Case study.

		Case Study Marc Yland, MD Author Attending Physician Department of Anesthesiology Huntington Hospital
Homepage Chronic Pain Conditions Services Offered Appointments and Directions Monthly Newsletter Case Study		Slam! From out of nowhere she was hit from behind. Initial terror, then shock, then relief that all of her body parts were still attached, then... Days, weeks, months; more of the same. Lisa would set her alarm each morning for 7:00 AM, and each morning it was the same routine: cycles of debilitating pain and equally compromising pills. While Lisa initially seemed to be fine after the accident, it was only a few days before the agonizing neck pain developed. Her pain would start as a spasm in one of the muscles of her neck, would then change to a dull ache spreading to her head, and within minutes she would feel as though she had a knife in her neck, penetrating straight through and down her right arm. In order to get to class in the morning, she would take two or three of the pills her doctor had prescribed for pain relief. However, this would only take the edge off, and no matter what she was doing she was always aware of that constant, stabbing, agonizing feeling that now seemed to radiate through her entire body. As time went on, she took more and more pills and they helped less and less. She felt hopeless, helpless, and depressed. Lisa is one of approximately 75 million Americans who suffer from some sort of chronic pain. Chronic pain is defined as pain, which lasts longer than six months and does not respond to usual medical treatment. It cannot be diagnosed with X-rays, blood tests, or any other objective test. Physicians who are trained to manage patients with chronic pain work with a wide spectrum of patients. This includes patients with cancer, many of whom are in the advanced stages of their illness; patients with ischemic pain secondary to coronary artery disease and peripheral vascular disease; and patients with traumatic injuries, just to name a few. In order to help the patient with chronic pain the physician must: 1) accept the patient's pain as real - find out why he hurts, not whether he hurts; 2) set realistic goals - expect to treat rather than cure; 3) educate the patient and family regarding treatment options and treatment limitations; and 4) teach the patient an appropriately paced home exercise program. Chronic pain results in a significant drain on the nation's work force. Back pain alone is responsible for the permanent disability of more than eight million Americans. After treatment at a multidisciplinary pain clinic the rate of return to work increases from 24% to 67%, resulting in a net savings estimated at $56,000 per patient. Thus, the impact of this form of treatment is to potentially save the United States many billions of dollars. Dr. Yland presents a unique multidisciplinary initiative that brings together a comprehensive team of professionals in the diagnosis and treatment of chronic benign, ischemic and cancer pain. This team includes anesthesiologists, psychologists and physical therapists as well as consultants in cardiology, neurology, neurosurgery, oncology, orthopedics, physical rehabilitation, psychiatry, radiology and vascular surgery. Depending on the type of pain process (neuropathic, nociceptive, visceral, somatic, etc.) an individual treatment plan is developed and specific medical objectives are pursued in helping patients obtain a more productive, comfortable lifestyle. Improved understanding of chronic pain mechanisms has resulted in the development of implantable nerve pacemakers which in selected patients can reduce symptomatology significantly. Current techniques of neural blockade allow nerve blocks to last months to years rather than hours or days. In cancer pain patients successful pain relief and fewer side effects can be achieved in most patients using nerve blocks or implanted pumps. Our behavioral therapy program is aimed at developing adaptive coping strategies. At Marc J. Yland, MD Interventional & Multidisciplinary Pain Management, cost-effective treatments are coordinated closely with the referring professional, emphasizing restoration of function and patient education.