As an anesthesiologist, pain medicine specialist, and clinical epidemiologist, my research interests span development of novel psychotherapeutic interventions at the intersection of pain, prescription opioid addiction, and psychology. As an NIH-funded researcher I am working to develop novel interventions (behavioral, medical technology, medical device) to prevent continued pain and opioid use after surgery. My clinical interests include treatment of chronic pelvic pain conditions including painful bladder syndrome/interstitial cystitis, endometriosis, pelvic floor myofascial pain, pudendal neuralgia, peripheral nerve entrapments, pelvic adhesions, vulvodynia, and chronic constipation.
- Pelvic Pain
- Interstitial Cystitis
- Painful Bladder Syndrome
- Perioperative Pain Management
Instructor, Anesthesiology, Perioperative and Pain Medicine
Residency:Cleveland Clinic Foundation Heart Center (2007) OH
Internship:Cleveland Clinic Foundation Heart Center (2007) OH
Board Certification: Anesthesiology, American Board of Anesthesiology (2010)
Fellowship:Stanford University Hospital - Pain Medicine (2010) CA
Residency:Stanford University Hospital - Anesthesia Dept (2009) CA
M.S., Stanford University, Epidemiology (2013)
Board Certification: Pain Medicine, American Board of Anesthesiology (2011)
Medical Education:Northeastern Ohio Universities (2005) OH
Current Research and Scholarly Interests
Perioperative Recovery of Opioids Mood and Pain Trial
Perioperative Recovery of Moods, Opioids, and Pain Trial (PROMPT)
The investigators aim to characterize the relationship between changes in emotional distress, opioid use, and pain throughout surgery and recovery. Additionally, the investigators aim to compare the effectiveness of post-surgical motivational interviewing and physician-guided opioid weaning vs. usual care on reducing persistent opioid use. Overall, the proposed research will advance knowledge regarding the role of psychological factors contributing to persistent opioid use after surgery.
- Taking adolescent prescription opioid use in context: risk stratification in early mid-life based on medical and nonmedical use. Pain 2016; 157 (10): 2143-2144
- (139) Risk factors for long-term prescription opioid therapy for chronic non-cancer pain. journal of pain 2016; 17 (4S): S10-S11
- Pain Duration and Resolution following Surgery: An Inception Cohort Study PAIN MEDICINE 2015; 16 (12): 2386-2396
Pain Duration and Resolution following Surgery: An Inception Cohort Study.
2015; 16 (12): 2386-2396
Preoperative determinants of pain duration following surgery are poorly understood. We identified preoperative predictors of prolonged pain after surgery in a mixed surgical cohort.We conducted a prospective longitudinal study of patients undergoing mastectomy, lumpectomy, thoracotomy, total knee replacement, or total hip replacement. We measured preoperative psychological distress and substance use, and then measured pain and opioid use after surgery until patients reported the cessation of both opioid consumption and pain. The primary endpoint was time to opioid cessation, and those results have been previously reported. Here, we report preoperative determinants of time to pain resolution following surgery in Cox proportional hazards regression.Between January 2007 and April 2009, we enrolled 107 of 134 consecutively approached patients undergoing the aforementioned surgical procedures. In the final multivariate model, preoperative self-perceived risk of addiction predicted more prolonged pain. Unexpectedly, anxiety sensitivity predicted more rapid pain resolution after surgery. Each one-point increase (on a four point scale) of self-perceived risk of addiction was associated with a 38% (95% CI 3-61) reduction in the rate of pain resolution (P = 0.04). Furthermore, higher anxiety sensitivity was associated with an 89% (95% CI 23-190) increased rate of pain resolution (P = 0.004).Greater preoperative self-perceived risk of addiction, and lower anxiety sensitivity predicted a slower rate of pain resolution following surgery. Each of these factors was a better predictor of pain duration than preoperative depressive symptoms, post-traumatic stress disorder symptoms, past substance use, fear of pain, gender, age, preoperative pain, or preoperative opioid use.
View details for DOI 10.1111/pme.12842
View details for PubMedID 26179223
Management of a Patient with a Thoracic Epidural After Accidental Clopidogrel Administration.
A & A case reports
2015; 5 (2): 18-20
We report a case of accidental clopidogrel administration in a patient receiving ongoing epidural analgesia postoperatively. The epidural catheter was removed 7 hours after the clopidogrel dose without incident. The onset of inhibition of adenosine diphosphate-induced platelet aggregation in healthy individuals has been reported at 12 to 24 hours after administration of a single 75-mg dose of clopidogrel. This case demonstrates the importance of understanding clopidogrel's pharmacology to avoid ordering unnecessary tests, which may delay catheter removal. Consideration of appropriate testing and limitations in the context of unintentional antiplatelet administration with indwelling neuraxial catheters is discussed.
View details for DOI 10.1213/XAA.0000000000000165
View details for PubMedID 26171737
- A Review of Chronic Non-Cancer Pain: Epidemiology, Assessment, Treatment, and Future Needs FOCUS: Journal of Lifelong Learning in Psychiatry 2015; 13 (3): 267-282
Factors Associated with Opioid Use in a Cohort of Patients Presenting for Surgery.
Pain research and treatment
2015; 2015: 829696-?
Objectives. Patients taking opioids prior to surgery experience prolonged postoperative opioid use, worse clinical outcomes, increased pain, and more postoperative complications. We aimed to compare preoperative opioid users to their opioid naïve counterparts to identify differences in baseline characteristics. Methods. 107 patients presenting for thoracotomy, total knee replacement, total hip replacement, radical mastectomy, and lumpectomy were investigated in a cross-sectional study to characterize the associations between measures of pain, substance use, abuse, addiction, sleep, and psychological measures (depressive symptoms, Posttraumatic Stress Disorder symptoms, somatic fear and anxiety, and fear of pain) with opioid use. Results. Every 9-point increase in the Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R) score was associated with 2.37 (95% CI 1.29-4.32) increased odds of preoperative opioid use (p = 0.0005). The SOAPP-R score was also associated with 3.02 (95% CI 1.36-6.70) increased odds of illicit preoperative opioid use (p = 0.007). Also, every 4-point increase in baseline pain at the future surgical site was associated with 2.85 (95% CI 1.12-7.27) increased odds of legitimate preoperative opioid use (p = 0.03). Discussion. Patients presenting with preoperative opioid use have higher SOAPP-R scores potentially indicating an increased risk for opioid misuse after surgery. In addition, legitimate preoperative opioid use is associated with preexisting pain.
View details for DOI 10.1155/2015/829696
View details for PubMedID 26881072
- Self-Loathing Aspects of Depression Reduce Postoperative Opioid Cessation Rate PAIN MEDICINE 2014; 15 (6): 954-964
From Catastrophizing to Recovery: a pilot study of a single-session treatment for pain catastrophizing
JOURNAL OF PAIN RESEARCH
2014; 7: 219-226
Pain catastrophizing (PC) - a pattern of negative cognitive-emotional responses to real or anticipated pain - maintains chronic pain and undermines medical treatments. Standard PC treatment involves multiple sessions of cognitive behavioral therapy. To provide efficient treatment, we developed a single-session, 2-hour class that solely treats PC entitled "From Catastrophizing to Recovery" [FCR].To determine 1) feasibility of FCR; 2) participant ratings for acceptability, understandability, satisfaction, and likelihood to use the information learned; and 3) preliminary efficacy of FCR for reducing PC.Uncontrolled prospective pilot trial with a retrospective chart and database review component. Seventy-six patients receiving care at an outpatient pain clinic (the Stanford Pain Management Center) attended the class as free treatment and 70 attendees completed and returned an anonymous survey immediately post-class. The Pain Catastrophizing Scale (PCS) was administered at class check-in (baseline) and at 2, and 4 weeks post-treatment. Within subjects repeated measures analysis of variance (ANOVA) with Student's t-test contrasts were used to compare scores across time points.All attendees who completed a baseline PCS were included as study participants (N=57; F=82%; mean age =50.2 years); PCS was completed by 46 participants at week 2 and 35 participants at week 4. Participants had significantly reduced PC at both time points (P<0001) and large effect sizes were found (Cohen's d=0.85 and d=1.15).Preliminary data suggest that FCR is an acceptable and effective treatment for PC. Larger, controlled studies of longer duration are needed to determine durability of response, factors contributing to response, and the impact on pain, function and quality of life.
View details for DOI 10.2147/JPR.S62329
View details for Web of Science ID 000364587600005
View details for PubMedID 24851056
Pilot study of a compassion meditation intervention in chronic pain.
Journal of compassionate health care
The emergence of anger as an important predictor of chronic pain outcomes suggests that treatments that target anger may be particularly useful within the context of chronic pain. Eastern traditions prescribe compassion cultivation to treat persistent anger. Compassion cultivation has been shown to influence emotional processing and reduce negativity bias in the contexts of emotional and physical discomfort, thus suggesting it may be beneficial as a dual treatment for pain and anger. Our objective was to conduct a pilot study of a 9-week group compassion cultivation intervention in chronic pain to examine its effect on pain severity, anger, pain acceptance and pain-related interference. We also aimed to describe observer ratings provided by patients' significant others and secondary effects of the intervention.Pilot clinical trial with repeated measures design that included a within-subjects wait-list control period. Twelve chronic pain patients completed the intervention (F= 10). Data were collected from patients at enrollment, treatment baseline and post-treatment; participant significant others contributed data at the enrollment and post-treatment time points.In this predominantly female sample, patients had significantly reduced pain severity and anger and increased pain acceptance at post-treatment compared to treatment baseline. Significant other qualitative data corroborated patient reports for reductions in pain severity and anger.Compassion meditation may be a useful adjunctive treatment for reducing pain severity and anger, and for increasing chronic pain acceptance. Patient reported reductions in anger were corroborated by their significant others. The significant other corroborations offer a novel contribution to the literature and highlight the observable emotional and behavioral changes in the patient participants that occurred following the compassion intervention. Future studies may further examine how anger reductions impact relationships with self and others within the context of chronic pain.
View details for PubMedID 27499883
- Pilot Study of a Compassion Meditation Intervention in Chronic Pain Journal of Compassionate Health Care 2014; 1: 4
- Perioperative Interventions to Reduce Chronic Postsurgical Pain JOURNAL OF RECONSTRUCTIVE MICROSURGERY 2013; 29 (4): 213-222
Exploratory factor analysis of the beck depression inventory: predictors of delayed opioid cessation after surgery in a pilot cohort study
CHURCHILL LIVINGSTONE. 2013: S25–S25
View details for Web of Science ID 000317639400100
Analysis of preoperative measures that predict interference with sleep recovery after surgery
CHURCHILL LIVINGSTONE. 2013: S19–S19
View details for Web of Science ID 000317639400076
- Local Anesthetics and Other Interventional Approaches Neuropathic Pain: Causes, Management and Understanding Cambridge University Press. 2013
Factors contributing to pain chronicity
CURRENT PAIN AND HEADACHE REPORTS
2009; 13 (1): 7-11
The chronicity of pain is the feature of pain that is least understood and most directly linked with our inability to effectively manage pain. Acute pain is relatively responsive to our current pharmacologic and interventional armamentarium. However, as pain persists, our ability to treat effectively diminishes and the patient's frustration and resource utilization increases. This article explores our current understanding of the factors linked to pain duration and the transition from acute to chronic pain in both human and animal models, and across a spectrum of human chronic pain conditions.
View details for DOI 10.1007/s11916-009-0003-3
View details for Web of Science ID 000263064900003
View details for PubMedID 19126364
- The dromedary sign - An unusual capnograph tracing ANESTHESIOLOGY 2008; 109 (1): 149-150