Conquering Pain
Treatments for body and mind break a cycle of agony
Because pain is both a mind and body affliction, drugs help manage it, too, even drugs that aren't aimed at pain. Neurontin, the antiseizure drug Mains is taking, is one example. Galbraith also likes to use Klonopin, a drug from the same family as Valium, because it reduces anxiety. Antidepressants like Prozac remove depression's magnifying glass from the pain symptoms. Local injections of opioids into muscle trigger points can stop the chronic pain cycle as well.
But which drugs to use remains a source of some controversy in the pain-management field. Harden, for instance, doesn't like his patients to take anything in the Valium family. Patients can build up tolerances, and he worries that the drugs can interfere with the concentration needed to learn other pain-management skills. As for painkillers like Vicodin or other narcotics, forget it. "They're too hard to manage and create dependency." Russell Portenoy, who chairs the pain-medicine department at Beth Israel Medical Center in New York City, disagrees. "Opioids get a bad rap," he says, citing one study of 36 patients with back pain lasting several months. Those on opioids had less pain and less distress than the nonopioid group. About 94 percent were responsible in their drug use--they stayed within their prescriptions. After six months, 86 percent had no withdrawal symptoms when taken off the drugs.
"Right now I'm taking care of an executive who's been in chronic pain for 20 years," says Portenoy. "She's had a hip replacement, sciatica, and arthritis in her fingers. She was just very, very miserable. And I put her on methadone." The drug, which has a slight molecular difference from morphine, is a powerful painkiller without the addictive potential of its cousin. "Now she sleeps better, her mood is much better." The key is not prescribing addictive drugs to patients with addiction-prone personalities, he says, and using the drugs with the support of a multidisciplinary program, not by themselves.
Still, a multitherapy approach is no guarantee of success, whether drugs are used or not, say some experts. "The patient's care can become fragmented," says Fishman. He worries that patients are pulled in different directions by different specialists and physicians. Patients can get confused and drop out if they can't turn to a single doctor for advice.
The high cost of a multidisciplinary treatment can prevent some pain sufferers from seeking help in the first place. Columbia, for instance, costs about $25,000 for the full six-week course. Some insurers will cover the cost if they know the program; Wisconsin's Blue Cross/Blue Shield, for example, covers treatment at Columbia.
For a growing number of patients, those dollars are buying a real reduction in human suffering. Bill Mains is back at work and using relaxation techniques to keep the cycle of pain, stress, and more pain under control. "Flare-ups are still scary," he says. "I had one my first day back. But now I have techniques that help me work through them. I think I'm finally understanding this is a lifestyle change." And Rick Rogowski? Neck straightened, he's on his way back to work, too. His occupational therapist says, without a hint of irony, that he has a real good head on his shoulders.
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