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AP National News

'Boot Camps' Treat Pain Sufferers

By CARLA K. = JOHNSON

Associated Press=20 Writer

CHICAGO=20

Last Updated:March 16. 2008=20 12:08PM
Published: March 16. 2008 12:08PM

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

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

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

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

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

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

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

And they = could=20 explain why the boot camp approach worked for=20 Parseghian.

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

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

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

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

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

"You will try anything and = everything to=20 get out of the pain," Parseghian said. "You discover all of = your=20 efforts are fruitless and you have spent monumental amounts = of=20 money."

She tried herbal patches, vitamins,=20 injections, prescription narcotics and a battery-operated = device=20 that uses electrical impulses to block pain. Nothing=20 worked.

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

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

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

In 2005, Americans with aching backs = and necks=20 spent $20 billion on prescription drugs and another $31 = billion for=20 outpatient doctor visits, according to a recent study in the = Journal=20 of the American Medical Association. Total spending on spine = treatments increased 65 percent from 1997, adjusted for = inflation.=20 But rising alongside that was the proportion of people with = spine=20 problems who reported limited function.

Such = spending=20 with such poor results gets insurance companies'=20 attention.

Chronic pain patients' medical and = pharmacy bills "show up on our radar," said Dr. James Cross, = Aetna's=20 national medical policy chief. The patients are "frustrated = and=20 clearly suffering" and "looking for an answer," he=20 said.

Although boot camp-style programs cost = up to=20 $20,000, Cross said that's cost-effective compared to the = procedure=20 and pill merry-go-round. The company cites studies showing = patients=20 who have completed boot camp programs experience lasting = pain=20 reduction and lower stress. Aetna also believes patients = completing=20 the programs are more likely to return to work and less = likely to=20 seek other expensive treatments.

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

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

"Anybody out there can put = up a sign=20 and say, 'I'm a comprehensive pain rehabilitation program,'" = Turk=20 said. He recommended programs affiliated with university = medical=20 centers and the nearly 100 interdisciplinary programs = accredited by=20 the Commission on Accreditation of Rehabilitation=20 Facilities.

Two weeks into the boot camp,=20 Parseghian's husband visited her in Chicago for the weekend. = They=20 toured an art museum and went shopping together. Later, he = phoned=20 her with an observation.

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

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

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

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

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

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

---

On the=20 Net:

Commission on Accreditation of = Rehabilitation=20 Facilities: http://www.timesdaily.com/article/20080316/APA/%3Ca%20href=3D"&= gt;http://www.carf.org/

Rehabilitatio= n=20 Institute of Chicago: http://www.timesdaily.com/article/20080316/APA/%3Ca%20href=3D= ">http://www.ric.org/

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