Breaking Free
If you're one of the more than 86 million Americans struggling with chronic pain, new treatment options can help you reclaim your life.
By Alyson Black

“If you sit by and wait for pain to disappear, you'll never get going—you'll get worse and worse. But we have so many options for treatment today. There is no reason to suffer.”

What's holding you back? If the answer is pain, you're not alone. As it turns out, you're in good company: One in three Americans suffers from some form of chronic pain, including back injuries, arthritis, headaches, fibromyalgia, and a host of other ailments. Unfortunately, the reality of pain is that it is insidious, often creeping its way into every facet of life. It disrupts sleep, mobility, relationships, and careers. In fact, according to statistics from the National Institute for Occupational Safety and Health, chronic pain is the No. 1 cause of adult disability in the United States today, costing $100 billion each year in lost workdays and medical expenses.

“The economic impact of pain is staggering,” says Gerard Malanga, MD. As the director of the Pain Management Center at Overlook Hospital, Malanga sees firsthand how chronic pain has the tendency to rob people of their lifestyles. “The biggest illusion is that you have to wait for pain to get better before you return to activity,” he says. “That mindset gets some people in trouble. If you sit by and wait for pain to disappear, you'll never get going—you'll get worse and worse. But we have so many options for treatment today. There is no reason to suffer.”

A Constant Companion
Chronic pain is defined as pain that continues a month or more beyond the usual recovery period for an injury or illness, or that goes on for months or years due to a chronic condition. Diagnosing the cause of pain and coming up with a treatment plan is as much a challenge as it is a science. “Pain is multifactorial,” says interventional pain management specialist Wayne Fleischhacker, DO. “It's very individualized. You're not always sure what the source is or what will be effective, so it's important to take each patient as an individual and create a treatment plan that works.”

An accurate pain diagnosis usually begins with a thorough examination and patient history. You'll be asked to answer a series of questions about the nature of your pain, other symptoms, and the treatments you've already tried. “This can be tedious,” Malanga admits, “so too often it's not done in a lot of practices today. People are hustled through. But it's important to ask the right questions.”

You may be asked to undergo such imaging tests as an MRI or CT scan, which can help pinpoint the source of pain. But Fleischhacker is quick to point out that imaging is only part of the puzzle. “You don't treat the pictures; you treat the patient,” he says. In other words: If the images show one thing but a patient is saying something else, it is critical that the doctor listen to the patient. The need for clear communication is key. When patients can describe their pain and symptoms accurately, doctors can form better hypotheses. Likewise, in delivering a diagnosis, Malanga stresses that doctors need “to be positive,” he says. “Words can set off a cycle of fear and distress. For example, doctors use the term 'degenerative spine' because that's the term we've been taught to use, but all it really means is a normal aging process of the spine. I tell a patient it's just like developing gray hair and wrinkles.”

Relief Is in Reach
“Pain management has come a long way,” says Fleischhacker, the chief of Union Anesthesia Associates. In returning people to improved levels of functioning, today's spectrum of treatment options is much broader than over-the-counter remedies and prescription narcotics. Doctors and patients must work together to determine the best course of action.

~ Infusion pumps, explains Edward Zampella, MD, chief of neurosurgery for Atlantic Health and president of Atlantic NeuroSurgical Specialists, can be used to deliver the same medications as would be taken orally or intravenously, but with the benefit of requiring smaller doses to achieve the same effects. “Higher doses equal higher side effects,” Zampella points out. With this therapy, the pump is implanted under the skin using a minimally invasive procedure, and anesthetic medication is delivered in a controlled fashion that would be impractical or unreliable otherwise.

~ Spinal cord stimulation (SCS) is an excellent source of relief for many chronic back-pain sufferers. This innovative implantable therapy, performed under sedation, takes an epidural-like approach to blocking the transmission of pain: The spine is wired with thin electrostimulators and a rechargeable battery source is implanted under the skin. (“Someplace with extra cushion,” says Malanga. “You don't even notice it.) Electrical stimulation is then used to generate a buzzing sensation that replaces pain signals and provides a more comfortable sensation in its place. “It's the Gate Control Theory,” explains Malanga. “By opening one gate, you close another. So by blocking off one highway, you open another with a tingling sensation that's more comfortable.”

~ Cancer-related pain is also treatable. “Radiation and chemotherapy can cause irritation to nerves,” says neurologist Seth Stoller, MD, the director of cancer pain at Overlook Hospital. “Medical treatment of pain not only offers better quality of life but also makes patients better able to endure certain treatments that they would not be able to tolerate otherwise.” For patients with heightened pain and limited lifespans, Zampella explains that “destructive procedures” can offer relief by selectively cutting certain spinal cord tracks that control pain, though these measures are reserved for the most intractable situations.

~ Physical therapy, aggressive strengthening, and rehabilitation may not be cutting-edge treatments, but they serve to restore strength and mobility and improve overall quality of life.

No two people experience pain in the same way, and no two people receive treatment the same way. But one thing is clear: It is no longer necessary to suffer in silence. Today's pain-management options are offering millions of people new leases on life. Shouldn't you be one of them?

The Psychology of Pain
When it comes to pain, it seems there are no boundaries. Chronic pain influences every aspect of life, and often those negative experiences go a long way in reinforcing pain. It's an unfortunate cycle, to be sure.

The interconnection between mind and body must always be recognized,” says Gerard Malanga, MD, director of the Pain Management Center at Overlook Hospital and clinical professor of physical medicine and rehabilitation at the University of Medicine and Dentistry of New Jersey. “There is no separation: What affects the body affects the mind. Unless you treat both sides of that, you're not going to be healed.”

For that reason, many patients at the Pain Management Center find themselves sitting across from clinical psychologist Sangeetha Nayak, PhD. “Even though pain starts as a biological factor, over time it can impact how people function and their levels of emotional distress,” she says.

The fear of experiencing pain takes hold over a life and creates a vicious cycle. “If people live with pain over time, they become more and more fearful of being active, and they don't realize the inactivity is actually more damaging,” says Nayak. “If the tendency is to avoid activity due to pain— even when the doctor contraindicates that—I show them that the more they avoid activity, the more damage they do. Once we break down those belief systems, the next step is to get them onto a regimen to make them more active and more purposeful.”

At the other extreme are people who are living with their pain but not functioning effectively. “They push so hard, they wind up paying for it,” Nayak says. She teaches this group of people to pace themselves and plan activities accordingly to enhance experiences— to “balance good days and bad days.”

Nayak further instills the importance of the proper use of medications; some people overuse medication, whereas others diminish their efficacy by waiting to feel pain before taking medication.

Cognitive-behaivor psychotherapy addresses the emotional components of pain, too. “Patients often get depressed, so the perception of pain gets worse,” Nayak says. “By getting control over emotional distress through the development of morerealistic perceptions, patients can improve their emotional and physical functioning. When they can manage their emotions better, they can better manage pain flare-ups.”

Nayak strives to achieve realistic expectations for her patients, which helps them to regain control over their lives. “People sometimes rely too much on their doctors for relief,” she says, “and they feel they don't have a lot of control outside of medication. But it's important for them to see that that's not so. That's the biggest contribution I can make: I can teach patients the skills they need to better manage their pain.”

Where to Turn
The team of doctors, nurses, and other healthcare professionals at the Pain Management Center at Overlook Hospital are nationally recognized pain-management experts with backgrounds in physiatry, anesthesiology, radiology, neurology, neurosurgery, and orthopedic spine surgery. The Center's specialists diagnose and treat a wide variety of conditions, including post-operative pain, neck pain and whiplash injuries, low back pain, chronic tendon and ligament pain, complex regional pain syndromes, neuropathy, fibromyalgia, pain from shingles, myofascial pain, and pain caused by cancer, to name a few.

The Pain Management Center, part of the Atlantic Neuroscience Institute, is a multidisciplinary outpatient facility that strives to eliminate or reduce pain in a minimally invasive manner. Services are designed to enable patients to return to daily functions as soon as possible.

The Center's team approach includes participation by the patient and family, as well as the primary care and consulting physicians. The medical staff works hand in hand to approach every situation from different angles to reach the best treatment options.

Comprehensive pain management may involve a number of different treatments, including medication, physical therapy, exercise, psychology, complementary
medicine, and surgery.