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Treatment at pain center can validate the injury, substantiate the pain
Being on pain medication is not consistent with rehabilitation and recovery; purpose should be decreasing dependency on medical system
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Chronic pain may begin with an injury, but the stigma associated with seeking treatment at a pain centers can also add an additional layer of emotional pain.
“If you see someone in a wheelchair, their pain is obvious. But someone just walking out of an elevator, their plight may not be so obvious,” said Robert W. Wildmon, an administrator for the Center for Spine Care at the Shepherd Center.
The spine center treats and helps prevent chronic long-term pain through a team approach using medical treatment, physical therapy, education and counseling.
Wildmon and others at Shepherd agree that a lack of understanding by family, friends, coworkers and employers can create emotional issues for a patient already in chronic physical pain.
“The pain center can validate the injury, prove the pain, and then help the patient deal with it,” Wildmon said.
Minimize medication
David Apple, MD, medical director of the Shepherd Center, said the stigma of pain centers as simply medication dispensers for addicts and patients with imagined pain gave him pause about having Shepherd branch out into the business of pain management. The positive results of the spine center’s work, however, have made it a worthwhile venture. But the center has not been immune to the ongoing stigma of pain treatment.
“A lot of orthopedists see a pain practice as a place to send medication-addicted patients, but we can’t really help that type of patient. We are not a detox center,” said Randy Rizor, MD, medical director of the spine center.
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Rizor said the title “spine center” was changed from “pain center” in the original name to improve public perception. He said that the spine center does everything possible to minimize medication use. “Being on pain medication is not consistent with rehabilitation and recovery. We want to decrease dependency on the medical system,” Rizor said.
Rizor said pain management should be perceived as the way to address a problem that does not respond to primary care measures and needs special attention.
Since most back injuries (80%) will heal regardless of the type of treatment they receive, prescribed medications typically help those patients through to recovery. But pain persists for the remaining 20% of patients. “When pain lasts long enough, it becomes a disease,” Wildmon said.
Treat quickly
Ideally, Shepherd hopes to treat patients during the critical phase — between six and 12 weeks postinjury — when pain can be addressed and rehabilitation can help eliminate it.
When that window is lost by a patient being sent from primary care doctor to an orthopedist and back again, Shepherd can help them with selective spinal injections that diminish pain for several months, allowing for effective rehabilitation and minimizing the need for other medication.
“It’s amazing how many people have been shuffled around to numerous health care providers and are still unable to manage their pain,” said Karen Feder, physical therapist at the spine center. “In terms of rehabilitating patients, educating them is just as important as proper stretching and strengthening exercises.”
While the stigma of pain centers has been a deterrent to proper treatment, a new federal mandate may help increase awareness of pain and improve its diagnosis and treatment. “There’s a real push to treat pain,” Apple said.
Federal mandate on pain
President Clinton in 2000 signed a resolution declaring the next 10 years as “The Decade of Pain Control and Research.” The decade is intended to raise awareness and promote education and research of chronic pain, according to the American Academy of Pain Management.
Currently, the National Pain Care Policy Act of 2003 is under consideration by federal lawmakers. Goals outlined in the resolution include establishing a White House pain conference and a National Center for Pain and Palliative Care Research as well as authorizing a public awareness campaign.