Taking Your Life Back from Pain's Control – with Mind, Body and New Medical Vision
Suzanne Ely was not yet 30 when she began to notice numbness and tingling in the fingers of her right hand. Then came the fiery pains, as shattering as electrical shocks, that shot up and down the inside of her right arm from wrist to elbow.
She couldn't figure it out. She hadn't hurt her arm in any way. Finally, she realized that the injury was probably the hours and hours of taking notes by hand each day at her job. Little by little, the pain bit into her ability to do the simplest things – like opening the door to her office.
The Menlo Park woman wasn't a complainer. "I love what I do and I didn't want not to work," she said. That was why, when doctors said they could move what they believed to be the problematic nerve, she took a chance. But that surgery, and then another one, didn't work. If anything, the pain was worse, harshly altering Ely's life. After six months of not being able to work and isolated by increasing depression, frustration and dependence on others to do even small tasks, she turned for help conveniently close to home—the Stanford Hospital & Clinics' Pain Management Center.
She is one of thousands enduring acute and chronic pain who arrive each year at the Center because nothing else has worked and no one else could make a difference.
Ely had great hope for what she might find at Stanford's Pain Management Center. It is just one of 12 treatment facilities in the U.S. to win the American Pain Society's designation as a Center of Excellence.
Ely's treatment began with an extensive evaluation by a team of physicians, nurses, physical and psychological therapists and other staff who fashioned an individualized and broad-ranged treatment plan for her. "We explore all the options," said the Center’s director, Dr. Sean Mackey.
Ely's diagnosis was one that reflects a common, but one of the most challenging, pain conditions. Her evaluation showed she suffers from complex regional pain syndrome, a chronic pain ailment described first by a Civil War surgeon caring for soldiers still in pain despite the healing of their musket wounds.
Pain's disruption of Ely's life is, unfortunately, not unusual. More than 50 million Americans are estimated to be living with pain so debilitating that it is costing billions in lost work and medical care. And many times its cause may be unclear. Research to understand its behavior and how to manage it has only recently begun to find explanations and solutions.
The Stanford Pain Center is the location for more than a dozen trials for new treatments which often can become part of its patients' treatment plans, as one did for Ely. She was an early recipient of one of the Center's newest approaches – Botox injected directly into a nerve center. Others have benefited from implant pumps to deliver paced doses of medication and implanted stimulators to convert pain to a tingling, buzzing sensation.
Engaging the brain to change pain
Mackey is excited about emerging tools to improve outcomes, including Ely's – new medications to target specific locations in the nervous system, new interventions to prevent pain and new ways to predict whether a certain patient will respond to a certain treatment. Where Stanford's Pain Center is most advanced is neuroimaging to create very clear windows into the brain to watch how it responds and generates pain. "We can learn to take advantage of the power of the brain to change," he said, "and those changes can have a real impact on our whole bodys physiology – for the better."
Ely worked her way through the package of treatments designed for her – the nerve blocks, medication, physical and psychological therapy and acupuncture – each with its own impact. But one of the chronic pain's uncomfortable realities is that sometimes there is no complete fix. That's difficult to accept in an age where medicine has conquered so many ailments. Then, the goal at the pain clinic becomes changing chronic pain from incapacitating to manageable. "No one should be sentenced to live with pain forever," said Dr. Ian Carroll, a pain center doctor. "We can help people live a better life despite it."
Ely's pain isn't completely gone, but her treatment at Stanford gave her back her independence and her work. Now, she understands the role played in her pain by anxiety and distress and has tools, including mindfulness meditation which she learned at Stanford, to ease her ability to moderate her stress, prevent flare-ups and get a good night's sleep.
"I'm getting the strength back in my arm. I have tried a lot and I know it could be worse," Ely said, "but I'm able to work and I can lead a relatively normal life." Once again, she can cook, open doors and work full days, as well as do those simple acts so important for a balanced, full life. "I'm able to carry things I couldn't carry – like my four-year-old nephew! I have definitely improved."