Tackling the Torment
Enhancing conventional medicine with a healthy dose of alternative
and complementary therapies provides relief for patients at the
IU Integrative Pain Center.
Patient, heal thyself may be an appropriate mantra at the Indiana
University Integrative Pain Center.
Pain is a complicated physiological and psychological syndrome.
As IPC Medical Director Palmer MacKie, MD, tells his patients, there
are no quick fixes and no magic pills. When new patients learn the
IPC is unlikely to end their pain, and that pain control depends
heavily on behavior and psychological adaptations, many are disappointed.
Instead of the word “cure,” Dr. MacKie talks about
increasing function. “If we can double what they are doing,
even with the same level of pain, that’s significant progress,”
he says. “The idea is functional recovery with, optimistically,
some measurable degree of pain relief.”
Although the amount of pain relief varies, research shows that
a thirty-percent reduction is considered significant for people
with chronic pain.
The Center’s behavioral specialist Cathy Scott, ACSW, LCSW,
MSW, says most patients expect more than is realistic when they
enroll at the Center. “Cure is a very bad word to use. Patients
are often too passive; they want a pill and they want to be cured.
We’re not about curing pain – we’re about management.
We try to help in healing and palliation.”
From Opiates to Optimism
Freelance photographer Treva Mitchell was more than willing to
accept the Center’s approach to pain management. She was desperate
for relief from weekly migraine headaches and tired of the disorientation
that comes with some medications.
“The doctor I was seeing really believed in pushing the opiates,”
the Indianapolis resident recalls. “He just kept rotating
the medications.”
Continuing that regimen was not in Mitchell’s game plan since
she had young children at home and couldn’t be dysfunctional
for hours or days at a time. “It’s hard to be a good
mom when you are throwing up or in a stupor in bed in a darkened
room.”
Mitchell found the Center’s approach refreshing because it
gave her an opportunity to be an active participant in her treatment.
“There are a ton of people who drop out during the six-week
orientation program, and that is their mistake,” she says.
“These people have a chance to help themselves. All you need
is someone to show you how.”
The concept presented during the orientation is challenging, even
surprising to many potential patients, and some don’t return
for follow-up treatment. Center visits are by referral only, and
patients sent there have endured chronic pain for two years or more.
Most of the patients have exhausted their primary care physician’s
aptitude for treating chronic pain, and many have exhausted their
own patience.
“Most of the time, a primary care physician can help patients
manage pain while their bodies heal,” says Dr. MacKie. “If
the pain becomes chronic, a more comprehensive treatment approach
is needed. Otherwise patients can become disabled, depressed and
alienated from family, friends and their life.”
While patients referred to the Center have a variety of ailments,
the most common include diabetic neuropathy, shingles, sciatica,
spinal arthritis, failed back syndrome, osteoarthritis and fibromyalgia.
Dr. MacKie and the Center’s staff have numerous approaches
to reduce or modify the pain. Medication is employed, but psychological
and lifestyle approaches are more common.
Prescription: Optimism
“The principal modality we offer is optimism,” says
Dr. MacKie modestly. “I tell them they can feel better and
do more.”
“Do more” is his clinical yardstick. Improved function
is measured inch by inch, day by day for some of his patients.
The first contact IPC has with potential patients is a letter explaining
the program and inviting them to attend a six-week pain management
program overview: “Taking Control of Your Pain, Taking Control
of Your Life.” About 180 people are invited to enroll every
six weeks. Typically, twenty to thirty start the program and two-thirds
complete it.
Those numbers may seem low, but Dr. MacKie explains that many people
are unable or unwilling to attempt modifying their behavior. Instead,
the pain controls them and their lives in ways people who do not
suffer chronic pain cannot understand.
“Pain devastates you on many levels,” Scott says. “It
affects all aspects of a person’s life. It affects them financially.
It affects their relationships. It affects their self-esteem.”
Pain perpetuates a vicious cycle of depression and loss of self-esteem
leading to increased pain leading to more depression and pain, Scott
adds. “They feed on each other. The more despair, the more
pain.”
This is the psychological element Scott works to help patients
understand and control. But before treatment begins, the IPC team
wants potential patients to know exactly how the program works and
the tools it offers.
Week one begins appropriately with a review of the physiology of
pain, followed by a session on the psychological, behavioral, social,
economic, spiritual and physical effects of pain. The second week,
Dr. MacKie launches into goal setting for improving function. To
augment that concept, patients participate in their first of many
discussions on mind/body control.
Over the next month, they strengthen their arsenal of pain-fighting
techniques by learning about common medications for pain, tricks
for better sleep, acupuncture and other oriental medicine approaches,
positive thought reinforcement, breathing techniques, meditation,
guided imagery, hypnosis and a host of other approaches.
Scott, who has extensive training in the techniques of mind/body
control, says much of what she addresses during the orientation
and during one-on-one sessions is “retraining the person’s
thinking, retraining their bodies to relax.”
The Alternate Route
Treva Mitchell already was a proponent of complementary and alternative
medicine for pain relief. She had tried biofeedback, which she characterized
as semi-successful because her insurance stopped covering the sessions
before she learned how to effectively implement the process. She
says she was learning to listen more intently to her body and improve
circulation in the blood vessels in her head.
Twenty-six when she first began having migraines, Mitchell’s
headaches became more frequent at age thirty-three after her first
child was born. Three years later, when her second son was born,
her migraines became even more debilitating.
“I feel like Chase spent the first year of his life in his
crib in a darkened room,” she recalls.
Dr. MacKie says Mitchell suffered from three types of headaches:
migraines, cluster migraines and sinus headaches. They nearly were
a daily event and could last for anywhere from a couple of hours
to a week.
In her headache journal shortly after she began the IPC program
in December 2001, Mitchell recorded headaches on twenty-five of
the month’s thirty-one days. Today, she can go weeks without
a headache.
Her hat trick of health, as she calls it, is relaxation and CAM
(complementary/alternative medicine). She practices yoga religiously
once a week, receives acupuncture from Dr. MacKie once a month and
gets massage therapy at the IPC.
At one time migraines or the fear of them filled her days. Now
her sons do. Between 4-H, scouting, swim lessons, golf and football
practice and guitar lessons, she barely has time for mowing the
yard, cooking, or the myriad other tasks moms perform. And for that
she is grateful.
“I’m investing less than seven hours a month on headache
prevention and getting no headaches,” she says.
Blissful Thinking
For some IPC patients, the road to recovery can be longer and involve
other options available to the pain specialists such as physical
therapy, surgical referral, pain medication, spinal injections,
chiropractic treatments, hypnosis, oriental medicine, and various
mind/body therapies.
The spiritual side of the human condition is critical to pain management,
says Dr. MacKie.
“A number of our patients have periods of grace when pain
melts away, and frequently it involves a grandchild or church activity
– situations that enable the patient to lose himself, to unite
with something beyond the body and its suffering.”
One patient, who had his necked bolted together in three places,
had a grossly limited range of motion. “He had pain every
hour of every day except when he was singing in church. At that
point, he didn’t feel pain,” Dr. MacKie recalls. “Participating
and celebrating and being in that presence was something that allowed
him to not feel the pain. Cathy [Scott] worked with him to try to
extract elements of that experience and relive them at other times.”
Indeed, focusing on pain-free moments can be fundamental to a patient’s
progress. “The idea is to seek those special pain-free, blissful
moments when you are holding your child or grandchild and seeing
him smile – to learn how to take that joy, that gift and transcend
it to other times,” says Dr. MacKie.
How strongly does Dr. MacKie believe in empowering the spirit/mind/body
connection to manage pain? Let’s just say that it isn’t
unusual for his patients’ prescriptions to read simply: Increase
bliss activities.
Mary Hardin is media manager in IUSM's Office of Public and
Media Relations and a frequent contributor to this magazine.
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