'Boot camps' treat chronic pain sufferers: = biofeedback, therapy, exercise under one roof

CHICAGO Ballet teacher Gayle Parseghian = thought=20 she might never dance again after a back injury while moving heavy = furniture=20 left her with unrelenting pain.

But an intensive, four-week "boot camp" got the 55-year-old dancer = from=20 Toledo, Ohio, back to the barre. The program at the Rehabilitation = Institute of=20 Chicago taught her to manage the chronic pain that had tormented her for = more=20 than a year.

"It affects your relationship with your spouse, your family, your = friends,=20 your boss," she said. "It's like you're trapped in your body and you = can't get=20 out. It's a feeling of being completely out of control."

New research suggests chronic pain affects the brain's ability to = rest,=20 disrupting a system that normally charges up some brain regions and = powers down=20 others when a person relaxes.

"I ask a patient who has had chronic pain for 10 years to put the = mind blank,=20 don't think about anything," says Dr. Dante Chialvo, a researcher at=20 Northwestern University's Feinberg School of Medicine who is not = involved with=20 the boot camp.

MRI images show the pain sufferer's brain lighting up, but not as a = normal=20 brain at rest would, he said. "There is an objective biological = difference in=20 the brain."

The early findings could explain the sleep disturbances, = decision-making=20 problems and mood changes that often accompany chronic pain, he = said.

And they could explain why the boot camp approach worked for = Parseghian.

The Chicago program, affiliated with Northwestern's medical school, = attacks=20 pain on three fronts - biological, psychological and social. It doesn't = claim to=20 cure chronic pain, but instead gives patients tools to lessen its hold = on their=20 lives.

Patients spend Monday through Friday stretching, exercising and = moving in new=20 ways. They meet with a physician, an occupational therapist, a physical=20 therapist, a biofeedback therapist, a clinical psychologist and a = movement=20 specialist.

They may address depression or sleep problems or adjust their = medications.=20 And they learn from the other patients in the program.

Getting all of these things under one roof differs from most = approaches to=20 treating chronic pain, said Dr. Steven Stanos, the program's medical=20 director.

Patients know the drill. In the fragmented world of health care, they = bounce=20 from internist to chiropractor to massage therapist to surgeon - with = none of=20 the experts sharing information.

"You will try anything and everything to get out of the pain," = Parseghian=20 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=20 battery-operated device that uses electrical impulses to block pain. = Nothing=20 worked.

Surgery would have been next. She was in a surgeon's waiting room = when she=20 read an article about the boot camp.

If acute pain is the body's alarm system, alerting to injury-causing = dangers,=20 then chronic pain is an alarm going haywire, screaming a warning long = after the=20 danger has passed.

The American Pain Society estimates millions of Americans are in = chronic pain=20 from backaches, jaw pain, headaches and fibromyalgia, a mysterious = syndrome=20 marked by muscle pain and fatigue. Sore spines alone cost billions of = dollars=20 each year.

In 2005, Americans with aching backs and necks spent $20 billion on=20 prescription drugs and another $31 billion for outpatient doctor visits, = according to a recent study in the Journal of the American Medical = Association.=20 Total spending on spine treatments increased 65 percent from 1997, = adjusted for=20 inflation. But rising alongside that was the proportion of people with = spine=20 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,"=20 said Dr. James Cross, Aetna's national medical policy chief. The = patients are=20 "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=20 cost-effective compared to the procedure and pill merry-go-round. The = company=20 cites studies showing patients who have completed boot camp programs = experience=20 lasting pain reduction and lower stress. Aetna also believes patients = completing=20 the programs are more likely to return to work and less likely to seek = other=20 expensive treatments.

Other insurers also cover the programs, but convincing more companies = will=20 take more evidence, said Dennis Turk, a pain researcher at the = University of=20 Washington in Seattle and a believer in the approach.

It's unclear what combination of therapies works best for which = patients and=20 whether four weeks are needed for everyone, Turk said. Patients should = be=20 cautious because quality varies, he said.

"Anybody out there can put up a sign and say, 'I'm a comprehensive = pain=20 rehabilitation program,'" Turk said. He recommended programs affiliated = with=20 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=20 the weekend. They toured an art museum and went shopping together. = Later, he=20 phoned her with an observation.

"You didn't say one thing about your pain or the back. That used to=20 monopolize our conversations," her husband told her.

That impressed Parseghian. "I guess I hadn't realized just how much = my back=20 issue had really manifested itself into our relationship," she said.

Two weeks later, she headed home with a detailed schedule for her = first week=20 back, including plenty of time to relax. She knew the staff would check = with her=20 in another four weeks to see how she was doing.

And she was armed with breathing techniques and phrases to repeat = when she=20 suffered a flare-up: "This has happened before and I have survived it. = I'm going=20 to be OK."

During her second week home, she reported, "I took my first ballet = class last=20 week."

"I thought that day would never come," she said. "Little by little, = I'm=20 regaining the control in my life that I thought the injury had robbed me = of."=20

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'Boot camps' treat chronic pain sufferers:=20 biofeedback, therapy, exercise under one roof

By CARLA K. JOHNSON

(Published March 16, 2008)

CHICAGO =97 Ballet teacher Gayle Parseghian thought she might never = dance again=20 after a back injury while moving heavy furniture left her with = unrelenting=20 pain.

"It affects your relationship with = your=20 spouse, your family, your friends, your boss," she said. "It's like = you're=20 trapped in your body and you can't get out. It's a feeling of being = completely=20 out of control."