I know all of us suffer varying degrees of pain in various places at various times. I know nothing about this place, but thought it might be useful to file away should the need arise. sheryl

Pain management focus of institute
By VICKI ROCK
Daily American Staff Writer
Tuesday, August 14, 2007 12:07 AM EDT

Everyone has felt pain at one time or another, but people feel pain differently.

The common pain scale is zero to 10, with zero being no pain at all and 10 being the worst pain a person ever felt or can imagine feeling, said Kristin Joltes, acute pain services coordinator, Memorial Medical Center, Johnstown.
“What may be a four for me may be an eight for you,” she said. “It's different between individuals. Men and women process pain signals differently. It's very tough to compare.”

Acute pain is that felt immediately after trauma or surgery. Chronic pain is that which has lasted six months or more. An estimated one in five Americans suffers from chronic pain.

When people have chronic pain their physicians may refer them to the John P. Murtha Neuroscience and Pain Institute, Johnstown. About 80 to 85 patients are seen at the institute daily.

“Some people feel pain to such a degree that they call us daily,” said Leslie Moran, associate director of pain and neurology services at the institute. “Others we only hear from when they have their appointments. What one doctor said is ‘Pain is whatever the patient says it is.'”

When someone is feeling acute pain, physicians may prescribe a nerve block, which can be pinpointed to the nerves closest to where the trauma or surgery occurred, Joltes said. It is also possible for chronic pain, such as occurs with cancer, fibromyalgia or trauma, to have acute exacerbation.

“Our goal it to make treatment seamless - to begin pain management after trauma or before surgery - and to follow up after the patient is discharged from the hospital,” Moran said.

The acute pain service at Memorial Medical Center has a multi-disciplinary team of doctors, nurses and pharmacists. In addition to nerve block, epidural steroids and oral medications, there are other treatments, including radiofrequency to destroy nerves if other treatment options fail.

The institute has programs in pain management, neurology, physiatry (doctors who specialize in rehabilitation), headache and balance disorders and neuromuscular disease.

Conemaugh Health System also has specialty clinics that combine traditional care with complementary therapies, including acupuncture, relaxation, aquatic therapy, aromatherapy and massage therapy. They are available to people with chronic neurological conditions, including post-polio syndrome, Charcot-Marie-Tooth disease, Parkinson's Disease and Lou Gehrig's Disease.

“We don't expect to make them pain-free, we expect to make them more comfortable,” Joltes said. “That is why we say pain management, not cure.”

“It is such a good feeling when someone comes in and says their pain is gone, or is now more livable,” Moran said.

Inflammation has a lot to do with pain, Joltes said. Different people produce different chemicals in the body, so some will feel pain more intensely or for a longer time. Depression is also a factor, Moran said. Someone with chronic pain may feel depressed, but medications for depression often help relieve pain as well. Psychological counseling may help as well.

Because of Defense Department funding, the pain institute also partners with Walter Reed Army Medical Center. Lt. Col. Chester “Trip” Buckenmaier, M.D., an anesthesiologist at Walter Reed, is one of the principal investigators in pain management for the military.

More than 90 percent of wounded soldiers in Iraq and Afghanistan have survived - the highest survival rate in American history - but they are suffering loss of limbs and severe head wounds.

Buckenmaier has expanded the regional concept in pain management to field hospitals in Iraq and Afghanistan, Joltes said. The thinking is to make the patient comfortable with nerve blocks immediately in the field hospitals, then continue the treatment as they are transferred to Landsthul Regional Medical Center in Germany and then to Walter Reed. That initial treatment is also helping prevent phantom limb pain.

Dr. James Tretter at Memorial Medical Center has been doing a trial study of patients who need to have a limb amputated. He starts the block medication 24 hours before the surgery. That helps prevent phantom limb pain. Pain management also begins before cancer surgery and total joint replacement.

“There are different theories as to what causes phantom limb pain,” Joltes said. “There has been a dramatic insult to the nervous system - a loss of limb - that it takes time for the brain to remap. We've talked to patients who say their foot itches, after it has been amputated. Because of our affiliation with Walter Reed, we are on the cutting-edge of anesthesiology and pain management and we're a rural area hospital. And we're helping to come up with better treatment for soldiers.”

The main thing to remember is that a person doesn't have to live with pain, she said.

“There are places to go and people to talk to that will help improve your quality to life,” she said.

“We've come a long way in the treatment of pain, but there's still work to be done,” Moran said.

(Vicki Rock can be reached at vickir@dailyamerican.com.)

Sheryl,

thanks for this- very interesting.