Issue link: https://viewer.e-digitaledition.com/i/674833
ABOUT DR. NAROUZE Born and raised in Egypt, Dr. Narouze received his medical degree and master of science degree in anesthesiology and critical care from Ain Shams University in Cairo, where he later served for three years as an assistant professor. In 1996 he came to the United States. "I came here specifically for a pain man- agement fellowship at Cleveland Clinic. It was a very competitive program, and the only way I could get in was to re-do everything. So I repeated my internship in internal medicine and residency in anesthesia at the Cleveland Clinic and then [in 2002] I was accepted into their pain management fellowship program," says Dr. Narouze. In 2005, he joined Cleveland Clinic's sta–, and later served as Program Director of its pain medicine fellowship program and as an Associate Professor at Cleveland Clinic Lerner College of Medicine. Seven years later, he earned a PhD in interven- tiona l ma nagement for cer vicogenic headache and neck pain from Maastricht University in the Netherlands. Today, Dr. Narouze holds clinical professorships at Ohio State University, Ohio University College of Medicine, and Northeastern Ohio Medical University. Much of his teaching, however, is not done in a class- room; it's done at The Center for Pain Medicine at Western Reserve Hospital. "We've had visiting faculty from Spain and visiting physicians from Hong Kong, Canada, Taiwan ... who came here to learn how we treat pain without narcotics," Dr. Narouze explains. "This hospital is not a˜liated with a big university. People come here because they know we've established an excellent program with excellent sta–." Like Dr. Narouze, all of the Center's physicians — namely, Syed Ali, MD, Tim Sable, MD, and Dimitri Souzdalnitski, MD, PhD — are board-certified in anesthesiol- ogy and pain management, and all received their fellowship training from Cleveland Clinic, where all were "chief fellows" in pain management. Their experience spans 10–29 years. As for their outcomes, they speak for themselves. And what they are saying, according to Dr. Narouze, is this: Non- opioid therapy works best to reduce and resolve pain in the majority of patients. NON-NARCOTIC PAIN MANAGEMENT Opioids can reduce pain, but only by about 30 percent. In the short term, defined as three to seven days according to CDC guidelines, they may be beneficial in reducing acute pain. However, in the long term, patients become tolerant to narcotics, and some may even experience hyperalgesia (increased sensitivity to pain). In addition, there's the well-known risk of physical dependency and addiction. So what are the non-pharmacologic alternatives? According to Dr. Narouze, and the CDC, there are many. They include + Physical therapy and exercise; + Psychological counseling to help cope with pain, deal with contributing stressors, and improve function; + Chiropractic medicine, including Active Release Technique, a soft-tissue motion treatment; + Relaxation therapies, including meditation and music therapy; + Functional medicine to eliminate risk factors, such as obesity and smoking, which may contribute to pain; + Medical interventions, such as nerve blocks, radiofrequency ablation and injections — joint injections, epidural injections, MSK injections. Regenerative pain medicine, which utilizes platelet-rich plasma (PRP) to promote quick, natural healing, is also an option at Western Reserve Hospital. "PRP treatment is for patients who don't heal appropriately or quickly enough," says Dr. Narouze. "We draw a patient's blood, use a specialized centrifuge to concentrate the platelets and growth factors responsible for healing, and inject this directly into the area of inflammation. PRP goes hand in hand with physical therapy." He explains that the best indication for PRP therapy is recurrent injury to the hamstring, Achilles tendon or even temporomandibular joint. Tennis elbow and knee arthritis are also indications. "This is my point: You find the source of the pain — the earlier, the better — and you treat that and hopefully reverse the complications, which would be chronic pain," Dr. Narouze says. "Just like you want to prevent diabetes from leading to amputation, you want to treat acute pain and subacute pain from escalating into chronic pain. If you don't, chronic pain becomes a disease in itself with complications like loss of function, disability and drug addiction." Dr. Narouze is shown here examining a patient's upper neck muscles and nerves with ultrasound to diagnose the cause of headache pain. PHOTOS BY KEN LOVE COURTESY OF WESTERN RESERVE HOSPITAL M D N E W S . C O M /// M D N E W S C L E V E L A N D /A K R O N / C A N T O N n M AY/J U N E 2 016 0 7