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Putting Pain in Its Place : Medicine Tackles an Age-Old Adversary With Inpatient Clinics--but Not Without Some Controversy

October 04, 1987|KATHLEEN DOHENY | Kathleen Doheny is a frequent contributor to The Times.

BERNIECE Davis took life at full tilt. She worked. Spent time with her husband and two kids. Enjoyed volunteering at church.

Even when she was exhausted or busy, she admits, she had trouble saying no to anyone who wanted her time. "I tried to be all things to all people," says the 45-year-old Los Angeles woman.

Then the pain started.

Last October, Davis began feeling discomfort in her abdomen. "In early January," she recalls with a grimace, "it got worse. I went to nine doctors, but none could figure out what was causing it."

Within a month, she left her job as a telephone-company service representative and went on disability. "I slept 20 hours a day," she recalls. "I took Tylenol and codeine, and I was (still) in pain every day."

Nothing produced relief. Finally, a doctor referred her to the Pain Management Program at Daniel Freeman Marina Hospital in Marina del Rey, an intensive five-week inpatient regimen. And while the pain hasn't stopped, she's relying on herself, not drugs or pilgrimages to doctors' offices, to control it.

Davis, a plump woman who now flashes a ready smile, remembers her turning point clearly. During her second week in the program, Richard Ross, a psychologist and clinical director of the program, asked her to draw a picture of her pain. "The image that came to me was someone driving nails into my upper abdomen," says Davis. A week later, Ross asked her to repeat the exercise. In the second drawing, Davis recalls, the claws of the hammer were turned up. "One nail had already been removed and the second was almost out," she says. "The full reality dawned on me--they were not promising the discomfort would go away." At that point, Davis says, she vowed to learn to manage the pain, to be in control.

Instilling that sense of self-reliance is at the core of the sometimes controversial and often costly inpatient pain programs operating around Southern California. Davis expects two insurance policies to cover most of her hospital bill of $25,000 plus an estimated $1,500 in physician fees. But she can't put a dollar value on the coping mechanisms she learned.

After her discharge, Davis took a week off to relax, then began working part time, planning to resume full-time work two weeks later. "It's still not easy (to manage the pain)," Davis says a few weeks after being released, "but it's possible."

ONE OF EVERY three Americans--about 86 million people--suffer from chronic pain, according to the American Chronic Pain Assn., a Pittsburgh-based self-help group. Back problems, recurrent headaches and arthritis are the top three causes, though sometimes the source remains a mystery, says Penney Cowan, founder and executive director of the association.

We spend about $70 billion a year on medical costs, lost workdays and compensation for chronic pain, Cowan says.

Traditionally, experts term pain chronic if it lasts six months or more. It's not the "healthy" pain you feel when you burn your finger on a stove. That sort of "acute pain is adaptive and protective," explains Dr. Armen Dumas, medical director of the Center for Rehabilitation Medicine at Valley Hospital Medical Center in Van Nuys. "It's a signal or a warning. In chronic pain, that signal goes awry. It's like crying wolf, and it's not serving a protective role anymore."

Pain--once the symptom-- becomes the disease in chronic-pain patients, some experts say. The pain, whatever its source, is real, not "all in the head," experts concur, and often represents a cry for help.

Chronic-pain patients will do almost anything for relief. Doctor visits become a way of life for many. Some back patients undergo multiple operations. Other chronic-pain patients try long-term physical therapy as outpatients. Some pour money into "passive" remedies such as ultrasound and massage. Many become dependent on painkillers and tranquilizers. And many feel guilty that they can't function normally while they may appear perfectly OK.

Some patients, like Davis, end up in inpatient pain-management programs, where directors tell them that they can regain control of their lives--if they're willing to work hard and to rethink the medical model of physician-as-fixer.

" 'Not by medicine alone' is our theme," says Harold Gottlieb, a psychologist who directs the Comprehensive Back Services and Pain Related Disorders Program at Casa Colina Centers for Rehabilitation in Pomona. "If patients look to the physician as healer, that simply doesn't work," adds Dr. Donald Weir, medical director of the Casa Colina pain program. "We change the approach to one in which they take control. To make that work, the physician has to take a more remote role."

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