David Thor Johnson, M.D., Ph.D., isn’t your typical doctor. The former ballet dancer doesn’t approach medicine in the typical way either. Johnson is a physician and scientist at MUSC Hollings Cancer Center specializing in both interventional and diagnostic radiology. He uses his talents to treat a problem that nearly all cancer patients suffer from – pain.
“If you ask cancer patients what they are most afraid of when they are diagnosed, No. 1 is death, No. 2 is how much pain they’ll be in and No. 3 is how they’ll afford the treatment,” he said.
Johnson is no stranger to pain and heartache and knows a lot about financial constraints. As a young child, he and his four siblings entered foster care where he experienced deep hurt firsthand. “I know what it is like to be a poor, dirty and hungry kid who didn’t even have a toothbrush,” he said. “I experienced welfare. Those experiences give me a different viewpoint when it comes to compassion, empathy and caring for patients who are already going through a rough time.”
His personal experience is one reason he’s so passionate about providing comfort to patients in pain. Johnson is working toward opening a new multidisciplinary pain clinic at MUSC for cancer patients that will provide a specific pain plan at the front end of treatment rather than at the back end. His goal is to make it as easy as possible to connect patients in pain with the care they need.
“I got frustrated seeing how hard the end stage was for a lot of my cancer patients and how little quality of life they had,” Johnson said. “They weren’t able to spend time with their loved ones, and you could tell that it impacted both the patient and family. I’m here to help change that.”
Patients who wish to be seen and treated in the pain clinic can either have their doctors refer them or they can refer themselves.
Johnson offers a variety of pain management techniques to provide comfort to patients. He said nerve blocks or nerve ablations are used a lot for cancer patients to prevent the transmission of pain signals to the brain.
“Cancer can make a patient’s nerves act out of control and act differently than they typically would. The nerves may send signals to the brain to tell the patient they are having pain when they really aren’t. This happens because tumors are able to invade and hijack cables that transmit pain signals throughout the body.”
Many cancer patients also suffer from nausea and abdominal pain, especially those battling pancreatic cancer. To treat those conditions, Johnson recommends a celiac plexus block, which helps to prevent pain signals from the abdomen being sent to the brain.
Patients undergoing treatment for gynecologic and rectal cancers may also experience sharp pain in the pelvic area. Johnson said he can provide relief to those patients through a visceral nerve block. “Nerve blocks are extremely effective and minimally invasive. Many times, a patient may have a block performed and then one or two days later be released from the hospital.”
In addition to nerve blocks and ablations, Johnson also is skilled at inserting intrathecal pain pumps. The pump can send medication to pain receptors to interrupt pain signals and provide relief to the patient. He said pain pumps are especially useful when treating neuropathic pain, which is caused by a chronic nerve disease.
“The idea is that there are a lot of things we can do from an interventional standpoint that can be used in addition to pain medicine in terms of management,” Johnson said. “We can avoid some of the side effects of opioids and use other methods to improve the quality of life.”
In addition to being a pain management specialist, Johnson is also a certified medication-assisted treatment doctor. Cancer patients may receive opioids to ease pain during and after treatment, especially those patients with a terminal illness. Johnson said while the medication can help to ease pain, it can also be harmful.
“It’s estimated that 6% of the population suffers from depression. In a cancer population, that number is 30%,” he said. “If someone is on opioids for more than a couple of months, the risk of severe depression increases dramatically. If we can do things to decrease the need for opiates, it can be incredibly helpful.”
Johnson uses other medications like Suboxone that contain the drug buprenorphine, which helps to block opiate receptors to reduce a patient’s urges. “Patients using opioids are often left in a fog and unable to do simple activities. That isn’t conducive to a quality life. If we can use other medications to treat pain that don’t have those same side effects, I think it is a win for everyone.”
To understand more fully which pain management method is best, Johnson said patients in the clinic will be thoroughly examined, looking at the type and location of the pain, severity of the pain, medications and methods that have already been tried and the disability level of the patient. “It’s not enough to survive cancer. You have to be able to provide patients a life that gives them dignity, independence and joy.”
Johnson hopes to have the multidisciplinary pain clinic open in 2022. He also said he plans to expand pain care to hospice patients to provide them with relief and a higher-quality end of life.
“Patients shouldn’t have to come off hospice care in order to see me or any other pain specialist,” Johnson said. “When hospice patients are in the hospital, I treat their pain on a routine basis. Now we have to work toward making sure no patient falls through the cracks in order to provide everyone the pain management they deserve.”
Those patients who wish to schedule an appointment should contact the Vascular Interventional Radiology Rapid Access Clinic at 843-792-9729.
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