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This is true even for patients in extreme agony. After knee-replacement surgery, Donna Jaeger, 56, of Auburn, Calif., developed a neurological condition that caused excruciating pain that she rated a "17 on a 1-to-10 scale." Pain-management experts at U.C. Davis prescribed a multifaceted treatment that included powerful opioid drugs and a spinal implant--all of which helped. But Jaeger regards psychologist Symreng as "my saving angel." Breathing techniques and soothing relaxation tapes help Jaeger reduce her pain level from 17 to 4 or 5 on a good day. "But really," she says, "it is just the talking to her that helps, because the more you hurt the more anxious you get, and the more anxious you get the more you hurt."
Imaging techniques, which build on biofeedback principles, are another psychological option used at pain centers. At Stanford, Mackey has taught patients to literally watch "their brain on pain," using functional magnetic resonance imaging. By relaxing, they can watch lighted areas change color as pain fades. "It's tremendously empowering," he says, "all without medication."
Psychologists often play a critical role in persuading pain-hobbled patients to get moving again despite the blaring siren that tells them to keep still. "By educating them, by saying 'You've healed as much as you're going to heal,'" says Symreng, "we can deal with the No. 1 issue from a psychological perspective: the fear of reinjuring something." Getting the patient to move--or, better yet, exercise--not only restores function and raises spirits, it also prevents the cascade of health problems that stem from paralyzing pain. "If you're lying in bed all day," explains UCSF's Palmer, "you're going to have more problems from a cardiac standpoint, a pulmonary standpoint and a mental-health standpoint."
THE ROLE OF MEDS
Even with the best alternative techniques, most patients with chronic pain will need some medication. Many general practitioners tend to use common analgesics as a one-size-fits-all remedy--a practice that contributed to the COX-2 fiasco--but pain experts try to carefully match the drug to the type of pain, the patient's risk profile and even his or her personality. "A patient's psychological preference for treating pain can be more important than the amount of medication," Palmer says. She cites the case of an elderly woman with arthritis in her back who preferred taking the oral narcotic Vicodin to using a more potent opioid drug delivered through a patch. "The Vicodin wasn't nearly as powerful as the opioid patch," says Palmer, "yet it gave her more pain relief. That tells you this is a patient who wants control. In some patients the psychological impact of being able to open a pill bottle, pull out a pill and take it gives them some sense of control in their life. If you have a pump sending medication into your spine, or a patch on your skin, you in fact may feel out of control."