In July 2021, Dr. Amitabh Gulati, lead researcher and also the President of World Academy of Pain Medicine United (WAPMU), was honored with the inaugural Lisa Stearns Award by the North American Neuromodulation Society at the 2021 Mid-Year Meeting. Dr. Gulati was presented with the award to recognize his work treating patients suffering from oncological pain. Since 2007, Dr. Gulati has been a chronic and cancer pain physician in New York City. His recent work is primarily in interventional cancer pain medicine and research focusing on diagnostic and therapeutic ultrasound and neuromodulation for the treatment of oncologic related pain syndromes.
In honor of his recent award and work with cancer pain, we caught up with Dr. Gulati to learn more about oncological pain, treatment options that exist for patients with oncological pain, and his work in the field.
SPR: What is the most common direct or indirect cancer-related pain you encounter?
Dr. Amitabh Gulati (AG): We see a significant number of both active cancer pain syndromes and treatment-related (post-surgical, post-radiation and oncologic treatment) pain syndromes.
SPR: Are there any trends in relation to pain severity and/or prevalence and different types of cancer?
AG: Yes, a few. We have noted an improvement in both oncologic management and disease control for our patients. Thankfully, this has resulted in a decrease in active cancer-related pain syndromes. However, this has also led to an increase in newer oncologic pain syndromes, such as immunotherapy, causing inflammatory pain syndromes. Overall, advances in oncology have likely led to patients with cancer presenting with chronic pain conditions (such as lumbar spinal stenosis) in cancer pain clinics.
SPR: What treatment options exist for treating oncological pain?
AG: We have the entire gamut of chronic pain treatments available for our oncologic pain patients. It’s important to note that oncologic patients usually have a need for imaging such as surveillance MRIs, which necessitates MRI conditional technologies being available for our patients. And in our experience, neuromodulation has had a significant impact in reducing the rate of neurolysis [the destruction of nerves for pain relief] for the cancer patient.
SPR: How do you personally approach treating oncological pain?
AG: We have so many choices now to help our patients. Our foundation for treating pain remains multimodal pharmacologic therapy, which includes judicious use of opioids. However, we introduce safe interventional pain therapies as treatment options early in the course of pain treatment. This may include temporary nerve blocks, neuromodulation, and percutaneous ablation, and may lead to opioid reduction.
SPR: Has the way you treat oncological pain changed over the last 5 years? If so, how?
AG: We have introduced spinal and peripheral nerve stimulation (PNS) as part of the treatment algorithm for cancer pain patients. This has led to a significant improvement in pain relief for many patients suffering from cancer pain syndromes.
SPR: How does the pain industry approach oncological pain? Has there been much or research into it?
AG: There is always innovation in pharmacologic therapy for oncologic pain. This includes advances in opioid therapy and monoclonal antibodies. In general, technological advances in the management of chronic pain help cancer pain physicians advance cancer pain medicine.
SPR: Is oncological pain difficult to treat? If so, why?
AG: Oncologic pain is not necessarily more difficult to treat than other chronic pain syndromes; however, the treating physician needs to understand oncologic disease and oncologic treatments, and side effects, to best implement pain therapies for the cancer pain patient.
SPR: You published a study in March 2020, “Pilot Study in Temporary Peripheral Nerve Stimulation in Oncologic Pain.”
- What were the objectives/goals of this study?
- AG: We were hoping to highlight the potential to help our cancer pain patients using new technologies in peripheral nerve stimulation
- Why was temporary PNS evaluated for treating oncological pain?
- AG: We feel in our population, in which many patients have end-of-life disease or evolving pain syndromes, temporary peripheral nerve stimulation (PNS) has a significant role in managing complex pain symptoms.
- Why were the findings obtained in this study important?
- AG: Many patients hesitate when considering permanent implants and permanent destruction of nerves. Percutaneous peripheral nerve stimulation addresses a substantial need and provides a novel therapeutic option for pain control for cancer patients. The fact that the leads are removed at 2 months is an important milestone for the cancer pain patient.
SPR: What is typically involved in your pain treatment plan when a patient has oncological pain?
AG: We always discuss a complete pain treatment plan with our patients. This includes multimodal pharmacologic therapy along with interventional pain therapies that may be beneficial for the patient.
SPR: How do you advise pain physicians to educate patients about oncological pain and available treatment options?
AG: Education in this field has always been elusive, but for physicians, multiple textbooks, publications, and online resources exist. Additionally, WAPMU is establishing a cancer pain educational program to address this need.
For patients, I have found online oncologic blogs and social groups have patients suggesting treatments to other patients on novel pain treatments. A significant need that exists is for an advocacy group for cancer pain patients. This is something that we [WAPMU] hope to address soon.
SPR: Cancer is a difficult thing for any patient. What it is a helpful tip to keep in mind when working with patients with oncological pain?
AG: I believe it is important to understand what a cancer patient may be undergoing during their care experience. Unlike a chronic pain patient, for whom pain may be the primary problem, for the cancer patient, pain is usually secondary to cancer or treatment. Patients’ primary focus is on their cancer and survival, so having compassion and empathy, along with a keen understanding for cancer care, will allow a pain physician to have a good relationship with and to appropriately treat an oncological pain patient.
SPR: One final question. What advice do you have for patients suffering from oncological pain?
AG: We advise our patients to work with their primary oncologist when requesting advanced pain care. In the end, patients and family are the best advocates, and working with and supporting our oncologists will help to provide the best pain care available for our cancer pain patients.
About the Lisa Stearns Award
Established in honor of Dr. Lisa Stearns, one of the world’s leading experts in interventional therapy for cancer pain, the award recognizes an individual who has worked in the field of neuromodulation for 5-20 years, has expertise in interventional therapy for cancer pain, including neuromodulation-based approaches, and has made significant practical and clinical, educational, or scholarly contributions to the field of oncological pain.
The SPRINT PNS System is indicated for up to 60 days for: (i) Symptomatic relief of chronic, intractable pain, post-surgical and post-traumatic acute pain; (ii) Symptomatic relief of post-traumatic pain; and (iii) Symptomatic relief of post-operative pain. The SPRINT PNS System is not intended to be placed in the region innervated by the cranial and facial nerves.
Physicians should use their best judgment when deciding when to use the SPRINT PNS System. For more information see the SPRINT PNS System IFU. Most common adverse events are skin irritation and erythema. Results may vary. Rx only.
Important safety & risk information: https://bit.ly/2FU92NH
FDA Clearance of an Expanded Indication for the SPRINT® PNS System Now Enables Treatment in Areas of the Head, Neck, and Torso
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