Stanford's GI pain program is not limited to a specific diagnosis, Prasad said. "Part of the value in our collaboration with GI physicians is that we pain specialists get to learn more about GI disorders and new possibilities for patients for whom GI physicians have done all they can,” Prasad said, "those people who might be thinking, 'It will never get better' or 'It's all in my head.' We want to offer them a pathway to help them recapture quality of life."
Some people may feel that going to a pain specialist is like giving up, that a pain specialist will automatically prescribe narcotics," Nguyen said. "What we in GI do with the pain group is try very hard not to do narcotics, to try other things."
In fact, Prasad said, contemporary pain care, particularly that offered at the Stanford Pain Management Center, integrates various approaches: non-narcotic solutions (mind-body therapies, including cognitive behavior therapy, hypnosis and meditation) to address the psychological component of pain; physical rehabilitation, pharmacology and new procedural treatments. Those new treatments are often focused controlling activity in very specific areas of the nervous system.
Nguyen hopes that this formal collaboration will help "get across the idea to GI physicians is that pain is a complex system, and that the longer someone has pain, the harder it is to control and the more psychological impact there will be," she said. "For example, if you look at patients who come to me with chronic GI pain, half of them will also be experiencing anxiety and depression because of that pain. And we know that very common disorders like irritable bowel syndrome are made worse by that anxiety and depression."
Knowing what all the options are means Nguyen can get closer to her goal of patient care. "The most rewarding part for me," she said, "is when someone comes in like a train wreck and leaves, maybe not perfect, but at least better."
She called the Stanford GI pain program unique, and something that has enhanced her ability to make positive changes in her patients' lives. "I've worked elsewhere and taken care of the same type of patient, but with the interaction with the Pain Management Center, I don't feel as though I'm alone."
The collaborative structure will not end with GI patients, Prasad said. "We want to build more pathways between us and other fields where pain can be difficult, such as gynecology and urology. A lot of things we do in pain management are somewhat universal."
Korstad's condition has not gone away--unfortunately, treatments to cure it are few. But her pain is less. She's been treated with a series of injections that have successfully blocked activity in certain nerve roots. "They've worked amazingly for my pain," she said. "My doctors told me they were like a control-alt-delete to calm things down."