Bio


Dr. Ottestad joined Stanford faculty in 2007 and became Director of the Acute Pain Service in 2009. As such, he manages acute, post-operative pain, acute-on-chronic inpatient pain consults, and cancer pain at Stanford Hospital. He is committed to the Stanford Pain Center’s multidisciplinary, comprehensive approach when treating pain clinic patients with chronic pain. In the outpatient pain clinic, Dr. Ottestad possesses expertise in advanced interventions such as intrathecal medications, spinal cord stimulation, peripheral nerve stimulation, cryotherapy and cryoanalgesia, radiofrequency neuromodulation and ablation and ultrasound-guided procedures in general for the treatment of chronic pain. Ultrasound imaging allows accurate imaging of soft tissues such as muscles, tendons, and nerves that are difficult to identify using only x-ray imaging or anatomic landmarks. This imaging is useful both diagnostically as well as therapeutically when specific, targeted treatment is needed in an area of pain.

Dr. Ottestad has written multiple book chapters and papers on pain management and has been an invited lecturer and instructor for over 60 national and international conferences in the last 8 years. He will become the President of World Academy of Pain Medicine Ultrasonography (WAPMU) in 2017. Dr. Ottestad is board certified in anesthesiology and pain management, and is an also an instructor and board examiner for the World Institute of Pain and the World Academy of Pain Medicine Ultrasonography, with secondary international qualifications FIPP (Fellow of Interventional Pain Practice) and CIPS (Certification in Pain Medicine Sonology).

Clinical Focus


  • Pain Management
  • Acute Pain Service
  • Nerve Pain
  • Interventional Ultrasound
  • cryotherapy
  • spinal cord stimulation
  • Anesthesia

Academic Appointments


Administrative Appointments


  • President, World Academy of Pain Medicine Ultrasonography (2017 - 2018)
  • Vice President, World Academy of Pain Medicine Ultrasonography (2015 - 2017)
  • Chairman of education committee, World Academy of Pain Medicine Ultrasonography (2014 - Present)
  • Director, Acute Pain Service, Stanford University Hospital (2009 - Present)
  • Member, Quality, Efficiency, Patient Satisfaction Committee (2012 - Present)
  • Member, Interdisciplinary Practice Committee (2011 - Present)
  • Member, Resident Education Committee (2010 - Present)

Professional Education


  • Residency: Stanford University CAPS Postdoctoral Fellowship (2007) CA
  • Medical Education: Baylor College of Medicine (2002) TX
  • Board Certification: American Board of Anesthesiology, Pain Medicine (2010)
  • Board Certification: American Board of Anesthesiology, Anesthesia (2009)
  • Fellowship: Stanford Hospital and Clinics - Pain Mgmt (2008) CA
  • Internship: The University of Texas Health Center @ Tyler (2003) TX
  • Board Certification, ABA, Pain Management (2010)

Current Research and Scholarly Interests


I have a strong interest in ultrasound for chronic pain management for diagnostics as well as therapeutics. I also have strong interest in acute pain in the hospital setting, including post-operative as well as cancer pain.

Clinical Trials


  • Using Peripheral Nerve Stimulation (PNS) to Treat Chronic Post-surgical Pain (CPSP) After Knee Surgery Not Recruiting

    SPRINT PNS System will be offered to patients with postoperative knee pain following primary unilateral total knee arthroplasty (TKA) who meet eligibility criteria and consistent with established coverage policy. SPRINT PNS System will be implanted for 60 days. At the discretion of the physician, the first lead may be placed to stimulate the nerve innervating the region of greatest pain. If pain is not adequately addressed by the first lead when assessed at 10 days, a second lead may be placed approximately 2 weeks following the initial lead placement.

    Stanford is currently not accepting patients for this trial.

    View full details

Graduate and Fellowship Programs


All Publications


  • Application of the novel Nalu Neurostimulation System for peripheral nerve stimulation. Pain management Kalia, H., Pritzlaff, S., Li, A. H., Ottestad, E., Gulati, A., Makous, J., Chakravarthy, K. 2022

    Abstract

    Peripheral nerve stimulation is an established treatment modality for chronic neuropathic pain. Over the last decade, with the advent of innovative devices and delivery platforms, peripheral nerve stimulation has evolved from invasive open surgeries to image-guided, minimally invasive percutaneous procedures. The authors hereby present a novel device, the Nalu Neurostimulation System(Nalu Medical, CA, USA), which has established its advantages in providing predictable and reliable peripheral nerve stimulation therapy for chronic neuropathic pain management. This novel device is effective in treating chronic pain conditions such as post-herniorrhaphy pain syndrome, intercostal neuralgia, post-laminectomy syndrome, and complex regional pain syndromeand holds great promise for the treatment of peripheral neuropathic pain.

    View details for DOI 10.2217/pmt-2021-0050

    View details for PubMedID 35946308

  • Considerations in Permanent Implantation of Peripheral Nerve Stimulation (PNS) for Chronic Neuropathic Pain: An International Cross Sectional Survey of Implanters. Pain practice : the official journal of World Institute of Pain Li, A. H., Gulati, A., Leong, M. S., Aggarwal, A. K., Salmasi, V., Spinner, D., Ottestad, E. 2022

    Abstract

    INTRODUCTION: Novel minimally invasive short-term and long-term peripheral nerve stimulation (PNS) systems have revolutionized targeted treatment of chronic neuropathic pain. We present an international survey of PNS-implanting pain physicians to assess what factors they consider when offering permanent PNS.METHODS: This cross-sectional study consisted of a survey (Qualtrics) that was distributed to PNS-implanting physicians in a device supplier's entire email database on November 13, 2020, with 3 weeks of response time. Physicians' contact information in the form of their email addresses had been previously collected by the supplier upon device distribution with permission to use survey responses for research.RESULTS: Of 2,032 database physicians, 40 physicians representing 37 institutions responded to the survey. The most common application of PNS was mononeuropathic pain (57%). The most frequently targeted nerve was the suprascapular nerve (29%). 14% of physicians reported 81-100% of their implants were dual-lead. The representative physicians ranged broadly in their most frequently-targeted nerves. Although mononeuropathic pain was the most common indication for PNS, there was still varied response regarding other indications such as CRPS and post-surgical chronic pain.CONCLUSION: In context of a low response rate, identifying such factors can help update the prevailing treatment algorithm for interventional therapies, assist pain physicians in better identifying which patients are the best candidates for PNS, and inform future clinical trial design on PNS efficacy.

    View details for DOI 10.1111/papr.13105

    View details for PubMedID 35178863

  • Understanding the role of patient preference in the treatment algorithm for chronic low back pain: results from a survey-based study. Pain management Staats, P., Deer, T., Ottestad, E., Erdek, M., Spinner, D., Gulati, A. 2021

    Abstract

    Aims: Interventional pain treatments range from injections to established radiofrequency ablation techniques and finally neuromodulation. In addition to safety, efficacyand cost dominance, patient preference for type of treatment is important. Methods: Chronic pain patients (n=129) completed a preference scale to determine which interventional pain management procedures they would prefer from among radiofrequency ablation, temporary (60-day) peripheral nerve stimulation (PNS), conventional PNS and spinal cord stimulation/dorsal root ganglion stimulation. A second survey (n=347) specific to assessing the preference for radiofrequency ablation or temporary PNS treatment was completed by patients with low back pain. Results: On the basis of mean rank, temporary PNS percutaneously implanted for up to 60days was the most preferred treatment compared with the other options presented (p=0.002). Conclusions: Patient preference should be unbiased and considered as an independent variable for physician discussion in treatment options and future research.

    View details for DOI 10.2217/pmt-2021-0011

    View details for PubMedID 34470473

  • History of Peripheral Nerve Stimulation-Update for the 21st Century. Pain medicine (Malden, Mass.) Ottestad, E., Orlovich, D. S. 2020; 21 (Supplement_1): S3–S5

    Abstract

    OBJECTIVE: To present a history of the development of peripheral nerve stimulation.METHODS: Narrative literature review.RESULTS: Peripheral nerve stimulation has a history stretching from Scribonius Largus and eels in Mesopotamia to Michael Farady's discovery in London, the German-English physician Julius Althaus's application of electricity to a peripheral nerve, the sensational "Electreat" in the United States, to the application by Wall and Sweet of the gate theory proposed by Melzack and Wall to specialized neurosurgeons.CONCLUSIONS: This is now a modern field in clinical neuroscience and medicine with improved technology, renewed interest by a diverse range of specialties, and accessibility with ultrasound.

    View details for DOI 10.1093/pm/pnaa165

    View details for PubMedID 32804228

  • Advances in Peripheral Nerve Stimulation: More Clinical Options, More Science. Pain medicine (Malden, Mass.) Ottestad, E., Gulati, A. 2020; 21 (Supplement_1): S1–S2

    View details for DOI 10.1093/pm/pnaa198

    View details for PubMedID 32804224

  • Peripheral Nerve Stimulation for Occipital Neuralgia. Pain medicine (Malden, Mass.) Salmasi, V., Olatoye, O. O., Terkawi, A. S., Hah, J. M., Ottestad, E., Pingree, M. 2020; 21 (Supplement_1): S13–S17

    Abstract

    BACKGROUND: Chronic headaches are the second most prevalent disease and second most common cause for years lived with disability worldwide. Occipital neuralgia can cause headaches or be present in addition to other more prevalent causes of headache. If these headaches fail to respond to conservative and pharmacological therapy, physicians proceed to more invasive treatments, starting with infiltration of the greater occipital nerve with local anesthetic with or without corticosteroids, followed by nerve ablation or stimulation. Occipital nerve stimulation gained more popularity as the technology improved and more pain physicians received training on interventional procedures.METHODS: In this manuscript, we are presenting our experience with ultrasound-guided implant of occipital nerve stimulators using peripheral nerve stimulator systems. After confirming appropriateness of treatment by a successful occipital nerve block (i.e., resulting in >50% relief in patients' pain intensity), we implanted five stimulator systems in three patients (two bilateral).RESULTS: We followed these patients for an average of eight months, and the average pain reduction was 50%. We did not observe any adverse events during or immediately after surgery. One patient developed an adverse reaction to the adhesive of the battery transmitter, but it was not severe enough to stop her from using the stimulator.CONCLUSIONS: Considering the ease of implant and minimal side effects, implant of peripheral nerve stimulators to stimulate the occipital nerve is a promising treatment modality for patients with chronic headache who present with features of occipital neuralgia. However, wider use of this treatment modality is subject to further studies.

    View details for DOI 10.1093/pm/pnaa083

    View details for PubMedID 32804226

  • Therapeutic Ultrasound for Chronic Pain Management in Joints: A Systematic Review PAIN MEDICINE Aiyer, R., Noori, S. A., Chang, K., Jung, B., Rasheed, A., Bansal, N., Ottestad, E., Gulati, A. 2020; 21 (7): 1437–48

    View details for DOI 10.1093/pm/pnz102

    View details for Web of Science ID 000593143900022

  • Therapeutic Ultrasound for Pain Management in Chronic Low Back Pain and Chronic Neck Pain: A Systematic Review PAIN MEDICINE Noori, S. A., Rasheed, A., Aiyer, R., Jung, B., Bansal, N., Chang, K., Ottestad, E., Gulati, A. 2020; 21 (7): 1482–93

    View details for DOI 10.1093/pm/pny287

    View details for Web of Science ID 000593143900026

  • Hearing the Call for Therapeutic Ultrasound. Pain medicine (Malden, Mass.) Gulati, A., Ottestad, E. 2020

    View details for DOI 10.1093/pm/pnaa156

    View details for PubMedID 32457983

  • INTRAVENOUS LIDOCAINE INFUSION FOR MANAGEMENT OF PAIN IN THE INTENSIVE CARE UNIT Jung, S., Ottestad, E., Aggarwal, A., Flood, P., Nikitenko, V. LIPPINCOTT WILLIAMS & WILKINS. 2020
  • Patients Maintained on Buprenorphine for Opioid Use Disorder Should Continue Buprenorphine Through the Perioperative Period PAIN MEDICINE Lembke, A., Ottestad, E., Schmiesing, C. 2019; 20 (3): 425–28

    View details for DOI 10.1093/pm/pny019

    View details for Web of Science ID 000467966600001

  • Patients Maintained on Buprenorphine for Opioid Use Disorder Should Continue Buprenorphine Through the Perioperative Period. Pain medicine (Malden, Mass.) Lembke, A., Ottestad, E., Schmiesing, C. 2019; 20 (3): 425–28

    View details for PubMedID 29452378

  • Therapeutic Ultrasound for Pain Management in Chronic Low Back Pain and Chronic Neck Pain: A Systematic Review. Pain medicine (Malden, Mass.) Noori, S. A., Rasheed, A., Aiyer, R., Jung, B., Bansal, N., Chang, K., Ottestad, E., Gulati, A. 2019

    Abstract

    Background: Low back pain (LBP) and neck pain are major causes of pain and disability that are experienced across all ages. The primary goals of treatment are to improve patient function and facilitate a return to the patient's desired level of daily activity. Therapeutic ultrasound is a noninvasive modality widely utilized in the management of musculoskeletal disorders, but there continues to be controversy regarding its use due to insufficient evidence of effectiveness. The objective of this systematic review was to evaluate the effectiveness of therapeutic ultrasound in the management of patients with chronic LBP and neck pain.Methods: Using PRISMA guidelines, a search of the PubMed and CENTRAL (The Cochrane Library) databases was performed to retrieve randomized controlled trials (RCTs) that evaluated therapeutic ultrasound in patients with chronic LBP or neck pain.Results: The search strategy identified 10 trials that met the criteria for inclusion. Three studies in LBP reported that both therapeutic and sham (placebo) ultrasound provided significant improvement in pain intensity. In each of these studies, ultrasound was found to be more effective than placebo when using only one of several validated instruments to measure pain. Three of the four studies on neck pain demonstrated significant pain relief with ultrasound in combination with other treatment modalities. However, only one of these studies demonstrated that the use of ultrasound was the cause of the statistically significant improvement in pain intensity.Conclusions: Therapeutic ultrasound is frequently used in the treatment of LBP and neck pain and is often combined with other physiotherapeutic modalities. However, given the paucity of trials and conflicting results, we cannot recommend the use of monotherapeutic ultrasound for chronic LBP or neck pain. It does seem that ultrasound may be considered as part of a physical modality treatment plan that may be potentially helpful for short-term pain relief; however, it is undetermined which modality may be superior. In both pain syndromes, further trials are needed to define the true effect of low-intensity ultrasound therapy for axial back pain. No conclusive recommendations may be made for optimal settings or session duration.

    View details for PubMedID 30649460

  • Therapeutic Ultrasound for Chronic Pain Management in Joints: A Systematic Review. Pain medicine (Malden, Mass.) Aiyer, R. n., Noori, S. A., Chang, K. V., Jung, B. n., Rasheed, A. n., Bansal, N. n., Ottestad, E. n., Gulati, A. n. 2019

    Abstract

    Treatments for joint pain and dysfunction focus on restoration of joint motion, improvement in pain and a return to the previous level of the patient's daily activity. Therapeutic ultrasound is a noninvasive modality widely utilized in the management of musculoskeletal disorders. The objective of this systematic review was to evaluate the effectiveness of therapeutic ultrasound in the management of patients with knee, shoulder and hip pain.Using PRISMA guidelines, a search of the PubMed, CENTRAL (The Cochrane Library), Web of Science and Scopus databases was performed to retrieve randomized controlled trials (RCTs) that evaluated therapeutic ultrasound (continuous and pulsed) in patients with chronic knee, shoulder and hip pain.The search strategy identified 8 trials for knee, 7 trials for shoulder and 0 trials for hip that met the criteria for inclusion. All 8 trials showed improvement in knee pain, and of these studies 3 showed statistical significance improvement for therapeutic ultrasound versus the comparator. For shoulder pain, all 7 trials showed reduction in pain, but should be noted that 4 of studies demonstrated that therapeutic ultrasound is inferior to the comparator modality.Therapeutic ultrasound is frequently used in the treatment of knee, shoulder and hip pain and is often combined with other physiotherapeutic modalities. The literature on knee arthritis is most robust, with some evidence supporting therapeutic ultrasound, though the delivery method of ultrasound (pulsed vs continuous) is controversial. As a monotherapy, ultrasound treatment may not have a significant impact on functional improvement but can be a reasonable adjunct to consider with other common modalities. In all three pain syndromes, especially for hip pain, further trials are needed to define the true effect of low-intensity ultrasound therapy knee, shoulder and hip pain. No conclusive recommendations may be made for optimal settings or session duration.

    View details for PubMedID 31095336

  • A Case Report of Combined Ultrasound and Fluoroscopic-Guided Percutaneous Radiofrequency Lesioning of the Obturator and Femoral Articular Branches in the Treatment of Persistent Hip Pain in a Pediatric Patient PAIN PRACTICE Khan, J. S., Krane, E. J., Higgs, M., Pritzlaff, S., Hoffinger, S., Ottestad, E. 2019; 19 (1): 52–56

    View details for DOI 10.1111/papr.12724

    View details for Web of Science ID 000455105200005

  • A case report of combined ultrasound and fluoroscopic-guided percutaneous radiofrequency lesioning of the obturator and femoral articular branches in the treatment of persistent hip pain in a pediatric patient. Pain practice : the official journal of World Institute of Pain Khan, J. S., Krane, E. J., Higgs, M., Pritzlaff, S., Hoffinger, S., Ottestad, E. 2018

    Abstract

    Hip denervation comprising radiofrequency lesioning of the obturator and femoral articular branches is used in adults with refractory hip pain who are not surgical candidates. Persistent hip pain infrequently occurs in pediatric patients and there is limited data on the safety and efficacy of this procedure in a pediatric population. We provide a case report of a successful ultrasound and fluoroscopic-guided hip denervation procedure in an 11-year old female with persistent right hip pain after septic arthritis refractory to conservative and surgical management strategies. At an 18- week follow-up, hip denervation provided improvement in pain, mobility, and reduced opioid consumption by 20%. This article is protected by copyright. All rights reserved.

    View details for DOI 10.1111/papr.12724

    View details for PubMedID 29896934

  • Flare of CRPS symptoms after lidocaine infusion Gong, Z., Fishman, M., Coleman, S., Ottestad, E., Navani, A. CHURCHILL LIVINGSTONE. 2015: S75
  • Pain over the dorsum of third metacarpophalangeal joint: which nerve to block, radial or ulnar? Gong, Z., Ottestad, E. CHURCHILL LIVINGSTONE. 2015: S68
  • Ultrasound-guided genicular nerve block for persistent knee pain after knee surgery Gong, Z., Ottestad, E. CHURCHILL LIVINGSTONE. 2015: S69
  • Pulsed radiofrequency neuromodulation of a painful saphenous vein stump Schmidt, P., Ottestad, E. CHURCHILL LIVINGSTONE. 2014: S99
  • Perioperative interventions to reduce chronic postsurgical pain. Journal of reconstructive microsurgery Carroll, I., Hah, J., Mackey, S., Ottestad, E., Kong, J. T., Lahidji, S., Tawfik, V., Younger, J., Curtin, C. 2013; 29 (4): 213-222

    Abstract

    Approximately 10% of patients following a variety of surgeries develop chronic postsurgical pain. Reducing chronic postoperative pain is especially important to reconstructive surgeons because common operations such as breast and limb reconstruction have even higher risk for developing chronic postsurgical pain. Animal studies of posttraumatic nerve injury pain demonstrate that there is a critical time frame before and immediately after nerve injury in which specific interventions can reduce the incidence and intensity of chronic neuropathic pain behaviors-so called "preventative analgesia." In animal models, perineural local anesthetic, systemic intravenous local anesthetic, perineural clonidine, systemic gabapentin, systemic tricyclic antidepressants, and minocycline have each been shown to reduce pain behaviors days to weeks after treatment. The translation of this work to humans also suggests that brief perioperative interventions may protect patients from developing new chronic postsurgical pain. Recent clinical trial data show that there is an opportunity during the perioperative period to dramatically reduce the incidence and severity of chronic postsurgical pain. The surgeon, working with the anesthesiologist, has the ability to modify both early and chronic postoperative pain by implementing an evidence-based preventative analgesia plan.

    View details for DOI 10.1055/s-0032-1329921

    View details for PubMedID 23463498

  • Perioperative Interventions to Reduce Chronic Postsurgical Pain JOURNAL OF RECONSTRUCTIVE MICROSURGERY Carroll, I., Hah, J., Mackey, S., Ottestad, E., Kong, J. T., Lahidji, S., Tawfik, V., Younger, J., Curtin, C. 2013; 29 (4): 213-222

    Abstract

    Approximately 10% of patients following a variety of surgeries develop chronic postsurgical pain. Reducing chronic postoperative pain is especially important to reconstructive surgeons because common operations such as breast and limb reconstruction have even higher risk for developing chronic postsurgical pain. Animal studies of posttraumatic nerve injury pain demonstrate that there is a critical time frame before and immediately after nerve injury in which specific interventions can reduce the incidence and intensity of chronic neuropathic pain behaviors-so called "preventative analgesia." In animal models, perineural local anesthetic, systemic intravenous local anesthetic, perineural clonidine, systemic gabapentin, systemic tricyclic antidepressants, and minocycline have each been shown to reduce pain behaviors days to weeks after treatment. The translation of this work to humans also suggests that brief perioperative interventions may protect patients from developing new chronic postsurgical pain. Recent clinical trial data show that there is an opportunity during the perioperative period to dramatically reduce the incidence and severity of chronic postsurgical pain. The surgeon, working with the anesthesiologist, has the ability to modify both early and chronic postoperative pain by implementing an evidence-based preventative analgesia plan.

    View details for DOI 10.1055/s-0032-1329921

    View details for Web of Science ID 000317597000001

    View details for PubMedID 23463498

  • Ultrasound-guided injections of the knee and hip joints Tech Reg Anesth Pain Manag Cheng P, Kim H, Ottestad E, Narouze S 2009; 13 (3): 191-197
  • Evaluating the management of septic shock using patient simulation CRITICAL CARE MEDICINE Ottestad, E., Boulet, J. R., Lighthall, G. K. 2007; 35 (3): 769-775

    Abstract

    Develop a scoring system that can assess the management of septic shock by individuals and teams.Retrospective review of videotapes of critical care house staff managing a standardized simulation of septic shock.Academic medical center; videotapes were made in a recreated intensive care unit environment using a high-fidelity patient simulator.Residents in medicine, surgery, and anesthesiology who had participated in the intensive care unit rotation.The septic patient was managed by the intensive care unit team in a graded manner with interns present for the first 10 mins and more senior-level help arriving after 10 mins. The intern was graded separately for the first 10 mins, and the team was graded for the entire 35-min performance.Both technical and nontechnical scoring systems were developed to rate the management of septic shock. Technical scores are based on guidelines and principles of managing septic shock. Team leadership, communication, contingency planning, and resource utilization were addressed by the nontechnical rating. Technical scores were calculated for both interns and teams; nontechnical scores applied only to the team. Of 16 technical checklist items, interns completed a mean of 7 with a range of 1.5-11. Team technical ratings had a mean of 9.3 with a range of 3.3-13. Nontechnical scores showed similar intergroup variability with a mean of 26 and a range of 10-35. Technical and nontechnical scores showed a modest correlation (r = .40, p = .05). Interrater reliabilities for intern and team technical scores were both r = .96 and for nontechnical scores r = .88.Objective measures of both knowledge-based and behavioral skills pertinent to the management of septic shock were made. Scores identified both adequate and poor levels of performance. Such assessments can be used to benchmark clinical skills of individuals and groups over time and may allow the identification of interventions that improve clinical effectiveness in sepsis management.

    View details for DOI 10.1097/01.CCM.0000256849.75799.20

    View details for Web of Science ID 000244470800011

    View details for PubMedID 17235260

  • Securing the airway of a 'super sized' patient: another use for the Aintree Catheter (R) EUROPEAN JOURNAL OF ANAESTHESIOLOGY Schmiesing, C., Collins, J., Ottestad, E., Kulkarni, V., Brock-Utne, J. 2006; 23 (12): 1064-1066

    View details for Web of Science ID 000242303600016

    View details for PubMedID 17042968

  • Central venous access in obese patients: A potential complication ANESTHESIA AND ANALGESIA Ottestad, E., Schmiessing, C., Brock-Utne, J. G., Kulkarni, V., Parris, D., Brodsky, J. B. 2006; 102 (4): 1293-1294

    View details for Web of Science ID 000236371100072

    View details for PubMedID 16551951