Targeting chronic pain

Some doctors specialize in treating specific pain

Some doctors specialize in treating specific pain

July 02, 2007|By TIFFANY ARNOLD

David Whittington found sitting, standing and walking unbearably painful five years after a 1999 back surgery to fix a herniated disc.

The surgery repaired the herniated disc, but scarred nerves lingered afterward, causing immense pain.

By 2003, that pain was too much to bear.

That's when Whittington, 51, of Kearnysville, W.Va., sought a pain treatment method outside his current system of medication and physical therapy - which wasn't working.

He went to a pain management specialist, a doctor who specializes in treating pain - a specialty that health care professionals say didn't exist a decade ago.

"My pain's been reduced almost 100 percent," Whittington said last week during a visit to The Spine Center at The Center for Pain Management in Hagerstown.


Whittington is among a growing number of pain sufferers seeking out physicians who specialize in pain management. It's part of a broader, national trend in which health care professionals are aiming to do more than get rid of the "ouch" with drugs and surgery, a concept known as pain intervention.

"In the past, when dealing with back or neck pain, the knee-jerk response was to operate," said Dr. Mark Yacyk, medical director for rehabilitation services for Washington County Hospital.

But today, doctors realize that surgery might not be for everyone, Yacyk said.

There's no consensus as to whether less-invasive forms of treatment should act as a substitute for surgery, but most doctors agree that it's an option that should be considered before the condition gets to the point where surgery is necessary, said Yacyk, the specialist at Washington County Hospital.

Center for Pain Management in Hagerstown is part of a network of five pain management centers throughout the State.

Ten years ago, 80 percent of the patients who came into the Hagerstown office were like Whittington, referred there by their primary care doctors after surgery, Loev said.

Now, more than 80 percent of patients seen at the Hagerstown office are referred by their primary care doctors without having seen a surgeon, Loev said.

Some patients are eligible for less invasive forms of treatment, such as injections of pain medicine, instead of full-blown surgery, though surgery is unavoidable in some cases.

The pain management center in Hagerstown sees roughly 2,000 patients a year, Loev said.

Of Loev's caseload of about 20 to 25 daily patients, half of them receive injections. The other half are on medication and are undergoing physical therapy.

Price of pain

Pain intervention doesn't just apply to neck and back pain.

Some physicians are considering pain as the fifth vital sign, in addition to pulse, respiratory rate, body temperature and blood pressure, said pain management physician Dr. Marc Loev.

New technology and the cost of treating pain are driving factors behind the trend.

The Illinois-based American Pain Society pegs pain as the leading public health problem in the U.S., resulting in 50 million lost workdays a year. The cost of pain in the U.S., the organization estimates, is $100 billion a year.

Without insurance, back surgery can cost as much as $20,000, compared with less invasive treatments such as injections, which cost the patient $2,000 without insurance coverage, Loev said.

Most insurance companies cover surgery and injection treatments, Loev said.

Most patients only pay the co-pay, "10 bucks or nothing," Loev said.

A reprieve

For Whittington, it's hard to say whether he would have been better off had he seen a pain management specialist prior to his 1999 surgery, said Loev, Whittington's pain-management specialist.

But there is one thing that is without question: "I've been feeling better since I started coming here," Whittington said during a recent visit to The Center for Pain Management.

Whittington was there to get a cortisone injection in his lower back, a procedure he receives one or two times a year. Loev uses an X-ray machine to pinpoint where the medication needs to go.

Before Whittington came to the pain management center, Whittington couldn't bear to walk more than two blocks, and he was taking at least five pain medications - with Vicodin and Percocet among them.

Now, Whittington is able to function virtually free of pain between visits. He still has prescription drugs, an anti-inflammatory and Vicodin for rare episodes of pain, which he might use once a month, Loev said.

Resources on the Web

Here are some online resources recommended by Washington County Hospital:

· American Academy of Pain Medicine,

· American Academy of Pain Management,

· American Board of Pain Medicine,

· American Chronic Pain Association,

· American Pain Society,

·Commission on Accreditation of Rehabilitation Facitlities

· (an educational resource sponsored by the Dannemil-ler Memorial Educational Foundation)

· American Pain Foundation,

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