Learn to control pain instead of letting pain control you
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Physical therapy is a component of pain management at Swedish.
Chronic pain is common and becomes more so as we grow older. In fact, after the age of 60, one in three people lives with chronic pain.
But how such pain affects one’s life can vary greatly, said Dr. Gordon Irving, medical director of the Swedish Pain & Headache Center. For some, chronic pain is a nuisance but for others, it can be debilitating.
Why this is so is unknown, said Dr. Irving, but the differences suggest that there are strategies that can help people overcome chronic pain and live happier, more fulfilling lives. This is the goal of the Swedish Pain & Headache Center.
Chronic pain and changes in the brain
Acute pain is the normal response to injury. Nerve fibers send signals from injured tissues to the brain where they are perceived as pain. Normally when the injury heals, the signals diminish and the pain fades.
In some cases, there is a chronic, pain-generating injury, such as damage due to arthritis, cancer and neuropathies. But in other cases, the perception of pain can persist even after the injured tissue has healed.
It is now known that the perception of pain can persist in part due to changes in the brain that occur in response to pain. In fact, such changes can be so profound, that brain scans of some patients with chronic pain show that areas of their brains have measurably diminished in size. “These and other findings have significantly changed how we think about pain,” said Dr. Irving.
Through the STOMP program, Dr. Gordon Irving helps patients get chronic pain under control.
The approach at Swedish is to help patients “to get outside of their pain, so they control their pain, instead of having their pain control them,” said Dr. Irving.
To help patients gain that control Swedish has put together a team with a broad array expertise, including pain-medicine specialists, anesthesiologists, physical and occupational therapists, psychologists and practitioners of complementary treatments, such as acupuncture.
“The center is unique in that it has a wide variety of practitioners all working on the same floor, all working together,” said Dr. Irving.
The team takes a step-by-step conservative approach to each patient, said Dr. Irving. After a detailed history and physical exam, patients may have an imaging study, such as a bone scan or MRI, if a serious structural problem is suspected. But in most cases, says Dr. Irving, such studies are not necessary and, instead, patients typically begin working on a plan to gain control their pain with physical therapy and a program developed at Swedish called STOMP, for Structuring your Own Management of Pain.
This program provides information about pain and pain treatments, but its primary focus is helping patients engage in a series of activities that have been shown to help people overcome pain. These activities include, improving sleep habits, engaging in regular exercises, addressing psychological problems, learning relaxation and “mindfulness” techniques and enrolling in an online “mind-strengthening” program that aims at reversing some of the brain changes seen with chronic pain.
The program is designed so that it can be tailored to each individual’s needs, said Dr. Irving, and allows the patient to decide on what goals he or she wants to pursue.
Coupled with the help of physical therapy and other interventions, the STOMP program helps many patients get control of their pain, but not all. In those cases, more testing might be needed with MRIs, bone scans and other imaging techniques. In some cases, it can help to look for the exact source of the pain by injecting an anesthetic under X-ray guidance to see if numbing specific nerves, joints and spinal disks relieves the pain. “It’s like finding a sore tooth,” explained Dr. Irving.
Other high-tech techniques are available for treating intractable pain. These include the use of spinal cord stimulators, which emit a low-voltage current that block pain signals, and pain-medicine pumps that can be inserted under the skin, which administer low-doses of pain medicine directly into the fluid surrounding the spinal cord.
With these and other interventions, most patients will get significant pain relief, said Dr. Irving, but not always. “In some cases, a patient comes back to the center and says, ‘Doctor, I’m feeling better – I still have my pain – but I’m able to live my life.’, said Dr. Irving, “That can be a good outcome, too.”
Links
To learn more about Swedish read other articles from the supplement:
- Brain Cancer: An Orphan Disease No Longer
- Headaches often Under-Diagnosed and Undertreated
- Medical Home: Changing the rules of primary care
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