Regarding Pain Management Departments

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      There have always been physicians or medical professionals of one type or another who devote a portion of their practice to managing pain.  Some chiropractors focus on pain abatement, and some of them have received training and certifications in order to become physician acupuncturists. Physical Therapists and Massage Therapists also do a great deal in order to manage chronic pain of many causes also.  There are also acupuncturists who are non physicians but who also have loyal followings of patients who have been at least somewhat delivered from chronic pain.
              I was aware that some hospital systems and medical centers have a Pain Management Department. I imagined this to be designed for the terminally ill, or those with multiple spinal fractures or trauima. I have never sent a family member, or accompanied one to a Pain Management Center at a major medical center which has a medical school.
              My eldest son, who is in his twenties has been experiencing some pretty severe symptoms following a lightning strike for a bit more than a year.  His primary physician is a highly regarded and well educated physician who has completed a couple of different residencies, including a fellowship in sports medicine. He has been unable however to do much about our son's continued leg pain which began to occur within a week or two of being struck by lightning while in a steel roofed building here on the farm.  Eventually, our son was sent for an EMG which seemed normal. However, our son was still bothered by significant leg pain and something called fasiculations, which are intermittent episodes of twitching in skin and muscles of both legs.  He had tried a TENS unit, and even narcotic medication, neither of which were terribly effective.  Eventually, he was referred to the "Pain Management Department".
                This department was not at all what I expected.  It is a multi-disciplinary team which meets with each patient, pulls their medical records and formulates a plan for management.  The director of the program is a board certified physician who is an anesthesiologist who has furthur specialized in the management of pain. She is also responsible for physicians who are also board certified physician anesthesiologists who are doing a fellowship in pain management.  Their patients include those who have had terrible accidents, workmen's comp injuries, burns, and those who have been left with phantom pain in a limb which has been long since amputated. They do see cancer patients, and on occasion, they also see those who have sustained injury and who have protracted pain which is the result of lightning strikes.   They are not restricted to the practice of handing out medications for pain willy nilly.   They focus on ascertaining the cause for pain and formulating a team approach to managing pain. They were very clear that narcotic pain management only ever works in the short term and that other strategies for pain must be planned for patients. Such plans must allow the patient to reach his maximum level of function.
                In my son's case, they were quite clear that the twitching in his legs constituted mild myoclonic seizures which could easily be attributed to lightning strike. They also did a neurological exam.  They prescribed a drug which would stop the switching in his legs, which is normally used for seizures.  They also prescribed a skeletal muscle relaxant that he could take if the pain became more severe.  With these issues managed, they wish him to begin to wean the narcotic tablets he had been taking.  They also obtained lab work in order to make sure that his calcium, magnesium and other levels obtained in a blood chemistry level are at levels which are optimal for his recovery. They believe that his supplemental magnesium given by prescription will need to be increased.  They also have referred him to another physician member of their team who teaches both pain management meditation and self hypnosis which he can use as his recovery takes place.They did not do this in my son's case, but they frequently refer patients to physical therapy as well.  They were careful to tell him that his nerves in his legs will likely never be as they were prior to being struck.  They also said that if the twitching of his legs could be made to stop for a period of time, and that if he could finally sleep a full eight hours a night, (which is not happening now), that he could begin to repair even the nerve damage he had sustained, and had potential to recover from this particular issue.
                So far, a fairly low level of the drug being taken to diminish the leg twitching is being taken, yet he is  better. They have left directions for it to be gradually and carefully increased, and we will remain in touch via e-mail. In just a few days he has markedly decreased the amount and frequency of narcotic he had been using for leg pain.  He has not yet used the skeletal muscle relaxant which was prescribed as needed, because he feels that he is doing well and doesn't need it presently.   He has not yet seen the physician who will use biofeedback, hypnosis and meditation.
               I must say, that a challenge which has kept other physicians thinking and reading was short work for a multi-disciplinary pain management team.  A neurologist will see him tomorrow to see that we are covering all the bases.    I am incredibly impressed and grateful for the expertise of this team of physicians. This is the way the team approach is supposed to work !

Artists conception of pain :  nuhopecare.com

               From a preparedness and survival standpoint, addressing chronic pain and promoting as full a recovery as possible is essential. We have no idea what will be required of us physically in the future during an earthquake, a fire or anything else.  Making sure we are in maximum possible working order is an investment in our own future survival, and also in the survival of our loved ones, who could need our help. Chronic pain is a major cause of suicide and suicide attempts all over the world. Too many times our primary doctors lack the time, the interest, the focus and the specialized training to treat this aspect of the human condition. So many of us think that we have seen a doctor and that nothing can be done for our pain. However, this is only very very rarely  true.With pain managed, and function improved, some patients will have overall activity increases which will result in weight lost and this will boost their health from other standpoints as well.

              If you or a loved one have a pain management issue, please don't hesitate to explore the possibilities of seeing a hospital based Pain Management Group run by an anesthesiologist.  An incredible number of different modalities are available depending upon the type and source of pain the patient is experiencing. Imagine the number of suicides that will likely be prevented by the simple management of severe or chronic pain of many different types. Imagine the improved quality of life for these patients.