Pain Management Specialist Knows the Value of Communication

Ali El-Mohandes, MD, likes challenges. The pain management specialist with Maryland-based National Spine and Pain Centers says that once he becomes really proficient at something and his abilities are no longer being taxed, he needs to move on to something he’s never done before.

His wife calls it the 5- to 10-year itch.

For example, El-Mohandes has a fear of heights. So what did he do?

“When you hate snakes, grab a snake,” he explains. “You don’t like heights? Learn to fly a plane.”

So he did—but it didn’t cure his fear of heights.

“I still hate heights,” he says. “Somebody will be sitting next to me at 20,000 feet and ask, ‘What’s that down there?’ Sorry, but I can’t look out the window.”

High Grades

El-Mohandes may not be able to look down from 20,000 feet, but achieving at high levels is not foreign to him. An army brat growing up who’s been through three passports, El-Mohandes attended school overseas where the education system is completely different.

“In the US you finish high school, you think you know what you want to do, or you know what you want to do, you have a drive, you go to college, and everything works out,” he explains. “That’s not the case in the rest of the world.”

In most of the rest of the world, examinations early on indicate whether an individual is inclined to achieve in the arts, or mathematics, or the sciences. Then, in the last couple of years of high school, depending on their grades, they tailor their studies specifically to attend a college focused on that specialty.

“Medical school starts right out of high school,” says El-Mohandes, who graduated from Assiut University Medical School in Egypt. “Five and a half years, rather than four years of college and then four years of medical school. It’s still the same 5-7 years of education, it’s just built differently.”

The Right Fit

After doing a year of surgery, El-Mohandes decided it wasn’t for him.

“Surgery is cut, stop the bleeding, tie a knot,” he says. “It takes you five years to learn to tie a knot so you don’t tie it too tight or too loose. That’s surgery, basically.”

Instead, El-Mohandes preferred to be on the move, going from room to room. Putting patients to sleep. Waking them up. Checking blood pressure.

“It was constant anxiety and work,” he recalls. “You needed to be on your toes consistently.”

Perhaps, but El-Mohandes also found that he wasn’t really talking to his patients—an aspect of medicine he enjoys. Then, during his residency and internship at General Hospital in Pittsburgh, he found his niche.

“I was doing shoulder blocks, neck blocks, where I kept the patient awake during anesthesia,” he says. “I would sit there talking during surgery, conversing, making jokes, and I enjoyed that. So I said this is pain management, and I enjoyed pain management, so I felt I should do that, which is the epitome of chronic care. Patients come in, they talk with you, you try to help them improve their capabilities, their sleep, or their depression … and I never looked back once I did that.”

Listening and Communicating

One lesson El-Mohandes learned early on was the importance of sitting down, talking with and listening to patients. It’s a skill, he says, that medicine is honing away from physicians.

Was listening to patients a skill he had to work at developing?

“I think my mother and my wife beat it into me,” he says, laughing, before turning serious. “Everybody has a slight talent to start with, but you have to learn how to play the piano. You have to hone it to perfect it. I’ve honed that skill over the years, and I work at it to make sure it stays at the top of its game.”

That’s where growing up as an army brat, moving from one location to another every six to eight months, has its benefits.

“You have to be open to conversation,” El-Mohandes says. “You walk into a room and you’re open. You’ve don’t have pre-existing judgments. It’s pain medicine, and pain medicine is fraught with opioid abusers and others. My job is not to judge. My job is not to dictate what you can and can't do. My job is to make you feel better, and function better.”

Avid Advocate

El-Mohandes has recently become a huge advocate for Stimwave, a device he says is a life-changing technological breakthrough for the approximately 400 million people worldwide who endure daily chronic pain.

“If I can get a device that provides some degree of pain control, and I don’t have to hurt the patient by using Schedule 2, which are the opioids and benzopine drugs for pain control and anxiety, then I’m way ahead of the game,” he explains.

The problem, El-Mohandes says, is that many pain management devices are big and bulky. The battery pocket is the size of a pack of cigarettes, and the wire has to go into the patient’s spine, which requires a surgical procedure. Stimwave developed a device the size of a fingernail that can be folded and inserted through a needle.

“That’s a no brainer,” El-Mohandes says. “They’ve taken the modality I want to do and made it less invasive. Made it very much more compact, easier to put in, and there’s no real adverse reaction. You’re cutting down the cost to hospitals and of hospital stays and complications. That’s huge. Anybody with just a little bit of intelligence should be all over that. It’s a huge step for medicine.”

Trust Factor

El-Mohandes says the most rewarding thing about the work he does is when he sees a new patient, un-referred by another physician, and the patient says a friend or family member referred them.

“That’s huge,” he acknowledges. “That means you have acquired the trust and thanks of somebody who is not related to you, and they’re trusting another family member to you. I’m just a normal guy like you. And if somebody goes out of his or her way to help me or bring me business, that just makes my day.”