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Health

Clinics help provide relief for chronic pain sufferers

| Monday, May 13, 2002

Thousands of patients are flocking to local hospitals seeking relief from pain.

Chronic pain affects 86 million Americans and costs business and industry $90 billion each year in sick time, reduced productivity and direct medical expenses.

In the past several years, area hospitals have created formal pain management clinics or centers that helps provide relief for patients suffering from what can be devastating life-altering conditions.

The Westmoreland Pain Management Center at Westmoreland Regional Hospital in Greensburg utilizes a multidisciplinary approach to pain management.

"The Pain Center offers a different type of service and different types of procedures to manage pain," said Nancy Yurick, a registered nurse and manager of the hospital's Pain Center. "One of our goals was to become a comprehensive pain management center."

Since its establishment last July, the center sees about 120 patients per month.

"A large percentage of our patients come in with low back pain," said Dr. Keith Zora, an anesthesiologist specializing in pain management. "When you do multidisciplinary pain, you start to look into what actually causes the pain. Then we can develop a treatment instead of just covering it up with a bandage."

State-of-the-art therapies may include nucleoplasty, vertebroplasty, and neuromodulation to reduce or eliminate the cause of pain.

Nucleoplasty is a minimally invasive procedure to treat patients with mildly herniated discs. A special- access needle is placed into the disc and a wand-type device inserted into the disc through the needle. The disc material, which is protruding and compressing the nerves, is removed using heat and the channel made by the needle is then sealed.

Vertebroplasty is utilized for the on-surgical treatment of compression fractures. A metal needle and a cement-like mixture are injected into the vertebral body or weakened bone. Neuromodulation is a series of techniques using electrical stimulation or administering medications through the use of specially designed pumps.

"The treatment necessary depends on the patient," Zora said. "Most are referred for epidural steroids. And they may get long-term or short-term relief. If they get only short-term relief, then we look into other areas to provide them with pain relief."

Surgery is more effective, Zora added, if the cause of the problem is known.

"Patients come to the center because it is easier for them and it's more cost-effective," said Yurick.

"A lot of people with chronic pain haven't been helped in the past and now they can come to our center and receive expert help in managing their pain," said Sam Ranieri, vice president of clinical support services.

Indiana Hospital's Center for Pain Management began last year and since then has seen about 1,800 patients.

"When we looked at providing this service we saw a definite need for this type of program," said Loraine George, director of surgical nursing services. "Patients that needed a pain management program were treated in the operating room and the cost to the patient was much higher. We took a look at our volume and decided that a clinic-type setting to care for these patients was much more efficient."

Dr. Armando Villarreal, an anesthesiologist who specializes in pain, said the majority of patients at the Indiana center have neuropathic or nerve damage of the spine.

"Most of the treatments we provide are injections into the spine or related to the spine," he said. "About 10 to 15 percent of our patients have nerve damage of some sort and between 70 to 80 percent of the treatments are related to injections.

"Depending upon the severity of the case, we start treatment with the analgesics and then continue from there."

The Pain Management Clinic at Latrobe Area Hospital was organized into a separate unit in 1994.

"Pain management was part of our outpatient surgery department and practiced in the recovery room where we monitored the patients," said Dr. Parvathi Rao of Latrobe Anesthesia Associates, in practice at LAH. "This clinic sees a majority of patients with low-back pain and spinal compressions, disc problems, arthritis, pain from accidents and work-related injuries."

The clinic also cares for muscular dystrophy patients and those with neck problems. About 10 percent to 15 percent of patients have neck pain associated with whiplash, degenerative arthritis and spinal problems.

"We do mostly epidural steroid injections," said Rao. "Steroid is an anti-inflammatory that reduces swelling and pain. If the patient has a chronic problem, they won't get complete relief. Some patients, however, will have relief for several weeks from pain."

Nerve blocks are used to treat pain associated with shingles, a disease of the nerves caused by a virus. The Latrobe clinic sees about one to two shingles patients a month and will receive treatment from Rao, Dr. Jae Joun Jo, Dr. Juci-Ling Chang, an acupuncturist, or Dr. David W. Beyer of the Latrobe Anesthesia Associates.

"A physician has to refer a patient to the clinic," said registered nurse Christine Senak. "We need a physical and medical history of the patient. Our goal is to try to get patients off oral medications."

"Most of the patients do not have any long-term side effects from the medications," Rao added. "Fifteen percent of our patients come off medications completely."

The clinic is accredited by the American Academy of Pain Management. Other treatments available include alpha stimulation andranscutaneous Electrical Nerves Stimulation, or TENS, a drug-free method of relieving chronic pain. A device sends tiny electrical impulses through the skin to small nerves. These impulses help trigger a different message through the original pain message being sent to the brain, thus eliminating the feeling of pain.

For the patients of Westmoreland Hospice, pain may be their constant companion.

"We have medications that we can have ordered and brought to the home and given in different ways," said Bonnie Loughner, manager of Westmoreland Hospice. "Hospice patients tend to need bigger doses and different types of pain medications. There are also medications that don't have to be swallowed, but placed on the skin or under the tongue to absorb. These are especially good for someone who can't swallow or is semi-comatose."

Ten Steps from Patient to Person


1. Accept the pain. Learn all you can about your physical condition. Understand that there may be no current cure and accept that you will need to deal with the fact of pain in your life.

2. Get involved. Take an active role in your own recovery. Follow your doctor's advice and ask what you can do to move from a passive role into one of a partnership in your own health care.

3. Learn to set priorities. Look beyond your pain to the things that are important in your life and the things you would like to do. Setting priorities can help give you a starting point to lead you back into a more active life.

4. Set realistic goals. Set goals that are within your power to accomplish or break a larger goal down into manageable steps.

5. Know your basic rights. Among these are the right to be treated with respect, to say no without guilt, to do less than humanly possible and to not need to justify your decisions.

6. Recognize emotions. By acknowledging and dealing with your feelings, you can reduce stress and decrease the pain you feel.

7. Lean to relax. Pain increases during times of stress. Relaxation exercises are one way of reclaiming control of your body.

8. Exercise. With your doctor, identify a modest exercise program that you can do safely. As you build strength, your pain can decrease.

9. See the total picture. You can see that pain does not need to be the center of your life. You can choose to focus on your abilities, not your disabilities.

10. Reach out. It is estimated that one person in three suffers from some form of chronic pain. Reach out and share what you know. Living with chronic pain is an ongoing learning experience.

Source: American Chronic Pain Association.

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