Pain Management Specialist · Expert Witness · IME
Physician
Yale and University of Maryland educated, Johns Hopkins trained. Over 25 years of clinical experience spanning academic medicine and private practice. Trusted by plaintiff and defense attorneys across the country to render objective, credible opinions since 2001.
Yale UniversityJohns Hopkins Fellowship50+ DepositionsFederal Court Qualified3 Published Books
Whether you're an attorney building a case, a patient seeking expert care, or a
physician looking for consulting guidance - Dr. Guarino brings the same standard of precision and integrity to
every engagement.
25+ Years. Hundreds of Cases. Trusted on Both Sides.
Dr. Guarino has been a medical-legal consultant in pain management since 2001, working with plaintiff and
defense attorneys across the country. Attorneys cite not only his clinical depth but his rare ability to make
complex pain science clear and convincing to judges and juries.
After more than 20 years as Director of Pain Management at Washington University / Barnes-Jewish West County Hospital - one of the country's leading academic medical centers - Dr. Guarino has spent the past seven years in private practice. That combination of academic medicine and private practice gives him a perspective that is both rigorously grounded and practically informed.
He does not accept contingency-based compensation and delivers the same impartial standard regardless of which side retains him.
From the clinic to the courtroom, every engagement is grounded in evidence-based
medicine and decades of hands-on procedural experience.
• Spinal Cord & Nerve Injury
In-depth evaluation of injuries to the spinal cord and peripheral nerves - including causation, severity,
standard of care, and long-term prognosis - for litigation and clinical purposes.
• Medical Malpractice & Standard of Care
Thorough review of whether a provider's conduct met the accepted standard of care in pain management,
anesthesiology, and interventional spine procedures.
• Independent Medical Examinations
High-level IME services for complex musculoskeletal and pain-related claims. Rigorous record review
determining causation, impairment, and treatment appropriateness.
• CRPS & Chronic Pain Disorders
Expert evaluation of Complex Regional Pain Syndrome and other difficult-to-quantify chronic pain conditions
- critical in establishing the full extent of damages and care needs.
• Post-Surgical Complications
Assessment of whether proper protocols were followed before, during, and after procedures - and whether
negligence contributed to a patient's ongoing pain or additional injuries.
• Workers' Compensation & Personal Injury
Accurate, well-documented evaluations of work-related and personal injury pain claims, including severity,
appropriate treatment standards, and expected long-term outcomes.
Why Attorneys Choose Dr. Guarino
Credibility That Holds Up Under Cross-Examination
"Dr. Guarino was very helpful in a difficult (opioid related) case. He was always prepared when we spoke and it was clear he’d done an exhaustive review of the records. Not only did he help us understand the medical issues in the case, he also helped us focus our defense strategy in a way that could easily be understood by a jury."
- John Hicks, JD Norris Kelpinger Hicks & Welder LLC
"“…case has been settled and dismissed. Your analysis of the medical records and subsequent assistance re the Defendant’s Opinion Witness Disclosure was key. The parties submitted the case to a mediator for resolution. The mediator was not able to obtain an agreement, but during the mediation I relied strongly on the Disclosure and the impact your opinions would have if the case proceeded to trial. A week after the mediation concluded, the attorney for the plaintiff called me to settle. He did so for an amount far less than what his client demanded at the mediation.”"
- Mike Welsh Erickson Davis Murphy Johnson & Walsh, Ltd.
"I am delighted to tell you that the jury reported a verdict of $6 Million in the case. Certain caps apply under Michigan law so there will be some dispute regarding the total judgment that will be entered. However, it will be substantial regardless. Your testimony was beneficial and you are a very believable witness. I just wanted to give you personal thanks and hope that you will be willing to work with us again in the future. Best regards."
- William D. Vines, III Butler Vines & Babb, Attorneys at Law
Qualified in Federal Court
Daubert-compliant methodology. Opinions grounded in peer-reviewed literature and
accepted clinical guidelines.
No Contingency Compensation
Dr. Guarino's fee structure is fixed and independent of case outcome, supporting
impartiality and credibility.
Plaintiff & Defense
Available to both sides. The same objective standard applies regardless of who
retains him.
Extensive Publication Record
Published in The Spine Journal, Anesthesia & Analgesia, Pain Medicine, and
other peer-reviewed journals. Author of three books, including a Johns Hopkins University Press title.
Get in Touch
Request a Consultation
Whether you need a preliminary case assessment, a full expert opinion, or a patient appointment - reach out and Dr. Guarino's office will respond promptly.
