On an April day in 2017, Chris Sheckells was renovating a house in East Baltimore. As he cut into a 2x4 using a circular saw, it kicked back and he cut off nearly all of his thumb and mangled the index finger on his left hand. He rushed himself to Johns Hopkins Bayview Medical Center, hand wrapped in his shirt, where doctors performed emergency surgery to reattach his thumb.

Following the surgery, Sheckells, who was in recovery and had been clean for years, was prescribed morphine and oxycodone to treat the pain — pain that only increased in the ensuing weeks, as he underwent five more hand surgeries. To manage the pain, he relied on increasingly higher and dangerous doses of those opioid medications.

When he arrived for his first appointment at the newly launched Johns Hopkins Personalized Pain Program (PPP) a few months after the accident, Sheckells, 49, was taking 120 milligrams of morphine and 60 milligrams of oxycodone each day. That’s a combination more than double the amount that the U.S. Centers for Disease Control and Prevention considers high overdose risk.

By this point, Sheckells had been off work for four months and was homebound, feeling stressed and scared. An HVAC master technician, he’d been told he wouldn’t be able to work in his trade anymore. His business partnership with a friend fell apart.

He suffered phantom pains and intense aches in his hand, sometimes running up his whole arm. He feared the pain would never go away and he’d be reliant on opioids the rest of his life. At the same time, he was anxious about tapering down, having been through opiate withdrawal before. The opioids clouded his thinking, giving him “tunnel vision,” he says.

“There was a side that was OK with taking that amount of opioids because I didn’t actually have to deal with the psychological trauma of being without parts of my hand anymore,” he says. “In the fear, there was a lot of security in taking those pills.”

Today, with the help of clinicians in the Johns Hopkins pain program, particularly the unwavering support of psychiatrist Traci Speed, Sheckells has been completely off of opioids for about three years. He feels the best he ever has. While working with Speed, he navigated a number of life challenges, including additional hand surgeries and the death of his father. He still sees her every two months — as other patients in the program do, even after they’ve weaned down their opioid use.

“Dr. Speed has been an absolute godsend for me,” says Sheckells. “In a lot of ways, that pain clinic has saved my life.”

Says Speed, “Oftentimes patients come to me and say, ‘Everyone else has said there’s nothing more I can do, and you’re telling me that there are all these treatments I haven’t even tried yet?’ I really like being able to help guide people toward the life that they actually want to live.”

The PPP team also includes anesthesiologists Marie Hanna, the program’s founder and medical director, Ronen Shechter, who is also director of the Johns Hopkins Acute Pain Service; and two triage nurse practitioners. Together, they see about 1,200–1,400 patients per year. Importantly, this core team maintains strong ties with Johns Hopkins specialists in integrative medicine, physical medicine and rehabilitation, and addiction medicine, who can be brought in depending on an individual patient’s needs.

‘A Big Deal’

The Johns Hopkins Personalized Pain Program, the only program of its kind in the country and only one of two in North America, works with patients like Sheckells to wean them off opioids — or get them down to lower, safer doses — while finding other ways to manage pain, with an emphasis on mental health.

While most patients are referred before or after surgical procedures that will have them taking opioids during recovery — such as back surgeries, spinal fusions or amputations — many have been using opioids for years due to previous injuries and procedures.

Being on high doses of opioids is a varied experience. For some patients, it helps them live functionally day-to-day. But for most, Speed says, the side effects prevent living life to its fullest. Long-term opioid use can even cause opioid-induced hyperalgesia, increasing pain sensitivity.

Speed’s presence on the PPP team as a psychiatrist is one of the program’s key differentiators. “When we work with people who’ve lived for years with chronic pain, it’s absolutely critical that we explore areas like depression, anxiety and post-traumatic stress, which are often underdiagnosed and undertreated,” Speed says. “Psychiatric comorbidities, whether they started before or after the pain, can make treating pain much more complex.”

While most pain programs have psychologists, her expertise in neuromodulating medications opens up more treatment pathways.

The multimodal approach has proven effective. The team presented data at the 2025 American Academy of Pain Medicine annual meeting showing that they have been able to wean about 60% of patients completely off of opioids by discharge, and those who successfully complete the program are able to remain off opioids or on lower doses up to two years after discharge.

“We’re talking about patients who have been on opioids for an average of six, seven years,” says Hanna, who is chief of the Division of Regional Anesthesia and Acute Pain Management. “So this is a big, big deal, and we show improvement in physical and mental activities and a decrease in pain interfering with their lives.”

That study examined opioid use in patients up to 24 months after their last PPP visit, and included 459 patients who were on opioids prior to coming to Johns Hopkins who had at least two visits to the PPP and hadn’t been seen in at least six months.

Perfect Timing

Hanna saw the opioid crisis coming years before the U.S. government declared it a nationwide public health emergency in October 2017. As an anesthesiologist, she works in the operating room with patients coming in for surgery. Back then, many were already on high-dose opioids and opioid pain patches from past issues and procedures, only to be sent home with more opioid prescriptions. Most had no one to closely monitor them or help them deal with side effects and manage pain as they tapered off those medications.

“There is no reason to be on a fentanyl patch and OxyContin when you had a procedure 10 years ago,” Hanna says. “This is when we started sensing that something bad is happening.”

When the idea for the pain clinic came to her in 2015, the world hadn’t yet started talking about the opioid crisis, Hanna says. “If we started the clinic two years before, when I first thought about it, it would not have been as successful because the country was not awake yet, and the CDC was not awake yet,” she says. “The timing was perfect.”

While it is not typical for anesthesiologists to see patients for regular appointments after procedures, as Hanna and Shechter do with PPP patients, their training and clinical work have given them deep expertise in treatment methods key to pain control. These include anti-inflammatory medications, nerve modulators, muscle relaxants, local anesthetics and nerve blocks.

“These chronic pain patients, their nightmare is not the procedure, it’s the pain,” Hanna says. “They commonly tell us they’re worried no one is going to handle their pain properly. So getting this anxiety out of the way was a big factor, and the continuity of care for these patients is extremely helpful.”

Also key to the approach of the program’s clinicians is their effort to forge a partnership with patients by equipping them with knowledge about how medications work and what they can expect when weaning off opioids. For new patients, a “pain passport,” in which they document side effects, pain, and medication intake between visits, has proven to significantly increase engagement. Patients found that the passport helped them track their pain, prepare for visits and share their pain experience, goals and concerns with their providers, according to a presentation the team gave at the 22nd Triennial Congress of the International Ergonomics Association in 2024. The CDC funded the patient engagement work through a three-year R01 grant.

Such engagement is crucial, as a 2022 study in the Journal of Opioid Management found a direct association between patient engagement and opioid reduction. Lead author Anping Xie, who spearheads the PPP’s engagement work and is a faculty member at the Armstrong Institute for Patient Safety and Quality, along with co-authors Speed, Shechter, Hanna and others, used data from 511 surveys that 155 patients filled out before each PPP visit from November 2017 to February 2020.

Sheckells says this partnership is what has carried him through weaning off opioids and the other difficulties he endured, including a slip-up when he was taking pills that weren’t prescribed.

“If you’re not believing in yourself in the beginning, they’ll do it for you,” Sheckells says. “[Dr. Speed] doesn’t give up. She doesn’t. I can’t even put it into words.”

Says Speed, “I think it’s really important for patients to know that we’re human and we make mistakes, and I wasn’t going to abandon him because he ended up overusing a medication. We’re going to continue to work together so that he can accomplish his goals.”

Antje Barreveld, president of the American Academy of Pain Medicine (AAPM) and medical director of pain management services at Mass General Brigham’s Newton-Wellesley Hospital, describes Hanna and Speed as “rock stars” in the pain management world. Their preventive and multidisciplinary approach to pain care stands out, Barreveld says, in a U.S. medical landscape of fragmented care, where patients typically bounce between different doctors without a coordinated vision for their recovery.

“Having leaders like Dr. Hanna and Dr. Speed, who bring not only expertise, but also their passion, to a program is what makes it just unbelievably valuable, because in the end, we’re talking about someone’s life and their ability to function on a day-to-day basis in society,” Barreveld says. “And not only to function, but really to live a fulfilling life.”

Hanna will succeed Barreveld as president of the AAPM, and Speed is co-chairing the American Academy of Pain Management’s annual meeting in March 2026.

Bedbound No More

While the majority of patients referred to the Personalized Pain Program need support in weaning down or off of opioids, a small subset are chronic pain sufferers who don’t have an opioid issue — but have struggled with debilitating pain for years and are at the end of their rope.

Among that group is Meredith Mangold.

Speed still remembers her first (virtual) appointment with Mangold in 2022. Her new patient was in the dark, wearing sunglasses and lying on her left side because it was too painful to lie on her right side.

“At that point, I had been bedbound for two to three years because of my chronic abdominal and pelvic pain, my POTS symptoms and other things, and I had zero hope that I would have any kind of fulfilling life ever again,” Mangold says. “I was just in bed or at doctor’s appointments.”

Mangold’s life was first disrupted in 2011. Then a sophomore at Georgetown, she experienced severe gastrointestinal symptoms and wound up in the ICU with toxic megacolon, a rare, potentially deadly condition causing inflammation and bulging of the colon. After an emergency colonoscopy, she was diagnosed with severe ulcerative colitis.

After two major surgeries, she developed chronic abdominal and pelvic pain that only intensified over time. She would later be diagnosed with a litany of other conditions, including POTS, chronic kidney stones and polycystic ovary syndrome, as well as osteoarthritis, osteopenia and Ehlers-Danlos syndrome, a group of connective tissue disorders.

Mangold finished college and got married, but she struggled with daily pain she rated as an 8 out of 10. She saw top doctors in Washington, D.C., and tried everything from opioids to ketamine to a spinal cord stimulator. She worked with a detox clinic to wean off of opioids — three times. “I felt like I wanted to rip my skin apart,” she recalls. “It was literal hell.”

By the time she got to the PPP to see Speed, Mangold was also dealing with depression, anxiety and medical PTSD from the years of pain and uncertainty.

“I was pretty much at rock bottom,” says Mangold. During their first appointment, Mangold told Speed she had tried everything and asked, “Is there anything else you have in mind?”

“And [Dr. Speed] was like, ‘Yeah, I have so many ideas,’” Mangold recalls. “In that moment, I had hope again, because no one else had any other ideas.”

Working collaboratively with Speed, Mangold estimates that they tried about a dozen medications until they found the right combination. She now takes an anticonvulsant usually used to treat seizures and bipolar disorder; a second medicine that increases levels of serotonin and norepinephrine; and a dopamine antagonist usually used to treat movement disorders.

“They’re essentially helping to rewire the pain signals and hopefully tuning down that overactive pain signaling,” Speed says, “then helping to form healthier connections between the healthy nerves.”

These days, Mangold’s pain is down from 8 to a 6 out of 10, even a 5 on some days. She’s able to do some housework and attend the occasional social outing. Most importantly, she’s on a new professional path: as founder and CEO of Empower Health Strategies. She flexes her own patient experience and engagement strategy expertise by helping digital health companies and health care organizations build patient-centered tools and platforms.

“Without Dr. Speed, I’d likely still be bedbound,” Mangold says. “She gave me my life back.”

A patient like Mangold, who still sees Speed once a month, is an ideal partner, Speed says — someone willing to advocate for themselves and put in the hard work.

“She wasn’t ready to give up,” Speed says. “Now she’s an entrepreneur who is advocating for people who have been through her experience. I’m so proud of her.”

Part of that hard work was going to physical therapy and aqua therapy as her pain decreased, in order to rebuild her weakened muscles.

Anesthesiologist Shechter has found that physical activity is crucial in the recovery process for patients coping with chronic pain. He works with patients in the PPP program to set goals, whether activity-related or simply being able to rest more comfortably.

“I find that function is a more accurate measure for recovery, because most of the time, being pain free is not an achievable goal,” he says. “There’s no fairy dust I can give them. There is no magic. It’s really hard work, and I would say the strongest medication I have is my words, my comfort and my guidance.”

‘A Message of Hope’

Marie Hanna sees the success of the clinic in the positive impact it has on her patients’ lives.

She points to a study involving 26 PPP patients who were interviewed an average of 33 months after their first visit. They described reduced pain, improved physical and mental health, the ability to return to work and improved relationships. Moreover, they reported their brain fog lifting and cognitive function improving. The study, published in the Journal of Personalized Medicine in December 2023, was authored by then-Johns Hopkins medical student Divya Manoharan, with PPP team members as co-authors.

“This is what keeps us going. For every family who has a chronic opioid user … it’s bringing that family member back to be a part of society, a part of life,” Hanna says. “It’s a message of hope.”

This rings true for Chris Sheckells. Today he’s married and has a 4-year-old daughter. He works for an HVAC company — he was doing hands-on work at first to prove to himself that he still could, but now he provides project estimates and supervises projects. While he still has pain, he’s learned to manage it without opioids. He and his family spend a lot of time at the pool, and every Tuesday is a daddy-daughter night out.

“I am living a life that I could have only dreamed of 10–15 years ago,” he says. “I just wake up and I’m grateful.”