Conquering Pain
Treatments for body and mind break a cycle of agony
With chronic pain, that same alarm is triggered over and over, sometimes by an ongoing disease like arthritis. At other times it continues long after the original injury has healed, perhaps because of damaged nerves. Either way, the endless alarm "sets off some really horrible things, because your body just isn't set up to handle long-term pain," says Galbraith. Constantly tensed muscles, for instance, make nerve endings more sensitive, leading to more pain and, not surprisingly, more muscle tension. You begin to hold your body in guarded positions that favor the hurt areas but stress new muscles, spreading the pain. As you become less active, muscles get weaker. You get depressed. Low moods magnify pain sensations. After a while, pain nerves seem to "cross wires" with nerves that transmit gentler sensations, so even a light touch is agony. These vicious loops of pain keep circling around your body, growing tighter with every passing month and year.
Breaking the cycle. Bill Mains enrolled in Columbia's program to break out of the loops. About 10 people, gathered around a conference table at Columbia, are going to try to help. One, rehabilitation physician James Lincer, summarizes Mains's plight: the fall on the ice, an operation two months later to remove a torn disk, anesthetic injected near the spine to numb the nerves--known as an epidural block--the next year and another one the year after that. "Each time the pain returned," Lincer notes.
Galbraith weighs in from the psychological side, giving the results of a lengthy personality test, which reveals depression and exhaustion. Olson, the physical therapist, reports that Mains has a lot of stiffness around his waist and hips.
Someone opens the door and Mains, who has been waiting outside, walks in. "How's it going?" Galbraith asks. "OK. But the gossip from the other patients at lunch tells me it will get a lot harder in the next few weeks," Mains answers.
"True," says Galbraith, smiling. After some chit-chat, the group maps out a strategy for dealing with Mains's pain: physical therapy to correct an imbalance in his posture; occupational therapy to teach him how to lift things using his legs instead of his back; biofeedback to train him to relax. Mains agrees to try drugs, including antidepressants and one called Neurontin. It was developed for epilepsy, but it also dampens the nervous system's alarmed response to pain.
Over the next three weeks, Mains will follow a routine that takes him from therapy to therapy for eight hours a day. A packed schedule has benefits of its own, says Chicago's Harden. "You have to remember these are depressed, discouraged people, and a lot of them have become virtual shut-ins. So we give them a place to go, appointments to keep for a full day, and they're not just sitting at home thinking about how much they hurt."
The routine also gives the therapists a chance to see people like Mains daily, check their progress and make adjustments. "I'll hear from the physical therapist that a patient is having trouble stretching," says Steve Rice, a biofeedback therapist at Chicago. "So we work on releasing those muscles."
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