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Treating the Person, Not Just the Pain
Like diabetes, chronic pain is a condition that needs to be managed on many fronts, says Dennis Turk, MD, the John and Emma Bonica professor of anesthesiology and pain research at the University of Washington School of Medicine in Seattle and president of the American Pain Society. "When we treat diabetes, we use insulin, but we now know that all people with diabetes also need to watch their diet and exercise, in addition to the use of insulin therapy [and other diabetes medications]. The same [multidisciplinary approach] is true with pain," he says.

Turk explains how-and why. "From a biomedical standpoint, we [tackle] the tissue source of the pain with medication or surgery. From a psychological standpoint, a significant number [of patients] have related depression and anxiety. From the social side, people with chronic pain may engage in bad behaviors that can make things worse.

"We need to find ways to treat the person, not just the pain," he says.

Treatment should also include coping and pain-management skills. "When you have chronic pain, you think that anything you do will hurt you further --- so you become a recluse," Sienkiewicz says. "The program enabled me to see that I won't hurt myself if I become active again."

Managing pain is often a family affair, says Stanos. "Pain psychologists work with the family, who want to help but go about it the wrong way. As a result, the patient gets lazy and passive because they know their family members will do it for them."

Some programs such as RIC's also include a recreational therapist. "A therapist takes them out and into the community," explains Stanos, "to use techniques learned in boot camp to get back to the activities they once loved. The problem in chronic-pain patients is that they are not coping well ... but learning to live better with the pain can decrease the ongoing use of medications."

"That's the best thing the clinic did for me," Sienkiewicz says. "I tried to fix the pain and get rid of it, as opposed to accept it and learn how to live with it."

Alternative Therapies Biofeedback, Deep Breathing, and More
Many of these programs use biofeedback and deep-breathing techniques. Biofeedback measures bodily functions, such as breathing, heart rate, and muscle tension. Patients learn to train their minds to control these functions. When first learning biofeedback, patients have sensors attached to their bodies and to a monitoring device that provides instant feedback about their pain. A biofeedback therapist then teaches them physical and mental exercises to help control that function.

The results are displayed on the monitor so that patients can see what works to relieve their pain. "People in chronic pain have elevated levels of stress, and we teach them to control their anxiety and reduce tension with a deep-breathing technique," Stanos says.

Patients in pain can learn much the same method at Stanford University's Pain Management Center, where they undergo cutting-edge functional magnetic resonance imaging (fMRI) scans to visualize pain in the brain by mapping blood flow. Then doctors feed signals back to the person, showing him or her how pain can intensify with stress and, conversely, improve with distraction techniques such as music or deep breathing.

Acupuncture is on the treatment roster of some major pain clinics, such as The Cleveland Clinic's Pain Management Center, which has acupuncturists like Timothy Rhudy, MS, Lac, on staff. "Clinics would never have non-MDs and acupuncturists in the past," he says.

According to Rhudy and other practitioners of acupuncture, this treatment uses needles to correct energy-flow imbalances in the body's qi, or energy patterns flowing through the body. Diseases, including chronic pain, occur when there are disruptions in this flow, they say.

But acupuncture is "no quick fix. It's part of an integrated approach," Rhudy says. "Acupuncture can sometimes jump-start a patient to get them to make changes in their own life, whether trying tai chi or yoga, or finding other ways of staying active and keeping the body flexible and working the muscles to keep pain at bay." In most cases, acupuncture requires multiple treatments over several weeks.

In a study of 570 people with knee osteoarthritis, those who received acupuncture in addition to anti-inflammatory pain relievers significantly improved knee function and had decreased pain compared with people who only took medication. This study appears in the Dec. 21, 2004, issue of the Annals of Internal Medicine.

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