Are Pain Clinics Right for You?
People with arthritis and related diseases may benefit from the integrative care offered by pain management centers.
Medications have come a long way in treating arthritis and other related diseases. But when pain persists even with early and aggressive treatment, you may wonder if it is time to consider a pain clinic.
Daniel Clauw, MD, rheumatologist and director of the Chronic Pain and Fatigue Research Center at the University of Michigan in Ann Arbor says if inflammation is the main driver of your pain -- probably not. “A rheumatologist is the best person to manage that kind of pain because they are the ones who really have the expertise and know what medications need to be added to a regimen to get inflammation under control,” he explains.
But if your inflammation is well managed (or your arthritis-related disease is not inflammatory) and you are still having pain, a pain clinic or pain management center may be your next step.
What Is a Pain Clinic?
Pain clinics focus on controlling chronic pain and there are two general types. “One is for procedures, such as injections to deal with specific areas of pain, for example, neck and back pain. The other offers integrative services, which include medications as well as physical, behavioral and psychological therapies,” explains Eric Matteson, MD, professor of medicine and rheumatologist at the Mayo Clinic in Rochester, Minnesota.
This latter type, often called an interdisciplinary clinic, helps patients manage chronic pain with non-narcotic medications; nerve blocks; physical and behavioral therapy; patient and family education; lifestyle changes; and complementary and alternative medicine (CAM). CAM therapies may include biofeedback, cognitive behavioral therapy, acupuncture, hypnosis, water therapy, massage and meditation. Services at multidisciplinary centers extend beyond doctors and may include physical and occupational therapists, social workers, psychologists and vocational rehabilitation experts.
A 2009 issue of Baylor University Medical Center Proceedings evaluated data from 108 people and found that after four weeks of this kind of comprehensive pain-management care, patients saw improvement in pain, emotional distress and function. Another study that same year found a multidisciplinary approach helped people with fibromyalgia symptoms, especially when treatment was tailored to a patient’s individual needs. Dr. Matteson says people with disabling neuropathic pain from rheumatic diseases, like peripheral neuropathy associated with lupus or vasculitis, also often benefit from integrative pain management services.
More Than Medication: The Importance of Self-Management
Patients with arthritis and other related conditions should not seek out pain clinics that primarily offer narcotic medications. These drugs can be addictive. They don’t treat inflammation, can interact with other medications and don’t help the widespread pain of fibromyalgia. They can actually make fibromyalgia pain worse.
“Most pain management doctors are aware of the downsides of narcotics. People can have increased pain when on narcotics because the medications change the way their endorphin system works,” explains Seth Waldman, MD, director of the division of pain management at New York City’s Hospital for Special Surgery. “There are some people who benefit from narcotics. But it’s a mistaken impression if you think going to a pain center means automatically getting started on them.”
Rheumatologists say chronic pain clinics are most helpful when they encourage people to be¬come active partners in their pain relief. That means focusing on self-management techniques like adopting an anti-inflammatory diet, starting low-impact exercise, identifying a personal support system and making self-care a priority.
A study published in 2009 in the journal Qualitative Health Research conducted 46 interviews of people with chronic pain and 46 interviews of people with RA-associated pain. They found that “for those living with pain, a sense of well-being is achieved not through pain control alone, but also through various mind/body techniques for managing pain, accepting new limits and adjusting the way people relate to themselves.”
What To Look For In A Pain Clinic And Questions To Ask
Health care providers make referrals to pain clinics and interdisciplinary centers, whcih are often affiliated with university hospitals.
When you call the pain management program, ask:
- What kinds of therapies and treatments do you offer? (You want the answer to be wide ranging and more than just oral and injectable medications.)
- Do you have physical therapists, occupational therapists and psychologists at your clinic?
- What non-drug treatments do you offer, such as cognitive behavioral therapy, meditation, physical therapy and occupational therapy?
- Are your pain doctors board certified, trained in fellowships and accredited?
- Do you treat fibromyalgia?
- Do you organize online and in-person patient support groups?
- Can I speak with patients with arthritis and related diseases who have completed your program?
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