New pain-management techniques help those aching for relief

Nutrition Health Review, Summer, 1995

At the University of Michigan Medical Center, physicians and nurses are taking the approach that "pain is an emergency" and that no pain is untreatable.

Two of the latest pain-management techniques being offered at the medical center represent opposite ends of the treatment spectrum, from high-tech brain surgery performed while the patient is awake to low-tech cognitive-behavioral therapy, a literally "hands-off " approach that helps break the cycle of chronic pain.

Deep-brain stimulation. Conditions such as paralysis, ruptured discs and reflex sympathetic dystrophy syndrome can cause chronic nerve pain that even morphine can't touch. For those who have tried and failed such standard first-line treatments as oral opioids, nerve blocks and corrective surgery, neurosurgeons offer a sophisticated weapon called deep-brain stimulation. During this procedure, electrodes are implanted into the thalamus, the sensation control center of the brain. Once stimulated, these electrodes send signals down the neuropathways, blocking the pain with vibrations - a sort of scratch-for-an-itch approach that distracts patients from their pain.

With the patient awake, neurosurgeon James A. Taren, M.D., bores a dime-sized hole into the skull and probes down toward the thalamus with a tiny electrode. Once the destination is reached, he stimulates the electrode, asking the patient where he or she feels a vibrating sensation. The surgeon hits the bull's eye when the patient feels vibrations in the body part that is most affected by pain.

Once the brain electrode is in place, a small pulse generator the size of a woman's powder compact is implanted below the collarbone; the patient then only needs to wave a magnet over the generator to turn the pulse on and off at will to receive the stimulation that gives relief. While a patient's pain may not disappear entirely, it can, in many cases, be reduced by at least 50 percent. "We turn things around for them so if they have the motivation, they can change their life," Taren says.

Eye-movement desensitization. For patients whose chronic pain is associated with post-traumatic stress disorder resulting from an accident or abuse, cognitive-behavioral therapy may be essential to long-term recovery. The pain may be closely associated with the event, flaring up years later in the same area as the original injury, triggered by a memory or suggestion of the traumatic incident. Typical cases involve those who have suffered work injuries, sexual abuse or car accidents. At the Multidisciplinary Pain Center, these patients often are treated by psychologist Jan Bachman, Ph.D., who has been using a new technique called eye-movement desensitization (EMD) to break the cycle of pain.

In weekly 90-minute sessions, Bachman asks patients to close their eyes and recreate the initial traumatic experience. Once they are in the midst of the moment, surrendering to the memory of the pain and voicing their feelings, Bachman asks them to open their eyes. He moves his hand back and forth across their plane of vision, forcing them to make rapid eye movements. Then they are instructed to close their eyes and let go of whatever is in their mind, take a deep breath and report what they are experiencing. "For many people, the pain surfaces during the memories and becomes very real again," says Bachman, who is among the first in Michigan to use this technique for chronic pain. "For some reason, over time, EMD disrupts the memories and breaks the connection with the pain. We can't say exactly why it works, but it does."