Section of Pain Medicine
The Problem
Pain touches us all – usually as a warning sign of injury or disease. Pain normally subsides following medical care and recovery. But according to the National Institutes of Health, 40 million Americans are unable to find relief for their pain. It is chronic, without correctable cause, and unresponsive to conventional treatments. It is frequently associated with low back disease, headaches, fibromyalgia or disorders of the nervous system. Such longstanding pain disrupts lives, tears at families, and jeopardizes careers. It causes productive people to withdraw into a downward spiral of anger, depression and despair. They become less mobile, losing strength and flexibility to the point that even minor activities may increase pain.
How We Can Help
To help those with chronic pain break out of this downward cycle and return to more normal lives, The Cleveland Clinic Foundation formed a Chronic Pain Rehabilitation Program in 1979. Since then, The Cleveland Clinic's Pain Management staff has helped more than 2,000 people manage their chronic pain. In an attractive and comfortable setting, patients receive comprehensive, individualized care that emphasizes a return to wellness. Each person's treatment - whether inpatient, day care, outpatient or follow-up – is coordinated by a team of experts.
Treatments provided
Following evaluation, there may be recommendations for treatment in the Section of Pain Medicine or for treatment at home or by other physicians at Cleveland Clinic. Treatment options may include physical rehabilitation, medications, referrals for such interventions as nerve blocks or spinal cord stimulation, and referrals for biofeedback training. An intensive interdisciplinary rehabilitation program is recommended for those with high levels of pain, suffering, and functional impairment, and may very in intensity from inpatient care to a few hours a day of outpatient care.
Chronic Pain Rehabilitation Program video
Mission Statement
The Chronic Pain Rehabilitation Program is dedicated to working in collaboration with people who have chronic pain to help minimize their suffering and restore their ability to take joy from life while contributing to it. The program will provide comprehensive specialized care to people experiencing chronic pain utilizing an interdisciplinary team approach. To these ends, the team works in a compassionate way to help people to exceed their perceived limitations, eliminate harmful behaviors, and replace them with healthy living.
Our Treatment Team
Because chronic pain affects so many aspects of an individual's life, it is appropriate that the treatment team be equally comprehensive. The team included experts in pain management, biofeedback training, physical and occupational therapy, vocational rehabilitation, nursing, nutrition and psychotherapy.
Treatment is provided in the W.O. Walker Center with modern pool, exercise equipment and electronic biofeedback equipment. When hospitalization is required, patients are admitted to Cleveland Clinic and transported to Walker for program activities.
Treatment Goals
The Pain Medicine team helps individuals to accomplish the following goals:
- Regain control of their lives.
- Resume normal function, including work, play and socialization.
- Overcome depression and anxiety.
- Regain the physical strength and endurance necessary for full involvement in life activities.
- Re-establish more normal relationships with friends and family.
- Become free of addicting drugs.
- Reduce level of pain, when possible.
- Replace a self-image of disability with one of wellness.
Our Commitment
The Pain Medicine team agrees to:
- Relate to patients as individuals with hopes, feelings and goals.
- Treat patients as people who are suffering, but not ill.
- Work with patients to help them improve their level of functioning and suffer less.
- Provide an environment in which people sharing similar problems can work together toward recovery.
- Help patients and families understand the causes of pain and ways to manage it.
- Explain to patients all that we do.
- Ask patients to take part in activities which may be painful at first, but not ask them to engage in activities that will cause injury.
- Attempt to be consistent in responding to healthy behaviors, and in not responding to pain behaviors.
Patient Responsibilities
Success in the Chronic Pain Rehabilitation Program requires that patients:
- Sincerely desire to live as normally as possible.
- Are willing to work toward making changes in their lives.
- Are open to investigating all factors related to their pain.
- Understand that improvement is not something we provide, but something we help them achieve.
- Are willing to allow others to relate to them as people, not patients.
Our Approach
We begin each evaluation by carefully reviewing the medical records from other institutions. For this reason, we ask that people send, or have their referring physician forward the results of any previous medical tests that relate to their pain.
Based on our review of these records, an evaluation is tailored to the needs of the individual, and appropriate members of the evaluation team are scheduled to meet with him or her. The person may be seen by specialists in pain management, rehabilitation medicine, physical therapy, neurology, orthopaedics, dentistry, gynecology, internal medicine or other specialities as appropriate. If a treatable cause for the pain can be identified, the appropriate treatment is recommended.
For individuals with unresolved chronic pain, we may recommend either inpatient or outpatient therapy in our Chronic Pain Rehabilitation Program. In any case, a pain specialist will discuss and carefully explain the treatment plan to patient and family.
Day care and inpatient treatments involve the same therapies except that day care patients spend evenings at home or in a lodging facility, while inpatients spend the night in the hospital. Twenty-four-hour-a-care is required for those who are most severely disabled, who are in need of medication adjustment, or whose depression or medical condition requires closer observation. Lodging is available on campus for day care patients.
Whether a person is treated on an inpatient or day care basis, or a combination of both, the usual length of stay is three-and-a-half weeks. Actual time in treatment varies, depending on progress and goals. Treatment in the Chronic Pain Rehabilitation Program includes such services as:
- Medication management to provide nonaddicting treatments for pain, insomnia and depression.
- Physical therapy to teach proper body mechanics and improve strength, flexibility and endurance.
- Functional capacity evaluation to determine work ability and assess needs for further patient conditioning.
- Biofeedback training to teach pain control by reducing muscle tension and nervous system arousal.
- Coping-skills training to teach stress reduction, interpersonal skills, and reduce the use of illness as a way of coping.
- Education to teach the causes of pain and the behaviors that are likely to make it better or worse.
- Monitored weaning of narcotics, tranquilizers and sedatives.
- Psychotherapy to reduce depression, anxiety, anger or other emotions which increase pain.
- Vocational counseling to assist re-entry into the job market.
- Occupational therapy to improve performance of tasks at home and at work.
- Work hardening to improve strength and endurance through the simulation of various work and leisure tasks.
Aftercare
Chronic pain usually is rarely resolved in three-and-a-half weeks. Although individuals experience benefit from treatment, there may be a tendency to slip back into old patterns. For this reason, we strongly encourage follow-up treatment. Our monthly, free-of-charge aftercare program is designed to reinforce the principles learned during initial treatment. This program includes discussions of progress and difficulties, physical therapy "brush up," practice in assertiveness and stress management, and medication management as needed.