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Ginsberg: This is America's patient advocate, Seth Ginsberg, filling in for my good friend Lisa Wexler and wishing her well on her much-deserved time off continuing, our conversation today, complicated to say the least but also very relevant given the fact that today is November 22, 2013, the 50th anniversary of the assassination of our 35th President, John F. Kennedy, someone that lived with a great deal of chronic pain as well as several other conditions that caused pain: osteoporosis- a weakening of his bones; colitis- a gut disease- as well as Addison's-an autoimmune condition, a very painful autoimmune condition. So when we learn now, after the fact, that JFK took up to 12 different medicines a day to treat his painful conditions, such as codeine, and Demerol and Methadone. That's an awful lot medication, even by today's standards. Here to talk to us a lot more about those medications as well as those that are available for us today is Dr. Jeff Gudin. Dr. Gudin, so you are a board-certified pain management anesthesiology, palliative care as well as in addiction medicine, Director of the Pain and Palliative Care of Englewood Hospital Medical Center in Englewood New Jersey, and a clinical instructor of anesthesiology at the Mount Sinai University School of Medicine. So you know a thing or two about pain, don't you Jeff?
Gudin: It sounds like it. That's what we live everyday.
Ginsberg: What's your perspective?
Gudin: You know it was very well known and obviously published a lot after his death when they were able to piece together his medical record that he did suffer with chronic pain and like you say, early bone loss osteoporosis. He was known to have a number of vertebral fractures as well as some , you mentioned some others like, adrenal insufficiency conditions and there were times that it was reported his pain was so bad that he would scream in pain, required these Novocain injections deep into the muscles of his back just to try to control his pain. So it's no surprise that the clinicians of the time used what they had at hand which were the pure, morphine-based medicines, morphine, methadone and oxycodone-like medicines and if you recognize those names which a lot of your listeners will, believe it or not, things really haven't changed all that much in the last couple of decades or so.
Ginsberg: The fact is we're dealing with very complicated conditions that create chronic pain, but absent; major injury or tear or break or hole in your body, the cause of it is still largely unknown, is that true?
Gudin: Yes, it turns out that a fair percentage of patients that visit pain management centers
really don't have a solid diagnosis. Pain is one of these things that stems from the nervous system. Remember back from junior high and high school science class, the brain is what we know is like the tip of the iceberg. There's a whole lot about the nervous system that we don't understand. And it turns out that the spinal cord where most of the pain processing happens in the body, can actually go haywire and become hyper excitable on its own. And doctors have just started to realize that hyper excitability, so to speak, is really at the root of things like migraine headaches, flairs of rheumatoid arthritis, some of the gastrointestinal painful abdominal syndromes, even some low-back flaring pain syndromes. Therefore, patients come in and often times even though they have pain in a certain part of their body, we're often unable to really find a cause because it's deep-rooted inside the central nervous system. In other words, if someone comes in with foot pain, they might not really have anything wrong with their foot. The kind of analogy I'll use, Seth, and people will understand, is if you knock out the electrical box or the fuse box in the house, your refrigerator might go off. There's nothing wrong with your refrigerator, you can get all the refrigerator repairmen in that you want, but unless you fix the only problem at the source where the signals are coming from, that is the nervous system, the brain and the spinal cord…
Ginsberg: The fuse box, in this case.
Gudin: Yeah, the fuse box, you're not really going to get to the source of the problem. That's why, Seth, most of our medications nowadays are what we call centrally acting, meaning they work at the level of the brain and the spinal cord.
Ginsberg: Well, you know, Dr. Gudin, we're going to have to leave it there here for our show. I'm getting the high sign. We really, really do appreciate your insights and your perspective and being on the frontline of pain management as the Director of Pain and Palliative Care at the Englewood Hospital and Medical Center. Thanks so much Dr. Gudin.
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