In the 1990s, Fannie Miller went to the Mayo Clinic because of the pain in her lower back. There she found out her spine was full of arthritis. They predicted she would be in a wheelchair in 10 years.
All these years later, Fannie at age 71, is still not in a wheelchair. But she does have pain. She’s tried a number of medications and not found significant, long-term pain relief from her opioids. About a year and a half ago, she went to see Robert Hill, MD, at Goshen Physicians Pain Management for help getting off her pain medication and finding new treatment options for her pain.
“I didn’t like being on an opioid,” Fannie said. “I never told anyone because I didn’t want them to know. I didn’t want someone breaking into my house to steal my medication. I never felt safe.”
Going off her pain medication was easier than she had expected.
“It wasn’t really that bad,” she said. “I was expecting it to be a lot worse. But I never abused my medication either.”
Fannie’s arthritis is now also in her neck and shoulders, and she struggles with fibromyalgia. But she manages with a small dose of an anti-inflammatory, a non- narcotic nerve pain modulator and acetaminophen.
“The Tylenol probably works as well as the Fentanyl did. Even when I had the patch, it didn’t take away all the pain.”
Fannie feels a sense of accomplishment about choosing to live without opioids. “I’m very determined. I’m not able to do everything I’d like to do.”
Still, Friday mornings she does her church’s bulletins. Wednesdays she often helps care for a woman with Alzheimer’s disease. And, she’s not in a wheelchair or addicted to painkillers.
Treating patients with pain
The first step in treating pain, similar to other health issues, is to gather a comprehensive history from the patient.
“There are complex processes that are interconnected. It’s like peeling an onion. Oftentimes, we treat one pain source only to uncover another. We address each of these concerns and incrementally improve the patient’s quality of life. Our goal is getting the patient better,” Dr. Hill said. “When we achieve that, it’s rewarding for the physician and life- changing for the patient.”
“For arthritis and bulging disks, for example, steroid injections can be very effective,” said Dr. Hill. “We strive to address the underlying problem that is causing the pain and treat it, rather than simply mask the pain. We work with our Colleagues in orthopedics to provide joint injections, physical therapy or nerve blocks when needed.”
Still, pain medication is necessary and appropriate for short-term use, for terminal patients receiving home or hospice care and also for patients who have or had cancer.
“Many people who are cured of their cancer may have lifelong pain,” Dr. Hill explained. “We explore solutions to give them the best quality of life we can, under their circumstances.”
But for many patients who have pain, “the underlying cause of the pain may not have been addressed in the past. Our team’s goal is to locate and stop the pain generator, not simply to mask the pain. Studies show that narcotics are effective for only two to three months of acute pain management. When used for long-term care, they tend to become ineffective and require higher doses. The side effects increase while the effectiveness of the medication decreases,” said Dr. Hill.
Recent research has shown that pain medications can actually contribute to patients’ discomfort. “That’s why we work so hard to give our patients other pain management options,” said Dr. Hill. “Our goal at Goshen Physicians Pain Management is to be at the forefront of current, multimodal pain management to help our patients live productive, pain-free lives.”
The role of mental health
Sixty-six percent of people with chronic pain also have a mental health condition.
“Managing people’s depression is critical to addressing their pain. We work with primary care providers, social workers and psychiatrists,” said Holly Lambdin, Nurse Practitioner. “We had a patient recently who said a steroid injection had not reduced her back pain. Then she started talking about being angry with her adult children for neglecting her. After a few visits with a social worker, her pain had greatly receded.”
The goal is to treat the whole patient. “It is very challenging to treat pain with depression and conversely it is very difficult to treat depression with pain. We use a multimodal approach with our Colleagues in the Goshen Health System to help treat the physical, emotional and social issues that affect our patients,” Holly said.
Personalized care for pain management
If you or a loved one is concerned about pain management, Goshen Health is here to help. Contact us at (574) 444-0042.
Ways to treat the causes of pain
- Physical therapy
- Occupational therapy
- Steroid injections
- Non-narcotic medications like muscle relaxants, anti-inflammatories and nerve-blockers
Whether you’ve been suffering for a few months or several years, we want to help you control your pain and return to a higher level of functioning and quality of life. For more information about our pain management program, call (574) 537-0423 or visit our website.