How pain medicine is evolving for physicians and patients

Shalini Shah, MD, professor and vice chair of the Department of Anesthesiology and Perioperative Care and director of pain services at UCI Health, joins Physician Huddle to discuss the growth and evolution of pain medicine.

Shah reflects on her path from anesthesiology training at Cornell to adult and pediatric pain fellowships at Harvard-affiliated hospitals, and how she was recruited to UCI Health to help establish a pediatric pain program. She describes how UCI Health developed one of the country’s largest pediatric pain programs by volume, with care designed to improve access for children and adolescents who should not have to wait for care.

The conversation explores how UCI Health has expanded pain services across Orange County, including the growth of multiple pain clinics and a multidisciplinary model that brings together physicians from anesthesiology, physical medicine and rehabilitation, neurology, psychiatry, and other specialties under a coordinated structure.

Shah discusses the state of opioid prescribing, including how the pendulum has shifted from overprescribing to fear of prescribing. She emphasizes that opioids are neither “the hero” nor “the villain,” but one component of a personalized treatment plan when used appropriately.

The episode also covers interventional pain therapies, longevity and function, lifestyle approaches to pain management, advocacy through organized medicine, and Shah’s reflections on physician leadership, work-life integration, and building teams that support people through different seasons of life.

Topics discussed: 

• UCI Health has developed a high-volume pediatric pain program focused on timely access, multidisciplinary care and community relationships.
• Shah emphasizes that pain care should not be siloed; the UCI Health model brings multiple pain-trained specialties under one coordinated structure.
• Shah’s leadership philosophy centers on building strong teams, understanding what people need to succeed and recognizing that team members operate at different capacities during different life stages.
• Medical education around pain and opioid prescribing has historically been limited, contributing to broader challenges in clinical practice.
• Shah helped advance a University of California-wide curriculum to improve medical student education in pain care and opioid prescribing.
• Opioids should be viewed as part of a personalized treatment plan — not as either the central solution or something to categorically avoid. 
• Interventional pain medicine is evolving rapidly, with new therapies, modalities and devices expanding treatment options.
• Pain management increasingly intersects with longevity, mobility, function and quality of life.
• Physician advocacy matters because healthcare policy is often shaped by people who have not directly cared for patients.

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