When it comes to pain, you don’t want to waste time – you want to get the best, fastest help possible. And for Dr. Shuchita Garg MD, being the best is her mission.
The esteemed doctor has worked on a panel of national and international experts to formulate guidelines for lumbar facet joint pain, so it’s safe to say she knows what she’s doing when it comes to pain relief.
She was voted amongst the top pain physician in Cincinnati in 2020 (see here) for her focus on safer pain relief treatments – she avoids opioids wherever possible.
We received the chance to speak with Dr. Shuchita Garg to learn more about her work and life as a doctor.
Dr. Garg, how does it feel to be listed amongst the Top Doctors list?
I am excited to be amongst the chosen Top Doctors list and one of the chosen group of physicians who are making a difference in people’s lives. I am blessed and thankful to all the voters who believed that I was capable of being here. I feel it is important to be humble but be recognised for the difference that you make. A pat from your boss or kind words from your staff members can simply make your day and bring out the best in you. Patients gratitude and appreciation bring the much-needed job satisfaction and confidence in a physician’s practice.
Dr Garg, you’ve had a long medical career. Let us know about your journey.
Yes, my journey in the field of medicine and anesthesiology has been long but very rewarding, personally and professionally. I think I am blessed to have trained with revered mentors at top institutes during my career. I started my med-school in India (1992). I worked as a critical care faculty for about three years before I moved to US with my family. The yearning to be able to treat pain momentarily brushed past me during my profession as an intensivist in India. Nevertheless, I got more inspired in this field of pain medicine after I started my anesthesia training at University of Iowa and that is where I decided to dwell more into it. While working as a resident at the pain clinic during my anesthesia training provided me a perception into the practical and real world of pain. To the world, the practice of chronic pain medicine may seem to be limited to mere prescribing of opioid medications, but I was amazed to realize that innumerable other possibilities are available that could be offered to the patients to help them overcome their painful ordeal. Honestly, my mentors and teachers, who do an exemplary job at taking care of their patients, their work philosophy and ethics, has inspired me and impacted my practice immensely.
What inspired you to become a pain physician?
Looking back at my life, I think my answers to this question kept changing dramatically and rather frequently over the time. I badly wanted to be a singer when I was in high school.
Anyhow, once I started my career in the medical field, I was enthused by effervescence offered by anesthesiology and pain medicine. Presently I am stimulated by the piousness and unpretentiousness we need to show to each and patient that walks in to our pain clinic or who comes for surgery. The drive to accomplish even the smallest improvement in the quality of the lives of my patients inspires me to keep going and to become a better physician.
I understand that you’re an expert in chronic pain. Could you explain that to me.
Yes, I am an American Board of Anesthesiology certified board specialist in Pain Medicine and a specialist in Anesthesiology. Chronic pain is a overwhelming disease related with not so encouraging health outcomes. Once patients are afflicted with it, the course is usually progressive with a steady march to functional decompensation, multitude of psychiatric comorbidities and disability, unless aggressive interventions are taken by a pain management physician in the early stages.
The patients often go through extensive imaging and physician consultations in search of plausible etiology for their pain symptoms. This not only creates dissatisfaction and frustration amongst them but also puts a huge financial burden on the economy. Low back pain is a major contributor to chronic pain. Overall, low back pain is the fifth most common reason for visiting a US doctor. It has been found that the prevalence of low back pain in the general US adult population is 10–30%, annually, and the lifetime prevalence of US adults is as high as 65–80%. Given the increasing number of patients with chronic pain, it is imperative to find solutions to prevent the progress of acute pain into chronic pain with its downstream complications. Meeting these crucial goals can only be accomplished through developing a better rapport, excellent communication, establishing goals and expectations with the patients. A better understanding of the mechanisms involving chronic pain as well as non-opioid based interventions are critically needed.
Opioid-based pain medications are NOT the answer to chronic pain problems and have caused havoc in the country with the opioid crisis being caused by poorly controlled chronic widespread pain and unsafe prescribing practices by practitioners not trained in safe practices of pain management.
Over the last few years, there has been an exponential increase in the percentage of the US population using and misusing prescription opioids, deaths due to opioid-related drug overdoses and economic costs of dealing with this prevalent epidemic. An average of around nineteen million opioid prescriptions are written monthly, and more than six thousand opioid prescriptions were dispensed per 100 000 patients. The Center for Disease Control has reported that death due to misuse of opioids has increased five times since 1999.
The current health care system produces fragmented care with poor delivery of necessary medical interventions when needed in the setting of chronic pain patients. This results in the rampant abuse of opioid or “narcotic” pain medications, unnecessary treatment with expensive injections and procedural interventions including surgery and a wide variation in the quality of pain care delivered across the country.
The pain management physician emphasizes on the need for multimodal approach towards pain management. This includes but is not limited to physical and occupational therapy, pain psychology therapies such as cognitive behavioral therapies, acceptance and commitment therapies, coping strategies, acupuncture, injection based therapies and yoga and relaxation exercises
Often, this is not well accepted by the patient population since they are usually expecting an instant relief/gratification from the pain symptoms. The course of treatment can be prolonged, gruelling and lot of times not a cure.
Patients suffering from chronic pain are falling easy prey to these practitioners who are dispensing large quantities of “narcotic” pain medications which are not indicated in non-cancer pain. I am one of the few physician scientists in the United States who has the training and expertise to not only discover novel findings and treatments relating to pain management in the laboratory, but also to bring these directly to the patient by translating these findings into clinical practice interventions.
Low back pain is not only common, but also holds a significant cost and health care utilization burden in a country where rate of health care expenditures is skyrocketing in relation to GDP growth and overutilization is a major concern. The total direct health care costs attributable to low back pain in the USA is more than twenty-six billion dollars. Apart from direct monetary health care expenditures, low back pain leads to significant costs as well. While low back pain remains the leading reason for disability and loss of work days.
The common etiologies of low back pain can be related to facet joint arthritis, discogenic disease/degeneration, SI joint mediated pain, failed back surgery syndrome.
As a pain physician, I am actively engaged in providing therapeutic modalities to patients who come to my clinic with complaints of pain related to the above etiologies including but not limited to the above.
What does your usual working day with patients look like?
I see around 400-480 patients per month. I am honoured to be of help as a physician to provide my services to the respected and revered ex-servicemen, and patients on Medicare by the virtue of providing medical care to the patients who come for surgeries at UCMC surgical centres and as well as those who come to the Pain Clinics.
As a Pain Medicine Specialist, my services involve and are not limited to placement of spinal cord stimulators for chronic pain conditions, radio-frequency ablation of articular facet medial branches and the sacro-iliac joint, Epidural Steroid Injections, differential Nerve Blocks, and Trigger point injections.
My other clinical responsibilities include providing expert pain consultation to other departments including surgery, orthopedics, obstetrics and gynaecology, emergency department and intensive care units for pain management.
I treat patients in both Chronic Pain Management Clinics, Acute In-Patients Chronic Pain consults, and patients who come for anesthesia (& surgery) from both in and out of state of Ohio. We also treat foreign national patients who come for treatment from abroad. Other than patients coming from all parts of Ohio, we cater to patients from adjoining states like, Kentucky, Indiana, and various other distant states.
I perceive that you have worked as a part of a special panel of an experts who formulated guidelines for managing of chronic pain, would you be able to share something with us please.
Yes, in 2019 I was honoured to be selected as a member of the national task force that would formulate guidelines for the lumbar facet mediated pain blocks and interventional procedures. I am part of the select group of experts that will formulate the guidelines for Facet Joint Blocks for low back pain. This committee comprises of national and international experts put together from various pain societies like the American Academy of Pain Medicine, American Society of Regional Anesthesia, World Institute of Pain, American Society of Anesthesia, American Society of Pain & Neuroscience, Canadian Pain Society, Korean Pain Society. The committee will suggest evidence-based medicine guidelines for practitioners of Pain management.
Way back in 1998, the total direct health care costs attributable to low back pain in the USA were more than twenty-six billion dollars. Low back pain is not only common, but also holds a noteworthy cost and health care burden in a country where rate of health care expenditures is rising steeply. Apart from direct monetary health care expenditures, low back pain leads to significant opportunity cost as well. The common etiologies of low back pain can be related to facet joint arthritis, discogenic disease/degeneration, SI joint mediated pain, failed back surgery syndrome. Facet-mediated pain is a result of a multifactorial process associated with degeneration of the intervertebral discs that leads to lumbar facet joint degeneration. It is important to standardize the procedural details for this commonly performed procedure. This not only will improve the patient care but also will cut down unnecessary interventions.
The country seems to be dealing with an opioid crisis. Are you involved in some kind of efforts to counter the problem?
I am happy you asked this question. I am also involved in two research projects to explore non-addictive and non-opioid therapies as part of the objective to address the enduring national crisis on opioid use disorder. Our first project is to evaluate the efficacy of epidural steroid injection with supplemental oral eplerenone for the treatment of low back pain. Our aim is to figure why epidural steroid injection are only effective in some patient despite having with similar back pain issues. Once completed, we hope to provide a guideline for the usage of steroid in back pain therapy. We are focusing on what specific steroid should be used; and what is to be done to circumvent likely side effects. Our second project is focuses on identifying specific biomarkers for a condition called the Complex Regional Pain Syndrome (CRPS). This is an obstinate neuropathic pain condition. So far, the only effective treatment that is provided or suggested to the patient is placement of a sympathetic nerve block. Nevertheless, till date, its outcome has remained unpredictable. In our research project we are trying to determine whether certain serum biomarkers are associated with reoccurrence of CRPS.
Many doctors later transition into teaching and research. Have you followed that same path and if not, do you have any ambition in doing the same?
I have so far more than 50 publications in peer reviewed journals with around 175 cross citations from researcher and physician’s world over. I have also published four chapters in standard anesthesiology and pain medicine related reference text books. I am currently the lead researcher for the department of Chronic Pain Medicine, and we have multiple ongoing research projects.
What are some of favourite aspects of your work? You’re out there constantly helping your patients, that must motivate you right?
I love that as a Pain physician I can work towards, assessing, analysing and configuring therapeutic modalities that can eliminate painful issues and improve patient’s quality of life. The most pleasurable aspect of my job is that my practice permits me to have direct patient interaction via an office-based practice, while still letting me perform beneficial procedures that can alleviate pain. Particularly I feel honoured when I get to address my patients’ susceptibility to not just their disease process, but also to their fear, solitude, anxiety, and apprehensions in dealing with it. It brings me immense satisfaction when my patients simply thank me because I bothered to listen and share what they are going through. A smile on their face when they leave, and also when they come back to see me, and telling me how better they feel is my motivation to turn up for work every day.
Do you have any important role models or influences in your life?
My mother who has always been a guiding force behind making me the person that I am today. I owe my values, my sincerity and my outlook towards life to her.
Anurag, my husband is a rock of support to me. He has always stood by me through thick and thin. I owe my perseverance and the strength to deal with the most stressful situations from him.
I am also thankful to all my teachers who made me what I am today.
How can I prevent myself from experiencing chronic or even mild acute pain?
Acute pain is actually a protective phenomenon offered by the body. It makes you withdraw from the triggering insult and prevent further damage. A major component of the acute pain is nociceptive in nature and hence responds favorable to analgesics such as anti-inflammatory medications and nerve blocks etc.
Constant bombarding from the insulting trigger causes alterations in the chemical transmission and the neurotransmitters at the various levels in the pain pathways. The resulting sensitization and hypersensitivity of the receptors can cause sustained pain even to innocuous stimuli or even in the absence of a stimulus. Often the pain symptoms seem disproportionate to physical findings or objective disease or injury. A large proportion of patients with chronic pain have associated psychiatric morbidities such as anxiety and depression which amplify the chronic pain state.
It is very essential to block the transition from acute to chronic pain as chronic pain becomes more of a disease and more challenging to manage for the above-mentioned reasons. Hence, pre-emptive analgesia which aims at targeting the pain prior to the insult such as nerve blocks prior to major surgical procedures is a useful therapy. Utilization of tools such as physical therapy/rehab after trauma or surgery, adaptation of healthy and active life style and education and awareness of the judicious use of pharmacological methods to treat the pain is essential.
Are there specific stretches you would recommend to relieve back pain?
We use our lower back for a multitude of things, from walking and running to simply getting out of bed in the morning. Keeping it in good working condition with regular stretching helps us relieve the built-up underling tension and develop strength. In my opinion, regular stretching exercises of the muscles and ligaments that support the spine and its integrity are the most vital part of any back-exercise programs. Stretching is both prophylactic and therapeutic. It helps in decreasing tension in muscles supporting the spine; increasing the range of motion and thereby improving overall mobility.
Many stretching exercises can be done for Low Back Pain, but before starting them always consult your physician or an expert. It’s pertinent that you do these exercises with utmost safety and care. Be especially gentle and cautious if you have any type of injury or health concern. It’s best to talk to your healthcare provider first.
Some of the common ones that can be done are, Sphinx stretch, Back Flexion Stretch, Knee to Chest Stretch, Kneeling Lunge Stretch, Seated spinal twist, Pelvic tilts, Piriformis Muscle Stretch. There are many resources, for example YouTube where you can see how these can be performed safely.
Medical professionals are usually the forefront advocates for a healthy lifestyle. Are there specific suggestions that you would recommend to those seeking to improve their wellbeing?
- Healthy balanced diet.
- Regular daily exercise.
- Stretching and core strengthening of low back muscles.
- Meditation, Yoga.
- Stay away from negativity.
What is your best life advice, motto or favourite quote?
My two favourite quotes are “My best is yet to come,” and “Never let your sense of morals prevent you from doing what is right,” – I believe Isaac Asimov said that.