Pain management doctor develops innovative methods to help patients

As patients we are so impressed when we connect with a high-quality physician and see the difference it makes in our life. Imagine the level of respect for one of those who is also an innovator in his field.

Dr. Bryan Marascalchi, an accomplished anesthesiologist and pain management specialist with a passion for treating patients with persistent pain in the spine, including disc pain, sciatica, and neuropathic pain, is one of those who takes such a devoted interest in his patient’s challenges that he has created new methods to further improve patients’ lives.

“It makes me want to do more when people are asking for help,” Marascalchi said.

Marascalchi felt it was important to bridge the gap between a patient’s experiences during their regular days at home and their medical visits. In developing something new, he addressed an unmet critical need in the market.

Marascalchi helped develop the Pain Scored platform, an intuitive mobile app for pain management, which allows a more fluid approach to enhance the doctor/patient relationship.

Pain Scored allows a patient to transmit their chronic pain in real time, allowing their doctor to understand its severity, patterns, and impact on the patient’s quality of life.

When patients are in pain on a daily basis, it can become difficult to reflect on the past month, when the pain was at its worst. Pain typically tires people and sometimes one day blurs into the next. Pain Scored removes the “I can’t recall” or “I’m not sure what I did prior to experiencing the pain” dialogue at a future checkup. This, in turn, offers doctors the ability to adjust to more tailored approaches to treating chronic illnesses and medical conditions.

Pain Scored, is “remote patient monitoring, the collection of self-assessments and physiologic data to improve health.”

Marascalchi explained what led him to help create Pain Scored. “The original intention was to collect data for patients that are not in the office and that’s kind of a very different approach,” he said.

I’m sure many of you are familiar with the 2- to 3-page printout of questions asking you to average out your pain, sleep, and mental state over the past month, 2 months, 3 months, or more. You know, you are asked to circle a number between 1 and 10 for “How many days you had a headache?” or “When you experienced pain, how often do you wish you could lie down?” or “How often have you felt sad?”

It’s tough filling these out. Why? Well for me and others I’ve spoken with about it, each day is unique and trying to quickly “average” them out by choosing one number for ninety days doesn’t seem realistic or very insightful.

Marascalchi said, “Usually doctors are asking how you’re doing not only during the day of an office visit, but in between at home. How far back can you remember? And patterns and nuances are a very challenging thing to tease out. Pain has a subjective component to it as well and the best way to evaluate it is through assessments.”

As has been reinforced to me thus far, in working on The Honest Migraine, pain is a highly individual experience. Our childhood, experiences, and influences all play a role in dictating just how we gauge pain. For me, my pain tolerance has increased by 1) Understanding the true 1 to 10 pain scale, 2) Having experienced a variety of health matters that continue to shape my perspective and re-define my level of pain, and 3) My mindset and the positive influences that surround me.

Marascalchi explained that Pain Scored has proven helpful because instead of a patient informing him of pain after being asked a series of questions, and then him needing to “record the answer, trend that answer over time, make sense of that answer over time, and find a pattern, then correlate that with clinical practice and make a decision,” is quite hard. Pain Scored “digitize[s] that process and also does so in a way where you are translating what a patient is telling you into what a doctor can understand” (a digital format). That makes good sense.

The Pain Scored app is a “two-way facing platform – one that faces patients so they can insert that data, and two – get that data back to physicians to make better decisions.” Essentially, it’s a “real-time” results-driven conversation with your doctor. 

Better yet, “the process is recognized by all insurers in America and incentivizes that collection of data and recognizes that importance.”  So, if your doctor hasn’t yet introduced you to the app – bring it up at your next visit and share your willingness to log your days in an effort to provide the data needed to achieve better health. Why not provide the best, most accurate data possible? It’s smart to immediately report pain episodes, insomnia, and how you’re feeling on a whole today.  

When using the old-style paper assessments, Marascalchi said it’s common they “aren’t used, filled out, or people miss a question.”

“You can’t really score that,” he said. “It’s all on paper and nothing gets in the [patient’s] chart in a meaningful way.” 

Marascalchi shared how pivotal logging a patient’s pain is at home. “It’s not as important to understand how you’re doing at a point in time when you’re at a doctor’s office visit, but how you do at home, what was going on last week, the week before, three weeks, four weeks – and the trend.” 

Unless a person is hospitalized, being closely monitored in a medical facility, or living in a nursing facility, most of our time is spent separated from our doctor and it’s just us and chronic illness.

Allowing your doctor to evaluate your symptoms, highs and lows, and patterns in-between office visits can be a game changer. It can become a great comfort to know you are getting real-time assessments for better treatment.  

Marascalchi emphasized that Pain Scored is “not just a pain score, it’s a function score, it’s an enjoyment of life, it’s a sleep, it’s a mood, it’s a disability, it’s a lot of things kind of rolled up into one.”

Upon using, your doctor can get straight to reviewing the efficiently presented data and reports that Pain Scored generates. Another plus for doctors, “They can look at how their whole clinic is doing and the health of their whole clinic. That’s what we’re doing with that product.”

We shared similar stories as to how pain affects quality of life and how it fluctuates. Marascalchi understands very well. He said when he had surgery, “It’s kind of this challenging thing; where you watch your pain go all over the place – 2 out of 10, 6 out of 10, 1 out of 10, 10 out of 10 all of a sudden.”

I have experienced something similar.

In enduring that type of situation, Marascalchi said, “The [doctor] may not see that trend, but once you track it, you’re like whoa, that’s a downward trend. It didn’t make sense. Why was it 1? Why was it 6? Why was it 10? And that’s the same thing for everything.” At the end of the day, logging your day medically and journaling your day personally can lead to profound change and insight. 

In reflecting on medical advances today, Marascalchi said, “The easy problems in medicine have been solved. The complex problems in medicine require a multi-prong approach – first starting with data, finding non-intuitive patterns with the data, building products off of perhaps non-intuitive inferences that were made from that research and then doing so in a way that is commercially viable.” Nonetheless, it has many challenging aspects to it.  

In addition to Pain Scored, Marascalchi is an innovator in another way. He is the expert that founded Pneumico. Pneumico increases the quality of monitoring respiration, including vital early alerts, while a person is unable to breath on their own.   

He clarified, “At this point in time, emergency ventilation is guesswork. Believe it or not. The current standard is kind of guesswork.” No wonder Dr. Marascalchi said there is need for improvement.

He explained a likely scenario, “What is the rate? Imagine being in the back of an ambulance – one person’s doing chest compressions, you’re trying to start an IV, breathe for somebody, you have a very challenging and adrenaline-rushed scenario and that kind of happens all of the time.”

In the above, “There isn’t a monitor in this location for this purpose,” said Marascalchi.

Marascalchi found an unmet, highly critical need and took steps to find a viable solution. As he said, “How can you improve what you don’t measure? That’s not only for Pain Scored, that’s for Pneumico. If you’re just currently guessing, to a degree, what could be better – well measuring it! Then getting feedback. What’s better than feedback? Actually being able to make clinical decisions with better information on the fly.”

To know that progress is being made to achieve more “knowns” instead of “unknowns” is incredible.

As Marascalchi said, this arena of healthcare “can be improved.”

“There’s a large economic burden from many healthcare problems,” he said. “The process of innovation culminates into a commercially viable product that provides value through reducing economic burden. That is very challenging for anyone – from small startups to the largest of companies to go through that process.

This challenging process goes something like this, Marascalchi said, 1) Make it, 2) Find funding for the process, 3) Optimize the usability of the product, 4) Go through the regulatory process, 5) Release the product, 6) Scale it – scale it up to where it becomes a standard.”

This is no small or short-term task as Marascalchi noted. “[It] takes an entire company, team, effort, and probably a minimum 7 years if not longer, maybe a 10-year process.”

It was clear through my interview with Dr. Marascalchi that he has an immense passion for medicine and care of the general public’s health.

When asked what made him so passionate to become an innovator outside of his anesthesiology career, Marascalchi said, “I think just being on that receiving end as a physician and wanting to perhaps just do more. And you know seeing the limitations of all of that just kind of makes me want to do more when people are asking for help.”

In addition to innovating, he is actively teaching others how to innovate and “go through that non-intuitive, very challenging process to find an unmet need, develop a solution and push it as far as you can.”

Dr. Bryan Marascalchi is an assistant professor of anesthesiology and critical care medicine at the Johns Hopkins University School of Medicine, and in the pain management division he specializes in treating patients with persistent pain in the spine, complex regional pain syndrome, disc pain, sciatica, and neuropathic pain, in addition to more.

Watch for more from Dr. Marascalchi on March 31, 2022

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