Conquering Pain
Treatments for body and mind break a cycle of agony
These programs--which treat people as outpatients for several weeks--give new options to patients who have been through countless doctors' visits, multiple surgeries, and a gamut of drugs. They still use drugs, but they also offer evaluations and help for newer pain victims who want to stop the problem before it grows worse (box, Page 64). The approach looks like a winner in a comparison between 3,000 patients who enrolled in pain clinics and other patients who had just one type of treatment, such as drugs or surgery. At the March meeting of the Midwest Pain Society, psychologist Dennis Turk reported that fewer than 17 percent of the clinic patients were rehospitalized within a year, while 40 percent of the single-therapy patients were. Of patients who were on opioid drugs, 78 percent of single-therapy patients were still on them a year later, but just 33 percent of the clinic patients were. "Remember these are the hard cases, the ones who've tried almost everything else first," says Turk, a pain specialist at the University of Washington in Seattle. "We're usually the court of last resort."
More such venues are opening. Some clinics are at community hospitals like Columbia; others are part of renowned facilities such as the Rehabilitation Institute of Chicago. Seventy-nine pain clinics were listed by the Commission on Accreditation of Rehabilitation Facilities in 1987. Today there are 200.
The treatments can cost as much as $25,000, and not all insurance plans cover them. Patients who hope for quick relief may be disappointed. "I see a lot of patients who go to these places and drop out," says David Stein, an anesthesiologist who has a pain practice in Milwaukee. "They don't stay because they're in too much pain." But others, such as cancer patient Alice Schaefer of Fox Lake, Ill., hang tough. "When my pain was bad, it was the end of the world," says the 76-year-old, who spent four weeks at the rehabilitation institute after radiation treatments damaged her nerves. "I felt as if I had tried everything, seen every top doctor. Nothing worked." That was last October. Today there's still pain, but Schaefer has learned to keep it in check. She has even gone back to an old hobby, windsurfing. "What I've learned to do is 'step over' my pain."
That sounds like New Age mumbo jumbo, admits neurologist Norman Harden, who directs the pain clinic at Chicago's rehabilitation institute. But it's not, he insists. "We've learned that chronic pain has many dimensions, physical, psychological, and social, and if we treat some of them, the whole situation usually will get better." Helping patients recognize that their pain doesn't signal danger to their bodies can go a long way toward ending their pain-tension cycle.
Chronic pain is different from what you feel when you cut your finger with a kitchen knife. That cut sends signals racing up nerves in your arm, through your spinal cord, and then to your brain, where they sound a loud alarm: "Body damage!" The brain responds with a command to tense muscles that jerk your arm back. It also triggers the release of your body's own painkillers, called endorphins.
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