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"The essential treatments are basic, simple commonsense approaches," said Gary Mills, director of Pacifica Pain Management Services in St. Helena. "These are cases where the truth of the matter is the pain condition does not have a cure."

Mills, a licensed psychologist, founded the Pacifica Pain Management program 27 years ago to help patients suffering from chronic pain syndrome. It is different from acute pain.

Chronic pain syndrome is described as an evolving set of dysfunctions with pain persisting beyond six months that result in a slew of other challenges. "What's the syndrome? Sleep disturbance, weight gain, sexual dysfunction, loss of employment, reduced strength, significant mood disregulation, medication dependence, and/or abuse and/or addiction," Mills said. "The collection of problems that commonly accompany pain syndrome is the target of the treatment."

Mills says patients learn to manage their pain rather than mask it with medications and/or medical procedures.

"Other doctors say they can't cure the pain, but they'll treat it primarily with many varieties of drugs in spite of their side effects," he said.

Mills says patients come in with a perception that they have a disability because of severe pain. His approach is that the disability is the result of the severe syndrome.

Typically, patients are passively waiting for a cure and have seen doctors who also operate on that same model, the biomedical model. Instead, Mills and his team use what he calls a biopsychosocial approach which he says activates the patient toward health.

One of the first steps to helping patients with chronic pain syndrome is detoxification from narcotics and other drugs. They start by educating patients.

"Regarding pain, we use the phrase, 'don't make it worse.' Without meaning to, patients often make their chronic pain worse, and by simply showing them how to reduce this behavior, they report less pain," Mills said. "Narcotics can make the pain worse." He says detoxification done slowly and carefully often results in reduced pain.

Another focus area is depression, common among chronic pain syndrome sufferers. Mills' philosophy is that antidepressants are not a cure.

"Antidepressants can be effective in reducing depression," he said. "They are not cures for depression."

Depression, as with the other symptoms, is treated with diet, counseling, isolation from life stress, exercise, and other therapies. For example, patients learn about foods that may increase their pain levels, which in turn can trigger a depressive response.

"One of the substances in many foods is called arachadonic acids," he said. "In the right balance, it's a wonderful thing. But when our diets are loaded with it, there's a greater likelihood for an inflammatory response."

Exercise is another main component of the program. Mills says patients workout for two hours a day, five to six times a week.

"We use cognitive behavior therapy with successive approximations toward the desired goal," he said. "We do these tiny steps to the point where they are wanting more as opposed to big steps they think they can't do."

Many chronic pain syndromes can be treated on an outpatient basis, Mills said, if the various practitioners can act in unison as a pain management team and the patient is motivated and cooperative. Otherwise, inpatient treatment may be necessary.

"With successful treatment, patients may experience clear pain that is managed without narcotics by using active coping skills," Mills said. "The solution may appear low tech, but the results can be dramatic."

Read more at the WorkersComp Forum homepage.

March 10, 2011

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