Another suggestion is to not rush into joint replacement surgery just because X-ray shows “bone on bone arthritis.” Surgery can be very effective; however, often, patients with these findings respond to other, safer approaches too.
So many people suffer from chronic pain. Often people believe that they have tried everything, and that there is no real hope for them to live pain-free. What are some things these individuals can do, to help reduce or even eliminate their pain? In this interview series, called “Becoming Pain-Free: How to Alleviate Chronic Pain” we are talking to medical professionals, pain management specialists and authors who can share their insights and strategies about how to alleviate chronic pain. As a part of this series we had the pleasure of interviewing Dr. Grigory Karmy.
Dr. Grigory Karmy, is the renowned Medical Director of Karmy Clinic and an Adjunct Professor at McMaster University, Department of Family Medicine. As Medical Director of one of the oldest clinics in Ontario, he is a leading authority on pain management and regenerative medicine who has been at the forefront of chronic pain management for over two decades. Dr. Karmy, with his exceptional qualifications and expertise, has been instrumental in spearheading innovative approaches to alleviate pain and enhance patients’ quality of life.
Thank you so much for joining us in this interview series! Before we dive in, our readers would love to “get to know you” better. Can you share your “backstory” with us?
I started my practice as a family physician and, on a lark, answered an ad in the newspaper advertising a position in a pain clinic. At that time, pain as a field of medical practice was barely known in Canada, so it was initially not part of my career plan. But I did find the field interesting, so I accepted the position and have been practicing in pain medicine ever since. When I first started, there were around 20 pain physicians in Ontario, and I knew all of them. In the past 21 years, I have been able to see the field grow and evolve. Now, there is a formal pain fellowship in most Canadian universities, and the number of doctors in the field is close to 300. There are also many more treatment options for chronic pain patients, including regenerative medicine approaches such as platelet-rich plasma (PRP) injections and stem cell injections.
Our clinic is the only clinic in Ontario that has permission from Health Canada to offer stem cell injections for patients with osteoarthritis of knees and hips.
Can you share the most interesting story that happened to you since you started your career? What were the main lessons or takeaways from that story?
One interesting observation is that I have seen some families where multiple generations develop chronic widespread pain. Although chronic pain is not supposed to have a strong genetic predisposition, I can think of several examples of having one parent in the clinic with chronic pain and years later seeing their children experiencing the same condition. Interestingly, children develop chronic pain at unusually young ages (sometimes as young as 16) and without a specific trigger (typically, chronic pain is precipitated by physical trauma, severe stress or infection). Often their pain becomes worse in university as they become more sedentary due to greater academic demands.
The takeaway for me was the importance of exercise for patients with a family history of chronic pain and fibromyalgia. Additionally, these patients should avoid contact sports as physical trauma is the most common trigger for the development of chronic pain.
It has been said that our mistakes can be our greatest teachers. Can you share a story about a mistake you made when you were first starting? Can you tell us what lesson you learned from that?
In my first three years of practice, I had a patient who was responding very well to a form of injections called nerve blocks. Then, after several years of responding favourably to my treatments, the patient stopped responding. Coincidentally, she developed abdominal pain, which her family doctor investigated and found pancreatic cancer. In retrospect, it is likely that the reason for the change in response to my treatments was that the patient developed a new source of pain. So, the lesson I learned is to reinvestigate patients who stopped responding to their usual treatments and not to forget that internal organ problems can radiate to the back and cause pain.
When it comes to health and wellness, how is the work you are doing helping to make a bigger impact in the world?
I am the executive of the Ontario Medical Association, Section of Chronic Pain, and in that capacity, I can advocate for the chronic pain field to the regulator as well as the Ontario Government.
Let’s jump to the main focus of this series. For the benefit of our readers, can you please tell us why you are an authority on the subject of chronic pain?
I have been in the field for over 20 years. Currently, I am an adjunct professor at McMaster University, where I have taught numerous family medicine residents about chronic pain. Additionally, I was an inspector for the College of Physicians and Surgeons of Ontario, where I inspected numerous clinics performing interventional pain procedures and evaluated physicians who were seeking to enter the field. Furthermore, since I am the executive of the Ontario Medical Association, Section of Chronic Pain, I advocate on behalf of pain physicians and their patients to various regulatory authorities and the provincial government. More recently, Karmy Clinic achieved a significant milestone, becoming the first clinic in Ontario and the second in Canada to be permitted by Health Canada to offer stem cell injections for Osteoarthritis.
Can you please share with us a few of the most common causes of chronic pain?
Arthritis, whiplash, fibromyalgia, back pain and sciatica (radiculopathy).
There are many different types of pain that people struggle with. Which specific form of pain would you like to focus on in this interview? Why that one?
Osteoarthritis — because it disproportionately affects the elderly, who are the most vulnerable members of our society.
Here is the main question of our interview. Can you share your top five “lifestyle tweaks” that you believe will help support people’s journey toward becoming pain-free?
1. The first lifestyle tweak is weight loss. Weight loss slows down cartilage deterioration in knees and hips. We had a patient who was scheduled for stem cell injections for knee osteoarthritis who cancelled her appointment after she lost weight on Ozempic (a new medication for diabetes and weight loss).
2. Many patients with fibromyalgia and other forms of chronic widespread pain become very socially isolated because fluctuations in pain severity do not allow them to plan social events. Invariably, multiple events cancelled at the last minute cause them to lose friends. If you are in that situation, consider joining a religious organization or a chronic pain support group. Emotional well-being has a significant impact on the ability to tolerate pain.
3. Once a patient develops a painful condition for more than three months, avoidance of activities that cause pain is no longer important, as generally speaking, all the healing has already taken place and resting more will not help tissues heal any faster. While returning to the activities at the same level of intensity as before the pain started may not be realistic, as the pain would become too severe; gradually increasing activity is crucial to avoid muscle atrophy and development of stiffness. Typically, I advise people to listen to their own bodies when it comes to specific activity recommendations. If activity hurts, that is not necessarily a signal to stop it. However, if the pain worsens after activity and consistently stays up for the following three to five days, then perhaps the activity is too intense for the patient to continue. So, in summary, pain during physical activity in the first few weeks after an injury is a sign to stop the activity, as tissues have not healed fully yet. Nonetheless, after the first three months, avoiding all activities which cause pain is actually counterproductive.
4. Another suggestion is to not rush into joint replacement surgery just because X-ray shows “bone on bone arthritis.” Surgery can be very effective; however, often, patients with these findings respond to other, safer approaches too.
Also, in the event that joint replacement does not help joint pain (knee replacements, for example, have a 30 per cent failure rate), some of these safer injection-based approaches are no longer treatment options due to the risk of infection of joint prosthesis.
5. Once you develop arthritis, understand that every treatment will only help a portion of patients. So, try exploring multiple approaches, and do not hesitate to stop the ones that are not helpful after two to three months. Be patient.
If you could start a movement that would bring the most amount of wellness to the most amount of people, what would that be?
I would create some way of allowing patients with chronic pain to continue working but at their own pace. I feel work has many benefits beyond just financial gain, as it gives patients a sense of purpose, helps with their self-esteem and provides an outlet for socializing outside of their home. Too many employers tell their employees, “Do not come back until your pain is cured,” and while this approach works well for other medical conditions, many patients with chronic pain may never be cured.
What is the best way for our readers to further follow your work online?
My website has a Frequently Asked Questions (FAQ) section, which can be informative. https://karmyclinic.com/
Thank you for these fantastic insights! We wish you continued success and good health.
About the Interviewer: Maria Angelova, MBA, is a disruptor, author, motivational speaker, body-mind expert, Pilates teacher, and founder and CEO of Rebellious Intl. As a disruptor, Maria is on a mission to change the face of the wellness industry by shifting the self-care mindset for consumers and providers alike. As a mind-body coach, Maria’s superpower is alignment which helps clients create a strong body and a calm mind so they can live a life of freedom, happiness and fulfillment. Prior to founding Rebellious Intl, Maria was a finance director and a professional with more than 17 years of progressive corporate experience in the telecommunications, finance, and insurance industries. Born in Bulgaria, Maria moved to the United States in 1992. She graduated summa cum laude from both Georgia State University (MBA, Finance) and the University of Georgia (BBA, Finance). Maria’s favorite job is being a mom. Maria enjoys learning, coaching, creating authentic connections, working out, Latin dancing, traveling, and spending time with her tribe. To contact Maria, email her at firstname.lastname@example.org. To schedule a free consultation, click here.