Division of Interventional Pain Medicine

The newly formed Division of Interventional Pain in the Department of Orthopedic Surgery is dedicated to reducing pain and improving function. The division takes pride in its use of evidence-based, cutting-edge interventions, multidisciplinary approaches, and non-opioid therapies to help patients manage painful musculoskeletal and neurological conditions. Each patient is unique, and we pride ourselves in providing patient-centered care through the establishment of an accurate diagnosis and integration with other specialists to develop a personalized treatment plan. Each year, the division performs thousands of interventions including targeted spinal injections at all levels of the spine, radiofrequency ablations (including cooled ablation technology), joint and other musculoskeletal injections, regenerative and orthobiologic injections, discography, spinal cord stimulation trials and implants, and more. Our passion is improving pain and our mission is to provide world-class, cutting-edge pain management for the San Diego community and beyond.

Kevin “Buzz” Barrette, MD (Division Head)
• Dr. Barrette is board certified in Physical Medicine and Rehabilitation and fellowship trained in Spine and Musculoskeletal Medicine. He is a graduate of Boston University School of Medicine and completed his Physical Medicine and Rehabilitation Residency and Fellowship at Stanford. Dr. Barrette is an active spine researcher and recently published on the Basivertebral Nerve Ablation for treatment of chronic low back pain (Intracept trial) and on patient experience in spine care. His clinical interested include comprehensive management of spine and musculoskeletal conditions with an emphasis on patient education, and fluoroscopic and ultrasound-guided interventions. He has special expertise in basivertebral nerve ablation, cervical, thoracic, and lumbar advanced interventions including radiofrequency ablations (including Coolief technology), discography, and regenerative treatments.

Ryan Frasier, DO
• Dr. Frasier is board certified in Physical Medicine and Rehabilitation and Pain Medicine. He is a graduate of Touro College of Osteopathic Medicine and completed his Physical Medicine and Rehabilitation Residency at Stanford, and Pain Fellowship at UCSD. Dr. Fraiser values spending time to get to know his patients and their experience of their pain, and he engages in shared decision making to determine the best path forward for treatment. His clinical interests include spinal and musculoskeletal pain with an emphasis on fluroscopic and ultrasound guided interventional procedures for pain management. He has special expertise in advanced procedures including radiofrequency ablation and regenerative medicine.

David Hiller, MD
• Dr. Hiller is board certified in Anesthesiology and Pain Medicine. He is a graduate of UT San Antonio and completed his Anesthesiology residency at University of Illinois at Chicago and Pain fellowship at UCSD. Dr. Hiller’s background in psychology, anesthesiology, and pain medicine gives invaluable insight providing evaluations and treatment for pain patients. His clinical interests include advanced diagnostic and therapeutic interventional pain/spine injections and musculoskeletal injections under ultrasound and fluoroscopic guidance. He has a special expertise in spinal cord stimulation, dorsal root ganglion stimulation for inguinodynia and other causalgias including complex regional pain syndrome, and coolief radiofrequency ablation.

Hai-Yan Li, MD
• Dr. Li is board certified in Physical Medicine and Rehabilitation and Pain Medicine. She is a graduate of Binzhou Medical College and completed her Physical Medicine and Rehabilitation residency at UT Southwestern, and Pain Medicine fellowship at Stanford. Dr. Li believes in treating her patients as individuals and working together to formulate specialized, comprehensive treatment plans that will ease pain and help prevent future problems. Her clinical interests include spinal and musculoskeletal pain with an emphasis on fluoroscopic interventional procedures for pain management. She has special expertise in advanced fluoroscopic procedures including epidural steroid injections, nerve blocks, regenerative medicine, and radiofrequency ablations.

James Modir, MD
• Dr. Modir is board certified in Anesthesiology and Pain Medicine. He is a graduate of the Medical College of Wisconsin and completed his Anesthesiology residency and Pain fellowship at UCSD. Dr. Modir holds a position as adjunct assistant professor at UCSD and lectures at several national and international conferences. He is a reviewer for the “Clinical Journal of Pain”. His clinical interests include advanced interventional treatments including radiofrequency ablation for facet mediated pain, ultrasound-guided procedures, and fluoroscopic-guided spinal procedures. He has a special expertise in spinal cord stimulators, cervical and thoracic spine injections, provocative and anesthetic discography, and regenerative treatments.

Nayna Patel, MD
• Dr. Patel is board certified in Physical Medicine and Rehabilitation and fellowship trained in Spine and Sports Medicine. She is a graduate of the University of Michigan Medical School and completed her Physical Medicine and Rehabilitation residency and fellowship at the University of Washington. Dr. Patel prides herself in diagnosis and non-operative management of lumbar spine disorders. Her clinical interests include fluoroscopically guided interventions in the lumbar spine including epidural steroid injections, nerve blocks, and radiofrequency ablation. She has special expertise in analysis of body mechanics, management of physical therapy and exercise programs, and non-narcotic medication for pain disorders.

Conditions We Treat
• Radiculitis and Radiculopathy
• Disc herniations
• Low back pain
• Neck pain
• Thoracic back pain
• Joint painc
• Facet pain
• Post-surgical pain
• Cervicogenic headaches
• Neuropathic pain
• Complex regional pain syndrome
• And more!

Our practice locations are as follows:

Scripps Clinic Torrey Pines
Hai-Yan Li, MD
Nayna Patel, MD
Ryan Fraiser, MD

Scripps Clinic Rancho Bernardo
David Hiller, MD
James Modir, MD

Scripps Clinic Encinitas
Kevin Barrette, MD
Hai-Yan Li, MD
Nayna Patel, MD

Scripps Clinic Jefferson – Oceanside
Kevin Barrette, MD

Featured Services

  • Fluoroscopic and ultrasound-guided musculoskeletal injections and nerve blocks

  • Epidural steroid injections

  • Joint injections

  • Peripheral nerve blocks

  • Spinal cord stimulation trials and implants

  • Radiofrequency ablation of lumbar, thoracic, cervical, sacroiliac, and knee joints

  • Complex diagnostic injections and discography to augment surgical planning

  • Treatment for cervicogenic headaches

  • Regenerative treatments for musculoskeletal disorders

Recognitions & Awards

  • Dr. Modir has been named a “Top Doctor” by “San Diego Magazine” in Pain Medicine with Specialization in Ultrasound-guided Treatments and lectures extensively for a host of national societies including the American Society of Anesthesiology, American Society of Regional Anesthesia and Pain Medicine, and California Society of Interventional Pain Physicians

  • Dr. Patel has been named a “Top Doctor” in San Diego 2013 and is recognized for her expertise in biomechanics and lumbar pain

  • Dr. Hiller has studied the use of Cannabis in Pain and has delivered a Grand Rounds presentation on the topic at UCSD

  • Dr. Barrette won the 2020 “Best Fellow Abstract” Award at the (International) Spine Intervention Society Annual Meeting for his work on patient expectations in spine care and a 2020 “Spotlight” Presentation at the American Academy of Physical Medicine and Rehabilitation Annual Meeting for his work on Basivertebral Nerve Ablation for chronic low back pain

  • The Division does not currently provide training opportunities, but is affiliated with the Pain Fellowship at UCSD and the San Diego Spine Fellowship
  • Medical and podiatry resident elective rotations available

  • Smuck M, Khalil J, Barrette K, et al. Prospective, randomized, multicenter study of intraosseous basivertebral nerve ablation for the treatment of chronic low back pain: 12-month results. Reg Anesth Pain Med. Aug 2021.
  • Browne, J; Fraiser, RM; Cai, Y; Leung, D; Leung, A; Vaninetti, M, Unveiling the Phantom: What Neuroimaging Has Taught Us About Phantom Limb Pain.” Brain and Behavior. Accepted for Publication July 2021.
  • Hughes T, Fraiser R, Eastman A. An Unexpected Myxofibrosarcoma Seen on Ultrasound of the Knee. Pain Med. 2021 Jun 4;22(6):1445-1447. doi: 10.1093/pm/pnab028. PMID: 34100075.
  • Levin J, Lowe A, Tamura L, Miller Olson, E, Koltsov, J, Kenrick, A, Barrette, K, Richardson, J. et al. Extensor digitorum brevis bulk and associations with fibular motor nerve conduction amplitude. PM R. Published online April 19, 2021.
  • Barrette K, Zheng, P, Smuck, M. What Does the Patient With Back Pain Want? A Comparison of Patient Expectations and Physician Assumptions. Pain Medicine, Volume 21, Issue 9, September 2020, Pages 2011–2044.
  • Merchant AC, Fraiser R, Dragoo J, Fredericson M. A reliable Q angle measurement using a standardized protocol. Knee. 2020 Jun;27(3):934-939. doi: 10.1016/j.knee.2020.03.001. Epub 2020 Apr 12. PMID: 32295725.
  • Barrette K, Levin J, Miles D, Kennedy DJ. The Value of Electrodiagnostic Studies in Predicting Treatment Outcomes for Patients with Spine Pathologies. Phys Med Rehabil Clin N Am. 2018;29(4):681-687.
  • House LM, Barrette K, Mattie R, Mccormick ZL. Cervical Epidural Steroid Injection: Techniques and Evidence. Phys Med Rehabil Clin N Am. 2018;29(1):1-17.
  • Kennedy, D, Frasier, R, Zheng, P, Huynh, L, Levin, J, Smuck, M, Schneider, B. “Intra-articular Steroids vs Saline for Lumbar Z-joint Pain: A Prospective, Randomized, Double-Blind Placebo-Controlled Trial”. Pain Medicine. (2018)
  • Barrette K, Perloff MD. Physical Medicine and Rehabilitation: The Changing Landscape of Residency and Career. Am J Phys Med Rehabil. 2017;96(2):131-132.
  • Lerman IR, Chen J, Hiller D, et al. Combined Ultrasound and Fluoroscopic Implant of High-Frequency Peripheral Stimulator for the Treatment of Refractory Post Herpetic Neuralgia: A Brief Technical Note Neuromodulation. 2015 Aug;18(6):487-493.
  • Annaswamy TM, Li H-Y. Atypical presentations of common peroneal neuropathy. PM R. 2012;4(6):462-465.
  • Krishnamoorthy V, Hiller D, Ripper R, Rothschild L, Oswald S, Weinberg G. Epinephrine induces rapid deterioration of pulmonary gas exchange in intact anesthetized rats: A flow and pulmonary capillary pressure dependent phenomenon. Anesthesiology. 2012 Oct;117(4):745-754.
  • Weinberg G, Lin B, Zheng S, Di Gregorio G, Hiller D, et al. Partitioning effect in lipid resuscitation, further evidence for the lipid sink. Crit Care Med. 2010 Nov;38(11):2268-2269.
  • Patel N. Percutaneous vertebroplasty: role in treatment of vertebral compression fractures. Phys Med Rehabil Clin N Am. 2010;21(4):869-876.
  • Hiller D, Di Gregorio G, Kelly K, et al. Safety of acute lipid emulsion infusion – a first approximation of LD50 in rats. Reg Anesth Pain Med. 2010 Mar-Apr;35(2):140-144.
  • Modir, J.G., Wallace, M.S. Analgesia: Methods and Protocols Series: Methods in Molecular Biology Chapter 12: Human Experimental Pain Models 1: The Ultraviolet Light UV-B Pain Model. 2010:159-164
  • Modir, J.G., Wallace, M.S. Analgesia: Methods and Protocols Series: Methods in Molecular Biology Chapter 13: Human Experimental Pain Models 2: The Cold Pressor Model. 2010:164-168
  • Modir, J.G., Wallace, M.S. Analgesia: Methods and Protocols Series: Methods in Molecular Biology Chapter 14: Human Experimental Pain Models 3: Heat/Capsaicin Sensitization and Intradermal Capsaicin Models. 2010:169-174
  • Hiller D, Di Gregorio G, Ripper R, et al. Epinephrine impairs lipid resuscitation from bupivacaine overdose, a threshold effect. Anesthesiology. 2009 Sep;111(3):498-505.
  • Cheng, P., Modir, J.G., Kim, H.J., Narouze, S. Ultrasound-guided shoulder joint injections. Techniques in Regional Anesthesia and Pain Management. 2009;13(3): 184-190
  • Weinberg G, Hiller D, Zheng S, Sturgeon C. Physical examination trumps mediastinoscopy in diagnosing Maffucci syndrome, a rare cause of mediastinal mass. Anesthesiology. 2009 Aug;111(2):441-442.
  • Weinberg G, Di Gregorio G, Hiller D, Hewett A, Sirianni A. Reversal of haloperidol-induced cardiac arrest by using lipid emulsion. Ann Intern Med. 2009 May 19;150(10):737-738.
  • Cheng, P., Kim, H.J., Modir, J.G., Grubb, D.J.: Diagnostic Neural Sonography Is there a role for the anesthesiologist? Abstract and Presentation American Society of Regional Anesthesia and Pain Medicine, November 20-23, 2008
  • Modir, J.G., Kuczkowski, K.M. Moeller-Bertram, T. Peripartum Care of the Parturient with Acute Fatty Liver of Pregnancy. Acta Anaesthesiol Belg. 2008;59 (1): 51-3
  • Saragoza, P.A., Modir, J.G., Goel, N., French, K.L., Li, L., Nowak, M.W., Stitzel, A. Identification of an Alternatively Processed Nicotinic Receptor Alpha 7 Subunit RNA in Mouse Brain. Molecular Brain Research.  2003;117(1):15-26
  • Stitzel, J.A., Modir, J.G., Goel, N., and Collins, A.C. Nicotinic Sensitivity and Molecular Variations of the nAChR Alpha 7 Subunit Gene. Society for Research on Nicotine and Tobacco. 1999

Research Ongoing

  • Basivertebral Nerve Ablation: The Intracept Trial – Barrette
  • Bone Marrow aspirate concentrate for osteoarthritis – Li
  • Cannabis in Pain Management – Hiller
  • App-based protocol for diagnostic medial branch block optimization – Barrette
  • Regenerative Medicine for discogenic back pain – Modir
  • MR STIR sequences and SPECT for diagnosis of Facet Mediated Pain – Barrette