Chronic Pain, Regenerative Medicine, and New Approaches to Healing
Conversation with Dr. Frank Kousaie
Host:
When you’re living with chronic pain, you often have to give up things that matter to you. Maybe you can’t play basketball with your friends anymore. Maybe you can’t play with your kids. Sometimes even a simple arcade basketball game feels like too much.
That’s what we’re going to talk about today: pain management. Dr. Kousaie, how are you?
Dr. Kousaie:
I’m doing very well. How are you?
Host:
Good. I should probably put this basketball away, or I’ll spend the entire show playing with it.
Dr. Kousaie:
Go ahead—have some fun.
Host:
We just recorded a show about gambling because the Cavaliers lost last night, and it seemed like the appropriate topic. I ended up losing $30 live on the air, so perhaps I’ve learned my lesson about gambling.
But let’s start by talking about you. Usually I jump right into discussing what someone’s practice offers, but you’re an anesthesiologist. For years I’ve been trying to get another anesthesia provider on the show so we could talk about anesthesia-related topics—probably much to the boredom of everyone else watching.
Tell us about your background. I know you’ve worked at Summa, Crystal Clinic, and several other places.
Dr. Kousaie:
I’ll start at the beginning.
I was born and raised in Kent, Ohio, just down the road. I haven’t traveled very far from home. And it’s great to be here with a CRNA. We’re all part of the same team.
I attended medical school at Creighton University in Omaha, Nebraska, then completed my training at the Cleveland Clinic and University Hospitals. I specialized in anesthesiology and also completed six months of pain management training, which was standard back in the 1980s. Today, there are full pain fellowships, but that wasn’t the model at the time.
Host:
That’s roughly thirteen years of education altogether.
Dr. Kousaie:
At least. Medical school, residency, and specialized training—it adds up quickly.
After that, I began building practices in Portage County and Summit County. I worked at Robinson Memorial Hospital, which is now part of University Hospitals.
Host:
My very first anesthesia clinical rotation was at Robinson Memorial.
Dr. Kousaie:
Back when it was still the last county hospital in Ohio.
I later helped develop the Western Reserve Surgery Center in Kent with fourteen surgeons and our anesthesia group. Pain management remained a major part of my practice. After that, I spent several years here in Wadsworth doing both anesthesia and pain management before moving on to Crystal Clinic and later Summa.
Why Anesthesiologists/CRNAs Think About Pain Differently
Host:
For people who aren’t familiar with what happens behind the scenes in an operating room, anesthesia is much more than simply keeping someone alive during surgery.
We evaluate patients beforehand, review their medical history, and develop a plan for pain control both during and after surgery.
Anesthesia providers are uniquely positioned because we focus so closely on every aspect of the patient’s condition. We routinely perform nerve blocks and regional anesthesia techniques to extend pain relief after surgery. If you’re having arm surgery, for example, we may numb the entire arm for 24 hours. Since the first day is often the most painful, that can make a tremendous difference in recovery.
It also makes my job much easier. Early in my career, we performed knee replacements without nerve blocks. We relied heavily on medications like fentanyl and hydromorphone to manage pain. Today, regional anesthesia allows us to block pain directly rather than trying to overwhelm it with medication.
Dr. Kousaie:
Exactly.
Host:
And that really leads into today’s discussion. As a healthcare culture, we’ve spent decades trying to mask pain instead of truly addressing it.
Dr. Kousaie:
That’s a great transition.
Historically, pain clinics relied heavily on opioid medications. Procedures such as epidural injections, facet injections, radiofrequency ablations, and sacroiliac joint injections were also common, but the effects were temporary.
With the opioid crisis, many providers began moving away from around-the-clock opioid therapy because of its many long-term consequences. At the same time, orthopedic surgeons became increasingly concerned about repeated steroid injections because of their effects on bone and connective tissue.
The Hidden Cost of Long-Term Pain Treatments
Host:
That’s actually a very forward-thinking approach because some health systems continue treatments simply because insurance pays for them.
Dr. Kousaie:
Exactly.
The challenge is that repeated interventions can gradually worsen overall health. When it finally becomes time for surgery, a patient may no longer be healthy enough to undergo it.
Steroids can weaken bones and damage tissues over time. Eventually an orthopedic surgeon repairs a joint and then hands the patient back to us and says, “Now what?”
Host:
That’s a very orthopedic perspective.
Dr. Kousaie:
They’re essentially highly skilled carpenters.
Host:
They’d probably agree with that description.
Long-Acting Nerve Blocks: A Lesson from the Past
Dr. Kousaie:
Interestingly, there was once an extremely long-acting local anesthetic that could block nerve function for weeks.
When I was a resident in the 1980s, it had already been removed from use. The problem was that patients could injure themselves without realizing it. They would burn themselves, reopen surgical wounds, or fracture bones because the pain signal was completely absent.
Host:
I had never heard that before.
Dr. Kousaie:
It sounded wonderful on paper. In reality, eliminating sensation for weeks created entirely new problems.
Why Opioids Create More Problems Than They Solve
Host:
One thing I’ve learned through ketamine therapy and pain treatment is that our goal shouldn’t be making someone comfortable for a single day. Instead, we should be trying to help them feel better for months—or potentially permanently.
A lot of chronic pain involves breaking cycles in the nervous system.
Dr. Kousaie:
Absolutely.
Opioids create many serious problems. They contribute to depression, sleep disruption, hormonal dysfunction, mood changes, and loss of physical activity.
Men can experience declining testosterone levels. Women can experience changes in estrogen, progesterone, and testosterone levels as well.
And as people become less active, they lose more of their ability to function. Pain creates a downward spiral.
Host:
What’s fascinating is how interconnected everything is.
You can normalize lab values, replace hormones, and optimize medications, yet still have an unhealthy, unhappy person sitting in front of you.
Humans are simply too complex for a single intervention to solve every problem.
The Search for Regenerative Medicine
Host:
Tell us about your current practice.
Dr. Kousaie:
For decades I’ve searched for complementary therapies that reduce pain, have very few side effects, and work consistently.
One of the first examples is acupuncture, which has been around for thousands of years.
Researchers studying Ötzi the Iceman—the remarkably preserved man discovered in the Alps—found markings on his body that corresponded to modern acupuncture points. They also found tools that may have been used therapeutically.
Acupuncture is remarkably safe. It appears to influence stem-cell activity and reduce pain.
Recently, researchers identified structures just beneath the skin called the interstitium, which may help explain some of acupuncture’s effects.
Electrical Medicine and Pain Relief
Dr. Kousaie:
I’ve also worked extensively with electroanalgesia, which today is often categorized under pulsed electromagnetic therapies.
Historically, electrical medicine dates back thousands of years. Ancient physicians reportedly even used electric eels to relieve pain.
Later, Russian researchers invested heavily in electrical medicine while developing medical systems for rural communities and space programs.
What these therapies do is stabilize nerve membranes, decrease pain signals, improve blood flow, reduce inflammation, and stimulate stem-cell activity.
Host:
So essentially, the nerves become less likely to fire pain signals.
Dr. Kousaie:
Exactly.
Think about gabapentin. It was originally developed as an anti-seizure medication. Instead of allowing nerves to fire continuously, it dampens the signal.
Electroanalgesia works in a somewhat similar way by stabilizing nerve activity.
Regeneration Instead of Suppression
Host:
What I find fascinating is that it appears to accomplish two things at once.
On one hand, it reduces excessive nerve signaling. On the other hand, it promotes healing through increased stem-cell activity and improved circulation.
Dr. Kousaie:
That’s exactly right.
You get new blood vessels, improved circulation, reduced inflammation, and support for tissue healing.
It’s regenerative medicine in a very practical form.
Laser Therapy
Dr. Kousaie:
The same concept applies to therapeutic laser treatments.
People often think of cosmetic red-light therapy, which helps collagen production and skin health.
Medical lasers go deeper. They can penetrate several inches into tissue and help reduce inflammation, promote blood vessel growth, stabilize membranes, and accelerate healing.
I’ve treated patients with severe back pain who were being advised to undergo surgery. After a series of laser treatments combined with physical therapy and anti-inflammatory treatment, some improved dramatically.
Host:
That combination is key.
One thing that both of our practices have in common is that we don’t immediately jump to the most aggressive intervention. We try to identify the few missing pieces that may help the body heal itself before resorting to surgery.
StemWave and the Future of Pain Treatment
Dr. Kousaie:
The treatment I’m most excited about right now is StemWave therapy.
Most people are familiar with lithotripsy, where shock waves are used to break up kidney stones.
StemWave uses a similar principle, but instead of breaking up stones, the shockwaves stimulate cells to release healing factors.
The body briefly interprets the treatment as a minor injury and responds by activating repair mechanisms. Growth factors are released, stem-cell activity increases, new blood vessels develop, and inflammation decreases.
That’s where the name comes from—stimulating stem-cell activity through acoustic waves.
Studies suggest athletes may recover significantly faster from injuries using this technology.
If an athlete injures a shoulder, knee, or other structure and needs to return to play quickly, StemWave may help accelerate healing.
Host:
That’s exciting.
And best of all, your office is right down the street, making collaboration simple. We can easily coordinate care and provide patients with a smooth transition between services.
Dr. Kousaie:
Exactly.
The Brain Is Central to Pain
Host:
One thing I’m especially excited about is your appreciation for the role of the brain in chronic pain.
Over the years, we’ve discovered that even ketamine treatments work best when they help shift brain networks and perception. Sometimes you don’t need a massive intervention—you simply need to help the brain feel safe again.
Dr. Kousaie:
That’s true.
Pain is fundamentally the brain’s way of saying something is wrong.
Until the brain feels safe, symptoms can continue long after tissues have healed. We see this in conditions such as fibromyalgia, multiple chemical sensitivity, Ehlers-Danlos syndrome, POTS, and many other chronic conditions.
Sometimes a single event can trigger long-lasting changes throughout the nervous and immune systems.
Host:
And ultimately that’s what both of our practices are trying to accomplish: helping people reset those systems and move toward healing.
Dr. Kousaie:
Exactly. It all comes back to neuroplasticity.
Closing
Host:
Well, thank you for joining us today.
Dr. Kousaie:
Thank you for having me. I appreciate it.
Host:
And thank you for watching.
Announcer:
You are watching WCTV, Wadsworth Community Television.
