[ 'Boot camps' treat chronic pain sufferers: biofeedback, therapy, exercise under one roof

[Guest guest]

'Boot camps' treat chronic pain sufferers: biofeedback,

therapy, exercise under one roof

By CARLA K. JOHNSON (Associated Press Writer)

From Associated Press

March 16, 2008 8:03 PM EDT

CHICAGO - 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

does not 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 (?13

billion) on prescription drugs and another $31 billion (?20 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 (?12,853), Cross said that is 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 is 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/