Conquering Pain
Treatments for body and mind break a cycle of agony
Relax. Relaxing on command is not easy, but it's crucial to breaking the link between pain and tension. Rice begins by showing patients the contrast between a tensed and relaxed muscle. A patient tenses muscles in his feet and then tries to relax them to highlight the difference, then does the same thing for other muscles. Next, the therapist hooks sensors to the skin over muscles to measure their tension. A biofeedback machine lets the patient see on a screen or hear from a tone how tense or loose muscles are getting. The goal is to relax without a machine.
The sense that patients' bodies are within their command is a big boost. Rick Rogowski, 31, a human-resource specialist in Chicago, woke up six years ago with what felt like a sprained neck. The pain worsened as he strained other muscles by tilting his head to the side, and he felt excruciating spasms every time he tried to hold his head erect. After three weeks in the Chicago program, he notes, he can feel the spasms coming on--"they don't sneak up and surprise me"--and uses progressive muscle relaxation to ward them off.
Physical therapy--strengthening and conditioning long-inactive bodies--tends to be much harder on patients than relaxation-oriented biofeedback. "Remember, we're dealing with people who've guarded themselves against pain by not moving," says Scott Fishman, chief of the division of pain medicine at the University of California-Davis Medical Center. But exercise releases pain-killing endorphins and makes the body more resilient.
Tinameri Turner is in Week 3 of the program at Columbia and Year 15 in her battle against fibromyalgia--muscle pain across her body with several exquisitely tender "trigger points." Every day her therapist has her stretch and do some very light lifting. "I dread physical therapy. I don't mind the stretching stuff. I mean, certainly it hurts, but it's a good hurt. But the strengthening stuff that they're trying to have me do is just so difficult," she says. Sam Marjanov, age 46, another pain patient, goes through a daily struggle with 10-pound weights.
Occupational therapy teaches patients how to perform daily tasks without reinjury. For Rachel Galarza, it means playing with putty. Last summer the 39-year-old woman threw out her back and had disk surgery. But the back spasms continued and she began to develop headaches, eventually landing at Columbia. "When I got here, I was wondering: 'Why am I rolling out putty? It's my back that hurts.' " But rolling putty strengthens the fingers and wrists. When Galarza has to carry a package, she can bear more weight on those body parts, rather than taking the weight on her torso and straining her back.
Mind and body. Rogowski is learning how to manage the emotional strain in individual counseling sessions. "I'm really realizing that when I came here, I was going through this cycle of frustration and incredible anger. I was frustrated with my doctors, and at home I just wanted my wife to leave me alone." Counseling has helped him come to terms with his pain. "I don't know if it can be cured, but I know I can learn how to manage it." For Jackie Gorecki, who walked gingerly into Columbia two years ago after being rammed by a forklift in a warehouse, help came from the other patients. "At first I didn't want to be one of them. It seemed incredibly unfair; I was only 20 and should have been out having fun. But I needed to hear what they had to say and learn how they coped."
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