'Boot camp' treats chronic pain sufferers

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'Boot camp' treats chronic pain sufferers

Biofeedback, therapy and exercise offered in four-week program

http://www.msnbc.msn.com/id/23662264/

Gayle Parseghian, left, a 55-year-old ballet teacher from Toledo,

Ohio, exercises with other patients in the pool at the Rehabilitation

Institute of Chicago during a four-week, intensive " boot camp "

program that is teaching her to manage the chronic pain that had

tormented her for more than a year.

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. Stanos, the

program's medical director.

Alarm going haywire

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. Cross, Aetna's national medical policy chief.

The patients are " frustrated and clearly suffering " and " looking for

an answer, " he said.

Quality varies

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. "