At Advanced Pain Care, Dr. Mark Greenberg provides comprehensive care to help reduce pain, restore function, and improve your quality of life. With decades of experience in treating chronic pain, he is able to find the most effective treatment for your pain problem. In today’s interview I speak with Dr. Greenberg about his practice here in Ashland, Oregon.
Dr. Greenberg, thank you very much for taking the time to speak with us today and welcome to LocalsGuide.
Thank you for the opportunity. I am excited to talk about the work I have been doing at Advanced Pain Care.
To begin with, will you please tell us a little bit about your medical background and training, and the history of Advanced Pain Care?
After graduating from USC School of Medicine in1981, I did extensive post-graduate training in Internal Medicine, Anesthesiology, and Pain Management at UCLA. I am currently Board Certified in these three disciplines. I practiced both Anesthesiology and Pain Management in Santa Monica, California until 1995 when I moved to Ashland to become Chief of Anesthesiology at Ashland Community Hospital. However, I was convinced there was an unfulfilled need for a full-time Pain Management specialist in the Rogue Valley, which led to the founding of Advanced Pain Care.
This was the first local full-time practice devoted to the outpatient treatment of chronic pain. I have had the opportunity to treat thousands of patients from all over Southern Oregon and Northern California. Our mission at Advanced Pain Care is to provide the most effective individualized treatment for chronic pain, with a focus on restoring function and quality of life. Most of the patients I see have suffered with chronic pain despite having had extensive previous treatment. Often I can I offer treatments that have not previously been considered.
When I first started treating chronic pain almost 30 years ago the medical field viewed pain as a symptom of an injury or disease. There was no appreciation of the difference between the pain one experiences from breaking a bone to having surgery to having a damaged nerve, other than some forms of pain resolved quickly and other pain did not. Available treatments were “one size fits all”—that is, a solution for the pain of surgery should work equally well as the solution for chronic nerve damage pain. Since then, Pain Specialists have learned that acute pain, which serves, as the body’s “warning system”, is a completely different entity than “chronic pain” which is NOT just a symptom or manifestation of an injury, but a completely distinct and often “invisible” disease of the nervous system. I treat the entire scope of that disease we call “chronic pain”. Patients I see often have localized neck or back pain, but chronic pain can spread and affect other parts of the body as well. Another form of chronic pain results from injury or degeneration of joints, ligaments or tendons and can affect almost any part of the body. For example, as we get older our knees, hips, and shoulders develop the wear and tear of the cartilage and can lead to chronic pain and disability.
Lastly, there is a wide spectrum of chronic pain that comes from injury to or dysfunction in peripheral nerves. This is the most common type of pain I see, and there are highly effective treatments available.
When I did my Postgraduate Pain Fellowship training, we had limited options for chronic pain—primarily pain medications and psychological counseling. For certain specific conditions we used steroid injections as well. I realized that our tools to treat chronic pain were inadequate. I have devoted my career to finding better solutions. I have learned from mentors willing to think “outside the box”, and adopt treatment methods from many different disciplines. However, my traditional medical education and training has grounded my practice in science and data-driven decision making. I use treatments that I consider to be on the “cutting edge” and have a solid basis in medical science, proven safety record, and known effectiveness, but may be considered “alternative” by mainstream medicine standards. An example of this is Prolotherapy. This is a treatment for various types of chronic pain that has been around since the late 1950s. It has certainly evolved and become much safer and more effective over time, yet it is not considered “mainstream medicine”. There are several offshoots of Prolotherapy that can be highly effective as well, namely Perineural Injection Therapy (PIT) and Platelet Rich Plasma (PRP) injections, which are also highly utilized in my practice. All of these treatments help tissues to heal, are part of a new treatment paradigm known as Regenerative Injection Therapy (RIT).
Can you tell us more about the Regenerative Injection Therapy that you use to treat pain?
Regenerative Interventional Therapy represents a paradigm shift in medicine. By that I mean a completely different way of looking at pain.
The basic principle is to use the body’s own healing and restorative mechanisms to treat chronic injury and pain whenever possible. Prolotherapy was the first of these treatments available. The term Prolotherapy derives from “Proliferate” or grow tissue. Earlier, many different injection substances were used as Proliferants to promote healing, but today concentrated Dextrose, a type of sugar, is accepted as the safest and most effective Proliferant. The injections are made into the connection between the ligaments and bones, into tendons, or into joints to stimulate healing of these structures. As this treatment has evolved, we are now using patient’s own blood platelets or even specialized healing cells called Stem Cells to serve this function. As I mentioned previously, chronic pain often occurs when the peripheral nervous system is dysfunctional. A treatment that addresses this specifically is Perineural Injection Therapy. This unique and highly effective treatment uses low dose Dextrose to restore these nerves back to their normal functional state and eliminate chronic pain. Moreover, the response of these nerves to simple injections can be used as a test to see if PIT is likely to work, so that we can avoid using treatments not likely to succeed.
Are you using these exciting new treatments for conditions other than chronic pain?
In addition to chronic pain I use these RIT techniques to treat a wide variety of musculoskeletal conditions that can occur from sports injury, chronic overuse, or nerve entrapment. For example, rotator cuff injuries, tennis elbow, or Carpal Tunnel Syndrome can all be treated effectively this way. Often I utilize Ultrasound in my office to obtain a detailed non-invasive image of the involved area to help diagnose ligament, tendon, muscle or nerve pathology, and to help guide the therapy. The ability to make a specific diagnosis greatly increases the likelihood of a successful outcome from the intervention.
Please tell us about your take on the Opioid Crisis and how this affects your practice.
When we don’t utilize potentially effective treatments, and rely solely on what has been available in the past, we end up with problems like the “Opioid Crisis”. Obviously the problem our society is currently facing due to overuse of opioid medications is complex, with many causative factors. Doctors prescribe opioids in large part because they are unaware of possible alternatives, or because of barriers to the use of these alternatives. One of my goals at Advanced Pain Care has been to avoid the use of opioids when possible. Opioids may have a limited role for some patients, but many patients I see are too reliant on these medications. Their practitioners are telling them that they must “get off the drugs” but are not offering effective alternative means to control pain. When I see someone on opioids I will always work with them to get their medication doses within accepted guidelines if possible—because these guidelines do come from research and study and are not arbitrary. But I am also trying to provide effective alternative treatments to deal with the pain at the same time. Many patients I have helped wean either off their drugs or to lower doses tell me they feel much better, more awake and alert, more like themselves than they did for years while taking opioids.
Can you give us an overview of Advanced Pain Care and tell us how your personal values have shaped the practice?
I am committed to a lifelong process of hard work, education and learning to find the best treatments for every chronic pain problem, and to do the best I can for patients. This requires that I see every patient at every visit. I feel it is crucial that I am the one making all of the assessments and treatment plans for my patients, so I do not utilize mid-level practitioners. I take the full responsibility of providing the best care possible. I believe most patients on opioids can be on lower doses or even off the drugs, and that is almost always a goal. I am aware that medication changes can be difficult, but my value system demands that I remain honest with my patients at all times, even if that means providing information or advice that is uncomfortable to hear.
In addition to dealing with opioid addiction, what are some of the biggest challenges you face as a practitioner when working with chronic pain patients?
Often patients with chronic pain do not have overt evidence of the injury or underlying condition causing them to suffer. In addition, there is no objective way to measure pain, or monitor how pain might change in response to an intervention. At best we have subjective reporting and behavioral manifestations to observe. We have no “pain blood test” or “pain scan” to use. These are real challenges. In addition, there are layers of psychological and emotional factors that influence patients’ ability to communicate about their pain to the doctor, and differentiate pain from suffering. All of this has to be taken into account when treating pain.
What are some of the barriers your patients face in obtaining access to the treatments you have available?
Some of the newer treatments are not covered by insurance, so there can be out-of-pocket expense associated with the treatments. This is a real challenge for some of my patients with limited resources. I believe that by placing financial barriers in front of patients seeking legitimate care for their chronic pain conditions we are perpetuating unnecessary suffering and harm. I point out that in our current insurance environment with high copays and deductibles, most of my treatment cost is actually lower than the patient responsibility for other options such as surgery. Moreover, the treatments I use are minimally invasive. They lead to far less potential risk and cost in the long run, and less time-loss and disability during recovery. I look at cost savings as a serious challenge and responsibility–I feel the pain management options I offer are highly cost effective both for individual patients and our society as a whole if the true and complete costs are taken into account.
Dr. Greenberg, how do you see you work changing the lives of your patients? What types of feedback are you receiving? Will you please share some recent success stories with us?
I am an avid tennis player and seeing my patients being able to return to their recreation of choice is quite rewarding. This is especially true when I see my patients either on the courts or at the gym, and they make a point to thank me for helping them maintain this crucial part of functioning and quality of life. I have had the recent pleasure of helping one of my friendly tennis opponents get back out on the court without the tennis elbow that had been hampering him. I have recently treated several equestrians who were able to get back to recreational and competitive riding, which made a huge difference in their quality of life. Often I help patients to return to work and fulfill their financial or familial responsibilities. One of the most common and most gratifying experiences I have in the office is when I see a patient who has had years of neck pain and limitation in their range of motion. At times, it is so severe they cannot drive safely. This neck stiffness often responds instantly to PIT. These are some of my most grateful patients.
Dr. Greenberg what are some of the most important questions you find that your patients are asking?
The most common questions that arise have to do with the outcomes and, duration of relief with proposed treatments, as well as alternatives if a given treatment does not work as expected. I have treated so many patients over the years that for almost any given problem I have a firm idea of the chances for success.
I am constantly evaluating the response that every patient is having to the treatments I provide, and if something isn’t working, I can move on to a new approach. My years of experience and learning has expanded my toolbox and I bring my almost 30 years of experience to the table for every patient.
Dr. Greenberg, what are the best words of advice you have to share with individuals dealing with chronic pain issues?
There are often more treatments available right in your own backyard than perhaps you are currently being offered or exposed to, so keep looking, and don’t give up hope. If you are not happy with your current treatment don’t assume that nothing else can be tried for you. But at the same time don’t believe everything on the Internet or that you read on Facebook. Chronic pain is an extremely difficult problem to treat–that is why it takes working with a dedicated, highly trained specialist to achieve results.
How can our readers go about learning more about your work and setting up an appointment?
My website at www.apcpain.net has some detailed information on chronic pain, the conditions I treat, and treatments I use. However, the best way to get information is to come in for a full evaluation so your specific condition and issues can be addressed. You can reach us to set up an appointment at 541-482-1712.
Are there any final thoughts or comments you would like to share with our readers?
Chronic pain is a condition that can often be managed by highly trained and experienced specialists in the field. It is a recently recognized medical specialty, and as such continues to evolve as new treatments become available. Seek out practitioners who are not only expert in this specialty, but also up-to-date on the latest advances for your care. Have realistic expectations of what can be done, and keep the lines of communication open with your Doctor.
Thank you for your time and attention.
Advanced Pain Care
Dr. Mark Greenberg MD
638 N Main St A