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The AMITA Health Neurosciences Institute takes an evidence-based approach to both inpatient and outpatient chronic pain management, adapting our comprehensive pain management program based on recommendations from the Centers for Disease Control and Prevention.
In the 1980s and 1990s, prescribing opioids for chronic pain was considered common practice, and many patients were started on chronic and high-dose opioids for their pain. We now know that the benefits of long-term opioid therapy for chronic pain are limited, while the risks are significant. Side effects include nausea, vomiting, sedation and constipation. Opioid use also increases the risk of dependency, tolerance, withdrawal, overdose and death. The health effects of opioid misuse and overuse have become a nationwide crisis, with daily news stories of the devastating impact on families and society. In Chicago and suburban Cook County, the number of opioid-related overdose deaths doubled from 2015 to 2016,1 exceeding the number of deaths related to gun violence (1,081 opioid-related deaths, 762 gun-related homicides in 2016).2 Opioid misuse also led to more than 5,000 emergency room visits in 2016 in Cook County, compared to 1,000 visits a decade earlier.3
Recognizing the growing opioid-related health crisis in the United States, the Centers for Disease Control recently released guidelines for prescribing opioids for chronic pain.4 These guidelines were developed based on evidence showing that most opioid therapy does not address the cause of the pain, only the symptoms, and that comprehensive pain management leads to improved outcomes. The AMITA Health Neurosciences Institute adopted these guidelines, developing a pain management program that approaches pain as a multifaceted chronic illness.
The Comprehensive Pain Management Program at the AMITA Health Neurosciences Institute helps patients identify the cause of their chronic pain and provides tools to empower patients to manage their pain on a day-to-day basis. Our multidisciplinary approach takes into account the physical, emotional, mental and functional aspects of pain. The Program partners with the Shirley Ryan AbilityLab (formerly known as the Rehabilitation Institute of Chicago) to provide physical therapy. Health psychologists give patients strategies to cope with chronic pain. Cognitive and behavioral therapy and biofeedback are included as first-line approaches for managing chronic pain.
Intended for patients who have chronic pain that limits their daily function and who need help learning how to manage their pain, the PRO Camp at AMITA Health Medical Imaging Schaumburg is offered prior to medical or surgical treatment options.is offered prior to medical or surgical treatment options. In this six-week, multimodal and multidisciplinary pain management program, four to six patients are enrolled as a group and attend lectures, participate in exercise and physical therapy, visit with a health psychologist and nutritionist and learn about options such as acupuncture and chiropractic care. Following the PRO Camp, patients can who need more help managing their chronic pain can be seen by the various specialists in the AMITA Health Neurosciences Institute Comprehensive Pain Management Program.
Physicians can refer their patients to PRO Camp by contacting Konstantinos Kostas, PhD, Director, Health Psychology Services at Konstantinos.Kostas@AMITAhealth.org or at 847.956.5311.
Various leading-edge pain management options are available to patients, with treatment plans individualized to meet each patient’s needs. Options include injections (epidural, medial branch blocks) and radiofrequency nerve ablation to address joint pain (spine, hip, knee). Spinal cord stimulation is offered as a treatment for chronic low back and neck pain in patients whose pain did not respond to less invasive treatments such as injections and physical therapy but who are not candidates for surgery. Electrodes are placed in the epidural space surrounding the spine to provide a light electrical signal that overrides the pain fibers. Spinal cord stimulation can help patients reduce their use of opioids and improve their quality of life and function.
R.S. is a 42-year-old male who was referred to Keith Schmidt, MD, for chronic pain related to an L4 to S1 lumbar fusion. He was taking opioids including hydrocodone, gabapentin and a potent muscle relaxant (methocarbamol). He reported taking up to 5 tablets of hydrocodone per day to control his pain and was experiencing unwanted side effects. The patient was looking for a more permanent solution that would allow him to stop taking medication. After collaborating with the patient’s surgeon and our health psychology team, we deemed the patient an appropriate candidate for spinal cord stimulation. Before undergoing a permanent procedure, R.S. was able to trial the spinal cord stimulator for one week. The patient reported that “after going through the trial for the spinal cord stimulator, my daily average pain level went from around a 5 or 6 down to between a 1 and a 2. It’s only 6 days after the procedure and my pain level is now a 1. The doctors and their staff in the hospital — the nurses, everybody — were absolutely exceptional. They take time, work with their patients, listen to their patients, and I am truly blessed to have the doctors and the staff and the care that I have received, I’m very pleased.” Since the outpatient procedure to permanently insert the spinal cord stimulator, the patient is now taking 0 to 1 hydrocodone tablets per day for post-procedural pain, and he expects to be able to stop taking all pain medications soon.
P.C. is a 53-year-old female who presented to Dr. Schmidt with postlaminectomy pain syndrome. She was taking opioid medications for post-surgical lower back pain that continued down her legs, reporting a pain level of about a 7. She wanted to stop taking medication and improve her quality of life. The patient underwent spinal cord stimulator implant for dorsal column stimulation. One week after receiving the implant, the patient reported no pain at all and that she is now able to do things around the house — such as making the bed and vacuuming — that she hadn’t been able to do before. She also reported being able to stop taking pain medications completely.
The Comprehensive Pain Management Program at the AMITA Health Neurosciences Institute can serve as a valuable resource for referring physicians, helping you and your patients pinpoint the cause of pain to find the right combination of approaches to manage chronic pain on a day-to-day basis. Our physicians are available by phone for consultation prior to referral.
The earlier a patient with chronic pain is referred to the AMITA Health Comprehensive Pain Management Program, the better. Once referred, a patient will start with multi-modal pain management — including the option to attend PRO Camp — before trying opioids. If opioids are needed, the Program ensures safe use through several checks and balances to prevent addiction and abuse. Once the lowest effective opioid dose is maintained, our pain management specialists will continue to serve as consultants and collaborators for future pain management needs. Physicians also can refer patients who are already taking opioids for an opioid risk assessment. Patients will meet with a health psychologist to ensure they are taking medications appropriately, assess risk for anxiety and depression and other risk factors for opioid use disorder. Patients can be referred for behavioral health or psychiatric care if needed.
Collaboration and frequent communication with referring physicians is vital for patients to safely manage their chronic pain and improve their quality of life in the long-term. All clinic notes are shared with the referring physician, and team members are available by phone to discuss individual patient care plans. Drs. Dave and Schmidt are available for consultations prior to referral by calling 847.981.3630.
The AMITA Health Comprehensive Pain Management Program team looks forward to building partnerships with referring physicians to find the best pain management options for their patients.
Ankur Dave, M.D.
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Keith Schmidt, M.D.
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