By Sarah Whitman
Dr. Sunil Panchal, physician at the National Institute of Pain in Lutz, shakes his head every time he hears about another pain clinic being raided by police.
“Some of these clinics were seeing more than 100 patients a day,” he said. “How can you properly evaluate a patient’s condition and devise a treatment plan when you are seeing that many people in a day? You can’t. I never just write a script for pills the first time I see a patient. That’s not what we’re here for.”
Panchal is a certified pain management doctor through the American Board of Medical Specialties and former director of Interventional Pain Medicine at Moffitt Cancer Center in Tampa. In 2006, he opened the National Institute of Pain at 4911 Van Dyke Road.
He does not have a line of people waiting outside his door. He does not prescribe oxycodone. He limits the use of opioid drugs entirely, opting to use controlled release medications that do not produce the euphoric effect associated with addiction.
“ My goal is to determine where a patient’s pain is coming from and create a comprehensive treatment plan using as little medication as possible,” Panchal said. “I want my patients to return to living full functional lives.”
Panchal treats patients experiencing pain associated with injuries, chronic diseases and side effects from cancer treatments. He uses treatments including radiation frequency, anesthetic block injections and the implantation of spinal cord stimulators.
“There are severe downsides to pain medication,” he said. “They cause side effects like itching, nausea and constipation. There is also an increased risk of a toxicity effect, opioid induced hyperaglesia, which can actually make pain worse. When that happens, a patient thinks the medicine is not working so they want to increase the dose, which only intensifies the side effect.”
Panchal said true pain management specialists know drugs aren’t the only option. Panchal studied medicine at Albany Medical College in New York, followed by a residency at Northwestern University in Chicago and a fellowship at the University of Illinois. He was director of the pain division at Weill Medical College of Cornell University and co-director of the Chronic Pain Service at John Hopkins University before coming to Tampa.
He advises anyone in pain to research before choosing a physician.
“A lot of these clinics are run by doctors who are trained in another specialty but call themselves pain doctors,” he said. “They advertise, ‘We prescribe vicodin. We prescribe oxycodone,’ because they know that is what the people are craving for. They are contributing to the problem.”
Yvette Rollings is one of Panchal’s patients. She was driving in Texas three years ago when a quarter ton truck forged ahead at 80 miles per hour into the back of her SUV. Rollings was left with severe neck and back injuries from the top of her head to the base of her spine. She was treated with medications, which did little to help.
“They just made me tired all the time,” she said. “I was depressed and all I wanted to do was sleep.”
When Rollings moved to Tampa, she visited and interviewed several pain management doctors before meeting Panchal. They offered suggestions ranging from more medication to putting a cage in her spine.
“When I got to Dr. Panchal, I was ready to give up,” Rollings said. “I was in so much pain I didn’t even want to fill out the new patient paperwork. When I met Dr. Panchal he said, ‘I can help you. You just need to have patience.’ ”
Panchal treated Rollings using radiation frequency treatments and the surgical implantation of a spinal cord stimulator. The stimulator utilizes probes permanently implanted on the spine and a small battery placed at the hip.
“The spinal cord stimulator changed my life,” Rollings said. “I am able to be a mom and a wife again. I’ve had 98 percent relief.”
Panchal said pain problems are often misdiagnosed. In Rollings’ case, much of her pain was caused by damage to the nerves and joints.
“A lot of times people will complain about neck or back pain and be sent for an MRI,” Panchal said. “One third of people will show a herniated disc somewhere but that isn’t necessarily what is causing the pain. The actual joints of the spine may be what is causing the pain, so we can do a selective block of anesthetic to numb the area.”
According to Panchal, a good way to tell if a pain doctor is credible is how knowledgeable they are.
“Anyone can claim they are board certified in pain medicine but unless they are certified by the ABMS and have passed the board exam, they are not,” he said. “I’ve had people come in who’ve had continual access to pain medication for whatever reason and they’ve never even been worked up to determine the real source of the pain.”
Panchal has also seen patients suffering from addiction or borderline addiction.
“I’ve had patients come to me who just want a prescription and when I won’t give it to them, they get angry,” Panchal said. “I’ve also had patients who say their dependency on the medicine is interfering with their lives and affecting their families, and they want to try something different. I’ve had some patients who’ve gotten completely off of medications and some who will always need some level of medicine, but we are able to find something that works for them other than the typical pain medication.”
In addition to time-release drugs, Panchal prescribes anti-depressants and anti-seizure medications to help with pain when absolutely necessary.
Rollings no longer takes medication but says people shouldn’t be ashamed to take medications as directed by a trained doctor.
“It’s a shame that some people will live in pain because they’re afraid of the stigma associated with pain management,” she said. “There are good doctors out there who can help and people should get the help they need.”
In Pasco County, Pasco Regional Medical Center has seven certified pain management physicians on staff. All are trained in the latest advancements and do not rely solely on medications.
“We treat a lot of people who are suffering acute pain and have been for a long time,” said Susan Frimmel, media relations representative for the hospital. “We help them manage the pain and have a better quality of life using different therapies including injections. Prescription medications aren’t always the way to go. Getting to the root of the problem for every patient is our goal.”
Panchal said the answer to the pain clinic problem is to require that physicians have proper certification.
“Hopefully in the future, only people properly trained in the field will be able to call themselves pain doctors,” he said. “What these clinics are doing now is ridiculous.”
For the National Institute of Pain, call (813) 264-7246 or visit www.nationalinstituteofpain.org. For Pasco Regional Medical Center, call (352) 521-1100.