Chronic pain sends sufferers to pain management clinics.
By Esther M. Bauer
The only thing certain about chronic pain is that lots of Americans suffer from it. According to the experts, 800,000 new suffers are added to the pain roster annually.
Keepers of such statistics report an estimated 50 million people are disabled to some degree by chronic pain.
To address the misery, thousands of pain clinics exist in the United States, with more than 2,650 such clinics advertising on the Web site www.pain.com. The actual number is pain clinics is unknown, however, as accreditation is voluntary, except for hospital-based clinics.
In addition to primary care physicians, many medical specialists including anesthesiologists, orthopedists, and neurosurgeons and those in perhaps 20 or more other disciplines ranging from psychiatrists and dieticians to biofeedback, physical and occupational therapists as well as exercise physiologists and social workers) collaborate in the battle to combat chronic pain. The most common pain affects the spine, but head, extremity and cancer also account for much suffering.
It's no wonder, then, that pain is a big business, with venture capitalists financing new therapies. Seattle-based Vertis Neuroscience recently announced $37 million in funding for Vertis PNTTM, a newly released FDA-approved treatment for low back pain via electrical stimulation.
"Pain is the primary reason most people see a doctor," says john L. White, M.D., an anesthesiologist who, along with Steven Remer, M.D., operate American Pain & Wellness clinic, (www.painandwellness.com) of Plano.
"Most are early diagnosed and treated, but there is a large subset of people whose pain is the primary factor and they need more specific investigation because their pain doesn't fit in any particular pattern."
Tracking the cause of pain and tailoring its treatment is much like detective work.
"Sometimes the underlying source has not been identified up-front," says Dr. Remer, who gives this example: A patient may have been treated for migraines when the headache is actually coming from the neck due to musculoskeletal problems from an earlier trauma.
We try to assimilate all the information, prior treatments and sort through it to make heads or tails of what is important," he says.
Phillip Brown, M.D., an anesthesiologist and medical director at the pain clinic at Parkland Memorial Hospital (www.phm.org), offers this message of hope:
"Something can almost always be done about pain. It may not be curable, but it is very likely that a pain management specialists can reduce the level of pain and therefore increase the level of function, whether it is getting somebody back to work of just getting somebody out of a chair and able to make a meal."
The nation's number of pain clinics is increasing, along with public and medical awareness of the human nervous system, which can make pain persist even after its initial cause has been successfully treated.
Many pain management clinics are under the purview of anesthesiologists whose repertoire of therapies includes painkillers and other medications such as anti-depressant and anti-seizure drugs, various injection treatments and electrical stimulation to block pain.
The choice of treatment depends on the patient, the type of pain and the length of suffering. Some patients have been in misery for years despite repeated surgeries and other treatments.
"The nature of chronic pain is that the nervous system alters its behavior and can actually carry on a pain after a problem has been dealt with… the nervous system becomes sensitized or would up and a pattern of memory can be laid down, like remembering a telephone number you use a lot like habit, only this is a well-trodden memory of pain… the nerves basically are not working normally," says Dr. Brown.
Due to that nature of some types of pain, such as neuropathic pain, specialists often cannot promise a cure, but rather the likelihood of improvement through treatments directed at the nerve abnormality. Pain clinics consequently depend upon an interdisciplinary approach to help patients better manage their lives around the pain.
The Eugene McDermott Center for Pain Management at The University of Texas Southwestern Medical Center has 13 ancillary services as part of its pain management clinic.
A typical back patient with a herniated disc is referred to the clinic and depending upon the circumstance a steroid injection may be ordered. If disabled, the patient might be considered for a long-term pain management program, which includes a team evaluation by a physical therapist and possibly a psychologist. Each discipline presents its finding on he patient and a case manager is assigned.
"We all put I what we are seeing and the different disciplines get the information from people in an organized fashion. It's a systematic way to make sure the patients get evaluated in a comprehensive way," says Carl Noe, M.D., an anesthesiologist and medical director of both the McDermott Center and the Baylor Center for Pain Management at Baylor University Medical Center.
The patient's baseline condition is measured and tracked throughout the treatment process and for a year after treatment ends. Some patients do well in a matter of weeks, while others require months of treatment. Relatively few require surgery.
"The goal is to help treat the patients' pain and also give them skills so they can be less dependent on the healthcare system," Dr. Noe says.
Psychologists who are part of the treatment plan employ the same principles as sports psychologists who teach coping skills to reduce stress and increase sports performance.
"It is common for people who have pain to be angry about it. Pain interferes with your sleep. It keeps you awake at night; you become fatigued and irritable. That can lead to depression. It's important to treat that along with the medical problem. An interdisciplinary approach takes time and effort by the patient, but the results are frequently better," says Dr. Noe.
He had bad news, however, for the rest of us.
"Pain is waiting for all us. As we age, the likelihood of having a pain problem increases. Just being upright animals walking on two legs puts a strain on our lower back. Sometimes it is gradual wear and tear that might start with a muscle spasm, then some degenerative arthritis, them maybe a disc protrusion. Other people might have an acute episode where they lift something heavy and that produces a disc herniation. Back pain is incredibly common.
