ERIC GRIGSBY, MD, HAS ALWAYS BEEN A RENAISSANCE MAN. AS AN UNDERGRADUATE, THE TENNESSEE-BORN FARMER’S SON PLAYED BASKETBALL WHILE HE RECEIVED AN IVY LEAGUE EDUCATION AT BROWN UNIVERSITY. HE WAS SENIOR CLASS PRESIDENT AT BOSTON UNIVERSITY’S COLLEGE OF MEDICINE, AND AFTER TRAINING AT THE MAYO CLINIC, HE OPENED HIS OWN PAIN CLINIC, FOUNDED A CLINICAL TRIALS RESEARCH COMPANY AND NOW RUNS A HEALTH CARE NONPROFIT IN CENTRAL AFRICA.
When he and his wife, dentist Mary Rocca, decided to return to school, they became something of a novelty among their classmates: they are the only married couple to ever earn MBAs from Duke University at the same time. And now they run a winery in Napa that produces award-winning cabernet sauvignon. But what matters most to Dr. Grigsby’s patients is his national reputation for compassionate care for people living with pain.
Though initially Dr. Grigsby completed residency training in anesthesiology and general surgery, his focus changed in 1984, when he witnessed one of the ﬁrst pain pumps being implanted, by Burton Onofrio, MD, a neurosurgeon at the Mayo Clinic. Dr. Grigsby became fascinated with what he calls “pain as a neurological condition.”
“I was there when Dr. Onofrio implanted one of the ﬁrst pain pumps, and realized pain is not a failure of a previous surgery or a failing on the part of the patient,” he says. “Pain is a very real problem all on its own.”
He also observed that in his early work at Boston Children’s Hospital in the department of orthopaedic surgery. The children he worked with had severe spinal deformities, cerebral palsy and other orthopaedic conditions, and their suffering and persistent pain distressed him.
Dr. Grigsby’s time as a young doctor at Mayo continues to inﬂuence his practice today. “I got to work with some really smart guys,” he says of his time at the storied clinic. “Dr. Peter Wilson, an anesthesiologist and pain specialist long before there was board certiﬁcation for such a thing, was one of those guys. He helped me understand the possibility of pain medicine as a ﬁeld of practice.” So from that time, anesthesiology and pain medicine would become his specialty and his life’s work.
MEETING NEEDS IN PAIN MANAGEMENT
Mayo ignited his interest in treating pain, but California beckoned. Dr. Grigsby’s work at Mayo helped him see how large the unmet need for pain management was. “I realized there were thousands — and now we know it’s actually millions — of people struggling with pain who weren’t being properly diagnosed and treated,” he says. He then founded the Pain Management Services Center at the University of California-Davis Medical Center.
When Dr. Grigsby ﬁrst started in medicine, he says the general school of thought was that someone living with pain “maybe needed just one more surgery.” In the worst cases, society and sometimes even medical professionals suspected patients with pain were just lethargic. “There were people with pain so unbearable, they basically couldn’t leave the house,” he says. “And doctors were saying, ‘You’re not trying hard enough.’”
Dr. Grigsby has been letting his patients know their pain is not their failing since he established the Napa Pain Institute in 1992. Today, he and his staff of more than 20 consult with patients from throughout Northern California, and he trains and mentors other physicians nationally in the ﬁeld of pain management.
Dr. Grigsby says he and his staff have four basic strategies when it comes to helping patients living with pain improve their quality of life. The ﬁrst is the simplest and most profound.“We embrace the fact that patients living with pain need a medical home, and we try to provide that,” he says. He describes what they do as“quarterbacking” and notes that pain medicine is really a combination of “high-tech and basic, primary care.” He sees himself as more generalist than specialist.
Part of providing that home base for patients is seeing them often. “There are a lot of issues that can accompany pain — sleep disturbances, water retention, de-pression and obesity, just to name a few,” says Dr. Grigsby. “We don’t just treat pain. We treat the other conditions that can go along with it.”
KEEPING PATIENTS SAFE
The second function the Napa Pain Institute performs is helping to manage patients’ medications. “Some describe the inappropriate use of prescription pain medication as an epidemic,” Dr. Grigsby says. “We do our best to keep patients safe and stay vigilant in keeping medicines out of the schoolyard and other places they don’t belong.”
Engaging the patient’s family in the treatment strategy and using current technology — such as a central data bank of all activity at pharmacies in California—helps.
“We make sure we know what medicines are in the patient’s system,” he says.“We do that through uri-nalysis and saliva tests. It’s really what every doctor’s ofﬁce should be doing. Not enough do.”
Minimally invasive procedures are the third principle Dr. Grigsby uses, when appropriate. Finally, the fourth principle and what he believes his clinic may be best known for is neuromodulation. This practice of changing the pain signal before it reaches the brain, which ﬁrst amazed Dr. Grigsby at Mayo, is now a regular part of how he cares for patients. When appropriate, Dr. Grigsby will implant a device — in the same sort of way a pacemaker or insulin pump would be implanted — that allows patients to dose themselves with morphine when they need it.
This direct delivery, he says, allows the patient to continue with daily activities, including work and exercise, that morphine in pill form tends to inhibit. While the implantable pain pump is often used instead of spine surgery, “a pump is a much safer way to get morphine into the system,” says Dr. Grigsby. “It’s a tiny dose, and we’re able to get it right where the problem is.”
PAIN, CANCER & OPIOIDS
The newer, more targeted approach is, he believes, the right response to what became an epidemic of overtreatment after an “epidemic of undertreatment of cancer pain” about 25 years ago. “Doctors began giving much-needed and well-deserved attention to cancer pain,” he says. “But that led to overtreatment. Then the medical community began asking, ‘Don’t we all deserve to be pain free?’ So, we started taking non-cancer pain just as seriously.”
“We started to — and needed to — treat all pain aggressively, whether it was related to cancer or not,” he says. “I agree with that serious-minded approach and with compassionate care. But we started prescribing high doses of opioids to non-cancer patients. That helped a lot of people, but it created a whole new set of problems.” He’s referring to people who became moody and tired much of the time and to what he calls “the diversion problem” — drugs ending up in the wrong hands.
Another signiﬁcant problem resulting from a steady stream of high doses of opioids is hyperalgesia. “If you take morphine for too long, it desensitizes you and makes you feel pain even more,” he says. “All of us in this ﬁeld have got to work hard toward getting to non-opioid solutions for pain.”
MD & MBA
Dr. Grigsby is always looking for solutions. That’s part of what led him “later in life,” as he says, to Duke University for an MBA. He jokes that a joint midlife crisis is what led him and his wife, Mary, to get their MBAs last year. (His wife runs the operations side of their Rocca Family Vineyards, so her MBA beneﬁts her and their business. Not that the winery needs much help: their cabernet was recently awarded Best of Show at San Francisco’s 2013 International Wine Competition.)
“Business school helps in your decision-making,” he says. “It teaches you to get people and resources moving in the same direction toward a common goal. That’s what I’ve always tried to do in my medical practice.
“What you learn in business school is valuable and practical no matter what ﬁeld you’re in,” he says.
Besides, he points out, medicine is a tough ﬁeld these days. The health care environment is changing dramatically. Dr. Grigsby wanted to learn how best to manage through that change. “We want to give our practice the best possible chance of succeeding so we can keep taking care of our patients,” he says.
THE FUTURE OF PAIN
The future for pain patients looks bright, Dr. Grigsby says. What’s more, he believes the same neuromodulations that have been successful for people dealing with pain may prove helpful in pain management for people living with Parkinson’s, Alzheimer’s, epilepsy and MS. “Science has spent many billions of dollars and, so far, we have zero cures for these diseases. Zero,” he says. “It’s time for newer, more creative strategies.”
Dr. Grigsby is committed to working on those strategies, and he’s hopeful; he’s seen great progress made in his ﬁeld. “It’s amazing to think how far we’ve come in the past 25 years,” he says. He considers one of the biggest advances — besides the technology and the revised thinking — to be the hope people now have.“ Today, people know there is an opportunity to get help. Pain is not a failure of personality. It’s part neurological, part cognitive and part physical. Patients today know they do not have to accept a life of pain.”
Like winemaking, developing treatments for pain takes time. But Dr. Grigsby is less patient in the wait for better pain treatments than he is as his prize-winning cabernet ages to perfection. He can’t hurry the fermentation process, but he can — and does —work with all due speed in developing safe, effective ways to help alleviate pain.
PainPathways is the first, only and ultimate pain magazine. First published in spring 2008, PainPathways is the culmination of the vision of Richard L. Rauck, MD, to provide a shared resource for people living with and caring for others in pain. This quarterly resource not only provides in-depth information on current treatments, therapies and research studies but also connects people who live with pain, both personally and professionally.