Quad Cities, IL/IA

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Pain and Perseverance: Do You Have Both?


Submitted by Pain Centers of Iowa

Chronic pain is pain that is present for longer than the usual period of time that damaged body parts or tissue take to heal, which is about six weeks. Once the pain lasts longer than that period, changes in the nervous system can occur which increase the intensity of the pain and can lead to a long-term chronic condition. Often times this chronic condition leads to deconditioned or weaker supporting tissues and muscles. The situation becomes a vicious cycle that sustains itself and interrupts the activities of one’s daily life. Other impacts such as sleep disruption and situational depression can develop as well. The progression creeps along quietly, so it is difficult to notice. The situation of chronic pain can be life changing for those in pain and their families. Job performance, schoolwork, or family interactions can also suffer.

If your pain seems to become a way of life and you’ve dismissed it as due to what you think is an “expected aging process.” You may want to see what’s new for you and consider seeing a Pain Centers of Iowa (PCI) specialist. There may be some therapies to assist with some of those developing issues. A joint could have bone spurs or missing cartilage and you might be heading down a surgical path that you want to avoid. PCI can intervene with biologics delaying a need for surgery and retrieving some of your daily function. Getting you active is key to a healthier life and getting you there may take some pain interventions from PCI. Treatment would begin with a “start fresh” approach, which means examining how your body functions, how you respond during physical exam, and sharing what your thoughts are on your pain. Starting fresh and having a new starting line approach is important. Just getting back to basics by doing a full physical evaluation, and perhaps re-doing physical therapy with the correct simultaneous intervention may just be your key.

Chronic Pain
It’s not uncommon that chronic pain patients feel dismissed by their caregivers, as a lot of caregivers simply don’t have the time to understand the nuances of chronic pain to support such a patient. A process called neuroplasticity, which is when pain sometimes finds another route to the brain, can make treatment difficult. When nerve paths reroute themselves, the diagnosis may seem very inconsistent and confusing to both the patient and provider, which can lend to lack of trust between them. Patients tend to internalize this and could feel judged because of their vague responses to questions about their pain. This is common for chronic pain patients and PCI understand this. What is undeniable, however, is what chronic pain can do to a patient, his/her family life, work life, and social life. We work very hard, with a no-nonsense approach with our patients and the pain.

Treating pain takes a keen eye and perseverance from both the doctor and the patient. As beginning treatment tiers are started, feedback during the “trial period” (time between appointments) is crucial to rule out or corroborate effectiveness of recommended therapies. We encourage a patient to keep a pain diary as well as logging some functional notes on the days between appointments. This is very useful information for the next visit. Patients need to keep in mind that “trial” periods need 100 percent compliance for this to work, to move to each step to find the correct answer for one’s pain.

Commitment to obtaining pain relief is patient dependent and necessary to gain some quality of life back. PCI is committed to each patient under our model of care. We offer solutions for patients and recommend they follow our suggestions as a team. Working together and agreeing to a plan is always the first hurdle. Some conversations are hard for patients to have and lifestyle changes are the most difficult of habits to break. However, we are incredibly impressed by the patient’s progress once they partner with the suggestions.

One in four people suffer from chronic pain (pain lasting more than three months) — 116 million adults — more than the total affected by heart disease, cancer, and diabetes combined. These numbers from the “Report on Chronic Pain” (Institute of Medicine 2011) are staggering. Pain costs the United States up to $635 billion each year, an amount equal to about $2,000 for everyone living in the United States in medical treatment and lost productivity. This is a call to action for health activists and advocates educating themselves in order to work toward better and more comprehensive pain management.

Dr. John Dooley
Dr. John Dooley understands this growing, under-served population and the layers of impact that chronic pain has on their lives and often the lives of their families. “I strive to work closely with the primary care providers because I know the impact on those practices managing their chronic pain population and now I can offer them a truly interventional pain management resource for their patients. Chronic pain truly is a huge evolving specialty, no longer recognized as a sub-specialty,” explains Dr. Dooley. There has been a call to action that Pain Centers of Iowa is prepared to answer for its colleagues and community. “It is clear to me that a comprehensive program is what is needed for these patients to succeed,” states Dr. Dooley.

John B. Dooley, MD, was born and raised in Iowa. He enjoys his family and friends as well as his hobbies of reading and flying. He is board-certified in anesthesia, critical care medicine and pain management, which has become his passion. He’s been treating pain in the Quad Cities since 1996 and his approach to managing pain starts conservatively and runs all the way through to the most current and innovative of treatments. As a true interventionist of pain it is important to aggressively train on new techniques from around the world and bring that to you as a patient. Dr. Dooley does not settle on just what he is familiar with. He is constantly keeping abreast of the latest therapies and is excited to grow the field of pain management benefiting Quad Cities.

PCI’s Approach to Pain
Dr. Dooley’s approach and focus is on understanding what causes your pain, even if that means starting at the beginning in order to find the exact pain generator. When you have pain for such a long time, the location of pain is difficult to pinpoint as your mind becomes desensitized to it. You may recognize that you ache only in the morning, or late in the day after walking, during certain weather or perhaps you may only recognize that some positions feel better to you. Simple things like standing at a sink, or rising from a chair may catch your attention. When these feelings of general discomfort severely decrease your life’s activity, the source is vague but the discomfort is clear. This is why you will find a “start fresh” approach from PCI. For some patients, their pain may be clear and easy to explain what is hurting and when, but we find that most patients struggle with those details and for good reason.

PCI will provide patients with a board-certified anesthesiologist, a critical care and pain management physician, three nurse practitioners, an in-house massage therapist, two nurses, and three medical assistants. Our program has developed and continues to evolve around the success of our patients, colleagues, and community. Our emphasis of patient education leads to self-awareness and important lifestyle changes, which leads to a happier person. We are proud of the success of our patients. At times, they may not like the direct approach from Dr. Dooley who is passionate about their needed changes. What usually starts off as direct and focused interaction asking for immediate lifestyle changes eventually develops into empowered, grateful patients who “get their lives back.” “Not everyone has the same coping skills, and recognizing that patients may need some guidance is part of my job,” shared Dr. Dooley. Our supportive staff is here to help anyone who may need support. We train our PCI staff to look for queues of stress and offer appropriate resources delicately. We understand that problems and pain circle each other ferociously. Likewise, we have come to observe that support and happiness do the same for a patient’s mental health.

Some people despair and others seek pain-killing medicine to ease the suffering of chronic pain. Neither of these options produces long-term improvement. Pain-killing medication is dangerous, as the amount required to produce significant relief is close to the amount that produces life-threatening effects; this is known as a narrow therapeutic window. It requires careful monitoring of the effects of the painkillers and strict adherence to prescription directions. Unfortunately, directions are frequently not followed, the medication not secured, or the medication diverted to non-prescribed uses. Drug overdose deaths are at epidemic proportions in the United States today. In 2008, 36,450 deaths occurred from drug overdoses, which include illegal drugs such as cocaine and heroin along with prescription painkillers. This should be alarming enough for anyone taking these medications or their family members to be genuinely concerned.

Some pain physicians will order serial injections at facilities such as surgery centers or hospital outpatient settings that may be redundant and more expensive than in an office setting. When a patient has come through our doors frustrated that they have “had every injection under the sky,” we feel responsible to spend time with them and explain that although trialing procedures can be disappointing, they can be necessary to identify the culprit/pain generator. However, there are many other things to consider. That is why when we get a referral for an injection, our necessary due diligence is to step back, see what has been done, and perhaps move in another direction if warranted.

Different Therapies
Medical advances do offer alternatives for many types of pain. These alternatives are usually improvements on existing techniques that can help an expanded list of pain problems or can be offered to those with health issues that would not allow the usual treatment to be offered. A review of newer advances follows.

Neurostimulation is a medical procedure whereby gentle micro-currents are applied to nerves so that the painful impulses that nerves carry are reduced. This technique has been around for years, but has been more rapidly developed over the past 30 years. Painful impulses may come from nerves that have been damaged by trauma, herniated discs, scar tissue, diabetes, circulation problems, or infections. Often these medical problems leave nerves in a damaged state and those nerves can then produce abnormal impulses that are felt as pain. When damage is early, the pain is usually constant with a burning or shooting quality, while later it can feel like a deep ache. Different nerve fibers produce different painful sensations. When usual treatments with anti-inflammatory drugs, steroid injections, anti-convulsant drugs, antidepressant drugs, chiropractic care, physical therapy, or previous surgery fail, then treatment with neurostimulation may be suitable.

“One attractive aspect to considering this type of technology to modify pain is that it can be tried before it is permanently placed,” explains Dr. Dooley. The trial involves placing the electrode contact leads or wires through a needle next to the nerve that is to be stimulated. The trial leads are placed under local anesthesia and mild sedation in an office, surgery center, or hospital. The trial period is usually about five to seven days and patients are on antibiotics to prevent infection where the lead enters the skin. Success is based on amount of pain reduction, pain medication usage reduction, and improved activity of daily life. If a successful trial is the result, then a permanent generator and leads can be placed as an outpatient under mild sedation with local anesthesia.

A final therapy that can be considered for chronic pain involves the delivery by a pump of medications directly into the spinal cord area through a small tube. The number of different medications that can be used to lessen pain in this fashion has greatly expanded in the past 10 years. There are close to seven different levels of medications or medication mixtures to consider. Different medications produce different effects and can be varied to treat different types of chronic pain. Insurance companies seem to delay reimbursement for PCI’s preferred medications making this process almost financially unbearable by all. We are currently trying to fight for this cause with the insurance carriers of our patients with success, but far too long with revenue delays. We will need patients to champion this treatment in the future with their selected insurance carriers. The medicine we use (Ziconitide) is an amazing treatment for chronic pain and Dr. Dooley is one of the only pain physicians in Iowa using it. Therefore the insurance companies aren’t sure how to process the claims, causing patients and physicians more stress than either should endure.

Dr. Dooley says, “What’s great about this therapy is that the amount of medication required to produce a result is very small, which leads to less of the side effects. These side effects can greatly decrease a patient’s quality of life.” The pumps are small, but usually can contain enough medication to last two to three months. They are placed just under the skin and are filled through a needle port periodically, and the batteries last about five to six years.

All of these techniques are available in the Quad Cities at Pain Centers of Iowa (PCI), located at 5515 Utica Ridge Road, Davenport, Iowa. The clinic offers services as a team of health care providers including John B. Dooley, MD, Director; Sarah Schlickman,
Advanced Nurse Practitioner; Terri Brinck, Advanced Nurse Practitioner; and Anthony Schwendinger, CRNA. Dr. Dooley has over 20 years of pain management experience. More information is also available at www.pcipain.com or 563-344-1050. Dr. Dooley also
offers newsletters on our website and interacts with patients on Twitter @painchat or join us on Facebook. We offer complimentary spine pain “Chat with a Nurse” education. Schedule an appointment by email at gjohnson@pcipain.com or call and ask for Gina.