Pain Management, Physiatrist in Irvine, California (CA)
Khang Lai DO
- PainCare Medical GroupPainCare Medical Group, 15701 Rockfield Blvd.Irvine, California, 92618 - United StatesPhone: 949-457-9900
About Our Practice
My pain medicine experience comes from physical medicine and rehabilitation training during residency training at UCLA and pain medicine fellowship training at Integrated Pain Management.
The scope of our pain clinic at UCLA consisted of a multi-disciplinary approach which included a team of physiatry, psychiatry, neurology, pain psychology and pharmacy. During the 3 years of residency at UCLA our pain clinic emphasized a team approach to the complex pain patients. All patients were evaluated for pain by way of ability to function with Oswestry Disability Index and ADL assessments. Psychological inventories and profiles were obtained with Beck Depression Inventory, and occasionally by the Minnesota Multiphasic Personality Inventory (MMPI). Full orthopedic and musculoskeletal exams were by body systems pertaining to their chief complaints by physiatrists. Their pain “case” would then be presented to the pain team and a thorough plan would be initiated with goals for treatment whether this was through the use of biofeedback, antidepressants, opiate pain medications, interventional pain procedures, rehabilitative exercises or psychiatric medications or a combination of all of the above.
My pain fellowship training at Integrated Pain Management was similar in focus as there was a strong component in multi-disciplinary approach to pain management. Similar Oswestry Disability Index and ADL assessments, psychological inventories and profiles were obtained with Beck Depression Inventory. Rehabilitation referrals were via our in house physical therapy department and psychological counseling was with our pain psychologist. There was also a comprehensive rehabilitative pain program which some patients were enrolled into the East Bay Functional Restoration Program. Neurological assessments were often with neurosurgical referrals and I would perform electro-diagnostic studies such as EMG/NCS for further examination.
Treatment Modalities: Pain can effect cognition. Further, cognitive testing is deferred to our pain psychologist for full evaluation of patient specific stressors, psycho-social factors related to their pain, coping mechanisms and strategies and associated psychiatric illnesses or personality traits.
Certain behavior modifications such as coping mechanisms and coping strategies are emphasized during the Bay Functional Restoration Program or routine pain psychological counseling. Biofeedback can often be helpful for recurrent muscle spasm associated pain syndromes. Yoga and meditation is often encouraged for stress reduction. Occasional lifestyle and behavioral modifications such as smoking cessation secondary to stress is also recommended.
Opiates are often used for nociceptive pain. For chronic pain, a long acting opiate coupled with a short acting breakthrough opiate has proven to be successful. Also, the use of anti-depressants often the SSRI or SNRI classes have also been helpful for the pain syndromes as they are often associated with anxiety and depression. Some patients respond to anti-epileptic medications for neuropathic pain. Others with inflammatory type pain like facet arthropathy or myofascial pain will respond to NSAIDS. Others will respond to topical crèmes such as capsacian, ketamine or topical lidocaine or patches. Often some form of each will be used as they provide some synergistic effects.
I routinely combine rehabilitative programs with interventional procedures that reduce pain and improve function thus improving the chances of rehabilitation. Common selective nerve root blocks or interlaminar epidurals can be helpful for discogenic or radicular pain syndromes. At times, facet joint blocks are beneficial and open avenues for radiofrequency thermocoagulation of medial branch nerves. Refractory cases may require spinal cord stimulators or neuromodulation such as severe cases of CRPS. Implanted intrathecal pain pumps may also be a resort to refractory cases where oral pain medications are not tolerated.
I often combine my pain treatment with a rehabilitative program. More long term improvements are seen with epidurals and interventional blocks with core strengthening or lumbar stabilization programs such as Williams or McKenzie’s protocols that facilitate a directional preference. Rehabilitation also includes home based exercise programs to maintain the core or spine strength. Also stretching programs have proven to be beneficial for myofascial related pain symptoms or overly tight muscles such as hamstrings gastrocnemius. I believe that rehabilitative programs help stabilize weakened segments of the spine or joints and allow the opportunity for many injured areas a chance to heal. Sometimes when any form of exercise cannot be tolerated, aquatic therapy will be helpful. Modalities such as TENS units, interferential stim, E-Stim, phonophoresis can all be helpful.
Complementary medicine does play a role in pain management. Facet syndromes will often respond to joint manipulation with a DO or chiropractor. Soft tissue massages will often help a fibromyalgia flare up. Acupuncture can reduce some times of pain syndromes. Often tai-chi will improve core abdominal strengthening. Some over the counter supplements such as glucosamine chondroiton sulfate can help joint arthritis. Naturopathic doctors can help with herbal remedies to reduce stress.
- Pain Management
- Board Certified
- Fellowship Trained
- Mission Hospital Medical Center, Mission Viejo, CA
- Saddleback Memorial Medical Center, Laguna Hills, CA