David Dickerson, MD, recalls a recent patient of his, a 24-year-old man who had beaten stage 4 lymphoma when he was just 17. The young man was a standup comedian, improv artist and filmmaker, but toxicity from his prolonged chemotherapy treatments left him unable to stand up for more than 15 minutes because of burning pain from his thighs to his feet. Despite 7 years of trying different medications and therapies to treat the pain, he had found no relief.
Dickerson, assistant professor of anesthesia and critical care, works with patients like this every day in the University of Chicago Medicine Pain Clinic: those suffering from chronic, persistent pain that limits their activities and severely impacts their quality of life. Whether the pain is caused by injuries, nerve damage or a side effect of cancer treatment, these patients turn to the pain clinic when they’re simply out of options.
In this case, Dickerson and his colleagues were able to implant a device near the young man’s spinal cord that sent electrical impulses to create waves of feelings in his legs instead of the pain. Within 5 days of the procedure, he was able to walk for miles for the first time in years. He now has the device permanently implanted.
“His mother came in for the trial and was in tears seeing her son do this,” Dickerson said. “He’s a 24-year-old that effectively has his life back from this procedure. That to me was a home run.”
The movie image of pain specialists is that of Dr. Feelgood, handing out doses of morphine to make everything feel better. But the current model of pain management takes a more comprehensive and focused approach to treat the biological, psychological and social aspects of chronic pain. Each factor plays into one another, as the pain begins to affect a patient’s daily activities, sleep, personality and relationships.
“When patients have a disease of the central nervous system, they can have a global change in their personality and function,” Dickerson said.
Some patients tolerate pain better than others, but being tough or gutting it out are more than just coping mechanisms. Pain tolerance could be related to a person’s neural makeup, and how patients cope can change as chronic pain overwhelms the system. Instead of helping people experience the world and enjoy touch, taste and smell, the nervous system can become a pain-processing center, doing little else.
Dickerson is one of six full-time faculty members from the Department of Anesthesia and Critical Care in the pain clinic, along with Magdalena Anitescu, MD, PhD, Dalia Elmofty, MD, Tariq Malik, MD, Sheetal Patil, MD, and Andrea Shashoua, MD. The clinic has been a part of the University of Chicago Medicine as a comprehensive unit for almost 20 years, and serves patients from all parts of the medical center, from pediatrics and cancer patients to mothers in labor & delivery.
Dickerson said that there is no standard type of patient they see; each has a different set of circumstances. Some have been suffering for years; others are in acute pain from a recent surgery or injury, which can transition to chronic pain. A point of emphasis for the staff is to recognize this inflection point because treatment for the two types of pain can be very different.
Pain medicine physicians also work to manage expectations, and help patients understand that no single procedure or medication will solve the problem: it’s a comprehensive package of treatments, diagnostic imaging, medication, counseling and rehabilitation. A condition that can be so baffling and life changing, to the point that it drives some patients to depression or even thoughts of suicide, requires more than a quick fix or bottle of pills.
“The main goal of our clinic is to help people become functional again and have a better quality of life,” Dickerson said. “We try not to trade pain for the side effects of common pain medicines, which can offset or debilitate function. Instead we try to help people get back to doing the things they want to do.”