At The Forefront

Louisiana Pain Specialists’ newest physician and Director of Neuromodulation, Dr. Nomen Azeem offers advanced techniques for the diagnosis and treatment of pain
– By Lucey Wright, M.S.

On the cutting edge of pain management, Louisiana Pain Specialists’ newest physician and Director of Neuromodulation, Dr. Nomen Azeem offers advanced training and a holistic perspective.

The Doctor

With his friendly nature and warm bedside manner, one would think that Dr. Azeem is from the South, so it is surprising that he recently resettled in the New Orleans area.

During his medical training, Dr. Azeem had the opportunity to escape the cold, icy winters of the Northeast for various conferences in the South. “The Southern hospitality and warm weather were infectious and convinced me years ago that I would return to settle. I moved into the New Orleans area in January 2014 and could not be happier.” He brought his advanced training and unique perspective to Louisiana Pain Specialists.

Dr. Azeem was born and raised in Washington, D.C. to immigrant parents who wanted to give their children more opportunity and access to a better education system. He seized this opportunity, excelling in academics. However, at the time, he was most enthusiastic about sports. He began playing football at eight years old, participating throughout high school, and then moving to rugby in college.

I would say the trial period was successful and relieved 90% of my pain. I am looking forward to the permanent solution

– Michael Power

Fame and glory as a world renown rugby star were not in the cards for Dr. Azeem though, as he had been developing another passion along the way. As a boy, he took an interest in and had an admiration for doctors. In college, he saw medicine as a career in which he could help others, and through his medical training, he came to a unique viewpoint of how he wanted to accomplish this.

“I admire all of the life saving specialties including emergency medicine, trauma surgery, neurosurgery, etc. But far too often these patients are in limbo after having been stabilized and in some cases discharged home. Once a person has endured a traumatic health event they may suffer from functional deficits, pain issues, and psychosocial issues. The focus of medicine has been adding years to your life. My focus has become adding the life back to your years!”

The Journey to Pain Medicine

Based on this philosophy, Dr. Azeem chose a residency in the field of Physical Medicine and Rehabilitation (PM&R), which focuses on restoring and optimizing function following a traumatic health event or on patients with systemic conditions that cause functional impairment. His residency program at Georgetown University Hospital PM&R had a strong focus on musculoskeletal medicine and he was trained to treat acute pain especially associated with
musculoskeletal injuries.

After his residency, he felt that he could do more for his patients if he had a better grasp of how to treat chronic pain. He decided to enhance his training by entering the Temple University Hospital Interventional Pain Fellowship under the guidance of Dr. Frank J.E. Falco, a pioneer in the field of Pain Medicine.

I owe my bedside manner to my parents who raised me on the foundation of respect, compassion, and honesty. I owe my expertise to the top notch physicians that trained me over the years. I owe my drive for incorporating cutting edge technology into my practice to the desire for the best long-term outcome for each patient. I am blessed to have found a home in NOLA where every morning I awake with the knowledge that I am able to do what I love….help people in pain.

– Dr. Azeem

This path brought him to a rewarding career in an area of medicine that he loves. “I believe that pain medicine is one of the most rewarding fields in medicine. The debilitating effects of chronic pain physically, mentally, and psychosocially are many times overlooked or discounted. Most of the patients that I encounter have seen brilliant physicians in other fields and have been referred to me for further management. I believe that this is the responsible and appropriate course to treat such patients. Once a patient passes the acute pain phase into the chronic phase, their care should be taken over by a Pain Physician with advanced training in both clinical and surgical techniques to comprehensively treat the chronic pain.”

“My philosophy on treating chronic pain is centered on treating each patient holistically. At times patients respond well to physical therapy and interventional techniques (i.e. epidural injections). Additionally, some patients have the best pain relief with advanced procedures (i.e. spinal cord stimulator). There are also occasions where medication management is the only option. Often, the interaction of these various treatments is the most successful in treating chronic pain in a motivated patient.”

The Technologies

Dr. Azeem’s belief that developing a multifaceted approach is the most effective method of treating various components of chronic pain has lead him to become an expert of advanced techniques in the field of Pain Medicine, including diagnostic and interventional ultrasound and spinal cord stimulation trials.

Diagnostic and Interventional Ultrasound

Musculoskeletal ultrasound uses high-frequency sound waves to create images of the inside of the body, specifically soft tissues and bony structures. The images are produced by placing an ultrasound transducer against the body. There is no radiation and therefore, the exam does not pose any radiation risk. The exam is also is painless and non-invasive. The images can be used for purposes of diagnosing disease or injury, and for guiding interventional procedures.

Dr. Azeem explains, “I am very fortunate to have been trained in musculoskeletal ultrasound during my residency. It is innovative diagnostic imaging that is safe, convenient, and dynamic in nature. More importantly, ultrasound guidance is an accurate method for the delivery of therapeutic injections in the musculoskeletal system. We can actually visualize the needle in real time which allows for precise and reliable placement of the needle tip in the tendon sheath, bursa, or joint of interest.”

Many studies have demonstrated the effectiveness of utilizing ultrasound for pain diagnosis and intervention. The American Orthopaedic Foot and Ankle Society found that through displaying soft-tissue structures, ultrasound is highly accurate method of localizing injections into a variety of locations in the foot and ankle. The Society of Radiologists in Ultrasound, the American College of Rheumatology, and the Journal of Rheumatology all reported that ultrasound guidance improves accuracy of the delivery of therapeutic injections throughout the musculoskeletal system.

Spinal Cord Stimulation (Neurostimulation/ Neuromodulation)

Spinal Cord Stimulation (SCS) is a method that physicians use to manage chronic pain and improve quality of life of patients who suffer from back, neck, arm, or leg pain. It works by blocking pain signals before they reach the brain, with a small system (similar to a pacemaker) implanted within the body. The system replaces pain with a feeling of gentle massaging or, in some cases, simply the absence of pain.

They put the trial in me, and the next day I felt like superwoman! When they asked me how my pain was, I said it was a zero on a scale of zero to ten. It’s the best thing that has happened to me in years and the best I’ve felt in years! I have my appointment to get the permanent one in next week, and I am really looking forward to it.

– Kathy Barnes

A number of studies have found that Spinal Cord Stimulators can provide a reduction in pain, allow for the reduced use of pain medication, improve function and mobility, and make it possible for some people who have left work due to the pain to return to work.

Dr. Azeem provides insight; “The technological advances being made in the field of neuromodulation
are astounding and have revolutionized how we think about treating neuropathic pain. All pain physicians worry of the long term systemic effects of pain medications. We now have an option that, in the appropriate patient, can help decrease the amount of pain medication necessary to control pain symptoms and even allow certain patients to discontinue pain medications all together. Although a select group of patients are candidates for neuromodulation therapy, each of those patients are able to try the spinal cord stimulator device during a one week trial period. This allows both the patient and the physician to be extremely confident in the long term pain relief that the device will provide.”

The Patients

Since 2010, local attorney Michael Power has undergone back surgery, epidurals, and physical therapy to try to get relief from the pain associated with his degenerative disk disease and scar tissue build up from a previous back surgery. Nothing helped, and the surgery even increased his pain. He was extremely uncomfortable from the afternoon through the night and had difficulty sleeping due to the pain.

Finally, a neighbor suggested Louisiana Pain Specialists. Mr. Power met Dr. Azeem, who suggested an SCS trial. “Dr. Azeem is fantastic. He is a very patient man. I had a thousand questions. I even brought my daughter, who is a nurse, to one of my appointments, and she also had many questions. He answered all of our questions and helped alleviate my anxiety.”

After all of his questions had been answered, Mr. Power decided to schedule the trial procedure. “It worked wonderfully. I would say the trial period was successful and relieved 90% of my pain. I am looking forward to the permanent solution.”

Kathy Barnes, a restaurant employee trainer and store manager has been through fifteen shoulder surgeries for a devastating injury that occurred when she was attacked at work. The injury and surgeries lead to excruciating pain for Ms. Barnes and kept her from going back to work.

“I was not sleeping at night. Some days I couldn’t even move. It was horrible.” Her doctors recommended physical therapy and shoulder injections, which did not work for her. Her orthopedic surgeon, Dr. Junius, then recommended that Ms. Barnes try Louisiana Pain Specialists. She was identified as a candidate for an SCS trial. “I was skeptical because I had never heard of it and I didn’t know anyone who had done it. But then I met someone who had gotten a lot of relief from SCS and decided to schedule it.”

The results were dramatic. “They put the trial in me, and the next day I felt like superwoman! When they asked me how my pain was, I said it was a zero on a scale of zero to ten. It’s the best thing that has happened to me in years and the best I’ve felt in years! I have my appointment to get the permanent one in next week, and I am really looking forward to it.”

These patient’s experiences are what drives Dr. Azeem to utilize the most advanced proven technologies available. He says,”I owe my bedside manner to my parents who raised me on the foundation of respect, compassion, and honesty. I owe my expertise to the top notch physicians that trained me over the years. I owe my drive for incorporating cutting edge technology into my practice to the desire for the best long-term outcome for each patient. I am blessed to have found a home in NOLA where every morning I awake with the knowledge that I am able to do what I love…help people in pain.”