Vivek Tim Malhotra Appointed Service Chief

Monday, February 1, 2010

Vivek Tim Malhotra
Summary

Vivek Tim Malhotra has been named Chief of the Anesthesiology Pain Service in the Department of Anesthesiology and Critical Care Medicine.

Vivek Tim Malhotra has been named Chief of the Anesthesiology Pain Service in the Department of Anesthesiology and Critical Care Medicine. Dr. Malhotra, a board-certified anesthesiologist with expertise in pain management, has played a major role in the management of the clinical, teaching, and administrative activities of the Anesthesiology Pain Service. He is a fellowship director for the Tri-Institutional Pain Fellowship, through which young doctors receive training from faculty of Weill Cornell Medical Center, Hospital for Special Surgery, and Memorial Sloan Kettering Cancer Center. Dr. Malhotra received his MD degree in 1993 from the University of Maryland School of Medicine and did his residency training at NewYork-Presbyterian Hospital, Johns Hopkins Hospital, and North Shore University Hospital. After earning an MPH degree in 1997 from the Bloomberg School of Public Health at Johns Hopkins University, he came to Memorial Sloan Kettering in 1998 as a fellow and joined the faculty in 2000.

Comments

Is it true the longer you are on pain med the harder it is to get off and the withdrawal are harder and last longer and is it true once you are on pain med and then get off you could go back to it even if it was sixty years ago

Carmela, thank you for reaching out. We consulted with MSK pain specialist Natalie Moryl, who responds:

"Almost all cancer patients, when the pain resolves after effective radiation, chemotherapy or surgery, are able to discontinue opioids easily. Of course, opioids need to be tapered down and not stopped abruptly to keep withdrawal symptoms to minimum.

In rare cases, withdrawal can be more pronounced or even significant. As you correctly noted, longer opioid treatment may be a risk factor for prolonged or more severe withdrawal symptoms. Other factors that can lead to increased withdrawal are younger age at the time opioids are started, higher doses of opioids, as well as uncontrolled anxiety or depression. We rarely see significant withdrawal symptoms without any known risk factors. In these cases, we slow down the opioid taper and may involve a multidisciplinary team including psychiatry.

Of course, some of our patients have a history of substance use disorder before they are diagnosed with cancer. If you have an addiction disorder, it is essential that you let your medical team know because you may need a higher level of support during treatment, higher opioid doses for pain, and higher attention during opioid taper when the pain resolves. Patients with preexisting substance dependence may benefit for returning to the AA or NA programs, seeing a social worker and seeking the help of the addiction counselors."

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