Date:
03/16/2008 12:53 PM 'Boot camps' treat chronic pain sufferers: biofeedback,
therapy, exercise under one roof
By CARLA K. JOHNSON
Associated Press Writer
CHICAGO (AP) _ Ballet teacher Gayle Parseghian
thought she might never dance again after a back injury while
moving heavy furniture left her with unrelenting pain.
But an intensive, four-week "boot camp"
got the 55-year-old dancer from Toledo, Ohio, back to the
barre. The program at the Rehabilitation Institute of Chicago
taught her to manage the chronic pain that had tormented her
for more than a year.
"It affects your relationship with your
spouse, your family, your friends, your boss," she said.
"It's like you're trapped in your body and you can't
get out. It's a feeling of being completely out of control."
New research suggests chronic pain affects
the brain's ability to rest, disrupting a system that normally
charges up some brain regions and powers down others when
a person relaxes.
"I ask a patient who has had chronic
pain for 10 years to put the mind blank, don't think about
anything," says Dr. Dante Chialvo, a researcher at Northwestern
University's Feinberg School of Medicine who is not involved
with the boot camp.
MRI images show the pain sufferer's brain
lighting up, but not as a normal brain at rest would, he said.
"There is an objective biological difference in the brain."
The early findings could explain the sleep
disturbances, decision-making problems and mood changes that
often accompany chronic pain, he said.
And they could explain why the boot camp approach
worked for Parseghian.
The Chicago program, affiliated with Northwestern's
medical school, attacks pain on three fronts — biological,
psychological and social. It doesn't claim to cure chronic
pain, but instead gives patients tools to lessen its hold
on their lives.
Patients spend Monday through Friday stretching,
exercising and moving in new ways. They meet with a physician,
an occupational therapist, a physical therapist, a biofeedback
therapist, a clinical psychologist and a movement specialist.
They may address depression or sleep problems
or adjust their medications. And they learn from the other
patients in the program.
Getting all of these things under one roof
differs from most approaches to treating chronic pain, said
Dr. Steven Stanos, the program's medical director.
Patients know the drill. In the fragmented
world of health care, they bounce from internist to chiropractor
to massage therapist to surgeon — with none of the experts
sharing information.
"You will try anything and everything
to get out of the pain," Parseghian said. "You discover
all of your efforts are fruitless and you have spent monumental
amounts of money."
She tried herbal patches, vitamins, injections,
prescription narcotics and a battery-operated device that
uses electrical impulses to block pain. Nothing worked.
Surgery would have been next. She was in a
surgeon's waiting room when she read an article about the
boot camp.
If acute pain is the body's alarm system,
alerting to injury-causing dangers, then chronic pain is an
alarm going haywire, screaming a warning long after the danger
has passed.
The American Pain Society estimates millions
of Americans are in chronic pain from backaches, jaw pain,
headaches and fibromyalgia, a mysterious syndrome marked by
muscle pain and fatigue. Sore spines alone cost billions of
dollars each year.
In 2005, Americans with aching backs and necks
spent $20 billion on prescription drugs and another $31 billion
for outpatient doctor visits, according to a recent study
in the Journal of the American Medical Association. Total
spending on spine treatments increased 65 percent from 1997,
adjusted for inflation. But rising alongside that was the
proportion of people with spine problems who reported limited
function.
Such spending with such poor results gets
insurance companies' attention.
Chronic pain patients' medical and pharmacy
bills "show up on our radar," said Dr. James Cross,
Aetna's national medical policy chief. The patients are "frustrated
and clearly suffering" and "looking for an answer,"
he said.
Although boot camp-style programs cost up
to $20,000, Cross said that's cost-effective compared to the
procedure and pill merry-go-round. The company cites studies
showing patients who have completed boot camp programs experience
lasting pain reduction and lower stress. Aetna also believes
patients completing the programs are more likely to return
to work and less likely to seek other expensive treatments.
Other insurers also cover the programs, but
convincing more companies will take more evidence, said Dennis
Turk, a pain researcher at the University of Washington in
Seattle and a believer in the approach.
It's unclear what combination of therapies
works best for which patients and whether four weeks are needed
for everyone, Turk said. Patients should be cautious because
quality varies, he said.
"Anybody out there can put up a sign
and say, 'I'm a comprehensive pain rehabilitation program,'"
Turk said. He recommended programs affiliated with university
medical centers and the nearly 100 interdisciplinary programs
accredited by the Commission on Accreditation of Rehabilitation
Facilities.
Two weeks into the boot camp, Parseghian's
husband visited her in Chicago for the weekend. They toured
an art museum and went shopping together. Later, he phoned
her with an observation.
"You didn't say one thing about your
pain or the back. That used to monopolize our conversations,"
her husband told her.
That impressed Parseghian. "I guess I
hadn't realized just how much my back issue had really manifested
itself into our relationship," she said.
Two weeks later, she headed home with a detailed
schedule for her first week back, including plenty of time
to relax. She knew the staff would check with her in another
four weeks to see how she was doing.
And she was armed with breathing techniques
and phrases to repeat when she suffered a flare-up: "This
has happened before and I have survived it. I'm going to be
OK."
During her second week home, she reported,
"I took my first ballet class last week."
"I thought that day would never come,"
she said. "Little by little, I'm regaining the control
in my life that I thought the injury had robbed me of."
———
On the Net:
Commission on Accreditation of Rehabilitation
Facilities: http://www.carf.org/
Rehabilitation Institute of Chicago: http://www.ric.org/
