Chronic pain is a complex condition that can be frustratingly difficult to treat. It differs from the acute pain we associate with bumps, bruises, cuts, broken bones, or surgery in that it persists long after tissue healing has occurred, and it can even develop in people who have no history of injury. Opioid medications, which can be effective in treating acute pain, proved to be woefully inappropriate for managing chronic pain, as the ongoing crisis of opioid addiction and overdose clearly demonstrates.
University of Toledo Medical Center physical medicine and rehabilitation specialist Ashley Schneider, MD, explains that the current opioid crisis has its roots in the 1990s when many in the healthcare field embraced the notion that pain was being undertreated and the concept of pain being the “fifth vital sign” emerged. As a result, opioid prescriptions began to rise dramatically—to the extent that by the year 2015, opioids were being prescribed at a rate three times higher than they were in 1999. Treating chronic pain with opioids led to longer prescriptions and escalating doses because patients were developing a tolerance, meaning they needed a higher dose of the drug to get the same level of pain relief. But tolerance wasn’t the only concern.
“Unfortunately, some also developed dependence,” Dr. Schneider says. “In 2016, 75 percent of heroin users cited prescription drugs as their first opioid. Now we know that opioids don’t work well for chronic pain and are only minimally better than placebo. Opioids don’t address the multifactorial nature of chronic pain and come with their own set of adverse side effects that have to be treated with other medications.”
Recognizing the need for an effective alternative to opioids for the treatment of chronic pain in our community, the UTMC Division of Physical Medicine & Rehabilitation has introduced a voluntary, outpatient Pain Rehabilitation program that addresses all aspects of this condition.
The program’s interdisciplinary team consists of physical medicine physicians, who can prescribe medications and procedures as needed; physical therapists, who improve patients’ strength and incorporate physical activity into their treatment; occupational therapists, who help patients set goals to improve their activities of daily living; and mental health professionals, who address the negative thoughts and emotions commonly associated with chronic pain. All of these professionals work collaboratively to develop an individualized treatment plan for each patient.
Dr. Schneider, who serves as medical director of the Pain Rehabilitation program, elaborates on why it takes an interdisciplinary approach to treat chronic pain: “The management of chronic pain is complicated because chronic pain itself is complicated and is experienced in different ways by different people. Also, there’s not one pain center in the brain that you can target. In fact, brain scans and MRIs show that multiple areas of the brain are involved. As a result, chronic pain affects multiple aspects of patients’ lives in addition to their biology, including their thoughts, emotions, function, and social interaction. All of these areas need to be addressed in order to treat chronic pain effectively.”
Chronic low back pain, chronic neck pain, chronic pelvic pain, neuropathic pain, central pain syndromes, multiple joint pain, post-laminectomy syndrome, fibromyalgia, myofascial pain, complex regional pain syndrome, and chronic headache/migraines are just some of the possible diagnoses that may benefit from the Pain Rehabilitation program.
The goals of the program include empowering patients struggling with chronic pain to improve their quality of life and function, minimizing the use of narcotic pain medications, decreasing healthcare utilization, and promoting a healthy lifestyle. To be eligible for the program, patients must have chronic, non-cancer pain that has persisted for over three months and not responded well to standard treatment options. “In addition, patients need to be motivated to treat their pain, willing to wean off narcotic pain medications, capable of participating both physically and emotionally, and willing to attend the program in its entirety, which is three days a week for seven weeks,” Dr. Schneider says.
Though more research needs to be done on pain rehabilitation outcomes, some studies have already revealed that a multidisciplinary approach to chronic pain management is more effective than traditional treatment and is similar in effectiveness to spinal fusion for patients with chronic low back pain. Furthermore, no side effects are associated with pain rehabilitation, so it’s a relatively safe approach compared to medications, surgery, and other procedures such as injections.
To be considered for enrollment, patients must be referred to Dr. Schneider for an evaluation. This will likely be followed by individual evaluations by a counselor and physical therapist. The program activities will be conducted at UTMC in the Morse Center, on the third floor of Dowling Hall. The treatment schedule is Monday, Tuesday, and Thursday from 12:00 to 4:00 pm. For more information, call 419-383-4022.