Pain Management w/ Dr. Amit Mehta

Episode Information

March 26, 2021

Interventional pain management physician Dr. Amit Mehta talks about treating chronic pain, the role of social media in the rising levels of chronic pain, intermittent fasting, and more.

Topics Include:

• His journey to becoming a doctor and specializing in pain management
• The specialty of pain management
• How patients often come to him after they have tried every other option
• Pain management techniques that he offers including spinal cord stimulation and radiofrequency ablation
• The nature of pain and how it is not only physical but also mental and emotional and how he tells his patients that they will improve their pain levels through social outlets and support at home
• The importance of psychologists in the pain management field
• How he tells his patients to stay active and to live a balanced life
• New techniques in the pain management field including regenerative medicine and newer ways to use ketamine
• How he went into private practice during the housing fiasco in 2008 and built up a big practice employing 50 employees in up to 8 Chicagoland offices
• His snowboarding accident and how that led him to appreciate every day
• How Doctorpedia is a platform where a core group of people provide quality healthcare information and how this helps both patients and doctors gain knowledge and make decisions with regard to their and their patients’ health
• How he has been doing intermittent fasting for a year and how it has helped him to lose weight and with his overall health and energy levels

Highlights

• “Becoming a doctor wasn’t one of those things where I had some inspirational story or somebody really inspired me. It was just one of those things where at school, I was good at science and better at those pre-medical classes. And eventually I started to enjoy the intricacy of the body and the physiology and it was challenging, but I was good at it. I basically was not good at computers or business or anything else at that point. So I went along with what I was good at. And then it built into something where I became more involved with the hands on experience and then dealing with patients, and actually making a difference in people’s lives and building from there.”
• “A lot of people honestly don’t know what pain doctors do and they think, “Okay, you have pain. A pain doctor might give you some narcotics or some opiates or some pain medication, and you’re good to go.” But it’s a whole new field that really has opened up over the past 15 to 20 years.”
• “I often tell patients I’m the doctor in between your chiropractor, your primary doc, your physical therapist, and then the surgeon. And so patients who have back pain, joint pain, disc issues, nerve issues, cancer pain, they’re not going to always jump into surgery. So they look for alternative options that hopefully can give them better functionality and pain relief. And that’s when they come to me.”
• “I’m not a big proponent of just, “Hey, let me write you these narco tabs or these pain pills”, or “Let me just keep doing the same thing”. If something’s not working for me, I like to say, “Hey, let’s look at plan B, let’s look at plan C, let’s see what other options are there.” That way we’re actually active in care instead of just doing the same thing over and over.”
• “The biggest thing is that after you lose weight, keeping that weight off will lead to less pressure on the joints, less pressure on the back. I tell patients that there is an emotional aspect and they have to have some outlet at home, whether it’s reading or whether it’s TV or movies or travel or hanging out with friends or family – that is going to help their pain too. So there’s a physical aspect and there’s a mental or emotional aspect that I usually try to hammer home with most of my patients.”
• “I think the biggest thing is the stressors of social media, I think it’s tougher to be a kid or a younger adult nowadays than it is when we were kids or at least for me, with everything now that you have Snapchat, you have Facebook, you have Instagram, and people are on LinkedIn and then there’s social pressures. People are going out, then you have all these dating apps. And I think all that plays a role in pain.”
• “I was a co-founder and managing partner of a private practice in Chicago. We started at the time at a fellowship in 2008, when most people would get jobs at a hospital, or get a job to start paying off their debt and loans. At that time, no one really went straight into private practice, one because it’s hard to build, two, at that time, it was the housing fiasco. So everything was a recession, your loans dropped, everything was at the bottom or in the red. We definitely put in a lot of sweat, time and effort. And over the 10 years, we were able to have up to 50 employees, seven to eight different locations in the Chicagoland area and we made it work. “
• “When I was in medical school, I was in Tahoe. I thought that I was good at snowboarding. Obviously I wasn’t. I fell and snapped my clavicle. And so for about six to eight weeks, I had to wear a brace. Looking back at that time, if I look at what it taught me, I would have to say that it taught me mortality and that we’re here for a finite amount of time, enjoy the time and appreciate today is how I look at it.”
• “Over the last two or three years, I’ve tried to improve my health from a general standpoint. The newest thing I’ve been doing over the last year is intermittent fasting. For me, having a balance of two to three days of working out, being active, eating healthy maybe five days out of seven. It’s not going to be every day, but intermittent fasting during the week where I’ll have dinner, but then the next day I’ll go 16 to 18 hours without having food and this has really helped as far as reducing some of my weight, helping with my overall body chemistry, with insulin, sugar levels, everything from that standpoint and my overall energy level.”

Relevant Links

• Doctorpedia Spotlight Interview
• Doctor Profile
• ABM Pain Consultants

Episode Transcript

Daniel Lobell: (00:00)
This podcast or any written material derived from its transcripts represents the opinions of the medical professional being interviewed. The content here is for informational purposes only, and should not be taken as medical advice since every person is unique. Please consult your healthcare professional for any personal or specific needs. Hello and welcome to the Doctorpedia podcast. I’m your host Daniel Lobell, and I’m honored to be joined on the line today by Dr. Amit Mehta.

Daniel Lobell: (00:30)
How are you?

Dr. Amit Mehta: (00:31)
Good, good. How are you?

Daniel Lobell: (00:33)
I’m doing well. Thank you. And I’m excited to talk to you. I have a lot of questions set up, but I want to first start with you, getting into why you became a doctor, where you grew up and then we’ll work our way to why you chose to work in pain management. Where did you grow up?

Dr. Amit Mehta: (00:54)
Sure. So I grew up in the suburbs of Chicago, grew up in Downer’s Grove from my childhood. And so most of my childhood was here in the suburbs of Chicago. And then I continued to stay out here, went to college out here, but then got a taste of the East and the West Coast as I grew up, as my parents moved out to California and I actually did some studies and fellowship out of New York. So I actually grew up in Chicago, but got a taste of the West Coast and the East Coast. So I got a little flavor of everything across the border.

Daniel Lobell: (01:32)
Okay, cool. And then you wound up back in Chicago?

Dr. Amit Mehta: (01:36)
Yeah, from New York. I came back to Chicago. My wife was out here and so I had to come on back. We had some family out here and then I started a practice in Chicago after my fellowship out in New York.

Daniel Lobell: (01:49)
When did you decide you wanted to be a doctor and were your parents doctors?

Dr. Amit Mehta: (01:53)
No. My parents are not doctors. My parents came here from India in 1975, my dad’s in marketing. He moved out to Silicon Valley. My mom worked for United Airlines, so I am Indian, but there are no doctors in the immediate family, which is oftentimes a surprise.

Daniel Lobell: (02:15)
Well, you fixed it. [Laughs].

Dr. Amit Mehta: (02:15)
Honestly it wasn’t one of those things where I had some inspirational story or somebody really inspired me. It was just one of those things where at school, I was just good at science and better at those pre-medical classes. And eventually I started to enjoy the intricacy of the body and the physiology and it was challenging, but I was good at it. And I basically was not good at computers or business or anything else at that point. So I went along with what I was good at. And then it built into something where I became more involved with the hands on experience and then dealing with patients, and actually making a difference in people’s lives and building from there. But initially, from undergraduate, it was what I was good at from a scientific or a book standpoint.

Daniel Lobell: (03:15)
You just played to your strengths, in other words.

Dr. Amit Mehta: (03:19)
To put it bluntly, that’s what I did. From there, it grew into a passion and evolved over time. In college and in medical school, you really don’t have that much interaction with patients. So it sounded like I was seeing a lot of patients or I had some type of a story growing up or I was determined to be a doctor. I didn’t have any of that. I was good at it. And one thing led to another and then after that, the bigger decision was in medicine, what I wanted to do and what I wanted to specialize in. And then how to go from point A to point B to point C to a point where I’m happy where I’m at and balancing everything and making as much of an impact in the healthcare spectrum as possible.

Daniel Lobell: (04:09)
Let’s get into the specialty, why you chose pain management specifically. And I know that’s not all you do, is it? You also work in spinal cord stimulation? Is that part of pain management or is that its own thing?

Dr. Amit Mehta: (04:30)
So pain management is a broad field. A lot of people honestly don’t know what pain doctors do and they think, “Okay, you know, you have pain. You go to your doctor, a pain doctor might give you some narcotics or some opiates or some pain medication, and you’re good to go.” But it’s a whole new field that really has opened up over the past 15 to 20 years. Many times what happens is physicians will go through a training like I went through anaesthesiology training. So I’m an anesthesiologist by trade. And then you do a subspecialty, which is a year of fellowship in interventional pain management, which means that I’m trained to do a lot of procedures within the spinal cord, a lot of nerve blocks, epidurals, and all these procedures are all gone under x-ray guidance.

Dr. Amit Mehta: (05:23)
So they’re outpatient procedures, but I often tell patients I’m the doctor in between your chiropractor, your primary doc, your physical therapist, and then the surgeon. And so patients who have back pain, joint pain, disc issues, nerve issues, cancer pain, they’re not going to always jump into surgery. So they look for alternative options that hopefully can give them better functionality and pain relief. And that’s when they come to me. Spinal cord stimulation is an option that falls under pain management or it’s another technique or another interventional option we have that we can do for patients who have had spine surgery, whoever herniated disc, or who have nerve pain. And it’s another modality treatment that we offer. So spinal cord stimulation is actually under x-ray. We put in two electrical leads that have eight contacts into your epidural space, which is a space right outside of your spinal cord.

Dr. Amit Mehta: (06:24)
Now these leads are connected to like a little pacemaker battery. Eventually they will be all implanted within you. It sounds kind of barbaric, but it’s a pretty quick, easy procedure and is usually indicated for people who have had what’s called ‘failed back syndrome’, who have had multiple back surgeries or people who have chronic nerve pain, or what’s called CRPS, complex nerve injuries in the extremities. And so patients who have nerve pain, or they’ve had multiple back surgeries who are not getting better with other modalities of treatment and who are not surgical candidates, they’re always looking for something. So spinal cord stimulation has been around since the 1960s, but over the last10 to 15 years has really revolutionized some of the technology and the techniques to treat some of these patients with this chronic pain and help them get off medications and be more active and basically live a more normal life.

Daniel Lobell: (07:28)
So basically you’re putting a battery inside somebody.

Dr. Amit Mehta: (07:32)
Correct. We’re putting in these two electrical leads connected to a battery. And then what happens is they can control those leads. So instead of feeling the pain down the legs, they’ll feel like a massage, vibrating sensation. So it’s kind of like an internal TENS unit. If anyone’s had a TENS unit where you put those stickies on the outside and it vibrates and relaxes the muscle, this is kind of an internal TENS unit where they’ll feel kind of a vibrating pulsating feel, which actually blocks the pain receptors and the pain signals in the body to the spinal cord. And so instead of feeling sharp pain down the leg, they’ll feel a vibrating pain and a warm pulsating pain. And patients say that’s much better than feeling sharp, burning, throbbing, painful sensations. And then they have full control of it. And then I’ll say, “You have a remote control and you control that internal stimulator within you,” and these are outpatient procedures, one of the many types of procedures that I do, but usually after a short recovery period of a few weeks, they can get back to usual activities and they’re riding bikes, swimming.

Dr. Amit Mehta: (08:44)
They’re doing everything because everything is internalized. So it’s another option which has really brought in the spectrum of interventional pain management.

Daniel Lobell: (08:54)
What happens when the battery dies? Is someone like “Quick, get a knife and a AA – I’m starting to feel bad.”

Dr. Amit Mehta: (08:58)
It does happen. I tell patients that there are risks with everything. The good news is with these products, the batteries usually last about seven to 10 years. And there’s a lot of these batteries now that are rechargeable, with technology of today, they literally can plug something into the wall and put this little port on the outside of their back and they recharge your battery. If the battery dies every 7 to 10 years, it can be replaced and that’s literally a quick one hour outpatient surgery. It’s a quick procedure where we go in and take the battery out and the battery is usually placed kind of in the upper buttock, lower back regions. And so that’s the area where you can go in and replace it. And so patients at the end look at risk benefit, “Hey, could I go through all this to alleviate that pain?” And at that point, many of these patients are kind of at the end of the wire where they tried everything and they’re open to any option or any hope that could kind of give them some type of functionality.

Daniel Lobell: (10:07)
All right. Well, do me a favor when the interview is over, can you send me one of those batteries that I can integrate into my iPhone?

Dr. Amit Mehta: (10:13)
Sure, right. [Laughs]. No problem.

Daniel Lobell: (10:13)
I mean, I don’t even get seven to 10 hours. What’s going on here? I feel like I’m getting scammed now. I didn’t know they had batteries that lasted that long. Fantastic. So you’re an expert in treating various different types of pain. How is your treatment approach different from that of other doctors?

Dr. Amit Mehta: (10:37)
Honestly what I usually tell patients is I think with my upbringing and my balance outside of medicine, I think I’m able to connect to a lot of patients, whether they’re younger, whether they’re older, whether it’s through music, whether it’s through food, whether it’s through travel, whether it’s through restaurants. So I think my ability to connect to patients on a personal level actually is a little bit different than some of the other doctors. I feel that a personal touch is always important with patients. And I think my upbringing and all my interests outside of medicine actually help me in the medical field because it allows me to relate to patients and actually treat them as equals when they come in to see me. And I try to get rid of that hierarchical doctor-patient relationship, where patients are worried or scared to come in, or I try to make it more of a level playing field. And I think that differentiates me from other doctors.

Daniel Lobell: (11:44)
That’s great. That relatability factor is so important. What’s the biggest compliment a patient can give you?

Dr. Amit Mehta: (11:52)
Honestly, the biggest compliment patients give me is that I’ve given them their life back. As pain doctors, we see patients at the end of the road, a lot of patients that I see have been having pain for years and they I’ve tried medications, therapy, surgeries, and they come into me because they’re looking for some type of hope or some type of functionality, whether it’s to walk the dog, whether it’s to play with their grandkids. So if a patient comes to me and says, “Hey doc, you gave me my life back, I’m able to do this. I’m able to do some of these daily activities, which we take for granted,” I think that’s one of the bigger compliments that I get here and there.

Daniel Lobell: (12:43)
Let’s delve into what pain is. I know from a very lay perspective that it’s the nerve endings are damaged and there’s some kind of misfiring of electricity going to the brain that’s causing some kind of misread. That’s my primitive understanding. How would you explain pain to somebody in a maybe more sophisticated way?

Dr. Amit Mehta: (13:16)
The way I would explain pain is it’s an abnormal sensation. Pain can be an abnormal sensation that is conveyed to your spinal cord and then to your brain. And so there are different types of sensations which relate to different types of receptors that are on your hands and your body. These receptors can differentiate between vibration, deep pressure, heat, cold. And all these different sensory stimuli activate these receptors in your hands or on your feet or in your body. And those receptors actually transmit a signal to your spinal cord and your spinal cord then transmits a signal to your brain. And that’s where you have your sensory inputs in your brain. And that sends a repeat response to your arms or legs or body to withdraw or move back, telling you that it’s pain. It’s a complicated system, but there’s different theories on exactly what areas are involved and what can be modulated and where we can actually block pain receptors, whether it’s a spinal cord or from the peripheral nerves, which is your arms and your feet, but that’s the gist of it where there’s an abnormal sensation or abnormal stimuli leading to a series of neurons firing causing those pain symptoms.

Daniel Lobell: (14:52)
So pain is essentially psychological?

Dr. Amit Mehta: (14:54)
There is a definite psychological component.

Daniel Lobell: (15:01)
Here’s maybe a little off color question, but I know that there are people who are sexually interested in pain. I know that that’s a subset of humanity. Are they experiencing pain differently than the rest of us? What’s going on there?

Dr. Amit Mehta: (15:19)
Yeah. There are lots of fetishes out there and there are some people who definitely have pleasure with pain.

Daniel Lobell: (15:31)
That must be psychological, right?

Dr. Amit Mehta: (15:34)
Well, there’s a gray area because a lot of these synapses in the brain overlap – when you have pain, there’s lots of different receptors that get released in your body. You have dopamine, you have different receptors and different enzymes get released now in the brain, a lot of these cross relate. So the way I look at it is it’s different highways that are overlapping. And so for some people, they have more of those highways overlapping in their brain, and now they have that emotional response to pain, where it actually makes them feel better or it makes them happier. And some people do have a psychological response to it. And I think it’s because everyone’s wired a little bit different, but there’s definitely overlap with pain, depression, happiness, from a psychological aspect.

Daniel Lobell: (16:31)
So if I’m correct, what you’re saying is that for some people, pain releases dopamine, which therefore feels pleasurable. If that’s the correct analysis, is there a way that somebody who’s just not necessarily fetishizing pain, but experiencing back pain, is there some way to do a dopamine release for that person to offset it as well? I don’t know if I’m just coming completely out of left field here, but these are just my abstract thoughts on the matter.

Dr. Amit Mehta: (17:02)
There are lots of different enzymes that do get released by pain. And researchers have looked at dopamine. Dopamine primarily has been studied with Parkinson’s and Alzheimer’s and some of these other neurological injuries. But the hardest part with these medications crossing the brain blood barrier. So getting these medications into the system is easy, but then having it absorb them is a big issue. There are pain treatments where we actually put wires called intrathecal pumps into the patient’s cerebral spinal fluid right outside the spinal cord that releases medications. These medications are narcotic medications, pain medications that actually bind to certain receptors in the spinal cord and that give patients pain relief.

Dr. Amit Mehta: (18:01)
So from a pain management standpoint, that is a current treatment where we’re actually physically putting medication right near the spinal cord in the cerebral spinal fluid, whether it’s a narcotic medication or an anti-inflammatory or a local anesthetic medication. The issue with dopamine and some of these other enzymes that have been seen to be linked, is that they can’t be absorbed. So just taking it by mouth or injecting it, it’s not going to be crossing your blood-brain barrier or getting into the spinal cord. It just won’t get there. So that’s the biggest roadblock.

Daniel Lobell: (18:43)
That’s very interesting. Can pain be treated mentally over physically? It seems like in these situations, you’re physically blocking the pain. I’m wondering if there’s a way that the receptors don’t communicate the pain to the brain and therefore it’s as if you never experienced it.

Dr. Amit Mehta: (19:17)
I completely agree with you. I think there is, and that’s why we have pain psychologists in our field. And I’ll actually refer many patients to a pain psychologist, whether they use cognitive therapy or feedback therapy, they have different modalities where they can open certain areas of the brain. I’m not an expert in that, but we do refer patients to them. And this is another aspect of pain management, just because it’s such a big field, that definitely is still being researched and still is not completely understood, but pain psychologists are the ones who will try to kind of break down the barriers, break down the walls. That way patients can understand what’s causing their pain.

Dr. Amit Mehta: (20:11)
They can overcome that psychological aspect and thus physically, they feel better. Just because there is a definite link between the physical, psychological, emotional, mental aspects, all that’s intertwined and helping any of those is going to help the others. Pain psychologists are very important in the field and they’re the ones who will help to break down some of these barriers that can help patients as well.

Daniel Lobell: (20:43)
Very interesting.

Dr. Amit Mehta: (20:45)
Does that make sense?

Daniel Lobell: (20:48)
Yeah. I wonder if there’s a point in time when the two fields will merge into one because it seems like they could be dependent on each other to some extent

Dr. Amit Mehta: (20:58)
Right. They’re very codependent, but they’re also mutually exclusive, so they’re different. Many pain clinics will have a psychologist in the office. And they’ll come in one day a week and an interventional pain physician will refer four or five patients and that psychologist would see patients there. So definitely in the field, they do share spaces and they do work together.

Daniel Lobell: (21:27)
My friend had a brain tumor when he was much younger and thankfully survived it. But as a result of the surgery, he lost all feeling in one of his arms. So he says, “You could put a knife in my hand and I wouldn’t feel it.” And my father, when he was younger, broke his back and he’s had all kinds of surgeries and things to medicate that pain. And I’ve often wondered if there was some way to give him the gift of numbness that my friend has in his arm, in his back?

Dr. Amit Mehta: (22:10)
Yeah. We have patients that come in all the time and they’ll say, “Hey doc, can you just burn my nerves so I don’t feel anything?” And that’s something that we would love to do. Tangentially, we do procedures called a radiofrequency ablation where we actually do burn nerves, but the issue is that we can only burn certain nerves. So if I burned the nerves going down the leg, unfortunately you’re not going to be able to walk, you’re not going to be able to do anything. You will probably have incontinence and a lot of other issues that you don’t want, because you’re burning all those nerves. And so there’s only certain nerves you can really burn or lesion or block. You don’t want to actually injure a nerve that has motor sensory or neurological functions.

Dr. Amit Mehta: (23:03)
I do what’s called the radiofrequency ablation a lot where you actually burn nerves for patients who have arthritis, neck pain, back pain, shooting symptoms, and these work well. They’re 25 minute outpatient procedures, but we have to actually specifically target certain branches and make sure that we’re not burning those motor sensory nerves going down the arm or the hand, just because you’re going to have side effects that you’re not going to want and that’s one of the risks with some of these procedures.

Daniel Lobell: (23:39)
You’re probably one of the only people on the planet that people walk into your office and ask you to get on their nerves. [Laughs].

Dr. Amit Mehta: (23:45)
[Laughs]. Correct. I haven’t heard that one yet, but I’m going to have to keep in my repertoire and bring that up because that’s true – literally.

Daniel Lobell: (23:55)
What is the most common pain complaint that you get?

Dr. Amit Mehta: (24:03)
Back pain is something that half of the world has, general back pain. I’d say I probably see 10 to 15 patients a day with back pain – it’s probably the most common complaint I hear on a daily basis.

Daniel Lobell: (24:31)
How do you know which kind of back pain it is and how to treat it? Are there certain things that are real red flags and you say, “Okay, this is definitely that.” Is there a scan that you perform? What’s the procedure?

Dr. Amit Mehta: (24:46)
Yeah. For any patient that comes in, we get a history from them, seeing did they do something, did they pick something up? What kind of work do they do? Getting a history is the first step, after that we will do a physical exam, making sure there’s no deficits where if they’re not able to walk right away or they have severe deficits, we know that that’s an emergency. So we want to rule out an emergent issue from a non-emergent issue. And that’s done by clinical history and exam. Following that, usually if patients are having symptoms and we think that they may have a disc, a nerve, a muscle or some type of issue there, we can always get MRI imaging, MRIs are kind of a gold standard for back pain.

Dr. Amit Mehta: (25:34)
Many people think of x-rays, but x-rays will be a quick snapshot of your bones and if anything’s fractured or anything moved, but the MRI will show us the soft tissue. So it’ll show us the disc, the nerve. Is there inflammation, is there swelling? Is there pressure stenosis? So it gives us a real good picture. Based off that, as a physician, usually I’ll tell patients that I like to start off conservatively if we can. That means physical therapy, chiropractic care, anti-inflammatories and if things aren’t getting better, then we’ll talk about certain types of injections that I do – epidural injections, neuro blocks, joint injections, burning of nerves, things like that. And if nothing works and seeing a surgeon usually is the last option patients usually try to avoid, but many patients need to see surgeons and they get great outcomes, but they usually try to do everything before going under the knife.

Daniel Lobell: (26:31)
Right. Are there any pain management practices you frown upon?

Dr. Amit Mehta: (26:37)
I don’t like to say anything bad about any other doctor or pain management in general, but everyone’s trained differently. Over the last few years, we always hear about the opioid epidemic and narcotics, and it’s always in the news. Patients are getting smarter these days, social media has blown up and patients do their own research. Back in the day, there were doctors kind of grandfathered in to pain management, who didn’t have a fellowship, who didn’t have the proper training, who just started seeing patients and they would write pills and do injections, and they just got grandfathered in. I think nowadays patients are smarter and they’re avoiding some of these practices.

Dr. Amit Mehta: (27:27)
Just because there are some people out there who think just for ease and just because they’re used to it, it might just be writing scripts or just doing the basic, “Hey, I’ll do an epidural” – avoiding all these newer techniques and newer technologies that are out there. I’m not a big proponent of just, “Hey, let me write you these narco tabs or these pain pills”, or “Let me just keep doing the same thing”. If something’s not working for me, I like to say, “Hey, let’s look at plan B, let’s look at plan C, let’s see what other options are there.” That way we’re actually active in care instead of just doing the same thing over and over.

Daniel Lobell: (28:13)
That makes sense. Are there any at-home patient management techniques you recommend to your patients?

Dr. Amit Mehta: (28:20)
The biggest thing from my standpoint is that I tell patients to be active and live a balanced life. I’m not a physical therapist, so I don’t know all the true exercises or what you should and shouldn’t do, but I always tell patients because patients will always ask, “Hey, what can I do at home?” After procedures, I tell them, “You can do your usual activities, but don’t go home and start overdoing it, doing a hundred crunches if you’ve never done crunches.” So I think everything in moderation. The biggest thing for joints and the back is weight loss and keeping that weight off. And everyone says that, myself included. I say to myself every morning when I wake up, “You’ve got to keep the weight off.”

Daniel Lobell: (29:03)
That’s usually in the middle of the meal. [Laughs].

Dr. Amit Mehta: (29:06)
Yeah. So that’s the biggest thing, keeping that weight off will lead to less pressure on the joints, less pressure on the back, and doing things in moderation, walking, staying active, and then everything is not physical. I tell patients that there is an emotional aspect and they have to have some outlet at home, whether it’s reading or whether it’s TV or movies or travel or hanging out with friends or family – that is going to help their pain too. So there’s a physical aspect and there’s a mental or emotional aspect that I usually try to hammer home with most of my patients.

Daniel Lobell: (29:44)
Here’s what I’m wondering. You mentioned a few of these different practices that you’ve been using. And one that’s been around since the 1960s, in which the technology has come a long way, putting batteries in people. Are there any new advances in the field that are coming around or are they just basically updating the old ones?

Dr. Amit Mehta: (30:07)
Sure. That’s a great question. There are new advances and that spinal cord stimulation is what we were talking about from the 1960s – that’s advanced now where there’s four or five different companies that have different treatment options where they’re looking at the neuromodulation or stimulation. So the new advances are using higher frequencies, using different types of programs. There’s what’s called burst stimulation where the studies have looked at rapidly firing and blocking those nerves versus doing long slow frequency or slower, lower impulses. So there’s lots of newer studies and newer advances in terms of how they want to discharge those electrical leads. And now there’s four or five different companies, each on their own has one or two different types of leads and programs and whatnot to use and they all have their pros and cons.

Dr. Amit Mehta: (31:16)
They’re now looking for more peripheral stimulation. So you can put these leads in the knees or you can put them in the hips, you can put them in different areas, the buttocks, the sacroiliac joint, different areas in the body instead of just the spinal cord. And so people who have had knee surgeries who have tried different things and have had knee replacements now are looking at what’s called peripheral stimulation, which means putting these leads around the knees to give stimulation there. So the initial technology has now spun off where they have different types of newer options, as well as less invasive options, longer lasting batteries. And then they’re using them in different areas of the body, which is a newer thing over the last five to seven years.

Daniel Lobell: (32:09)
That makes me wonder, are they treating certain parts of the body by treating other parts of the body? Or are they, for instance, treating the back through the knee or are they only targeting the knee because the pain is in the knee?

Dr. Amit Mehta: (32:30)
That’s another good question. I think you’ve done your research here. The nerves that go to the knee come from the back, so when we put these leads in the back, whether it’s the neck or the lower back, the nerves that go to the knees, the legs are all coming from the lower back. And so when we’re putting them there, we’re trying to help the back pain as well as shooting symptoms down the legs, whether patients have sciatica symptoms or pain going down to their feet. If we put it in the neck, we’re trying to help neck pain, as well as possibly pain going down the arms.

Dr. Amit Mehta: (33:04)
For specific areas like the knees or the hips or the lower back, or the ankle, some patients have had multiple surgeries there, whether it’s knee replacement or traumatic injury. Sometimes if they just have localized pain there where they don’t have anything shooting in the leg or nothing going from the back, then you can do that peripheral stimulation, which will target specific nerves that innovate that knee. So there’s a peroneal nerve and there’s different nerves that go to the ankle and the knee, you can put this right on top of that nerve and it just kind of the same concept or it vibrates. And instead of causing that pain symptom, there’s theories that it decreases that and has a different sensation for patients. So in reality, there’s two ways to block the pain. One is from a central aspect, which is through the spinal cord and then one is peripheral, but we’re actually putting it near the near the knee or the ankle. Does that make sense?

Daniel Lobell: (34:08)
That makes sense. So would you say that’s the most exciting advance that’s happening in the field right now?

Dr. Amit Mehta: (34:17)
That’s one of them. In the field, there’s a few. The newer one now that’s blown up over the last three to four years is regenerative medicine, where we actually take your own blood and then we spin it down and you might’ve heard, you get STEM cells or you get PRP, which is platelet rich plasma. And then we can put that back into the joints around the space. And that has been seen to have a good response with anti-inflammatory properties and regrowth and things like that, just because of the enzymes. So the whole field of regenerative medicine with STEM cells, PRP, that has definitely grown over the past few years, and is interesting from a variety of aspects. And then from a pain management standpoint, the other aspect which I think has grown, which is interesting, is ketamine. Ketamine has been around for years as well and higher doses of ketamine were originally used in the civil war. And then there are horse tranquilizers or there’s different uses for ketamine and there’s a street drug PCP – there’s different uses for ketamine, but ketamine is an anesthetic. So anesthesiologists uses it a lot when we have to intubate patients and put patients to sleep.

Daniel Lobell: (35:41)
Who doesn’t love a nice horse tranquilizer?

Dr. Amit Mehta: (35:44)
Yeah. Right.

Daniel Lobell: (35:44)
[Laughs].

Dr. Amit Mehta: (35:44)
But it does its job in the right hands. So over the last three, four or five years, we have seen that ketamine can help with chronic pain complaints, such as depression, chronic nerve pain, cancer pain. And the reason it does that is they say it modulates or changes the NMDA receptor. So certain receptors get changed in your body with ketamine. There are some great studies, and then there’s some not so great ones, but it’s another option that I think has gotten pretty popular. And if you Google it, you’ll see ketamine clinics have popped up everywhere over the past few years, where patients are going in and they get hooked up to an IV and they get ketamine for about an hour and they walk out of there. And now usually with these, they will do a series of them.

Dr. Amit Mehta: (36:33)
So they’ll do like two or three, or even up to four or six, over a few months span. And the theory is your nerve endings and how everything is firing in your body slowly changes and you don’t perceive that pain as much. And so I think ketamine, regenerative medicine that I touched upon, spinal cord stimulation, the radiofrequency ablation burning of the nerves, those are the four or five big things in interventional pain management that I specialize in and that has changed over the past five to seven years. And I think it gives patients more hope, it gives them another option besides the usual cortisone or the usual script that they might’ve had in the past.

Daniel Lobell: (37:18)
Right. I saw an article that said that chronic pain is on the rise. In your opinion, what do you think is responsible for that worrying trend?

Dr. Amit Mehta: (37:28)
Chronic pain is a big term, but I agree. I think the biggest thing is the stressors of social media, I think it’s tougher to be a kid or a younger adult nowadays than it is when we were kids or at least for me, with everything now that you have Snapchat, you have Facebook, you have Instagram, and people are on LinkedIn and then there’s social pressures. People are going out, then you have all these dating apps. And I think all that plays a role in pain.

Daniel Lobell: (38:11)
I had a lot of pressure on me trying to score high at Sonic the Hedgehog.

Dr. Amit Mehta: (38:19)
Yeah. My youth was different. But all these societal pressures play a role.

Daniel Lobell: (38:30)
That’s the psychological aspect, right?

Dr. Amit Mehta: (38:31)
Right. So it’s all intertwined and it’s a big puzzle, but that’s the biggest issue that has changed over the past 10 years. And of course the same amount of patients are going to have back pain. We know that the people who are working and the people who have injuries will have back pain but some of these other outside factors definitely play a role and they play a role when patients have injuries whether they don’t have the inner drive to get better or they don’t have the inner drive to improve or respond to therapies. And I think society in general, different factors have led to increased chronic pain from a broad spectrum.

Daniel Lobell: (39:26)
What would you say has been your specific greatest accomplishment as a doctor to date?

Dr. Amit Mehta: (39:35)
I think specifically I started out right out of fellowship. I was a co-founder and managing partner of a private practice in Chicago. We started at the time at a fellowship in 2008, we came out and most people would get jobs at a hospital, or you got a job to start paying off your debt, your loans at that time, no one really went straight into private practice, one because it’s hard to build, two, at that time, it was the housing fiasco. So everything was a recession, your loans dropped, everything was at the bottom or in the red. And at that time we decided to open up a practice and we stuck with it. We definitely put in a lot of sweat, time and effort. And over the 10 years, we were able to have up to 50 employees, seven to eight different locations in the Chicagoland area and we made it work. So if I look back on my accomplishments, that’s one of them, just getting somewhere from nowhere, or as Drake said, “Started from the bottom, now we’re here.” And that’s how I look at it.

Daniel Lobell: (40:52)
There it is. That’s relatability – how many doctors are quoting Drake?

Dr. Amit Mehta: (40:56)
Right. So that’s how I would look at it. I did that for 10 years. Healthcare was changing so I decided to do my physician’s MBA at Auburn and switched certain things, but looking back, being able to grow a practice out of nothing to that scale, I think was my accomplishment.

Daniel Lobell: (41:19)
Very cool. That sounds like a great accomplishment to me. I think you should be proud.

Dr. Amit Mehta: (41:23)
Thank you.

Daniel Lobell: (41:25)
Have you ever been on the patient end of things, and if so, what did it teach you?

Dr. Amit Mehta: (41:31)
I have. Knock on wood, luckily I haven’t had any surgeries, but when I was in medical school, I was in Tahoe. I thought that I was good at snowboarding. Obviously I wasn’t. I fell and snapped my clavicle. And so for about six to eight weeks, I had to wear a brace. Luckily I didn’t need surgery, but my left clavicle healed on its own over six to eight weeks. Looking back at that time, if I look at what it taught me, I would have to say that it taught me mortality. And from that time, I’ve learned to appreciate today and not to worry about tomorrow’s problems. One little fall six inches to the left or six inches the right, I could have been paralyzed, just because I landed on my neck and my left shoulder, but just thinking about that, I think mortality and that we’re here for a finite amount of time, enjoy the time and appreciate today is how I look at it.

Daniel Lobell: (42:50)
Good advice. Do you still go out there or was that it for you?

Dr. Amit Mehta: (42:54)
No, I’ve been out there. I really haven’t gone snowboarding or skiing since then, eventually I have to get back into it. I won’t be as adventurous at this day and age anymore.

Daniel Lobell: (43:09)
But you’ve got the best pain management techniques. If anybody should take a risk, you should. You could just put a battery in there. [Laughs].

Dr. Amit Mehta: (43:21)
Put a battery, but yeah, I have a son, so I want to get them back into skiing. There’s a lot of things out there. I just have to be a little bit more cautious. Let’s put it that way.

Daniel Lobell: (43:32)
So what are you doing for fun these days?

Dr. Amit Mehta: (43:36)
Living in Chicago right now, we’re just kind of in hibernation, but I’m an avid sports guy. I like music, in my free time I like hanging out with family, friends, we travel a lot. So we travel every year, at least five or six different places, cool places. And we like to go with friends or family, restaurants, movies, you name it. I’m pretty open to everything. And luckily we have a lot of good friends, college buddies in the area we hang out with and family. And so there’s always something that keeps us busy on the weekends and when I’m not working

Daniel Lobell: (44:15)
All the best parts of living, some of them anyway. So we’re doing this podcast for the great Doctorpedia. And so I wanted to ask you what problems do you think that physicians face and that Doctorpedia can help solve?

Dr. Amit Mehta: (44:31)
I think with physicians and patients in general, there’s an overabundance of information where I always say there’s more quantity over quality. And what Doctorpedia really does is it puts together a good core group of people where true facts and good quality information come together to form a good platform. So I think Doctorpedia can have a good platform with quality evidence-based information that patients and physicians can go to to make more logical decisions, to get more knowledge and to learn something and to make society better as a whole. I think the biggest thing right now with the internet is you can Google anything – You just don’t know where it’s coming from, you don’t know if it’s true. I have patients all the time who say, “Oh, you know, I’m going to be paralyzed with this. I’m going to do that” and I’m like, “No.” Just because they read it somewhere or they heard it somewhere. And so the quality of the information is not the best. And Doctorpedia really channels that and makes it a good foundation for a healthcare platform.

Daniel Lobell: (45:48)
So what role are you playing in Doctorpedia?

Dr. Amit Mehta: (45:52)
From my perspective, I will help to build a pain management channel to offer insight on different types of pain, diseases, pain management, treatment options, as well as the future, what it holds with pain management and how to treat it. Pain management is a huge field and my role will be to offer my advice and my clinical experience and where I think this is going as far as treatment with technology and hopefully helping patients get to the next level or the next decade, as things are changing on a different basis, day to day.

Daniel Lobell: (46:37)
I’m excited to see what you do with the channel. I’m looking forward to checking it out.

Dr. Amit Mehta: (46:42)
Thanks.

Daniel Lobell: (46:43)
Doctor, I’m going to ask you the question I round up all these interviews with, and you touched on it a little bit when I asked you what you do for fun, but maybe there’s more you can expand on – what do you do to stay healthy?

Dr. Amit Mehta: (46:54)
That’s a good question. Over the last two or three years, I’ve tried to improve my health from a general standpoint. The newest thing I’ve been doing over the last year is intermittent fasting. The biggest thing that was killing me was during the week we would get rep lunches, so we’d have lunches. You have pasta, you have deep dish pizza, you have food that it’s hard to say no to at the office. And that was one of the biggest things. Physicians eat that a lot.

Dr. Amit Mehta: (47:34)
We’re healthy at home during the weekdays. For me, I always think balance. And so having a balance of two to three days of working out, being active, eating healthy maybe five days out of seven. It’s not going to be every day, but intermittent fasting during the week where I’ll have dinner, but then the next day being I’ll go 16 to 18 hours without having food has really helped as far as reducing some of my weight or overall body chemistry with insulin, sugar levels, everything from that standpoint and my overall energy level. So a good balance of exercise and trying to eat healthy, not all the time, but as much as possible. And then intermittent fasting is my newest thing that I’ve thrown in there.

Daniel Lobell: (48:30)
And when you do the fast, are you drinking water throughout it? Or it’s a complete fast?

Dr. Amit Mehta: (48:34)
I’ll usually do water or black coffee.

Daniel Lobell: (48:37)
Very cool. Very interesting. I’ve heard good and bad things about intermittent fasting, so I’m not sure.

Dr. Amit Mehta: (48:45)
Yeah. Everyone’s different. I wouldn’t recommend starting off by going 24 hours without eating. I think when I first started, I would go eight and 12 and gradually get up there. It works for some, but you have to find what works for you and go from there.

Daniel Lobell: (49:03)
How long have you been doing it for?

Dr. Amit Mehta: (49:06)
About a year.

Daniel Lobell: (49:08)
That’s commitment. I’m going to take it seriously then. [Laughs]. If you’re like a week and a half, I might be like, “I don’t know, let’s see how it plays out.” But a year is a good sample time.

Dr. Amit Mehta: (49:19)
It’s has been going well, so I’ll stick with it that way. It also justifies me – that way on the weekends if I want to eat pizza or go out and put unhealthy things in my body from a food standpoint, I definitely justify it by saying, “Hey, Monday to Thursday, I’m going to intermittent fast.”

Daniel Lobell: (49:38)
I’ve been doing intermittent eating. Is that not the same? [Laughs].

Dr. Amit Mehta: (49:40)
There’s always two sides to the story, but yeah. Tomato, tomato.

Daniel Lobell: (49:47)
I don’t know. That’s where you eat most of the time, but barely fast, I think. [Laughs].

Dr. Amit Mehta: (49:56)
That’s the weekend.

Daniel Lobell: (49:58)
Dr. Mehta. It’s been so great talking to you and it’s so fascinating to learn all about pain management. Thank you so much for your time and expertise.

Dr. Amit Mehta: (50:07)
No, thank you. I appreciate it.

Daniel Lobell: (50:14)
This podcast or any written material derived from its transcripts represents the opinions of the medical professional being interviewed. The content here is for informational purposes only and should not be taken as medical advice since every person is unique. Please consult your healthcare professional for any personal or specific needs.