Dr. Anthony J. Oddo, a Pain Management Specialist at Mendelson Kornblum Orthopedics, joined us today on Head to Total to talk about pain management, how he helps his patients manage pain, and some of the biggest misconceptions around the subject. Join us as we talk about everything from head to toe on the Head to Total Podcast.
#opioids #pain #painmanagement #podcast #podcasting #healthcast #synergy #medical #medicine #podcaster #host #Doctor #Synergy #synergyhealth #help #health
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Dr. Anthony J. Oddo, a Pain Management Specialist at Mendelson Kornblum Orthopedics, joined us today on Head to Total to talk about pain management, how he helps his patients manage pain, and some of the biggest misconceptions around the subject. Join us as we talk about everything from head to toe on the Head to Total Podcast.
#opioids #pain #painmanagement #podcast #podcasting #healthcast #synergy #medical #medicine #podcaster #host #Doctor #Synergy #synergyhealth #help #health
Refresh by Roa Music | https://soundcloud.com/roa_music1031
Music promoted by https://www.free-stock-music.com
Creative Commons Attribution 3.0 Unported License
https://creativecommons.org/licenses/by/3.0/deed.en_US
Colleen Young: Hey guys, welcome to Head To Total, the podcast that talks about everything head to toe about the medical field. Good times today Dr. Tony Oddo from Mendelson Kornblum Orthopedics. He's the pain management specialist, and we have him on today because I think there are a lot of questions about pain management, what he does and I think a lot of people have some misconceptions. I really wanted to pull back the curtain today and have a great conversation with him. So welcome Tony, how are you? Great to have you.
Anthony Oddo, OD: Great to be here, thank you for having me.
Colleen Young: Why not start with telling our audience, again, your voice goes everywhere, we are national, we are nation-wide, we're global, who you are and what you do?
Anthony Oddo, OD: I'm Dr. Tony Oddo, I've been a pain management physician now practicing in Macomb and Wayne for the last 10 years through Mendelson Kornblum Orthopedics and it's a great opportunity for me to see a lot of different varied patients. I've really enjoyed pain management for quite some time now. I did my initial training in physical medicine and rehabilitation. Then I did fellowship training in pain medicine, where I had the opportunity to learn different aspects of pain medicine interventionally and a more holistic approach to how to treat people who are having pain conditions. So it's been a great opportunity to work in an orthopedic clinic where we have a lot of patients with back pain and neck pain and a lot of different painful conditions that I've been able to work with.
Colleen Young: How long have you been with Mendelson Kornblum?
Anthony Oddo, OD: It has been a little over 10 years right now.
Colleen Young: That's a long time to put up with those guys, I've met some.
Anthony Oddo, OD: Vice versa as well, I am sure.
Colleen Young: All right, so tell us about if you're seeing, you said neck, back and shoulder, what's a typical day in your life, what does that look like? What types of patients are you seeing?
Anthony Oddo, OD: So we see a varied amount of patients, and most people are going to have back pain at some point in their life. Fortunately, most people get better with that and they don't need to come to see me by doing some simple things. The people that come to see me are those people that have the pain that just kind of stays there for a long time and doesn't get better. Or if they have pain that radiates down the leg or radiates down the arm if there's a pinched nerve. I see a lot of people, younger patients who have had acute injuries from lifting something, done something or been in an accident and have painful conditions from that. And you see a varied amount of different types of pain as well. There are different types of nerve pain where people come in who may have had some other injury in the past where they've injured their leg or an arm, and then they have some different type of nerve pain thereafter. So we treat head to toe, within the group we have doctors who treat headache and everything related to the different areas where we may have pain, where we try to help and see what’s the source of the pain, and then figure out the best way to try to improve that and improve function as the bottom line of what we try to do.
Colleen Young: I'm sure there's a management of expectations that you have to do. And when they go in to see you, do you do the pain scale thing, like “Coleen, do you feel pain from one to five? How often do you feel five?” And then do you manage the patient's expectations or is it, yeah, you give them a pain-free life or is it case by case. How does that work?
Anthony Oddo, OD: So it's very different for everybody, the pain scale is a very subjective measure. Everybody has a different measure of where they are and that's what you take for them, everybody is different. And it really depends if you have somebody who has a new onset of a pain and it's something that once the injury heals, the pain is going to get better, then I have a good chance that they're going to have a point where they're not having pain at all. If I have someone come to me who has had a 20 or 30-year history of having back problems and chronic pain, really had a struggle with that and they have really bad degenerative changes in their spine and really bad injuries and issues, I can't wave a magic wand and fix that.
Colleen Young: You seem pretty remarkable, I would say.
Anthony Oddo, OD: Yeah, I tell them there are ways that we can improve their functionality, improve their pain management. And it's not a one way street, there are things that they have to do as well. My whole job with any patient that comes in is I'll tell them what I think are realistic options to try to help them to really have the best life going forward. You can have a bad degenerative back and still live a full and happy life, you can have flare ups of pain and we can help manage that and there are things we can do. But to be absolutely pain-free, if your spine is to a point where surgery will be something to consider, you don't realistically want to do that, that's not something we can look at. But if you're miserable every day and you really can't continue doing the things you want to do, there's a lot of things we can do to help.
Colleen Young: Tell me about some of the things you can do to help out. I know you and the rest of the MKO physicians are at the forefront of absolutely everything. I know Steve Mendelson does peripheral nerve stimulators. What are you doing at the forefront of medicine to help people with chronic pain?
Anthony Oddo, OD: So there's a lot of different things that we look at with chronic pain. We have a great physical therapy department. And one of the most important things to treat chronic pain is to keep them moving and active. Bed rest for back pain doesn't help, it actually makes things worse and to get into a program, I understand that things are going to hurting, and figuiring a way to be able to manage that is really important. And physical therapy is one aspect of that. We look more at what we call a multimodal approach, meaning different mechanisms of how things work to try to help improve your pain, and improve your function. One of them is therapy, plus we have a very interventionist mentality. There's a lot of different injections and procedures that we do, from things like epidural injections which are essentially steroid injections that go under imaging or under x-ray into the spine to try to help people with painful conditions. There are different nerve block type injections that we do for people with back pain or back problems, or neck problems. They are different blocks of different joints or nerve blocks beyond that that we look at. There's things like spinal cord stimulation, which are these implantable devices to try to block pain in the spinal column to help people with chronic pain conditions.
There are things like ketamine, which is sort of an IV infusion of an anesthetic drug for people who have gone through a whole gamut of different things and have more of what we call central pain, which is essentially the body after having had a painful condition for a long time, the receptors in the brain become upregulated. You keep hitting with signals, it's like with your kids, they're yelling at you non-stop, you just kind of start going off, right? Same thing with your brain, now those receptors are getting hit by painful signals and we're trying to reset that with a lot of different therapies that we look at for this. So there's a lot of different modalities that we do, there's different types of nerve pain medications. And again, the different multi-modal approach I use. There's different mechanisms of how these medications work, from anti-inflammatory-type medications to antispasmodic medications that help with spasms, nerve pain medications, and sometimes different pain medications beyond that as well.
Colleen Young: kay. There was a lot there. I gotta go back, this is fascinating. Most people, when you say epidural, the first thing that comes to their mind is childbirth.
Anthony Oddo, OD: I tell most people that they don't get a child with this epidural, unfortunately. So some are happy, some are not so happy.
Colleen Young: I have this image in my head doctor, of you're going to put a needle in somebody's back. Which obviously is terrifying.
Anthony Oddo, OD: Yeah, and most women are screaming for an epidural when they're pregnant because they want to help with the pain, so epidural is just the name of a space. And when you go in, when you're pregnant, it's the exact same space that I access, but I can do it in a much more controlled setting. So when you're pregnant, in between contractions, an anesthesiologist comes in and tries without any imaging, to essentially put a catheter in that space and then put some numbing medication so you don't have the pain of labor and delivery. When I give an epidural injection, we can do it in a controlled setting, so if we do it in our procedure room or if someone is very anxious we can do it with a little sedation in one of our surgical centers. And you're lying on your belly and we're using a large guided imaging machine called fluoroscopy, which is taking live x-rays as we're doing the procedure and we're guiding the needle in. As I said, you're lying down so you're not between contractions and we're slowly going in and bringing that needle in, then instead of what they do when you're having an epidural when you're pregnant, where they just put some numbing medication in that space, we're injecting a steroid or a cortisone that works as a strong anti-inflammatory to help with pain. And often if people have what we call radiculopathy or a pinched nerve in the back, that causes pain in the leg or in the arm, the steroid can calm the inflammation and help relieve the pain going into your extremity. It's a fairly quick procedure, which sounds more in depth than it is and we take our time and do it right, but the whole thing takes about five minutes and that's it, and hopefully gives you some relief.
Colleen Young: I had no idea that it was a space, I thought the actual epidural was like the needle going in, I had no idea.
Anthony Oddo, OD: Yeah, it's not common when people say give me this epidural and that's the name of a space. Epi means around and dura is kind of a sac where that spinal fluid is living. So you're trying to bathe where those nerves are for the pregnancy, just a numbing medication so you don't feel it and with the procedure where we're doing an epidural steroid injection with a steroid.
Colleen Young: Now let's go to ketamine, because you talked a little bit about ketamine. I think it's a buzzword that people are saying now. What actually is ketamine? What's its history? How are you guys using it?
Anthony Oddo, OD: Ketamine has sort of mixed bags of what people think of it, right? You hear about ketamine and people misusing it and you've probably heard about all kinds of terrible things related to it. But ketamine has been around for a long time and it's essentially an anesthetic drug that's been around for a long time, an anesthesia for people. Anesthesia is still used today in certain cases, in fact, my youngest son, when he was five or six years old, cut his lip and they needed to sedate him so he wouldn't move so they could sew his lip and they used ketamine. It's just a matter of what is the best medication to try and do your anesthesia for. One of the advantages we have seen in chronic pain is that it is used through an infusion where you start an IV and you use ketamine to help with these central chronic pain syndromes where people have had pain for a long time and that is where we are resetting that pain pathway.
Colleen Young: Okay. And then I think a lot of people when we talk about doing this kind of podcast, people ask me, are you going to talk about opioids? But there's so many different things that you guys are doing now that's opioid free in a lot of areas. But can you talk to me a little bit about if we still use them in the MKO practice? What's the protocol there? What's your stance on opioids?
Anthony Oddo, OD: Yeah, I mean, opioids have been a big topic not only in pain management, but in our country there's been a problem with the misuse of these medications and there's a big pendulum swing of where they've gone. It used to be when I was training 10 years ago, that there's no limit on these, you should have patients who have no pain at all and be writing very high amounts of opioids which I never really subscribed to. And it's gone all the way down to they're the devil and it's actually somewhere in between. There's a potential, but again, chronic opioids for pain, there's not great evidence that it does anything. So they have a role. And for some people they can also help with function as well and it's carefully managed and monitored. We check patients' urinalysis to make sure they're taking the medication properly, but it’s really not a great role and there's not a lot of evidence to show that it does a lot for chronic pain. So we look at a lot of other different modalities that can help with chronic pain. That being said, we prescribe opioids in selected cases and we manage and monitor them very carefully and my end goal is always to try to reduce them or cut them off because again, I don't think they help long term, and there are other things we can do to help. But for acute pain or someone who's having post-surgical pain, we definitely use opioid medications to help manage those patients. But again, there's a whole armamentarium between the different interventions that we do and the different types of medications beyond that which can help with different pain beyond that are also non-opioids.
Colleen Young: Well, I think you hit on two things, right? I think that right now in society they are the devil, and it's the worst thing you can ever do. But to the point you made earlier, the physician does the work, but then the patient also has to do the work. So the patient has a certain amount of responsibility as well. You know, if you're testing them and testing the urine and they are progressively getting better, they've gotta wean themselves off too. It's not like, you know I'm gonna swallow this pill just because I can.
Anthony Oddo, OD: Right? And again, medicine's not gonna fix everything. And none of the medications can get to a point where you're gonna get rid of all the pain either. You know, it's very important, we do monitor the patients and there's a lot of different tools that can help with chronic pain beyond that, beyond medications as well. We talked about intervention, there's mindfulness, there are things where they can work with different counseling and we can do different techniques to help with pain management through that as well that have been shown actually to help out better than a lot of different other modalities that we use. So it's not just just one magic pill that makes everything better. But opiates at the same end, are never not used, it's not like it's not something we would consider, but it's not something that we look at long-term at all and it doesn't fix anything. And it's important, as I said, the patients understand that sometimes you are gonna have some pain in how we're gonna manage that and get you through and do your normal day-to-day activities. And that's what our focus is on, you know, are these things making you better? I've had patients who are on opiates chronically in the past and they come in with the same pain score that they had before I started them on an opiate. And it's not uncommon at all. And the question is what can I do today that I couldn't do yesterday, whether it be with medication, with therapy, with injections or other treatment modalities? How am I making your life better that you can do the things you wanna do on a day-to-day basis and function? And that's always gonna be the questions in what we're trying to strive to help with patients.
Colleen Young: You have to be the favorite within the practice because people feel better when they see you. Be honest, you’re the favorite in the practice aren’t you?
Anthony Oddo, OD: We have a lot of great doctors who work throughout MKO and they all bring different great attributes to the table. That's one of the great things about the group that we have, I don't do everything in pain management, I don't do obviously everything in orthopedics and I have a lot of colleagues that do other things. So I do things like acupuncture where other colleagues in pain management don't. I myself don't do ketamine, but other doctors do that. I'll refer to it when I think it's appropriate, whether it be spinal cord stem or different treatment modalities that we have. And amongst the group that we have, we really cover head to toe. You know, we have a great group of people that I trust, that I can send you to. And I’m not that bullheaded to think that I know everything, I will send when I don't know what's going on or I need a second opinion on this. Or I have a colleague who specializes in this and I say hey, you may be better served going to them because I think this is the right way to go for you. And so I think that's one of the great aspects we have in our group. In pain medicine, we have a wide coverage, but then I have orthopedic colleagues that can help. If I think that hey, maybe this neck pain is really actually stemming from the shoulder or the pain that you have going down your leg is actually more of a hip problem and I can then refer you off to a colleague. We have great spinal surgeons who we can send if things are more urgent and I can say hey, this is something that needs to get fixed and if it doesn't, it's not gonna get better. And we try to avoid surgery at all cost, especially when it comes to the spine, but there's times when it's needed and it's knowing when that is and when to refer out and having somebody that you trust that you can refer to, which is really important.
Colleen Young: Coming up on one of our future podcasts, we're talking to a colleague of yours, Rashid Aviola, and he said 80% of patients that come to see him need a spine surgery; he doesn't do surgery. And I think that for somebody who has to go see a spine surgeon, those are big words, right? I mean that's a hard pill to swallow, a spine surgeon, and to know that there are other ways. In fact, for those of you that don't know, I do have the privilege of working with a lot of the physicians at Mendelson Kornblum Orthopedics at Synergy Health Partners, and I did see Dr. Oddo the other day in orthopedic practice. And it is cool because you guys do go back and forth and pull each other into the rooms and say, what do you think of this? What do you think of that? The patient really does benefit because you're all there together and that's great for them.
Anthony Oddo, OD: Yeah, it's a great opportunity. If you're going to a surgeon who says, “You know, most of the people I'm seeing I'm doing surgery on, you're going to a surgeon who I think is overly aggressive. And as I said, I think the surgeons that we have are people that I would send family to. They're people that I trust. They're not overly aggressive with what they're doing. And they're people that are gonna offer surgery to people who I think need it and are gonna benefit from it. And I agree, we're a busy clinic and a busy group and we have a bunch of docs there that I can bounce things off pretty easily, which is always nice to see.
Colleen Young: Doctor, you said something really key in there that I wanna hit on. You said acupuncture and I think a lot of people are curious because they're hearing the term dry needling. What is the difference between dry needling and acupuncture?
Anthony Oddo, OD: So acupuncture's been around a long time and I've been doing it now for about 10 years. I did my training in acupuncture through a doctor who trains doctors, essentially. It's called Helms Medical Acupuncture and it's pretty extensive training that we do. So it's kind of head to toe of different modalities and different ways you treat and generally when people think of acupuncture they think needles and a lot of people get scared because they have a phobia of needles. And I've treated a lot of people who are very afraid of needles who keep coming back because they get a lot of benefit from it. These are fine needles. There's no medicine that's going into these, and it's very safe. Among the things we do in medicine, it's probably one of the safer things that are out there because there's really no medicine that's going in. And I don't try to string people along. I have people that get some benefit and I have people that don't get as much, and I'm gonna give you an upright answer and I'm gonna say we give it a try. We usually set up for about four treatments and see what it's gonna do. There's been good evidence behind it, there's a lot of evidence that's out there for back pain and for a lot of different pain conditions where it's been well researched and shown to have good evidence. And so acupuncture, there's a lot of different aspects of that.
There's things that we do for things called trigger points where there's muscles or parts of muscles that continue to fire. I'm sure if you're kind of rubbing on your neck, you can find little spots where you're like, oh yeah, that's the spot right there. Those are often trigger points and those are painful areas where the muscle continues the fire, especially if they’re sitting at their laptops or on their computers kind of hunched over, we get those little areas. And so what dry needling is doing is really trying to go towards those specific spots as well with a single acupuncture needle and trying to kind of break up some of that muscle firing as well. So it's working on some of the tenets of acupuncture, a little more localized over different areas into different muscles to try and help with people who have different conditions of painful areas. Acupuncture I think is a little more broad in what we can offer as well. And we do some of the traditional energy movement points in addition to different areas. Generally in my practice, I'm obviously doing pain management, so I'm usually treating people with either neck or back pain. And you know, I have people that fall asleep during treatments and can be pretty relaxing and comfortable during it. So people think needles and they think oh, this is gonna be really terrible. But most of the time you bring some music, you relax and hopefully you get some good benefit that lasts.
Colleen Young: I've tried acupuncture before, it really works, at least it works for me and you're right, I think you go into it thinking, oh my gosh, they're going to be sticking needles in. But if you can get out of your own head, it's a very relaxing experience.
Anthony Oddo, OD: Yes. I usually tell people that the first time the unknown is the worst part and you've survived and now you can go into the next one with an open mind and really let it do what it's going to do.
Colleen Young: How does anyone get started in pain management? If there was a young physician looking to specialize, what was the path you took there?
Anthony Oddo, OD: I kind of stumbled upon it. You know, it's not an area of medicine where going into med school I'm like oh, I'm gonna be a pain management doc. I initially was very interested in orthopedics and in sports medicine with my background and really liked that. When I got into residency and actually before residency and training I really didn't like the surgery as much, so orthopedics wasn't the great choice. But physical medicine rehabilitation or PM&R was a great field which offered a lot of musculoskeletal medicine and spinal cord injury and stroke and brain injury and a lot of different things that really appealed to me, and that's how I got into that. And then one of the subspecialties that you do off of that is when you do pain medicine. And so you treat a lot with spine and a lot we can do great with PM&R with therapy and different modalities, but then it kind of felt like it stopped and short of surgery, pain medicine kind of fills that gap. And so it was kind of a nice field when you started doing it, it kind of gave a mix of some intervention as well as medicine. And so you got the best of both worlds. You know, when you're a surgeon, you're kind of always in the OR, if you're an anesthesiologist, you're not interacting with patients as much. This, you get to use your hands, you still do some interaction with patients and get to kinda learn about them and form relationships while still doing then also procedures. So you kinda get the best of both worlds.
Colleen Young: So Tony, there are many medium and small orthopedic practices in southeast Michigan. When you made the decision where you wanted to practice, why did you choose Mendelson Kornblum Orthopedics?
Anthony Oddo, OD: So yeah, when I was coming out, it's been a little over 10 years actually now. So I came right out of fellowship and I had some different offers out of state, I had a couple offers locally. And in the end we wanted to stay local, I have a family here and my wife's here. And Mendelson Kornblum, what was really appealing is when I first met them, it was a group of brothers and it reminded me of life around my dinner table at home. You know, they're chatting and talking and getting along and I got in pretty early on in the process and we've grown quite a bit since then. But the nice part was I had another physician that I already worked with that was here, and it was kind of the camaraderie. It was the people that were already here that I felt like I could work with that were reasonable people. A lot of people are less than easy to work with sometimes. And just the initial impression from the group, it was a smart group of people, it was a good practice, they worked hard, they had a wide variety of what they were able to see. It was people that got along and I would want to go in and work with. And when you do that, you find yourself in a nice position where you can be happy, you can provide good care for patients and give them a good opportunity to do the best they can.
Colleen Young: So Dr. Oddo, you work with an incredible group of people, that practice is really thriving. What distinguishes you within that practice with respect to who you are as a physician and with your patients?
Anthony Oddo, OD: So yeah, I've been practicing now for, as I said, a little over 10 years, so I've seen a lot of what there is in pain medicine and in different patient problems. And you know, we offer a wide variety of things and I think I take the time to listen to the patient and try and figure out what's gonna be the best option for you and help you have an educated decision about what is the best treatment going forward. I offer a lot of different interventions and I've been doing it for a long time and I like to think that I'm pretty good. And have gone through a lot of this and kind of know how to get through these when they're tricky, how to manage these different situations. And again, listening to the patient to find, shout and make sure that you understand exactly what we're doing and give you all the options and the education to make a good decision about what's best for you.
Colleen Young: You know, one of the things that you said that's really important as a patient, when you go to a physician like yourself, someone who listens, right? Because you know what happens, we patients are terrible. The first thing we do if something hurts is we go on Google and then we run to you and we're like, this is what's hurting. And the fact that you listen to us and use your experience to make us all better is to be appreciated.
Anthony Oddo, OD: Yes, and I always encourage patients, you know, because you're gonna have questions and you're gonna forget them, I do when I go to a doctor, is to write them down. And when you have a list of questions, you bring them in and we'll go through them step-by-step and I'll make sure all questions are answered and you understand what I'm talking about. Because again, it's your body, it's your decision. My job is to educate you on what the choices are, what I think makes sense from a physician of experience and knowledge in this area of pain. And so that's what I take the time on and say hey, this is what I see going on, this is what's an option, this is another option. This is what would happen if we don't do it or if we do it. And it's your body and it's your choice about what I think you wanna do and where you wanna go with the treatment going forward.
Colleen Young: Dr. Oddo, so much good stuff that you gave us today. I have so many more questions. You know, again, in looking at your webpage, I gotta tell you, there's a lot of things that I can't even pronounce, but I think a lot of people would be interested in. You're just gonna have to kind of bring it down on a level for us. Would you be interested in coming back and talking to us again?
Anthony Oddo, OD: I would love to, that would be great. Thank you.
Colleen Young: Thank you so very much. Mendel Kornblum Orthopedics, they can come see you, they can get some acupuncture, they could get some good treatment and they can have a good time while doing it. So thank you so much.
Anthony Oddo, OD: Thank you very much. It has been great to be here.