Piedmont Interventional Pain Care – What Is an Interventional Pain Care Practice?

MedSoup 0:05
Welcome to the MedSoup podcast, where we talk about trending healthcare topics. I’m your host, Laura Schumacher; let’s dig in. 

MedSoup 0:18
Today we are joined by Dr. Robert Wilson, the founder and medical director of Piedmont Interventional Pain Care. Dr. Wilson has served patients in the Salisbury and the greater Rowan County region for over 15 years. He is board-certified in both anesthesiology and pain medicine by the American Board of Anesthesiology. He completed his residency in anesthesiology and a fellowship in pain medicine at Wake Forest University Baptist Medical center in Winston-Salem, North Carolina. Dr. Wilson is trained in the latest pain management techniques and therapies, and is an avid speaker, providing information to the public and medical professionals across the United States about the latest interventional pain treatments. 

He is an active advocate for the prevention of opioid abuse and serves on the opioid task forces for the Department of Health and Human Services, the Industrial Commission of North Carolina, the North Carolina Medical Board, and the North Carolina Medical Society. Additionally, Dr. Wilson is the president-elect of the pain society of the Carolinas, also known as PSOC, a long-standing member of the PSOC, and has served as chairman of the government advocacy committee.

Dr. Wilson, how would you define Piedmont Interventional Pain Care as a truly interventional pain practice? 

Dr. Robert Wilson 1:43
I think anyone that has a practice like mine, where we use the latest interventional or minimally invasive surgical techniques for pain control, could be defined as interventional pain care. The one thing I would say too is that we’re not just simply interventional based and that we take care of the patient from A to Z regardless of what they need because sometimes, you’ll find a procedure and try different procedures, and it doesn’t help them. And what you’ll need to do is write for pain medications as well to help control their pain. So, one of the things I stress is that we are very interventional based, but the reality is that we take care of the patient as a person, whatever pain therapies they need, we off them. 

MedSoup 2:31
What would you say are some of the most used interventional pain techniques? 

Dr. Robert Wilson 2:36
That’s a good question. We do a full range of different types of injections. I have my two Physicians assistants, Chris Watson and Medan Winegar, who perform most of the trigger point injections and trigger point injections are simply muscle or myofascial injections of local anesthetic and usually an anti-inflammatory agent in the area where the inflammation is. We also, because patients may come here for a spinal problem, they also have arthritic joints, etcetera. So, we find ourselves doing a lot of joint injections. And again, my physician’s assistants that work with me do the majority of those. But, that can include any joints, the knees, hips, shoulders, etcetera. 

Dr. Robert Wilson 3:24
It’s interesting that you take on a patient who had came here for one pain problem. And then, as they’re here longer and get more comfortable, there’s other things that come up, and joint issues are a big problem. The majority of what I treat are spinal issues, as mentioned, and most of those spinal issues occur on the lumbar spine is just how we’re made, how we age. With time, the lumbar spine seems to give us more trouble, and there’s different approaches to doing different types of Lumbar injections. 

Dr. Robert Wilson 3:52
In the old days, people would just sit on the side of the bed and have an epidural steroid injection performed, using a “call a blind” technique. And really, what that means, is without the use of fluoroscopy, but now of course we do them all under fluoroscopic guidance. I can get it in and watch the dye spread and the medication spread in the epidural space. A lot of times, for sciatic issues, and this can be different nerve roots and lumbar spine, what we do what’s called a lumbar transforaminal epidural steroid injections or selective nerve root blocks. Those respond really well, sciatic does respond really well with this type of injection because you basically watch the dye go across the nerve that is inflamed. And, again, leaving the needle there and injecting a steroid and local anesthetic solution will calm down the inflammation. When you calm down the inflammation, the nerve track stops sending pain signals. 

Dr. Robert Wilson 4:51
Other things we do in the lumbar spine are very popular, especially with the VA population. We see a lot of what’s called the facet joints or facet joints of the lumbar spine get arthritic. There’s a small nerve fiber that lies in that joint called the medial branch nerve, and we will do injections of that nerve, a couple of rounds of those to see we’re targeting the pain problem that they have. If that works, then we will move on to do what’s called a lumbar radiofrequency ablation or a facet neurotomy, different names for it. What that really is, is just cauterizing the nerve that is laying in that joint, that medical branch nerve. It is a sensory only nerve so that you can inject and cauterize that nerve, and it won’t cause any limitations in your ability to talk. So, that’s a nerve that can be cauterized, and patients generally get anywhere from six to twelve months of benefit out of having that done. 

Dr. Robert Wilson 5:51
That’s a procedure you can repeat as long as you need to. I’ve found that very beneficial to those who have what’s called facet joint arthropathy or preset arthritis. We also do a variety of peripheral nerve blocks again; being anesthesiology trained, I’ve done a lot of regional anesthesia for different surgical procedures. And basically, any peripheral nerve, we can inject and inject steroid on to calm down the inflammation of it. If it is a nerve that has a sensory only function, we can again also cauterize that nerve as well to make it last longer. One of the procedures that is a good example of what we do is what’s called the genicular nerves that innervate the knee capsule. People who have bad knee joints and we’re able to block the nerve to make sure that would benefit them. We move onto the cauterizer of the nerve, so we have been doing quite a bit of that for knee pain control, and this can be done for the patient who’s had previous knee surgery or not. They may be a patient who needs to have knee surgery done, but other health issues keep them from it. 

Dr. Robert Wilson 7:03
So the peripheral nerve radiofrequency in different areas, we can do, and they have been very beneficial and simply a longer-lasting benefit. With all of these other types of injections, I should also say this, to a lot of the things that we do for the lumbar spine, we can do for the thoracic spine and the cervical spine really without exception. All of these different procedures, the facet joints, the ablation, the nerve root blocks, the midline epidural injections of steroid, all of these can be performed up and down the spine. If all these things fail, we do go on. We have other things to offer, such as spinal cord stimulation therapy, which means placing leads in part of the spine where the nerves are causing the pain signals to be sensed, and this insertion of the leads are then attached to a generator. The generator will emit a small electrical signal that will blunt the ability for that nerve signal that will blunt the ability for that nerve signal to be able to reach the brain. Where you don’t interpret the pain, a lot of this is done for lumbar, low back pain, and leg pain. In fact, just yesterday, I was in the operating room and planting two different patients with this device. We’ve been trialing already so that go through a 7-day trial, the spinal cord stimulation and if they have a more than fifty percent benefit with that device, we make plans to go to the operating room and put it in permanently with an implanted generator, which has a battery life of about nine years. That’s been very beneficial and I’ll say again, in the VA population, we have found it to be very beneficial because these patients have had a lot of back issues for years and years. These are veterans from the Korean War, a few from World War II, a lot from the Vietnam War. But, their backs in excess of what you normally see in a normal population. I found this to be very beneficial, and these are patients who simply can’t have surgery or have had multiple back surgeries, there’s no other options for them, and it’s been very beneficial 

Dr. Robert Wilson 9:08
One other thing I talked about, also that I’ve been doing in the recent two months or so, has been the Superion Device. It is basically an indirect lumbar decompression device that I implant in outpatient surgery for patients who have spinal stenosis, causing neurogenic claudication. Neurogenic claudication is leg pain that occurs if you’re up ambulating and you walk a distance of any type from a few feet to a few hundred yards, but you have to top and sit down because your legs hurt and you stop and rest, and lean over, your pain gets better because all of the tightenings in the spinal column. This small device will decompress the levels that are bad and will give an opening to the spinal canal and allow patients to talk more freely. And, we’ve been very, very impressed in a short amount of time and what this device has been able to do. So, there’s always something new. I try to stay on top on top of anything new that is out there from an interventional standpoint, medication standpoint, but we basically offer all options for interventional pain medication that anyone could offer. 

MedSoup 10:20
So, you mentioned the different types of surgical techniques, but the majority of what you’re doing is done in the office. Is that correct?

Dr. Robert Wilson 10:29
That is correct. There’s really no other reason for us to go to the operation room except for the implantation of the spinal cord stimulation device. The trials, we generally always do them here in the office. There are some insurance companies that won’t for it to be done here, and they make us basically go to their surgery centers to have that done. We accommodate, we do that and then, of course, the Superion devices, well, really with just those two procedures, the only thing that I’d go to the operation room is for, all the others are done in my clinic here. I have three rooms with fluoroscopy, which gives me the ability to see what I need to do through a mobile X-Ray device. It gives me a picture when I need it to see where the needle needs to go and inject the dye, and to watch it go to the area we want to go to. So, we’re very well equipped. 

Dr. Robert Wilson 11:27
We are so busy here; we’ve set up two and now three rooms to accommodate all the different types of interventional therapies that we do here. All of the joint injections, we do under fluoroscopy to assure that the medicine goes in the joint, which I think gives you better outcomes as well. 

MedSoup 11:44
So, what can a patient expect when seeking care at your practice? I know they have to set up an initial consultation. 

Dr. Robert Wilson 11:53
Exactly, Laura, when patients come here, they can expect a comprehensive workup. Now, some patients come here with any laboratory, without any X-Ray Radiology studies, and we’ll start from scratch do all that we need to do. The physical exam is more important, especially with the beginning visit here to our clinic, and that we have to target where the problem is coming from. Again, sometimes, we have a lot of data and it’s already predetermined. Basically, what we need to do sometimes in find some more difficult pain problems. You have to do some testing and different procedures to figure out what we need to do to help them. So, one thing we don’t do is just to be a clinic that will just do any type of procedure at any time. We look for the reason why you have pain, we focus on that, and trying to get you better from the standpoint of what’s causing your pain. So, we have an action plan that we set up based on medication needs, based on interventional therapies, minimally invasive surgery, etc. And that’s what we put in place. Sometimes, patients are sent here because of my ability to do a lot of these different procedures that maybe some other procedures that clinics don’t do. They are sent here for me to do just higher advanced therapies, but most of the patients come here with an idea of having pain, and we have to figure out why and we’re very, very thorough in doing so. 

MedSoup 13:28
And also, on the note, you have a lot of patients here that currently served or have served in the military. You have a very good relationship with the VA hospital as well. 

Dr. Robert Wilson 13:40
We do, we’ve had a very good relationship with the VA hospital as well for eight or nine years now, where we sought after them really because of the need that I saw for these veterans. Understand also that it wasn’t that many years ago when the VA was writing a lot of opioid medications, and the first couple of years, we got patients from there, it was a difficult task because we had to do the procedures. We had to convince the patients that they need to be on these medications and those who are willing to try without exception, we’re able to get them off of them, the medication. Again, but since we started with the VA, we have had a good relationship with them. 

Dr. Robert Wilson 14:27
I can’t tell you how many of these vets that we treat now in our practice on a monthly basis, but everybody that we have here through the VA is very appreciative of what we do. I just couldn’t be happier with the relationship I have with them because the benefit we see in patients and the joy we bring in those patients being able to function better. I’ve had VA patients who came here in wheelchairs, and in a particular four or five of them, we’ve implanted spinal cord stimulators, and they’re now ambulatory, using a cane to get around, so it’s very rewarding in someone who does what I do for a living to see that. 

MedSoup 15:05
Well, I think other people can see that by visiting your website as well that they’re quite a few testimonials on there from your patients as well as veterans who have been helped tremendously by some of these interventional techniques. And in addition to that, if somebody wanted to understand more about an interventional technique, you have a wide variety of educational resources on your website where they can just watch and see what happens during that procedure and what to expect. 

Dr. Robert Wilson 15:39
Exactly, Laura. It’s interesting that you say that because we have so many patients that I might be meeting for the first time who will come here and say, “you’re just like your videos or like your pictures.” They’ll go to the website and research that, and that’s what people do now more than ever. And it’s not just young people; it’s every age of patient that can come in. It’s amazing to me how much they will utilize we’re very proud of our website and what we do on that for both education videos, and graphic animates that we have. Because, anytime that you can educate a patient about what you’re doing, what they’re getting ready to go through, they’re going to be more at ease. They’re going to feel more comfortable about being here. So, I’ve always been big about patient education and couldn’t be happier with the way our website and all of our educational videos and animates are being utilized. 

MedSoup 16:30
Yeah, I do think that adds to the comfort level if someone can come in and understand or if you discuss a particular type of procedure, and then they can go home, and kind of process that, and watch an animation, and learn more about what’s going to happen. 

Dr. Robert Wilson 16:51
And a lot of times we do just that, we have printouts from those same videos that will be handed to the patient and say, “here’s a two-page paper that talks about it.” But, if you have a computer at home with both audio and video, you can watch it and have a better understanding of what we’re going to do when you come back and have the procedure. 

MedSoup 17:07
So, are most of your services covered by insurance?

Dr. Robert Wilson 17:11
About all of them are. There are a few that we know about ahead of time that aren’t covered, and it’s so difficult. I say this probably every day that taking care of my chronic pain patients is the easiest thing I do; dealing with insurance companies is the hardest thing I do, but we do make sure that the procedures we are authorized by the insurance companies of the patients, so the patients aren’t surprised and have a bill sent to them to cover it. But, essentially, there’s only one or two different insurance companies, one or two different procedures that they don’t cover. 

MedSoup 17:49
If there was some way to define kind of what sets your practice apart from maybe other interventional pain practices, how would you describe the difference?

Dr. Robert Wilson 18:01
What I would say about pain clinics, I think anybody can hang a shingle and say they’re a pain clinic. The reality is, I have a bias because of my education, my certification, and in what I do. There’s a lot of different practices out there are what I call block shops. And, what I mean by that is they’ll have you come in, they’ll do two or three epidurals on you, and then when you’re not any better, they’ll basically say I can’t do any more for you and then you to someone qualified like I am to take care of your problem. I take pride in the fact of us treating patients from A to Z doing whatever needs to be done, and I’ll say this too, I can’t cure everybody. I can’t take care of every pain problem. Sometimes surgical referrals need, sometimes simply, physical therapy needs to be etcetera. But, if we don’t do it here in house, we refer out to the appropriate type of providers that need to take care of your problem, and that’s going to assist you with your pain-needs. And again, being an independent medical practice, I’m not told by a governing body that I need to keep it within the same network. I send patients out to simply the best, qualified people that I work with to take care of the problem that needs to be taken care of. 

MedSoup 19:23
I think it’s important to note your board certifications and your experience. So, maybe if you could just…

Dr. Robert Wilson 19:30
Sure, yeah, my background after medical school, I did my internship and then my residency in anesthesiology Wake Forest Baptist hospital, and after that, I stayed an additional fifth year and did a pain fellowship. So, a total of five years after high school to do what I do today. I did both anesthesiology and pain management for a period of about six years, but for the last 13 years I’ve done nothing but focus on chronic pain patients. I’ve always been so busy in the clinic, it got to the point where I just could not do both, and my true love is to take care of these chronic pain patients over and above doing anesthesiology. So, really, kind of decided which to do, but again, I’ve been certified in both specialties. I’ve been recertified in those specialties as well and stay current with all the latest literature.

MedSoup 20:30
And then even though you’re located in Salisbury, which is Rowan County, you serve a really wide area, correct?

Dr. Robert Wilson 20:37
I do, we have patients that come from South Carolina, Virginia, West Virginia, again, because of some of the things I do, these are patients, family members of patients. Since I take care of our friends that hear about us, we do get patients that drive from different parts of the state and different states around. So again, I want to say that’ probably due to the fact that we take good care of patients. When doctors send their patients here to be taken care of, they know we’re going to monitor them closely, we know they’re not going to get too much opioid pain medications and will do whatever we can to get them better. But, we will provide good care and whatever we feel like the best we can and doing a combination of whatever needs to be done for the patient.  

Medsoup 21:21
If someone wants to schedule a consultation, what do they need to do?

Dr. Robert Wilson 21:32
Simply call our office, we are able to see patients without a referral. To call or fax would be the best way to do it. We don’t have to have a physician referral to get in here. Sometimes, we’re finding patients who have been sent to “pain clinics” that are within a network that these physicians try and keep them in, and it’s not necessary here. You don’t have to have a referral to get in here, just simply give us a call. 

Medsoup 22:06
Alright, thank you.