Protocol for Pain

Non-narcotic treatment eliminates long-lasting, post-cancer pain.

Sherry Penoff is no stranger to pain. The software developer has suffered with fibromyalgia and chronic back pain, has already had one aching hip replaced and recently discovered that instigating osteoarthritis is now destroying the cartilage in the other.

 Dr. Arpit Patel of Florida Pain Medicine in Brandon, Wesley Chapel and Zephyrhills treated Sherry Penoff for post-cancer pain.

Dr. Patel’s therapy allowed Sherry to remain active through cancer treatment.

She thought she’d battled the worst pain of her life, but then came devastating news and the realization she hadn’t.

“It was May 2015,” states the Indiana native. “I was diagnosed with breast cancer. To treat it, I went through a mastectomy, chemotherapy and radiation.

“Having your breast removed is extremely painful. I also went through reconstruction surgery, which is also very painful. But when I started my chemotherapy, that brought on a whole new level of pain.

“Sometimes, it was a burning pain, and sometimes, it was just a general aching. When my nerves started regenerating, it felt like more of a stabbing pain. There were times when I hurt all over, and I would have to close my eyes and try to relax and calm myself. On a scale of one to ten, my pain was usually a seven or an eight.”

The excruciating pain Sherry experienced affected her everyday life in many ways. There were some activities she was unable to perform, but there was one key activity she maintained that gave her hope during this difficult time in her life.

“I was able to continue working,” Sherry relates. “I had to stop cleaning the house, and I had to stop gardening, and being a very caring person, not being able to do things for others was very difficult for me.

“I got in trouble with my family quite a few times for doing things I wasn’t supposed to be doing, but I was able to keep working, and that was the most important thing for me and my family – that I was able to be a productive person.”

Sherry was able to work because she had a guardian angel who helped her deal with her post-cancer pain. After her mastectomy and before beginning her chemotherapy, Sherry’s cancer physician referred her to Arpit Patel, DO, a double board-certified pain management specialist at Florida Pain Medicine.

Two-Pain Plan

“The first thing Dr. Patel did was develop a plan,” reveals Sherry. “His plan was to manage my post-surgery pain and wean me off of the morphine I was taking for it. His goal was not only to control the pain, but also to reduce the use of that drug.”

Many people who suffer with cancer pain don’t just deal with it during their battle with the cancer and its treatment. In many cases, the pain lasts for weeks, months and even years afterward. According to Dr. Patel, much of it is a combination of neuropathic and nociceptive pain.

“Neuropathic pain originates from a nerve,” he explains. “It may be from a disc pushing on a nerve that goes from the back down the leg, or from any type of insult to the central or peripheral nervous system. Many times, neuropathic pain presents as an electric, burning sensation, as opposed to nociceptive pain, which is more musculoskeletal.

“Nociceptive pain generally starts right away after an injury or surgery. Neuropathic pain starts later, often several months after the patient has been diagnosed. However, we target it early in the treatment plan to keep it from getting worse down the road.”

Dr. Patel notes that cancer pain can be difficult to treat because many of the chemotherapy medications and most types of radiation have long-lasting side effects. Radiation can cause a tightening of the joints and tendons in the treated area, called fibrosis, and many chemotherapy medications lead to drug-induced neuropathy.

“The challenge of cancer pain is that it’s a puzzle,” offers the doctor. “Each patient is unique and reacts differently to cancer treatment. We cater our protocols and treatment plans according to each patient’s reaction and symptoms.”

For Sherry, Dr. Patel created a treatment plan that addressed not only her cancer pain but also her other pain problems. He also sought to return her to her activities of daily living without resorting to high doses of opioid medications.

“I treated Sherry with a combination of tricyclic antidepressants along with a muscle relaxant,” discloses Dr. Patel. “Many people think these antidepressants are used just for psychiatric reasons, but at very low doses, they are quite effective for neuropathic pain. I used those for her neuropathic pain and added the muscle relaxant for her nociceptive pain.

“We aim to get our patients pain free, but our true goal is to restore function, so our patients can live life again. If Sherry’s able to move, she’ll be able to do the activities she was doing before her cancer and post-cancer pain. That’s what we care about most.”

“One of the things I really liked about Dr. Patel is that rather than prescribe large doses of opioids, which cause my joints to ache anyway, he gave me a muscle relaxant,” says Sherry. “That helped with the pain and helped me relax. He came up with this alternative because I didn’t want to take big doses of opioids.”

Working Through It

A breast cancer diagnosis took Sherry by surprise in May 2015, and so did its persistent complications. Fortunately, Sherry’s cancer doctor thought ahead and got Dr. Patel involved early on. The pain management specialist was able to create a plan to help Sherry manage the pain of her disease and its aftermath. The plan was effective, and Sherry responded positively.

“I feel great now,” she enthuses. “Of course, I have follow-up appointments with both my cancer doctor and Dr. Patel, but I’m doing great. My pain level from my breast cancer right now is a zero.”

Although she’s found relief from her post-cancer pain, Sherry still suffers from her other chronic ailments, the fibromyalgia and hip and back pain. Because she still has pain with these issues, she’s slowly getting back to activity, but isn’t yet back to full function.

“I’m not doing housework yet, but I have done some gardening,” relates Sherry. “My family still has to help me with most things because I still have the back and hip pain to deal with. Dr. Patel is giving me injections for that.”

Sherry says she’s already recommended Dr. Patel to some of her friends in pain. She adds that she appreciates the pain management specialist’s calming influence during this stressful period in her life. She is grateful he was an integral part of her cancer treatment.

“Dr. Patel is very smart and sensitive,” she describes. “His bedside manner is so caring, and he listens to his patients. He’s sympathetic with them, and he helps them any way he can. He really helped me.

“I went through a mastectomy, chemotherapy and radiation, and because he helped me manage my pain, I was able to continue working through it all. I only took a few weeks off before the mastectomy. If it hadn’t been for Dr. Patel and Florida Pain Medicine, I would have been on short-term disability.”

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    • Florida Pain Medicine

      At Florida Pain Medicine, your interventional pain and diagnoses experts, their mission is to help you “RESTORE FUNCTION & RELIVE LIFE.” Florida Pain Medicine offers complete, compassionate, and comprehensive pain care. They provide the la... Read More

    • Maulik Bhalani, MD

      Maulik Bhalani, MD, is the founder and CEO of Florida Pain Medicine. He earned a Bachelor’s degree at Creighton University in Omaha, NE, and medical degree at Creighton University School of Medicine. Dr. Bhalani completed a residency in anesthe... Read More