Boot Camps Treat Chronic-Pain Sufferers

CHICAGO - Ballet teacher Gayle
Parseghian thought she might never dance again after a back injury
while moving heavy furniture left her with unrelenting pain.

However, an intensive, four-week "boot camp" got the
55-year-old dancer from Toledo, Ohio, back to the barre. The program at
the Rehabilitation Institute of Chicago taught her to manage the
chronic pain that had tormented her for more than a year.

"It affects your relationship with your spouse, your family,
your friends, your boss," she said. "It's like you're trapped in your
body and you can't get out. It's a feeling of being completely out of
control."

New research suggests that chronic pain affects the brain's
ability to rest, disrupting a system that normally charges up some
brain regions and powers down others when a person relaxes.

"I ask a patient who has had chronic pain for 10 years to put
the mind blank, don't think about anything," says Dr. Dante Chialvo, a
researcher at Northwestern University's Feinberg School of Medicine who
is not involved with the boot camp.

MRI images show the pain sufferer's brain lighting up, but not
as a normal brain at rest would, he said. "There is an objective
biological difference in the brain."

The early findings could explain the sleep disturbances,
decision-making problems and mood changes that often accompany chronic
pain, he said. They also could explain why the boot camp approach
worked for Parseghian.

The Chicago program, affiliated with Northwestern's medical
school, attacks pain on three fronts -- biological, psychological and
social. It doesn't claim to cure chronic pain, but instead gives
patients tools to lessen its hold on their lives.

Patients spend Monday through Friday stretching, exercising
and moving in new ways. They meet with a physician, an occupational
therapist, a physical therapist, a biofeedback therapist, a clinical
psychologist and a movement specialist.

They might address depression or sleep problems or adjust
their medications, and they learn from the other patients in the
program.

Getting all of these things under one roof differs from most
approaches to treating chronic pain, said Dr. Steven Stanos, the
program's medical director.

Patients know the drill. In the fragmented world of health
care, they bounce from internist to chiropractor to massage therapist
to surgeon -- with none of the experts sharing information.

"You will try anything and everything to get out of the pain,"
Parseghian said. "You discover all of your efforts are fruitless, and
you have spent monumental amounts of money."

She tried herbal patches, vitamins, injections, prescription
narcotics and a battery-operated device that uses electrical impulses
to block pain. Nothing worked.

Surgery would have been next. She was in a surgeon's waiting
room when she read an article about the boot camp.

If acute pain is the body's alarm system, alerting to
injury-causing dangers, then chronic pain is an alarm going haywire,
screaming a warning long after the danger has passed.

The American Pain Society estimates that millions of Americans
are in chronic pain from backaches, jaw pain, headaches and
fibromyalgia, a mysterious syndrome marked by muscle pain and fatigue.
Sore spines alone cost billions of dollars each year.

In 2005, Americans with aching backs and necks spent $20
billion on prescription drugs and another $31 billion for outpatient
doctor visits, according to a recent study in the Journal of the
American Medical Association. Total spending on spine treatments
increased 65 percent from 1997, adjusted for inflation. Rising
alongside that was the proportion of people with spine problems who
reported limited function.

Such spending with such poor results gets insurance companies'
attention.

Chronic-pain patients' medical and pharmacy bills "show up on
our radar," said Dr. James Cross, Aetna's national medical policy
chief. The patients are "frustrated and clearly suffering" and "looking
for an answer," he said.

Although boot camp-style programs cost up to $20,000, Cross
said that's cost-effective compared to the procedure and pill
merry-go-round. The company cites studies showing that patients who
have completed boot camp programs experience lasting pain reduction and
lower stress. Aetna also believes patients completing the programs are
more likely to return to work and less likely to seek other expensive
treatments.

Other insurers also cover the programs, but convincing more
companies will take more evidence, said Dennis Turk, a pain researcher
at the University of Washington in Seattle and a believer in the
approach.

It's unclear what combination of therapies works best for
which patients and whether four weeks are needed for everyone, Turk
said. Patients should be cautious, he said, because quality varies.

"Anybody out there can put up a sign and say, 'I'm a
comprehensive pain-rehabilitation program,'" Turk said. He recommended
programs affiliated with university medical centers and the nearly 100
interdisciplinary programs accredited by the Commission on
Accreditation of Rehabilitation Facilities.

Two weeks into the boot camp, Parseghian's husband visited her
in Chicago for the weekend. They toured an art museum and went shopping
together. Later, he phoned her with an observation.

"You didn't say one thing about your pain or the back. That
used to monopolize our conversations," her husband told her.

That impressed Parseghian. "I guess I hadn't realized just how
much my back issue had really manifested itself into our relationship,"
she said.

Two weeks later, she headed home with a detailed schedule for
her first week back, including plenty of time to relax. She knew the
staff would check with her in another four weeks to see how she was
doing.

She also was armed with breathing techniques and phrases to
repeat when she suffered a flare-up: "This has happened before and I
have survived it. I'm going to be OK."

During her second week home, she reported, "I took my first
ballet class last week."

"I thought that day would never come," she said. "Little by
little, I'm regaining the control in my life that I thought the injury
had robbed me of."

Originally published by The Associated Press.

Source: The Charleston
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