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Chronic Pain Management

Multiple Approaches

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Chronic Pain Management

Chronic pain affects millions of people. According to a report issued by the National Institutes of Health, “The annual cost of chronic pain in the United States, including health care expenses, lost income and lost productivity, is estimated to be $100 billion.”

Causes of chronic pain range from injury to illness, but it affects all aspects of an individual’s life, says Beverly Field, Ph.D., a Washington University psychologist at the Center for Advanced Medicine’s Pain Management Center. “Chronic pain affects people physically, psychologically, socially and economically,” she says. “So we need a multidimensional approach to teach people how to cope.”

To provide that approach, Field directs the pain center’s STEPP (Supportive Training and Education for People with Pain) program in which psychologists, physicians and physical therapists collaborate to help in pain management. “There can be a great deal of loss associated with chronic pain,” she notes. “People may lose their ability to work, and they may not be able to participate in favorite hobbies. We address all aspects of life, managing pain like we would any other type of chronic health problem.”

Collaborating in the STEPP program is Dr. Rahul Rastogi, a Washington University anesthesiologist specializing in acute and chronic pain. “Working together, we discuss a patient’s options in all dimensions,” he says. “While we work to get the pain medically treated, the patient also has therapy sessions to learn self-management techniques.” At the end of the 10-week STEPP program, patients may continue treatment or may be ready to manage on their own. Most in the program have been referred by their physician.

“Studies show that treating pain with multiple disciplines is more effective than using any single modality,” Field says. “Coping strategies are important, and people need to remain as active and productive as possible without exacerbating their condition.” To this end, Field is open to the use of such complimentary therapies as self-hypnosis, biofeedback, relaxation techniques and meditation. “We don’t provide acupuncture here, but some of our patients do use that technique,” she says. “This is a chronic problem, and its management requires many approaches. Fortunately, we can combine the newest medical technologies with a variety of other techniques to offer hope.”

Dr. Rajiv Yadava, an osteopathic physician, agrees that chronic pain often requires more than a purely medical solution. He precedes treatment decisions by conducting a medical history interview that seeks to determine both physical and psychological contributors to a patient’s pain experience. “Diagnosis is key,” he says. “And then it’s important to help the patient learn to relax and allow healing to occur.”

In doing this, Yadava explains to patients that pain is not an enemy but merely a signal that the body needs attention. He provides osteopathic treatment, trigger-point injections and homeopathic remedies while encouraging his patients to develop relaxation techniques, such as diaphragmatic breathing, meditation or prayer.

Among all the techniques used to address pain, the chiropractic approach is the most common non-surgical treatment for chronic back pain, says Matthew Berman, D.C., of Berman Chiropractic and Wellness in Clayton. He uses spinal adjustment to treat restricted mobility, which often improves function and decreases pain. Massage and stretching relax muscles that are shortened due to spasms.

Berman is particularly enthusiastic about a new cold laser treatment. “We use an FDA-approved system, the only one of its kind in St. Louis,” he says. “The laser delivers billions of photons to the tissue surface, driving energy down to the damaged cells that require it for healing. This can dramatically increase the healing rate of damaged cells, allowing the body to heal itself at an accelerated rate.” Regardless of the approach taken, people who suffer from chronic pain should know that there is hope for a full and active life.

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