UW opens new pain center

The University of Washington has opened a new pain center that will focus on the prevention and treatment of chronic pain.

Chronic pain, defined as pain that persists for six months or more, is common, affecting an estimated 70 million Americans, a number that is expected to grow considerably as the U.S. population ages.

In many cases, pain persists simply because the injury is chronic, such as may be the case with arthritis.

But in other cases, pain may persist because pain circuits in the nervous system continue to transmit pain signals even when the initial injury has healed.

Similar alterations in neural circuits can amplify pain, transforming what might otherwise might have been mild, easily tolerated pain into pain that is severe and disabling.

This new understanding that pain is not just a symptom is changing the way we approach the treatment of pain, says Dr. Alex Cahana, director of the UW’s new clinic and chief of the UW’s newly formed Division of Pain Medicine.

“The current model is that pain is a byproduct of the disease–treat the disease and the pain will be gone,” says Dr. Cahana. “But today we know that pain can itself be a disease.”

The new clinic, called the UW Pain Relief Center, will use a team approach, enlisting the skills of pain medicine specialists, mental health professionals, physical therapists and other experts, says Dr. Cahana.

This interdisciplinary approach to pain management was pioneered at the UW in the 1960s by Dr. John Bonica, who was chairman of the UW Department of Anesthesiology from 1960 to 1972 and who is revered by many in the field as the “Father of Pain Medicine”.

Dr. Cahana said that if chronic pain cannot be prevented, the goal of the center will be to eliminate a patient’s pain or if that is not possible help alleviate it so that the pain is not disabling.

Because patients can experience pain in dramatically different ways, as a first step patients will be asked to complete a questionnaire to determine their “psychotype”–a sort of pain personality profile.

Because one’s response to pain can be due to both life experiences and inherited factors, patients will also have genetic testing to identify genes that have been linked to the pain perception .

“There are different genes that we know are linked to different tolerance to pain and also to different responses to pain therapy,” Dr. Cahana says.

Such psycho- and genotype information can not only help guide treatment, says Dr. Cahana, but it can also help predict which patients are at high-risk for developing chronic pain.

Steps to manage pain early on in such high-risk patients, for example before, during and  after surgery, can help prevent the onset of chronic pain, Dr. Cahana said.

Illustration of the pain pathway in René Descartes' Traite de l'homme (Treatise of Man) 1664

For those already suffering from chronic pain, interventions might range from the use of high tech nerve blocks, to medications, to exercises, to coping skills training, Dr. Cahana said.

In addition to mainstream medical approaches, the center will also offer alternative medicine treatments such as massage and acupuncture.

In addition, to patient care, Dr. Cahana hopes the center will become an educational resource to improve pain care in the community

Most patients with chronic pain are treated by primary care providers, family physicians, internists, and others who not pain management specialists. In fact, few have had more than a few hours of instruction in pain medicine. As a result, many physicians are unprepared to treat chronic pain and often become frustrated with patients who fail to improve.

“These patients get passed from physician to physician like a bad penny,” Dr. Cahana says.

There is also a tendency to send patients with chronic pain, especially those with lower back pain, too quickly to surgery, Dr. Cahana says. “Today, the practice is: if you fail two tylenols and a massage, you go to the surgeon.”

The result, says Dr. Cahana, is often more, not less pain.

Only when all else fails do most physicians think about referring a patient to a pain specialist, Dr. Cahana says. “We’re an afterthought, we’re the end of the food chain, we’re the dump.”

Dr. Cahana hopes the center can help physicians in the community do a better job managing pain and “when pain lasts longer than they think it should, send those patients to us.”

To learn more:

• Visit the Web page for the UW Pain Center
• Visit the National Library of Medicine’s MedLine Plus page on pain .

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Tags: Pain, University of Washington

Category: Provider News