Managing Pain Requires a Comprehensive Approach
any people suffering with chronic pain start to feel helpless, and in some cases side effects of treatment produce symptoms worse than those of the original injury or illness. It can feel like an endless, overwhelming loop. But area experts say there is hope if you become your own advocate, embrace a global viewpoint of the body and available treatments, and “get the total pain picture.”
“I think it’s sad that so many patients have been led to believe they are helpless in dealing with their chronic pain,” says Dr. William Fowler of Physical Medicine Rehabilitation Independent Services (PMRis), “and therefore also have been led to believe that they have to be dependent on the health care industry to manage it.”
Fowler has been practicing physical medicine rehabilitation for 20 years in the southern Wisconsin area, and at PMRis he offers a wide variety of medical interventions. However, Fowler encourages his patients to be advocates for their own individual situations. He seeks to help them get a clear picture, both of the legitimate available treatments and the realistic limits of their particular diagnosis.
“By definition, chronic pain is not something that disappears,” says Fowler. “So we are trying to help patients manage their own pain. That to me is more useful or helpful than making them think they must take a different colored pill or get a bigger needle stuck in them or have yet another surgery done.”
That’s not to say those myriad treatments aren’t effective—they are. But many of the patients Fowler sees are people who have had so many things done to them medically, they’ve become disengaged and, ultimately, disempowered.
“I see my role as being a communicator and an educator, helping them understand what they can do for themselves,” says Fowler. “Hopefully what I can provide to them is a better understanding of their situation, and how best to go forth in life and deal with it.”
Dr. Maher Fattouh, medical director of Advanced Pain Management in Madison, says oftentimes patients believe there is nothing they can do about their chronic pain, that perhaps it’s just their load to bear. But he says advances in pain management and a comprehensive approach spell relief and hope for many who suffer.
“I want everybody to know there are two kinds of pain,” says Fattouh, noting that “good” pain acts as an alarm to protect us, but “bad” pain is the kind that goes well beyond the expected healing process. “We know this kind of pain can be very detrimental because it can impact every single part of the body, and can actually worsen over time if you don’t seek help in a timely matter.”
Fattouh, who is board certified in pain management and anesthesiology, says the clinicians and physicians at Advanced Pain Management take a comprehensive approach to treatment, utilizing “every single tool” at their disposal. In addition to medical intervention, this includes seeking outside consultations from specialties such as physical rehabilitation, chiropractic, psychiatry and neurology.
“It’s not just pills anymore. We look at the pain, and we want to know exactly what is causing it, not just the symptoms. We combine medical management, minimally invasive therapies, alternative medicine options and more. Then if the pain continues, we offer a wide variety of medical interventions to relieve pain, expedite recovery and get the patient back to having more and better function as soon as possible.”
Seeking Help in Unexpected Places
Back and neck pain is one of the most common forms of chronic pain, and increasingly the scientific community recognizes chiropractic care as an effective and safe solution for these issues—but there are many other less obvious illnesses and injuries that can be improved with chiropractic, including digestive problems, foot pain and even childhood ailments such as ear infections and croup.
“You have not tried everything for your pain until you have tried chiropractic,” says Dr. Tim Turino, one of several highly specialized chiropractors at Madison Chiropractic. “Chiropractic is a unique science un-duplicated by other professions, and we really look at things differently when it comes to pain management.”
Turino points out that chiropractors are tops in the field when it comes to mechanical back pain, but that the holistic approach they take to the body is just as important. For example, a hip problem may also be responsible for bad knees, painful foot arches, neck problems or shoulder pain. An imbalance in the middle part of the thoracic spine may cause issues with stomach acid, leading to digestive problems.
A spinal surgery, if successful, may bring relief but won’t correct the way the rest of your body protectively overcompensated for your original injury. That’s why Madison Chiropractic has several offices staffed by experienced doctors with numerous specialties, including orthopedics, trauma and sports.
“We want people to be aware of their choices,” says Turino, “in seeking the kind of treatment they need for their chronic pain.” Dr. Chris Hammes of Hammes Family Chiropractic also takes a holistic approach when it comes to pain management, supplementing traditional manual adjusting techniques with therapeutic ultrasound, interferential current (electrode pads are placed on inflamed muscle tissue) and nutritional counseling.
He also utilizes the high-tech ProAdjuster machine, which uses computer technology to scan the spine and perform adjustments. In addition to visually tracking progress on the screen, it allows Hammes to control the amount of force used. This helps patients who are anxious to rid themselves of pain but are still squeamish of the normal pops, bends and twists that come with traditional adjustments, and it’s especially useful for patients with advanced degenerative diseases such as osteoporosis, so as not to apply too much pressure to bones that are already weakened.
“We treat a wide range of conditions,” says Hammes. “We try to understand exactly what’s going on to help them not only manage their pain, but achieve optimal health.”
Hammes “takes a family approach,” starting with the low back pain experienced by pregnant women and treating early childhood issues such as earaches and allergies, and sports injuries down the road. He says it’s a misconception that once you go to a chiropractor “you have to keep going forever,” but also cautions against quick fixes.
“You won’t magically be better after one treatment,” says Hammes. “But the goal is to get you out of pain, then help you maintain proper mechanics and give you what you need to avoid recurrences.”
“We run into misconceptions about what pain is,” says Dr. Bruce Agneberg, senior VP of Medical Services at HospiceCare Inc. “I think one of the beauties of doing this kind of work is that we recognize that pain is really multi-factoral.”
At HospiceCare Inc., each patient is assigned his or her own interdisciplinary team of medical staff, psychosocial workers and spiritual caregivers, all of whom address pain from a different but complimentary perspective. HospiceCare employs two nurse practitioners and nine full- or part-time physicians, allowing for top-notch medical care.
“That’s a very unusual circumstance,” says Agneberg. “It’s a pretty rare hospice that has a full-time employed physician staff.”
But the experts at HospiceCare also know that pain management extends beyond the medical component, and to the entire community.
“When we examine a patient and listen closely, we are really able to get at the heart of the matter,” says Agneberg, “and it may be something you don’t necessarily treat with medical modality.”
In addition to the work done by the interdisciplinary team, nearly 1,200 local volunteers help manage pain through massage and Reiki, and therapies such as art, music, spa, garden and pet. Last year alone, nearly 8,000 people participated in grief support groups at HospiceCare.
“Part of being an expert in pain management is understanding the solution isn’t always in taking a pill,” says Agneberg. “Pain management is also listening deeply to the person, getting the story, understanding the disease process, figuring out how it’s affected their total life and well being, looking at effects that are psychosocial and spiritually oriented, and really getting that total pain picture.”