Re: People.com article

May 7, 2003

For those of you who are still unable to access the magazine article on pain

from People.com, I am copying the text below. Hope this helps.

People.com magazine Article:

Mind Over Misery

Left jab, right cross, left hook: Hannah Terrell pummels a punching bag in

full-out fury, her red boxing gloves set off by a pink T-shirt and pearl

earrings. No, this isn't a gym, and Terrell isn't training for a shot at

Laila Ali. The Vanderbilt University sophomore is a patient at the Cleveland

Clinic's Chronic Pain Rehabilitation Program, where hitting the big bag is

part of her therapy - a way of purging half a lifetime's worth of anger and

frustration. Since shattering her left ankle in a fall 10 years ago, Terrell,

now 20, has endured five surgeries and physical anguish so punishing that she

sometimes could not stand upright for more than a few minutes. Last fall " I

was crying all the time, " she says. " I skipped classes because I was knocked

out by medications. My body was out of control. "

Her suffering is all too common, for Terrell is among millions of Americans

tormented by chronic pain. A recent study published in the Clinical Journal

of Pain shows that the majority of patients receive inadequate treatment. In

part this is because all too few physicians are trained specifically in pain

management. Even excellent doctors tend to regard pain as a byproduct of

illness or injury; they try to treat it with drugs, from aspirin to opiates.

" All of us would rather have someone take away our pain with an injection

than be taught how to live with it, " says Dr. Covington, director of

the Cleveland Clinic program. But meds often offer only brief or partial

relief, and when prescribed improperly their side effects (ulcers from

analgesics; dopiness from narcotics) can be nasty.

Covington, 56, is helping to pioneer a more comprehensive - and, experts say,

effective - approach. " Ed is a leader in his field, " says Dr. D.

Rome, medical director of pain rehabilitation at the Mayo Clinic in

Rochester, Minn. The Cleveland program is one of a handful in the U.S. that

attack intractable pain not only with carefully calibrated pharmaceuticals

but also with exercise, biofeedback, self-hypnosis, psychological counseling

and family therapy. That regimen is based on a growing body of research

showing that pain is " intensely affected by emotions, fears and beliefs, "

says Covington, and that treating it as a mere symptom is not always enough.

In chronic cases, says Covington, pain can cause permanent neurological

changes. " Pain becomes an evolving, perpetuating problem, " he explains. " A

disease. "

That was certainly the case for Terrell. An athletic girl who loved field

hockey, she was 10 when she plunged 15 ft. off a zip line - a backyard cable

ride strung between two trees. Despite years of operations, nerve damage set

in and her agony became unbearable. Painkillers (Celebrex and Percocet, among

others) worked only intermittently. " Pain defined her, it ruled her life, "

says her mother, Sally, 45, a homemaker. By last fall the child-development

major was falling behind in her classes and dropping out of campus social

life. " I missed my old self, " Terrell says. " I felt helpless. "

She discovered the Cleveland Clinic in December, after years of shuttling

from specialist to specialist in several states. Told by a surgeon that she

needed yet another operation, Terrell consulted a California pain counselor,

who suggested that she try a new strategy - one available just a few miles

from the Chagrin Falls, Ohio, home she shares with her mother and her father,

Steve, 46, a financial consultant. " It was really my last resort, " Terrell

says. " I'd tried everything. "

So have most patients at the Cleveland Clinic's all-day program, which offers

a three-to-four-week course to a dozen sufferers at a time. They learn that

the mind-body phenomenon of pain can be modified by psychological or external

events. An adrenaline rush, for example, can minimize pain. " That's what

allows you to score a touchdown with a broken leg, " says Covington, a

psychiatrist and married father of three who got his medical degree at the

University of Tennessee and came to the Cleveland Clinic in 1979. On the

other hand, he notes, brain-imaging studies show that fear or anxiety

increases pain. " Some areas of the brain reflect the sensory component - the

'ouch' factor, " he says. " Others reflect emotional suffering. "

Covington " understands that you can't be in pain for any significant period

and not become depressed or anxious, " says Dr. Hubert Rosomoff, medical

director of the University of Miami's pain rehab center. Former patients

agree. Spinal fusion surgery had left Darlene , 46, with severe pain in

her limbs, back and head, forcing her to quit her nursing job. " I was so

depressed, it was like living inside myself in a hellhole, " she recalls.

Thanks to Covington, is working at her family's window company and now

makes the clinic sound like Lourdes on Lake Erie. " A woman came in with a

cane and dumped it the second day, " she says. " A woman in a wheelchair was

walking. But it isn't the physical transformations that are so amazing, it's

the emotional ones. You see people become alive again. "

For Terrell that process was not easy. At Cleveland the staff pushed her to

be more active - learning to put into practice the philosophy of " working

through your pain. " By the end of the first week she was jogging, swimming

and lifting weights. " It wasn't that she did not have pain but that her pain

didn't get worse once she started to work out, " says physical therapist

Maribeth Gibbon. " Her confidence in her body increased. " Along with

counseling, exercise helped her clear a major barrier: fear. " One of the most

important things we do is send people to the gym, where they find themselves

doing things they didn't think they could do, " says Covington. " They think,

'Maybe I'm not quite as helpless as I thought I was.' "

But during her second week Terrell suffered a setback during a session in

which 50 ex-patients discussed how they managed their pain. The dispiriting

word was " managed. " Though many who spoke were upbeat ( " I have such a desire

for life that I did not have, " said one woman who suffers from excruciating

cluster headaches), the reality that their pain - and hers - might never

disappear made Terrell slump lower and lower in her seat. A few hours later,

in a family therapy session, she broke down. " My pain is not going to go

away, " she sobbed. " I can't deal with it. "

By the end of the third week, however, she had righted herself. And on Jan.

17 she was discharged to return to school. Covington prescribed a battery of

medications - including an anti-depressant, two anti-epileptic drugs known to

fight pain, and Ultram, an analgesic. But she was also assigned activities

such as walking, yoga and relaxation exercises.

" I'm still in pain, but when I find myself slipping back, I can catch myself

and try to calm down, " she says. " We talked in the program about how you have

to allow yourself a bad day every once in a while. " Now the good days are

more frequent. Terrell regularly walks to class. Not only does she stand and

schmooze at parties, but she has been known to dance. " It's nice, " she says,

" to feel a little bit more normal. "

RICHARD JEROME

- GIOVANNA BREU in Cleveland

Jill

" The minute you settle for less than you deserve, you get even less than you

settled for " .

~Maureen Dowd

May 7, 2003