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School of Medicine
Director: Michael R. Clark, M.D., M.P.H.
Nurse Manager: Mary Cooper, R.N., M.S.
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 evaluation and treatment of chronic pain.
• 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 including a signed Admissions Agreement
• Pre-authorized for admission by health insurance (if applicable)
SUMMARY OF TREATMENT PRINCIPLES AND METHODS
Full evaluation and clarification of diagnoses by our interdisciplinary 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
- Reduction of pain and discomfort to the greatest degree possible
- Use of novel pharmacological regimens
- Tapering from ineffective medications (e.g., opioids, benzodiazepines, muscle relaxants)
Treatment of the psychological distress that often accompanies intractable pain
- Treatment of depression and anxiety
- Treatment of symptoms such as insomnia, fatigue, and cognitive problems
- Training in communication, interpersonal and coping skills
- Creation of a daily routine for optimal management of symptoms and functioning
Improving physical function
- Normalization of body mechanics
- Increase of activity level and endurance
- Use of targeted myofascial treatment (if applicable)
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 relieved 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.
Our treatment goal is to increase function including the reduction of chronic pain, accompanying emotional and medical complications, and physical deterioration. 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.
Immediately upon admission, your need for medication will be assessed and all medications that you are taking will be reviewed. Most chronic pain conditions, especially neuropathic pain, can be treated with medications and many options are available. Unfortunately, medications produce side-effects or can have harmful interactions with other medications — all without relieving pain significantly. We will want to eliminate the use of ineffective medications and 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 Depression and Anxiety
The attending physicians are psychiatrists. This does not mean that we suspect your pain is not real. Psychiatric symptoms such as depression and anxiety often accompany chronic pain. It is very important that they are assessed and specific causes treated for full recovery. In many cases, medication may be recommended to specifically address these problems.
Physical Activity and Behavior Modification
Chronic pain often leads to a 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 level of function. As part of this process, suggestions will be made as to how to change some behaviors to move the pain experience “out of the spotlight” and become more productive.
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.
You will learn techniques to decrease muscle tension or increase blood flow that can reduce certain types of pain. The same training will help direct attention away from the pain experience through active, focused exercises involving breathing, progressive muscle relaxation, and imagery. These techniques decrease anxiety and promote a sense of actively taking control of one's problems.
Biofeedback equipment will be used to enhance you sense of having mastery over your physical and mental function. The experience of patients as well as pain research has taught us that catastrophizing over one’s symptoms can be a particularly distressing aspect of chronic pain.
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 emerge with chronic pain syndromes. Cognitive-behavioral principles provide the foundation for discussing how patients can objectively analyze their circumstances and sustain their function despite the challenges of illness.
Social workers and other staff will examine with you the impact of your illness on your family. Family members will be asked to participate in your care to help increase forms of support and emphasize the benefits of close personal relationships. Special education sessions are conducted on the weekend and additional meetings may be recommended as part of your treatment.
LENGTH OF TIME IN THE HOSPITAL
The length of time in the hospital for each patient depends on many individual factors. 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. Stays may be extended if the team feels that patients need more time in treatment before transitioning to the Day Hospital or 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. every attempt will be made to communicate with your outpatient care to ensure a coordinated approach for continuing your rehabilitation after discharge. If additional outpatient services are needed, the PTP will make these referrals with specific recommendations for your overall treatment plan.
SEARCHING FOR THE SOURCES OF PAIN
While finding a cure for the cause of your pain would be ideal, the search can lead to even more problems. Repeated consults, diagnostic tests, and therapeutic interventions carry the risk of making pain worse and even causing new types of pain. They cost time, money and other resources that delay rehabilitation. Every patient's case will be reviewed and if no coherent explanation for chronic pain exists, the necessary evaluation will be performed. However, patients must be open to hearing the PTP's formulation and avoiding the trap of having just one more consult, test, or surgery.