Physician's Corner: Dr. Scott Glaser, MD, DABIPP

Posted 3/1/2017 in Physician's Corner | 301 view(s) | 0 comment(s)


Dr. Scott Glaser, M.D., DABIPP 

Pain Specialists of Greater Chicago 

Introduction by Gina Pongetti Angeletti, MPT, MA, CSCS, ART-Cert. 


Pain management is one of the most important aspects in the treatment of orthopedic injuries ranging from the elite athlete to the person on disability. The common misconception is that people need to deal with pain, and should "push through" the discomfort in order to be and stay tough. Quite the contrary, as medical professionals, pain is a signal from the body about limitations, cause, and injury.

Pain management physicians are used to treating a population that consists of chronic pain diagnosis and a population of people that are often on vast amounts of oral medication and/or disability. Why is this? The answer is two-fold. First, there is a social stigma to an athlete complaining about pain. Therefore, they often do not address this part of their injury and rehabilitation. This leads to increased fascial tightness, protective mechanisms, change in biomechanics, anxiety, lack of sleep, and more. Pain physicians can focus on stopping the inflammation cycle, or decreasing local irritation, and even resetting the mind-body tension level.  Second, pain physicians themselves do not often educate the public/sports population or seek out the athlete to treat. Often this is because the pain physician believes that orthopedic physicians/sports medicine doctors are handling this...and unfortunately, this is not the case. Oral medication and cortisone injections are often the go-to for sports medicine doctors, as well as referring to Physical Therapy. It is the physical therapist, in the end, that often recognizes chronic issues through thorough evaluation of not only the issue at hand, but other issues such as altered biomechanics, muscle guarding, flexibility changes/protective mechanisms and movement dysfunction.

In the end... managing pain is an integral part of the rehabilitation process. Addressing the orthopedic issue, the connective tissue, analyzing films such as X-rays, MRI, CT, Bone scan and more, the nervous system and the psychological component to pain will help to holistically treat the patient, whether elite athlete or perpetual weekend warrior!

It is our pleasure as Achieve, with both chronic pain patients and an elite level athletic population, to work closely with Drs. Goodman and Glaser with Pain Specialists of Greater Chicago.  We would like to thank Dr. Scott Glaser, M.D., DABIPP for taking the time to answer a few questions for us to help better educate the public on Interventional Pain Management physicians.

Achieve:  What is your educational background?

Dr. Glaser: I went to Notre Dame undergraduate, Indiana University for medical school, and Northwestern for residency and fellowship. Like the majority of Interventional Pain Physicians, I did my original training in anesthesiology, the specialty which has spearheaded the development of the subspecialty of pain management.

Achieve:  Why did you decide to go into pain management?

Dr. Glaser:  There are a few distinct things that stand out in my mind. First was the first-hand experience of the transition to epidural infusions for pain control following major surgeries such as procedures in the chest. Patients that are used to intubation and a ventilator for 1, 2, or 3 days right after surgery secondary to pain and the inability to take a deep breath prior to epidural infusions. My fellowship year, with the use of epidural infusion through catheters we placed pre-operatively in the thoracic epidural space, patients were completely comfortable and able to comb their hair with the arm on the side which they had the incision on right after surgery. It was truly remarkable what two or three milliliters of medication per hour infused near the spinal cord could do to totally change the patients experience and was such a remarkable advance and so humane.

Another incident which led me into pain management was when a good friend, an ICU nurse I worked with my first year after training, was told by a neurosurgeon that her lower back pain was in her head because her MRI was relatively normal. I was astounded and knew there had to be a better way of treating spinal pain. It was so obvious to me at that point already the lack of diagnostic capability MRIs in identifying the source of pain. I also was offended by the surgeon’s lack of empathy and felt that every patient needed to be believed and treated appropriately.

Achieve:  What is the most challenging part of your profession with regards to people recognizing your specialty?

Dr. Glaser: The question about chronic pain management is very interesting. Originally, 20-30 years ago, when our field was just coming in to existence, patients with severe chronic pain who had exhausted multiple other options were the only patients which we treated. We had better options for them such as expertise in medication management and when possible, we performed interventional procedures to reduce their pain. We have many lifelong patients because of that who rely on us to mitigate their symptoms to improve their quality life although we are never able to completely eliminate their pain.

We began to note recurring themes in the medical histories of the folks who developed chronic pain. Multiple ER visits, redundant imaging of the spine, fruitless symptom treatment, and often a jump to surgery because they were being managed by surgeons. We realized we could actually reduce the incidence of chronic pain by assuming the management of patients much earlier on. We have made concerted efforts to be the first physician managing their pain rather than the last. This has led to better pain control or elimination, less narcotics, less ER visits, less imaging, and best of all better outcomes and less surgery and chronic pain and disability.

The official designation of our field is Interventional Pain Management. We are always attempting to treat the source of pain whenever possible minimally invasive way to avoid medication management and surgical options. We integrate therapy and other symptom management at all times while we are attempting to treat the source of pain. We treat acute, subacute, and chronic pain.

A person is not born with chronic pain. They injure themselves, experience pain, and that is called acute pain. If it persists longer than expected it is subacute pain and if it is not treated appropriately it can become chronic pain. Patients who are in the acute or subacute phase need to be managed by a board certified Interventional Pain Management specialist. If we manage a patient's care the outcome is much more likely to be positive. Managing the patient at the acute and subacute stage allows us to educate the patient, to teach them the facts about their MRI or other diagnosis test, and put the findings in their proper perspective.

Most importantly, managing acute and subacute pain allows us to and educate individuals about all of their options if the pain persists. We are able to explain the risks and benefits of those options when it clear that a specific treatment will be needed, we then can proceed to treat them with all minimally-invasive options available utilizing scientifically proven treatment algorithms to reduce their symptoms safely and allow them to rehabilitate with the help of excellent physical therapists.

Achieve:  What is the largest thing that has changed in the field of Interventional Pain Management since you started?

Dr. Glaser:  Probably the greatest advancement in pain management since the origin of this subspecialty is the knowledge of the treatments of joint and nerve pain in the spine. We now have well-established algorithms that allow us to pinpoint the cause of the pain and treat it safely through inter articular injections (joint injections) even of the small joints of the spine and, if that is not successful, treatment of the pain in the nerves that provide innervation of those joints.

Achieve:  Can you explain the importance of physical therapy in your practice?

Dr. Glaser:  Physical therapy is the most important aspect of pain management. Often, we are able to control pain but if the patient does not work with a physical therapist the duration of the relief may not last. Also, and this is very important, patients lose muscle strength, joint function and range of motion, and need to be rehabilitated after suffering pain. Only Physical Therapy can do that. Lastly, only physical therapists are in the position and have the knowledge to educate the patient about how to reduce the risk of future pain through appropriate exercises and behavior modification. Physicians do not have this important knowledge as part of their training.

Again, we would like to thank Dr. Glaser on behalf of Pain Specialists of Greater Chicago for spending some of his time to help educate the public on a very important aspect of medicine, Interventional Pain Management.  For much more information on their practice and to schedule an appointment, please visit their website at: www.PainChicago.com

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