longer part of it. Once awake, the brain will still think the left arm is not there and will stop sending signals. Unfortunately, this patient did not have that course of treatment and therefore had severe phantom pain that is chronic and central in character and requires several medications and blocks just to decrease some of the chronic pain. This becomes very taxing to the patient, society, and the system.

It is best to refer these complicated cases to pain specialists early on. It is imperative to treat acute pain aggressively before it becomes chronic and agonizing.

For a list of conditions treated and procedures performed, view Dr. Shanti’s website at

Dr. Shanti is currently seeing patients two days a week at 127 E. Main St., Payson. Call 928-783-3445 to schedule an appointment.

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