In this interview from the Penn Medicine Spine Center Podcast Series, Drs. Arthur Kitt and Michael Hodde discuss the treatments offered at the Spine Center. Dr. Kitt elaborates on anesthetics and pain management during surgery; Dr. Hodde reviews adjuvant therapies for those with back pain.
Podcast Interview Transcript
Melanie Cole, MS (Host): Welcome. Today we’re talking about the latest treatment options and procedures available at the Penn Medicine Spine Center. My guests in this panel discussion are Dr. Michael Hodde, an assistant professor of physical medicine and rehabilitation at Penn Medicine, and Dr. Arthur Kitt, an assistant professor of clinical anesthesiology and critical care medicine at Penn Medicine. Gentlemen, thank you so much for joining us today.
Dr. Hodde, I’d like to start with you. When would you advise primary care providers to refer their patients when they're suffering from back and neck issues?
Michael E. Hodde DO, FAAPMR (Guest): Most acute back pain typically will resolve on its own in a few weeks. Primary care doctors can usually start the workup in the office and getting them some exercises and over the counter anti-inflammatories typically are helpful. But if the pain persists beyond several weeks or if they have any new onset neurologic deficit or if the pain is very significant or severe then they can come see us even sooner.
Host: Dr. Kitt, as an anesthesiologist, tell us a little bit about your field and pain management because it’s really a burgeoning field right now.
Arthur Kitt MD, MPH (Guest): I'm trained as an operating room anesthesiologist first. Then trained to take an extra year doing a fellowship in pain management. This includes various aspects of medication management, inpatient management of patients who have poorly controlled pain, as well as outpatient pain procedures the first modality that we like to utilize in pain management is conservative treatment with physical therapy and medication management. Once patients have failed those we consider interventional pain procedures. This includes epidural injections, different types of nerve blocks and nerve ablations just depending on the patient’s source of pain.
What’s happening in the field of pain right now, it’s actually quite complicated.
As we all know, there is a lot of issues over the last few years with increasing rates of opioid-related overdoses and deaths. So our field has really pushed to decrease the number of people who are prescribed opioids, and for those who are, to decrease the doses of opioids prescribed for those patients. So it presents a challenge for us in terms of finding alternative ways to treat patients who have poorly controlled pain.
Host: Tell us a little bit about the Penn Spine Center and what you're doing there that’s unique.
Dr. Hodde: My base training is in physical medicine and rehab, and prior to that I was an athletic trainer working with athletes and acute sports injuries. So myself and Dr. Kitt focus on the non-operative management side of things. So when I see a new patient coming to me for any variety of musculoskeletal or neurologic pain complaint, I tend to go to my roots as a sort of musculoskeletal medicine and physical therapy minded person. I work a lot with patients on their posture, their ergonomics, their lifestyle modifications and things like that as a first line means of managing their pain.
Then if those basic maneuvers and things don’t succeed in alleviating or at least substantially managing their pain the benefit of the Penn Spine Center is that we have multiple specialties that work together and collaboratively along the spectrum of treatment options. If these things are failing then that’s when we’ll talk about options like steroid injections or nerve blocks or ablations.
We’ll assess patients for those first and foremost through history and physical exam and then select imaging modalities, then potentially those interventions based on the cumulation there. Then if all of these things aren’t still managing them or if there's indication for it, in the spine center we also have access to and collaborate with the surgeons. So we can help to direct these patients to the appropriate surgeon or surgical subspecialist to help with their issues thereafter.
Host: Dr. Hodde, with the Penn Medicine Spine Center, what are you seeing as far as results from patients using all these various modalities.
Dr. Hodde: Sure. So like most things in medicine, it’s a bit varied, and depending on the presentation of the patients certain people will respond better to those modalities than others. In general, I do think the physical modalities and those things are sort of the mainstay, especially in terms of posture, ergonomics, mechanics, alignment, symmetry.
The manual therapies and whatnot—are a very good adjuvant to medication management, to the interventions, to potentially surgery. Having had surgery does not preclude you from any of the other options down the road. I think the most important thing, again, is having the proper diagnosis and the proper patient selection makes the key as to whether or not somebody will or will not benefit from any one of these modalities, be they invasive or non-invasive.
Host: Dr. Kitt Tell us just a little bit more about some of the injection procedures that you're able to offer that sets you apart?
Dr. Kitt: When we try to do procedures for discogenic disease, it involves doing things like epidural injections that are fluoroscopically guided, which we do in a procedure suite or an operating room. We do them in awake patients and we are very careful to talk them through the procedure. Typically if they are to see relief from pain, they are to see relief within a few days after the procedure.
We do these procedures in the cervical spine, the thoracic spine, and the lumbar spine. We do various other procedures. We have these facet joints throughout our spine as well that are common sources of pain. There are different nerve blocks and nerve ablations that we do for people who we believe have facet mediated pain in the neck, midback, or low back.
Host: Dr. Hodde, what would you like other providers to take away from this segment and when do you feel it’s important that they refer to the Spine Center at Penn Medicine?
Dr. Hodde: Sure. So first of all, we’re here to help. Anything we can do to help your patients get better, that’s what we’re here for. That’s what we want to do. Most of the time an acute issue, aside from acute neurologic complications, will tend to get better with conservative care. If they're not, then we’re certainly here to help. Or even if the primary care doctor is overwhelmed with other patients and other responsibilities and just wants a second eye or an expert opinion on things, we’re here to help.
Host: Dr. Kitt, what would you like to leave other providers with as far as the field of pain management at the Penn Medicine Spine Center?
Dr. Kitt: I don’t think that there's any one specific scenario in which patients should be referred to us. Like Dr. Hodde mentioned, we’re really here to help with any questions or in any situation. So even if a patient has yet to have any imaging or undergo conservative physical therapy. We’ve all seen these patients who just have an acute onset of low back or neck pain that is just so debilitating and severe. So we’re really experienced with taking care of all sorts of different types of pain as well, not just spine related pain but various different types of pain including joint pain. We often treat patients who have other musculoskeletal disease like fibromyalgia.
So it’s really a comprehensive pain center where we have a number of specialists who are all working together to try and maximize the brain power that we have and the procedural skill and knowledge that we have under one roof. It’s really a place where people who have pain of any sort are welcome.
Host: Thank you gentlemen for joining us today and sharing your expertise and telling us all about the comprehensive multidisciplinary approach to back and neck issues that so many people suffer from. Thank you, again. That wraps up this episode from the experts at Penn Medicine.
To refer your patient to a specialist at the Penn Medicine Spine Center, please visit our website at pennmedicine.org/refer, or you can call 877-937-PENN for more information and to get connected with one of our providers. Thanks for listening, I'm Melanie Cole.