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When chronic pain sufferers enroll in the outpatient pain management program at the Chronic Pain Care Center of the Rehabilitation Institute of Chicago, they are hoping for a miracle because nothing else has worked.
What they get in the four-week program is a series of group lectures as well as individual work with a physical therapist, occupational therapist, psychologist, and physician. "The pain management program teaches them the tools they can use for the rest of their life," says Elizabeth Granfeldt, RN, CRRN, patient education coordinator at the Chronic Pain Care Center.
Those who enroll in the pain management program usually suffer from chronic low back pain, knee pain, headaches, fibromyalgia, complex regional pain, and myofacial pain syndrome. However, not all chronic pain sufferers are accepted into this program. Every candidate for the program is evaluated, and only those who are motivated to learn and make behavioral changes to control pain are accepted.
Patients who complete the program have follow-up appointments at one month, three months, six months, and one year after completion. At each follow-up appointment, patients are evaluated to determine whether they are putting into practice the things they were taught. For example, the physical therapist will ask them to demonstrate the exercises they learned.
An important part of the program is a series of educational lectures conducted by nurse educators that cover medication, sleep, sex, nutrition, and laughter. These topics all play a part in pain control and quality of life. The information and tips covered in these lectures include the following:
In this lecture, patients learn about endorphins, the body’s natural painkillers. "The body makes these natural painkillers when there are small amounts of pain and stress in a person’s life. Endorphins tend to get slowed down by chronic pain, stress, nicotine, caffeine, and long-term use of narcotics," says Granfeldt. Patients learn how to increase production of endorphins, and one of the main ways to do this is through aerobic activity.
Also covered in the lecture is information on how narcotics and non-narcotics work to reduce pain and what some of their side effects are. The program teaches that the fewer narcotics used for chronic benign pain, the better. "Most are in this program because the narcotics have failed. I tell patients to save the medicine for the bad times," says Granfeldt.
Instead of using medication, patients use such techniques as pacing skills. For example, rather than mowing the whole lawn, they can mow three strips of grass, go inside and use a heat pack for their pain, and then go mow six strips.
Sleep deprivation increases pain, so patients are taught how to sleep well at night. The lecture covers things that interfere with sleep, such as caffeine and nicotine. It also covers sleep hygiene, which encompasses establishing a regular time to go to bed and get up, limiting TV watching and reading in bed because they stimulate the brain, and stopping thoughts from racing when trying to go to sleep by imagining a big stop sign or writing down the thought in a journal and then going back to bed.
During the class, participants also take a bedroom inventory, evaluating lighting, bedding, and other factors that could influence whether or not they get a good night’s sleep.
Chronic pain often impairs people’s sexual activities and therefore their quality of life, which is why the topic is included in the educational lectures. "I emphasize communication and experimentation. People must be willing to talk with their partner and experiment with different sexual techniques and postures. I tell them that almost anything they are learning about therapy, they can apply to sex," says Granfeldt.
This lecture covers the importance of eating a good, balanced diet based on the food guide pyramid. Also covered is a discussion of herbs, because many people ask about herbs and herbal medicines. The policy of the center is that until there is a double-blind placebo-controlled study that shows the value of an herb, the center will not advocate the use of it, says Granfeldt.
Lots of jokes and funny stories are told during this lecture to get participants to laugh. Information on the health benefits of laughter is provided. For example, laughter is good therapy for stress and chronic pain, and it improves circulation.
Each discipline at the Chronic Pain Care Center builds on the education provided at the basic lectures. For example, psychology teaches people how to deal with stress, fear of helplessness, and feelings of loss of control, which are moods that go along with pain.
"In our program, we treat the whole person, not just back or neck pain," says Granfeldt.