The Right (and Wrong) Way to Treat Pain

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At top pain-management clinics such as those at Stanford and UCSF or the Wasser Pain Management Center in Toronto, doctors dive in with a broad array of therapies, devising a program that is tailored to the individual patient. The four main elements of such programs are drugs; injection therapies (nerve blocks like epidurals); physical therapy and exercise; and behavioral techniques that include relaxation training, biofeedback and psychotherapy. "If you ask most physicians how they would treat a patient, they would say, 'I use this drug' or 'I use that drug.' But there are many ways of treating chronic conditions that don't involve drugs," says Dr. Allan Gordon, director of the Wasser Center. "You have to look at the whole individual. A multidisciplinary approach is the only answer." A patient who learns to reduce pain with breathing exercises or biofeedback, Gordon notes, can often manage his misery with lower or only intermittent doses of drugs, reducing the risks of side effects that come with every pain-killer.

That's been true for Bill Highland, a retired electrician from Yuba City, Calif., who for the past two years has been battling searing pain in his shoulder blade and armpit from shingles. Highland tried a variety of drugs, but they brought only temporary relief. Finally he was referred to pain psychologist Ingela Symreng at the Pain Management Center at the University of California, Davis, to learn techniques that would help him control his pain. Symreng teaches patients relaxation exercises, breathing skills, guided imagery (focusing on pleasant mental images) and distraction techniques. Highland, 83, quickly became a master of deep abdominal breathing. "It's pretty amazing, because older folks tend to not be as open to this type of therapy," says Symreng. Highland put his new skills to the test when he was struck by a horrific shooting pain while driving on a Sacramento freeway. "As soon as I felt it," he recalls, "I just breathed through my nose and let it go out my open mouth without moving my chest--two or three times. I felt relief almost instantaneously."

Pain psychologists like Symreng play a vital role at most pain-management centers, though patients are often reluctant to consult them. "Patients hate to hear you offer them mind therapy, because they feel what you're doing is telling them they have a mental illness and you don't really believe they have a physical problem," says Dr. Scott Fishman, an anesthesiologist, internist and psychiatrist who is chief of pain medicine at U.C. Davis. But the mind is always actively involved in pain, especially in chronic cases. "We know that when you image the brain, the areas that light up when you experience pain include parts of the brain involved in emotions," says Fishman. That is why learning to relieve fear, anxiety and depression related to pain actually helps bring relief, probably by activating the body's own pain-killing chemicals.