Patients in the Johns Hopkins Pain Treatment Program are often so impaired that they spend a significant portion of their days lying down. There’s often a psychiatric comorbidity involved — typically depression — and some patients have bipolar or substance use disorder.

They’ve tried many treatments, often including surgeries, with no success.

Yet if they stick with the inpatient chronic pain program, they will almost invariably get “dramatically better,” says psychiatrist Glenn Treisman.

“My favorite cases are the ones where people come in in a wheelchair, and get out of it,” he says.

The program, with only 11 slots available at a time, is one of just a few multidisciplinary inpatient pain programs in the country. It started more than 40 years ago for patients with failed back surgeries, grew to focus on patients who were on narcotics for a variety of pain conditions, then later began treating patients with complex comorbid conditions.

Treisman, who has been at the helm of the program for about 20 years, is now co-director, with fellow psychiatrist Traci Speed serving as lead director.

Patients generally fall into three categories. Many come in with widely known pain conditions that are hard to treat, such as chronic low back pain, trigeminal neuralgia and migraines. Others have been managing chronic pain with high-dose opioids — often paradoxically increasing their pain sensitivity. The third category is patients with unclear diagnoses that can involve sympathetic overactivation, postural orthostatic tachycardia syndrome (POTS) or another immune system issue.

“For a lot of our patients, no one knows what’s wrong with them,” Treisman says. “It has become a program for clinical mysteries.”

When patients arrive at the clinic, nurses and residents perform evaluations and take extensive, multi-hour medical histories. Once admitted, patients meet with occupational and physical therapists and have sessions five days a week, in addition to group therapy sessions on how to cope with pain. They are also treated by physicians from other specialties as needed, including physical medicine and rehabilitation, internal medicine, rheumatology, orthopaedics, urology and gynecology.

For Speed and Treisman, the goal is to pin down a diagnosis, as atypical as it may be, which then guides treatment.

“We’re trying to figure out what kind of pain the person is experiencing, whether it’s sympathetic, neuropathic, central sensitization, opiate-mediated or conditioned,” Treisman says.

He says the team uses a variety of medications to tackle patients’ pain and conditions, including those that regulate overly active pain neurons, such as anticonvulsants and tricyclic antidepressants, and neuromodulators. Additionally, patients use biofeedback, self-hypnosis, relaxation breathing and mindfulness to manage their pain.

“All of those things go together to help our patients get better,” Treisman says. A typical patient stay is 20–25 days.

“Here, we have a team of experts that is able to observe and supervise a patient 24/7, and that allows us to make changes rather rapidly,” Speed says. “We can change the trajectory of someone’s life in four weeks compared to four years.”

Speed understands why patients view the Pain Treatment Program as a “miracle service.”

“Patients come in assuming that there are no other options, that this is their last hope. And then they collaborate with us and work really hard,” she says. “It goes to show that if you can help a patient focus on rehabilitation and some short-term goals and really work as a team, you can help them find the life that they’ve lost.”