Chronic pain is a real, unremitting, and demoralizing condition that can become a pervasive and overwhelming state of affliction. In many cases, the condition is under diagnosed and treated, causing intolerable suffering, exhaustion, depression, and financial loss to individuals, companies, and society. It is estimated that more than 40 million people in the U.S. live with a chronic pain condition. Over 50 percent of those who suffer with chronic pain have not been able to find adequate relief for their condition and would benefit from more ample forms of pain management. It is reported that for pain sufferers who sought treatment for their condition, nearly all have switched caregivers at least once, and many have tried over three different forms of management. It is estimated that 50 percent of pain sufferers have lived with the condition for more than five years.

Chronic pain is defined as out of control pain that does not respond to conventional medical treatment. Most who live with chronic pain become the victim of a vicious cycle of an unhappy state of being, marked by suffering, sadness and sleeplessness. It is a calamity that is as hard on the family as it is on the victim.

What is Chronic Pain?

• Pain that goes on longer than six months and does not respond to conventional medical treatment
  
• Pain that may not go away
  
• Pain that often has no concrete explanation nor tangible diagnosis
  
• Pain that is real even though cause for the pain cannot always be determined
  
• Pain that many people have to learn to tolerate and treat with relaxation and stress management techniques
  
  

How Does Chronic Pain Affect One's Life?

• Anyone at anytime can be affected by chronic pain
  
• It affects the individual's coping mechanisms, as pain causes suffering
  
• It affects the individual's family and friends, too
  
• When the individual first experiences the pain, others may be supportive and caring. Ultimately others may become frustrated
  
• The individual may withdraw from family and friends, feeling ignored and abandoned
  
• Soon the pain may control a large part of the individual's life
  
  

Issues That Must Be Reconciled

The pain is only one factor that contributes to suffering. Other issues that can increase suffering are:

Isolation - Believing that you are the only one in the world who has chronic pain can create a sense of hopelessness. Pain can cause withdrawal from social and family support systems.

Confusion - Chronic pain, in many ways, has no visible signs. The level of functioning changes daily. It is not surprising that those around the individual may question the reality of their pain. The individual may sometimes believe it is imaginary.

Uncertainty - In part, the pain is an aspect of the mind and belief system, as the mind and body cannot be separated. The body's experience affects emotional well being and mental attitude. The reverse is also true. The absence of a concrete diagnosis, or a reason for the pain, can cause the individual to question the reality of the suffering. Even with a diagnosis, the individual may find it hard to believe that modern medicine cannot help him.

Suffering - An individual who is experiencing chronic pain will suffer. If one gives too much attention to the pain, suffering can become overwhelming. If the attention can be redirected to other issues, the sense of suffering can be reduced.

Guilt - The individual's inability to contribute at work or at home may create a sense of guilt. Many individuals believe that their value is measured by what they accomplish.

Anger - The individual may be angry with the medical community for not making them better. They may be angry with co-workers for not understanding. They may be angry with friends and family for not being more supportive and understanding. They may be angry with themselves for not getting better.

Attitude Can Affect the Level of Suffering

A negative attitude focuses on inabilities, suffering, negative emotions and uncontrollable situations. This can make moving about difficult, as it can increase the pain. Yet, it is important to maintain a certain level of activity to maintain good muscle tone and eventually reduce pain levels.

Assertiveness is also a necessary component of regaining one's health. If the individual does not use an assertive approach to life, it will increase the level of pain and suffering over the long term. People with chronic pain may be afraid to speak out on their own behalf. Learning to become assertive will allow individuals to regain control of their lives.

Setting Realistic Goals Will Help

• Make a commitment to regain control of life
  
• Express confidence in the ability to be productive
  
• Focus energy and establish priorities
  
• Take charge and build a positive self image
  
• Set realistic goals, which will prepare you to regain your health. Express confidence to meet your own needs. Setting realistic goals also provides a focus.
  
• Devote time and energy to things to be accomplished so there is less time to think about pain. The less you think about the pain, the less you will suffer.
  
  

Recognize Feelings

• What one feels each day has an effect on the pain
  
• The feelings that one experiences emotionally will affect the level of pain
  
• It is impossible to separate the mind from the body. If the mind is under stress, the body is affected in the form of pain, as stress increases pain.
  
• Feelings are an integral part of an individual. Accepting them, recognizing them, and learning to deal with them will reduce stress and tension.
  
  

Learn to Relax

• Tension causes increased pain. Relaxation techniques are effective in reducing tension. Recognizing tension is the first step to relaxation.
  
• Knowing how to reduce tension is a learned skill. Learning how to recognize tension and using relaxation skills to reduce tension will decrease pain.
  
  

One Day at a Time

• Pain is a frightening thing. It is not unusual to be afraid of pain, to avoid activity, to sit hour after hour, or to stay in bed all day.
  
• Start each day with a sense of ability. Anything is possible if you take one day at a time.
  
  

Program Philosophy

The Wellness Project is an integrative, successive, and multidisciplinary approach to the treatment of chronic pain conditions, focusing on the evaluation and management of symptoms. It is our belief that patients with chronic, complex pain problems can significantly improve by learning how to manage the body and brain's perception and response to painful stimuli, reducing the impact that pain has on their lives.

Using a psychosocial and physical pain approach, our team of physicians, counselors, physical therapists and auxiliary pain specialists work with patients to develop a master plan that will help them learn alternative ways of coping with their limitations, reacquiring a realistic level of functioning.

After a thorough assessment and evaluation by our staff physician, the individual is admitted to the treatment program. The patient is assigned a Case Manager who consults with the physician and the treatment team to develop a comprehensive plan of treatment.

Instillation of Hope: The instillation and maintenance of hope are crucial in all aspects of pain management. Not only is hope required to keep the individual engaged so that the other curative factors may take effect but confidence, which is the maintenance of hope, can itself be therapeutically effective. Many individuals enter a pain management program with a sense of hopelessness. When life gets to a point where nothing seems to bring relief, or pain and stressors keep getting worse, the individual eventually develops a give-in and give-up attitude. Unless the individual can reunite with a sense of hope, progress is rarely possible.

Scope of Therapeutic Services:

Group Therapy: In this basic group, with the aid of a counselor, individuals learn to discuss personal, practical, occupational and social problems in a supportive atmosphere with other people who have similar problems. This group helps individuals develop the necessary insight to prevent future problems, relieves the emotional symptoms that accompany chronic pain, builds confidence and self-worth, thus leaving participants with a feeling of freedom and serenity.

Relaxation and Stress Management Training: This group training is basic to the successful development of an individual's personal pain management program. Learning to recognize stress and how it affects the body, mind and attitude is vital. Techniques for relaxation, such as deep muscle relaxation and guided imagery, are learned and practiced to perfection. Through practice, a sense of achievement is gained, and the ability to cope with stressful situations is mastered.

Biofeedback: Biofeedback is a self-regulation process that helps individuals develop the skills necessary to relieve negative and stressful situations. It is training for the mind, teaching one to access the mind's powerful healing potential and regulate the body's response to stress, pain, and disease. As one becomes trained in relaxing, there is a gradual proficiency in the ability to relax during periods of stress, pain, or illness. During training sessions, the individual learns to consciously change negatives into positives through relaxation and stress management techniques.

Hypnotherapy: Hypnosis is neither sleep nor unconsciousness, but an altered and focused state in which a person has shut out all other distractions. It is a normal state, and nearly everyone experiences a hypnotic state daily and spontaneously, while daydreaming, or even while driving.

While under hypnosis, a person is more receptive to positive suggestions. Hypnotherapy is used to assist people in gaining greater control over their lives. It teaches how the mind works and can be used to change negative attitudes and beliefs.

Coping Skills Group: This group, important to the development of a personal pain management system, utilizes instructive and behavioral theories to help individuals look at their current belief systems, self-defeating attitudes and thoughts, and their impact and influence on feelings and behaviors. Participants are taught to approach pain management through learning and understanding how their negative thinking patterns influence their reactions to pain and stress. New, encouraging and self-enforcing techniques are taught, as well as alternative ways of coping and problem solving, helping the individual gain a more positive approach to pain management.

Vocational Counseling: For individuals who have not worked for a period of time, or for those who cannot return to their previous career, a standard set of vocational assessments are administered. Throughout the course of the treatment program, job and training options are presented and discussed. As the development of a significant purpose for one's life apart from the pain is an important element of a successful pain management program, this aspect of the treatment program is of great value.

Physical Therapy, Exercise and Conditioning: Physical conditioning is a vital part of the treatment program. Inactivity as a result of chronic pain can reduce muscle strength, flexibility, and endurance, heightening the intensity of the pain. When muscles become stronger and better conditioned, pain levels will decrease. Greater muscle flexibility allows mastery of the activities of daily living, and enables the individual to return to an active daily routine. Endurance training develops the stamina needed to resume participation in a full and active life.

Family Counseling: Family members and significant others often misunderstand the patient's response to pain and do not know how to respond in appropriate and supportive ways. For this reason, those close to the patient are encouraged to participate in family counseling. This allows each member of the family to express feelings, define and resolve problems, and assist the treatment team in defining treatment goals, outcomes and aftercare needs of the patient.

Pain and Management Defined
Pain is defined as a physical suffering associated with:

• A disorder of the body
  
• A disorder of the mind or the thinking process
  
• A mental or emotional condition of distress
  

Pain is a personal experience that differs by individual. But to everyone, it involves not only the physical discomfort but also the emotional experience associated with pain.

The body's natural defense system uses the sensation of pain as a warning signal that there is damage, disease, or discomfort. The body's nervous system signals the presence of the stimulus to the brain. The brain then releases specific chemicals to feel the pain, react to the pain, or to eliminate the pain.

One of the classes of these chemicals is called endorphins. They are considered the natural painkillers in the body and are chemically similar to the drug morphine. Endorphins are usually produced naturally after exercise or stimulus. This is why many athletes experience a natural high after strenuous activity. It may also explain how they are able to manage pain in the middle of strenuous physical activity.

Medication that is prescribed for the management of pain is divided into two categories - narcotic and non-narcotic medications. Narcotic medications are addictive because of the way that they act on the brain and nervous system. Narcotic medications hide the pain temporarily but do not manage the pain permanently. Most patients who use narcotic medication for more than two to three weeks at a time will notice that the pain medication no longer relieves the pain at the prescribed dose and a greater dose is required to relieve the same amount of pain. The body's need to require more medication is termed "tolerance" and is a sign that the body is developing a dependency on the medication. This is not an appropriate management of pain, and it may indeed lead to a generalized dependency on the chemical substance.

Non-narcotic medications include the use of non-steroidal anti-inflammatory drugs. Non-steroidal anti-inflammatory drugs are often very effective in chronic pain management when accompanied by anti-depressants. An over the counter medication such as Advil is an effective anti-inflammatory medication, and is similar to prescription medications but in a lower dosage.

There are other medications that have influence on pain and these include steroids, which can be used for short periods of time as a very potent pain relief medication. However, steroids have extremely serious side effects if taken for a long period of time.

Muscle relaxant medication, another drug prescribed to reduce pain, can cause sleepiness and lethargy. The muscle relaxation effect is not always achieved, thus a chronic use of muscle relaxers for management of pain is not always beneficial and may lead to sleep problems.

Pain is generally caused by a physical disorder that is stimulating the pain response in the brain. Chronic pain is a condition that persists well beyond the usual course of an injury or disease, or in spite of medical or surgical treatment of the original physical cause.

Chronic pain may become a disease within itself. Chronic pain is often characterized by the interaction of many different factors that reinforce one another. These different factors represent more than just a physical condition, but may also involve mental, emotional and lifestyle issues. Some of these issues are:

• The quality of one's life and vocational situation
  
• The conditioning of the mind to be hypersensitive to the pain response
  
• Depression and anxiety due to situations that appear hopeless or out of one's control
  
• Change in the level of one's activities of daily living
  
• A dependency on pain relieving drugs