Director: Michael R. Clark, M.D., M.P.H.
Nurse Manager: Mary Cooper, R.N., M.S.
The inpatient unit is located in the Meyer Building of the Johns Hopkins Hospital, which also houses the departments of Neurology and Neurosurgery. The Pain Treatment Program (PTP) draws on the multidisciplinary expertise of various specialties for coordinated, multi-departmental consultations, including physical medicine and rehabilitation, orthopedic surgery, internal medicine, neurology, neurosurgery, anesthesiology, gynecology, oral surgery and dental medicine. The unit is staffed by physicians, nurses, social workers, nurse practitioners, physical therapists and other specialists who are trained in the treatment of chronic pain.
ADMISSION CRITERIA
• Chronic pain or other physical complaint (e.g., fatigue, dizziness) for at least six months
• Medically stable and cleared for admission by referring doctor
• Agreeable to admission for the purpose of rehabilitation
• Pre-authorized for admission by health insurance (if applicable)
SUMMARY OF TREATMENT PRINCIPLES AND METHODS
Full evaluation and clarification of diagnoses by our multidisciplinary team
- Comprehensive evaluation, including interdisciplinary consults (if needed)
- Review of patient records
- Formulation of individualized treatment and rehabilitation plan
Evaluation of medications for effectiveness, side effects, dependency, and interactions
- Detoxification from medications (e.g., opioids, benzodiazepines, muscle relaxants)
- Reduction of pain and discomfort to the greatest degree possible
- Use of novel pharmacological regimens
Treatment of the psychological distress that often accompanies intractable pain
- Treatment of symptoms such as insomnia, depression and anxiety
- Training in communication, interpersonal and coping skills
- Creation of a daily routine for optimal management of symptoms
Improving physical function
- Normalization of body mechanics
- Increase of activity level and endurance
- Use of targeted myofascial treatment
WHAT CAN YOU EXPECT?
If you adhere to your individualized treatment program during and after hospitalization, then you can expect a reasonable degree of relief from your pain and improvement of your function. Some patients are completely cured of their pain, and most receive enough benefit in terms of physical functioning and quality of life to have made their efforts worthwhile.
Patients must bring to the program a willingness to work hard and an openness to learn new ways of dealing with pain, and then apply the principles they learn in the program to life at home following hospitalization.
TREATMENT APPROACH
Patient-Focused
Our treatment goal is to reduce chronic pain and accompanying emotional and medical complications. This can only be accomplished when a patient forms collaborative relationships with a staff of experts. The program is highly structured and active with an emphasis on promoting independence. It is completely voluntary. You may refuse to comply with the treatment plan at any time and be discharged from the program.
Medications
Immediately upon admission, your need for medication will be assessed and all medications that you are taking will be reviewed. Many medications produce side effects or have harmful interactions with other medications — all without relieving pain significantly. We will want to eliminate the use of harmful or ineffective medications and to educate you about pharmacological treatments for pain and related conditions. If you have developed a drug dependence disorder (addiction), detoxification and specialized drug treatment services are available.
Treatment of Insomnia, Depression and Anxiety
The attending faculty members are psychiatrists. This does not mean that we suspect your pain is not real. Psychiatric symptoms such are insomnia, depression, and anxiety are often generated by chronic pain. It is very important that they are assessed and treated for full recovery. This may require that you take some psychiatric medications that are commonly used to relieve pain and accompanying psychiatric symptoms. You will also undergo standard psychological testing designed to help you understand your particular strengths and vulnerabilities when faced with the stress of living with a chronic pain condition.
Physical Activity and Behavior Modification
Chronic pain often leads to loss of physical activity and general deconditioning which contributes to a patient’s disability. In the first few days after admission, your physical capacity will be assessed and a program of individual and group exercises will begin, as well as individualized physical therapy. We expect progress during your hospitalization, but this activity program is designed for you to continue on a long-term basis to improve your physical ability and function. As part of this process, your reaction to pain will be observed by staff and suggestions will be made as to how to change some behaviors to move the pain experience “out of the spotlight.”
Transcutaneous Electrical Stimulation (TENS)
Depending on your specific type of pain, you may be treated with an externally applied TENS unit to determine if transcutaneous electrical stimulation will benefit you. TENS is thought to work by “overriding” or blocking the transmission of pain signals from the body to the brain.
Relaxation Training
You will learn techniques to decrease muscle tension that can increase pain. The same training will help direct attention away from the pain experience through active, focused exercises involving breathing, progressive muscle relaxation, and imagery.
Biofeedback
Biofeedback equipment will be used to enhance you sense of having control over your physical and mental function. The experience of many patients as well as pain research has taught us that losing a sense of mastery over one’s body can be a particularly distressing aspect of chronic pain. In addition to helping to restore your sense of control, biofeedback will also enhance your relaxation training and other coping skills.
Group Therapy
Daily group therapy sessions with patients on the unit provide a forum to explore the challenges of coping with chronic pain and its toll on relationships, work, and emotional life. These meetings provide the opportunity to learn from other patients and decrease the loneliness and isolation that often come with chronic pain syndromes.
Family Involvement
A social worker and other staff will examine with you the impact of your illness on your family. Family members will be asked to attend at least one special education program conducted on the weekend. Additional meetings may be recommended as part of your treatment.
Treatment for Sources of Pain
As these other activities commence, we will attempt to clarify the medical aspects of your pain. Pain is a complex phenomenon of the central nervous system. Your case will be reviewed in conference with other relevant disciplines such as neurology, neurosurgery, anesthesiology and orthopedics. If we can find a specific medical treatment that will significantly improve the pain problem, of course it will be offered to you.
SAMPLE Pain Treatment Program Daily Schedule
8:00 a.m. Breakfast and Rounds (meeting with the team)
10:00 a.m. Physical Therapy
11:00 a.m. Occupational Therapy or RN Group
12:00 noon Lunch
1:00 p.m. Cognitive Behavioral Therapy Group
3:00 p.m. Social Work Psychotherapy Group
5:00 p.m. Dinner
6:00 p.m. Classes (Topics may include Pain Management,
Medication, Stress Management,
Relaxation and Communication)
LENGTH OF TIME IN THE HOSPITAL
The expected length of stay on the inpatient unit is two weeks, at which time patients are transferred to the Day Hospital, where the expected length of stay is an additional two weeks. This stay may be extended if the team feels that patients need more time in treatment before returning home. We work together with you to formulate your treatment goals and to determine a discharge date. Of course, you may choose not to continue in the program and be discharged at any time. The principles and practices that we begin with you in the hospital are meant to be continued once you return home.
