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Omaha has one of longest-running pain programs for patients who have tried everything

June 18, 2018 GMT

When patients have tried everything else — surgery, physical therapy, acupuncture — and still are struggling with chronic pain, there are at least a couple of other options in the area.

One is Nebraska Medicine’s Pain Management Program. At upward of 40 years old, it’s one of the longest-running interdisciplinary programs in the country.

Dr. David Cates, a clinical psychologist and the program’s director, said the goal of the four-week program, which patients attend daily on weekdays, is to help patients improve their physical function and learn strategies to cope with pain and pain-related problems.

Patients participate in physical therapy and exercise to rebuild the physical function they’ve lost as pain has caused them to avoid moving. Patients also work with therapists to identify and address any psychological and social issues, including depression and frayed family ties, associated with or caused by pain.

For patients who are taking opioids when they enroll, the team works to taper their use.

“The folks we’re getting are those who have struggled so long and sacrificed so much of their lives, they really, really need that level of support,” Cates said. “We don’t promise they’re going to have less pain. The whole focus is managing their pain.”

QLI, which specializes in brain and spinal cord injuries, has been offering a multidisciplinary pain management program for a handful of years. Patients, who have to commit to eliminating narcotics, live on campus during the eight- to 12-week inpatient program, which also aims to restore function and uses a variety of therapies.

CHI Health plans to launch a program this fall, starting at the Immanuel Medical Center. Details are being worked out.

Dr. Doug Hostetler, who lives north of Seward, Nebraska, completed the Nebraska Medicine program in March 2017. He’d already tried a number of procedures to address the degenerative joint disease in his neck, as well as his migraines.

Exercising, which creates endorphins, and improving the flexibility he’d lost to inactivity both helped a lot, said Hostetler, 61. So did learning to meditate and focus his mind away from the pain.

“It’s not a treatment for the pain,” he said. “It’s a way to deal with it and not have it control your life.”

Hostetler said he has good days and bad days. He’s now on disability after 11 years as an associate professor of veterinary medicine at the University of Nebraska-Lincoln. He’s spent a total of 40 years in the veterinary field, between his time as a veterinarian and as a veterinary technician.

He has to be careful not to overdo it. But he can work in the yard for up to 25 minutes at a time. Before, he’d had periods where he couldn’t do that.

Cates said program officials measure a number of variables before and after the program.

During 2016, depression ratings for the 59 patients surveyed decreased 62 percent . While the program doesn’t aim to reduce pain, Cates said, patients usually report less pain by the end. The same year, pain severity decreased 35 percent and pain interference with activity by 33 percent.

“We never tell patients the pain is in their heads,” he said, “but we tell them how they think, how they cope … affects how they perceive their pain.”