Pain programs turning to alternative medicine

Mind-body approach provides relief

Rehab providers are finding that alternative therapy modalities such as relaxation techniques, stress management, biofeedback, and other mind-body techniques give chronic pain patients relief when more traditional approaches have failed.

"We've had the pain management program for 15 years at Spaulding and have found that the mind-body approach is much more effective than mechanical range-of-motion and physical therapy techniques," says Rick Leskowitz, MD, consulting psychiatrist to the pain management program at Spaulding Rehabilitation Hospital in Boston.

Spaulding's inpatient pain management program takes an interdisciplinary approach. All patients are evaluated and treated by physical therapy, occupational therapy, physical medicine, and psychological services. Then a program is tailored for each patient based on an assessment and on whether he or she is open to some of the alternative techniques.

All patients learn meditation techniques in a group and are exposed to biofeedback. Those who are interested in continuing either approach may work on it in individual sessions.

Patients also are trained in stress management techniques. They learn "mindfulness meditation," which helps them feel more connected to their bodies, Leskowitz says. The program also uses energy-based therapies, such as therapeutic touch, which help people dramatically shift their pain.

For instance, an amputee had been treated successfully for phantom limb pain with transcutaneous electrical stimulation and medication. She had a dramatic response to her pain with therapeutic touch.

The Spaulding program tracks depression and utilization of health care resources at admission, six months after discharge, and one year after discharge from the program. The outcomes data show positive results from the program as a whole, but because it is an interdisciplinary approach, it is impossible to say what component was the most helpful, Leskowitz says.

The pain management center at Beth Israel Deaconess Medical Center in Boston offers a 10-week outpatient clinic for people who've had chronic pain for at least three months, says Carolyn Guberman, clinical research coordinator. "Our program is designed to give people active coping tools they can use themselves to help manage their symptoms."

Participants attend for 90 minutes once a week for 10 weeks. The program helps them identify the connection between individual pain symptoms and emotional stress, Guberman says.

Patients learn to understand the pain process and their role in managing it. They learn to examine factors that can affect pain, such as lifestyle, diet, and physical and emotional tension.

Usually there are 20 to 25 people in a group. They have a wide range of diagnoses but have the common experience of chronic pain, she says.

The program is co-directed by Margaret Caudill, MD, PhD, DABPM, and Carol Wells-Felderman, MS, MEd, RN, CS, both specialists in pain medicine. Caudill developed the program after studying 109 chronic pain patients who averaged 12 doctor visits a year. After the patients attended 10 behavioral medicine-based outpatient sessions, all visits to doctors dropped by 36%.1 (Clin J Pain 1991; 7:305-310).

[Editor's note: For more information on Spaulding's inpatient pain management program, call (617) 720-6668. For information on the Beth Israel Deaconess program, call (617) 667-0293.] n