Whole Health Pain-Management Solutions

Chronic pain brings misery to hundreds of millions of Americans each year, wreaking billions of dollars of damage in medical bills and missed work.

It is “the most universal form of human stress,” according to a Center for Disease Control report, which says that eighty percent of all physician consultations are related to pain. Yet five area practitioners offer a singular and welcome message: You don’t have to face chronic pain alone.

We’re all familiar with botulinum toxin injections—most commonly known by the popular brand name Botox—when it comes to cosmetic enhancements. But many are surprised to learn that botulinum toxin injections have been used to treat painful muscle spasm problems, including complications from multiple sclerosis, cerebral palsy, spinal cord injury, strokes, neck spasms and, most recently, severe migraine headaches.

Botox for pain?

“I was fortunate because my residency director at the University of Minnesota in the late 1980s was one of the first people in the country to research botulinum toxin before it was even released for use,” says Dr. William E. Fowler of Physical Medicine Rehabilitation Independent Services (PMRis). “Once I came to Madison and started practice in 1992, I was already very familiar with it. I’ve been successfully using it to treat painful muscle spasm conditions for nearly twenty years now.”

Torticollis, or cervical dystonia, is a painful neck muscle spasm or abnormal muscle tone so severe it may cause your head to twist or tilt. Regular botulinum toxin injections partially weaken the targeted muscles, increasing flexibility and decreasing pain. The same is true for patients with, for example, a fist curled so tight he or she can’t fit an arm into a sleeve. Now the FDA has approved Botox for treating severe migraines—those with a severe headache at least four hours a day, for at least fifteen days within a thirty-day period. These Botox injections for headaches involve injecting the many muscles located between the skin and bone of the scalp.

“Botox, for certain patients, has been a real godsend,” says Fowler.

Beyond chiropractic

As a former Olympic skier, Dr. Kurt Stein of Dynamic Chiropractic experienced healthcare in a way most of us could only dream about.

“I grew up in Olympic training centers where they have immediate diagnosis and treatment. Whatever you need, you walk in and just get it,” says Stein. “That’s what I thought healthcare was.”

Stein still applies an athlete’s perspective and a holistic approach to the body when working with his patients. From sore soccer kids to a 95-year-old looking to maintain mobility and range of motion, Stein says prevention through alignment and proper form can protect us from the onset of pain. And, he says, if you’re already suffering, a holistic approach is more critical than ever.

“Low back pain isn’t just about the low back, for example,” says Stein. “Chiropractors adjust shoulders, wrists, elbows, feet, ankles, knees, hips. Your whole body is one piece and it all has to work together.”

Likewise, Stein began to feel his chiropractic services alone were not enough; he decided it was time to bring in a team to treat his patients holistically. This summer Dynamic Chiropractic is changing its name to New Health and expanding its current space to seven thousand square feet. A whole body one-stop-shop, New Health will coordinate a team of practitioners in modalities including physical rehabilitation, yoga, Pilates, acupuncture, massage and eventually, osteopathy.

“Why wait until you’re degenerated and decrepit and need surgery? Least-invasive intervention is my primary goal,” says Stein. “We start with structure. Then soft tissue. Then lifestyle, nutrition, teaching people how to take care of themselves. You don’t have to live with pain.”

Soft-tissue pain

Oftentimes chronic pain is the result of damage to or constriction of soft tissue: the tendons, ligaments, fascia and muscles that connect or support the body.

“I think soft-tissue pain is one thing that isn’t really addressed well in your typical medical environment,” says Heidi Aschenbrenner, owner of Renu Massage Therapy. “Massage and bodywork, cupping therapy and acupressure are all really great ways to alleviate things many people think they just have to live with.”

Muscles that experience trauma often “freeze” to protect themselves, tightening and causing pain with patterns developed over time. Various massage techniques and cupping therapy can help release soft tissue and restore function for people suffering from things like shoulder pain, meniscus injuries and more, says Aschenbrenner.

“The body is very trainable,” says Aschenbrenner. “Muscles respond very well to change, you’ve just got to prompt them.”

Regular massage is an effective process, but it may take several months to help with deeper issues. Cupping therapy, on the other hand, though its success is anecdotal and it has not been subjected to clinical trials to prove its efficacy, can sometimes take only a handful of sessions to lessen or resolve pain. It can affect muscles and tissue more deeply and more intensely, but Aschenbrenner, who is trained both by the International Cupping Therapy Association and by Chinese acupuncturist Dr. Zhou from the East-West Healing Arts Institute, says it’s the most effective remedy for soft-tissue pain she’s ever experienced—including injuries she has suffered in the past.

“It’s worth a try,” says Aschenbrenner. “It’s not medication, so there are no [medication] side effects. It’s not invasive, and it’s one of the more effective ways to deal with soft-tissue injuries and the resulting pain. We can avoid surgeries and eliminate chronic issues. I’ve seen it happen over and over again.”

In-home pain management

For thirty-five years, Agrace has brought a holistic touch to end-of-life pain management. Now, with two new in-home palliative care services, Agrace extends its reach to patients who do not qualify for hospice care.

The expansion began in 2012 with the subscription service Care Navigation, a nurse-driven program that helps chronically ill patients navigate the healthcare system. An assigned nurse works one-on-one with patients in their homes, those who do not have a prognosis of six months or less but still need expert guidance. In just eighteen months Care Navigation has proved to be a marked success; before enrollment, a group of participating patients logged fifty-five emergency room visits and twenty-three hospitalizations. After enrollment, the same group logged only five ER visits and four hospitalizations.

Building on these remarkable results, on April 1 Agrace launched a second program called Agrace Palliative Care Consultation Service, in which physicians and nurse practitioners provide a one-time in-home consultation for patients with a referral from their primary doctors. Unlike the subscription-based Care Navigation, the consultation is covered by Medicare, Medicaid and often by private insurance. Both programs are open to qualifying patients still seeking curative treatment.

“When we visit patients in their own environment we often get a more realistic picture than when they get dressed up and come into the clinic to see their physicians,” says Dr. Dena Green, Agrace physician. “Now we can help manage their symptoms with a holistic approach so they can have the best quality of life and live life to the fullest.”

Move the pain away

Research shows that keeping the body active is one of the most effective ways to prevent new pain and manage existing pain. Yoga, Pilates and range-of-motion exercises can strengthen and elongate muscles with slow and controlled movements. Tai Chi improves balance, helping to prevent falls. Strength training is essential for strong bones, and aerobic exercise improves cardiovascular health, helps control weight and increases stamina. Always consult a doctor first to determine which type of exercise is safe and appropriate for your specific condition, but do whatever you can to get moving now.

“Being in the water is great for someone with joint pain,” says Sharon Baldwin, senior director of marketing and healthy living at the YMCA of Dane County. “It gives you a cardio workout and resistance, without putting any weight on the joints.”

The YMCA offers LIVESTRONG, a research-based cancer recovery program. Certified instructors are trained in the elements of cancer, helping participants reduce inflammation and painful side effects with post-rehab exercise, nutrition, and supportive cancer care. Arthritis is also a condition that responds well to low-impact aerobic activities, such as swimming, walking and cycling.

“Any movement, no matter how small, can help,” says Baldwin. “If a particular workout or activity appeals to you, always consult your doctor to find out whether it’s right for you. Be sure to tell your instructor about your condition and avoid positions or movements that can cause pain.”

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