Chiropractic & Pain Management

When it comes to chronic pain, these local providers think outside the box

Most people can wrap their minds around the opposing states of optimal health and full-blown disease, but in reality the vast majority of Americans live somewhere in between. Maybe your shoulder hurts but the MRI was clear. Your bloodwork was “within normal ranges” but you can’t shake that sluggish, achy feeling. So many decide to live with chronic pain as their own reluctant version of normal, but Dr. Steve Puckette of Puckette Chiropractic says it doesn’t have to be this way.

 “I have people come in all the time in pain and they have no name for their disease at all, because by all the diagnostic criteria, medicine says we can’t find anything wrong,” says Puckette. “But when I look at them with a more functional approach—is your metabolism what it should be? Is your nervous system where it should be?—we can find all kinds of places where it’s out of balance. It doesn’t have to be extreme before we can help.”

As a practicing chiropractor in Madison since 1994, Puckette has always taken a holistic approach to health care. But it was his own wife’s years-long struggle with pain and fatigue that ultimately drew him to chiropractic neurology, a field that not only helped in the search for her autoimmune disorder but also changed the trajectory of Puckette’s practice. Chiropractic neurology looks at the breakdown between the body and brain’s interaction, then uses that information to strengthen the nervous system with things like alignment and nutrition instead of side-effect-laden drugs.

“Chiropractic is for all kinds of sick, not just musculoskeletal sick. It’s for thyroid. Irritable bowel. PMS. Alzheimer’s. Chronic pain. It’s for all kinds of sick, because all kinds of sick have got a nervous system component. Every single part of the body is controlled by the nervous system, and it can all be helped.”

Dr. Kurt Stein of Dynamic Chiropractic knows a thing or two about chronic pain. As an Olympic and World Cup skier until the age of twenty-five, “I learned to rehab pretty much every part of my body,” says Stein. “What I know for sure is this: If you don’t do things correctly, it always comes back to bite you later, either with another injury that’s usually bigger from improper rehab, or the structural misalignment that got you there in the first place.”

When evaluating and treating pain, Stein relies on a trusted team to provide the best holistic care possible, working with physical therapists trained in motion-based rehab and massage therapists who strip scar tissue from older injuries. 

“I hear all the time from new patients, ‘I tried it and it felt better for a while but then it came back,’” says Stein. But he says you can’t simply treat the spot that hurts. “We need to look at everything to understand the history and the biomechanics of how your pain originated. If your hip hurts, it could be a broken arch or weak ankle mortise. If your shoulder hurts but we don’t look at the scapula joint, you’ll be temporarily out of pain but then it’s just going to wear down and come right back.”

Stein says there’s no cookie-cutter approach to wellness. Athletes have more specific problems that vary by sports. People who sit all day have different issues than people in factories or restaurants dealing with repetitive- motion injuries.

“You need to put as much time into your body as you do into your kids, your house, your school, your job. The body isn’t automatically healthy,” says Stein. “The problem is, most people put themselves last and then they think they have to live with pain. But they don’t have to.”

End of Life Pain Management

When it comes to pain management, the interdisciplinary staff at Agrace HospiceCare has been lauded for exceptional end-of-life care for over three decades. But one little-known fact is that Agrace discharges thirteen percent of hospice patients every year because they improve and no longer qualify for hospice benefits through Medicare. It’s good news, but it doesn’t mean these patients are out of pain, or no longer need the support and advocacy to which they’ve become accustomed.

“We started to look at what was happening to those patients, and we found that frequently they suffer without our services,” says Agrace’s John Van Dyke. “That feels pretty horrible when our entire mission is to enhance quality of life.”

Enter Agrace Care Navigation, a brand-new program for which Van Dyke is the RN care manager. Through Care Navigation, non-hospice-eligible people receive support managing the pain and symptoms of their serious or chronic illness at home. It’s a monthly subscription service, and anyone from dementia sufferers to those with a chronic illness is eligible, regardless of whether they have used Agrace hospice before.

“Our philosophy was, why don’t we bring in what we do so well at Agrace earlier in the trajectory of the illness?” says Van Dyke. “We’re in these patients’ homes regularly, we can note changes in pain management needs and communicate these to their primary physician quickly and efficiently so they and their loved ones don’t have to. Or we can send out our Agrace volunteers to give caregivers a badly needed break. 

“Most people in pain say it’s okay, this is our normal, but it can be better,” says Van Dyke. “You can have less pain and really focus on quality of life while living with a chronic illness.”

An integral part of pain management is recognizing and treating psychic pain, in the form of emotional and spiritual support for hospice patients and their families.

“So many people believe that hospice is for when you don’t have a cure,” says Tom Moreland, CEO of Saint Jude Hospice, a Catholic-based organization with seven hospices in four states, including Wisconsin. “But even when there’s not a cure, there can still be healing. We approach pain management holistically, from the physical to the spiritual to the psychosocial. We are not treating a broken hip, we are treating a person in their wholeness. We are treating their physical ailment, their pain and suffering, but we are also treating their soul.”

In addition to the RNs and home health aides overseen by the medical director, Moreland says St. Jude employs social workers and chaplains to explore emotional and spiritual pain, provides relief from practical headaches by offering assistance for managing end-of- life paperwork, and utilizes volunteers to alleviate stress by painting nails, cleaning the kitchen or simply sitting and talking. He acknowledges that these are difficult conversations to have, but the sooner we have them, the more relief we can have from all kinds of pain.

“Just because there isn’t hope for a cure, do we give up hope for that whole person?” says Moreland. “What about the hope of having a special goodbye with family? Of being surrounded by loved ones? What about the hope of a pain-free death, or being able to take away any fear of death? That is to me a great hope. That, to me, is the ultimate pain management.”

- Maggie Ginsberg-Schutz

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