Chronic pain patients often drag from doctor to doctor for months, even years, vainly seeking help. Along the way they often have surgery, sometimes more than once, and have taken an assortment of drugs, sometimes becoming dependent on them. And they still hurt.
But now a growing number of pain clinics and pain management centers -- perhaps close to 1,000 throughout the country -- are approaching pain in new ways, tailoring treatment to the individual patient and to the individual pain. Sometimes total success is elusive, but still, more and more patients are finding relief.
One is government attorney John Scheibel, a back pain victim until about 15 months ago.
"A few years ago," he says, "a prominent orthopedist told me that sometimes you do something to your back and push it over the hump and it will never be the same. And I believed him."
"But a few months later I saw an article about a doctor in New York, Dr. John Sarno, and he helped me."
Sarno, at the Institute of Rehabilitative Medicine, says most back pain that persists long after the back injury is healed results from a vicious cycle: pain causing tension that causes more pain. Using the latest in neurobiological research and, when necessary, individually tailored exercises, he teaches his patients to take conscious control of the tension element, thereby reducing the pain.
His theories and techniques are described in his book, "Mind Over Back" (William Morrow Co.).
Scheibel says Sarno helped in two crucial ways: "I'm more relaxed when I use my back, because he convinced me that I won't hurt it." Also, "and this is the most important thing he did for me, when I feel a twinge of pain in my back, I can say to myself, 'Look, there's nothing wrong there,' not, as I used to think, 'Oh my God, there it goes again.' And now the pain will subside fairly quickly.' "
Barbara Moffet, a 33-year-old writer, has a different story. Her back pain came "out of the blue" in 1981, and by the time she started on the journey to recovery she had seen every kind of back doctor she could find, been operated on and ended up spending months in bed -- working lying down. Through another back pain patient, "a woman who had five back operations," she found her way to the Pain Management Program at Duke University, an inpatient facility considered among the best in the country where neurologists, psychiatrists, behaviorists and physical therapists work as a team. They might use biofeedback on one patient, transcutaneous electrical nerve stimulation (TENS) on another, just exercise for still another. Group sessions enhance the individual therapy.
Moffet is working again, on a schedule of 50 minutes up and 10 minutes down. She carries around a digital clock that tells her whether her time is "down" time or "up" time. She does prescribed exercises and feels she is back in control. "It's you telling the pain," she says, "not it telling you."
A 43-year-old mother of six suddenly developed shoulder and neck pain. "They told me 'degenerative arthritis,' " the woman says now. "You, know, instant falling apart. Here I am 12 years later and I haven't fallen apart yet."
The woman, now 55, found her way to Dr. Bruce Smoller, orthopedist turned psychiatrist and the psychiatric consultant to the NIH pain laboratory. Smoller approaches pain control as a problem of the family, not just the individual patient, and has written a book describing how family can help or hinder the pain patient's progress -- "Pain Control, the Bethesda Method" (Doubleday).
The woman now feels she at least understands her pain and has gained some control -- the critical element in all these behavior-oriented approaches.
Another of Smoller's patients, a young woman injured in a car accident, says she is still in pain most of the time but knows that "frantically running from doctor to doctor" is not the answer. She may hurt, but "I'm not anxious about it anymore." Soon after the accident, she recalls, the pain was so bad that "sometimes I'd have to wait for everybody to leave the school where she taught so I could cry as I crawled out."
Smoller conducts small classes for his patients, describing -- as Sarno does to his groups -- pain mechanisms and what is known about the mind's effects on them. Although sometimes drugs may be prescribed, they are rarely the main treatment. As for surgery, except in rare instances, it is, as John Sarno has described it, "a very powerful placebo."