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UVM Medical Center Program Provides Alternatives to Medication for Patients with Chronic Pain

Yoga is one aspect of comprehensive pain treatment

Catherine Huskisson spent about three years living with severe pain from fibromyalgia and finding few solutions that helped.

Huskisson never liked taking medications and wanted to stay away from opioids to treat her pain. So she asked her primary doctor, “What else can you do for me?”

Ultimately, the doctor referred Huskisson to the new Comprehensive Pain Program at the University of Vermont Medical Center. Over eight weeks this summer, she participated in group sessions, learned mindfulness exercises and received acupuncture and massage therapy.

Each visit to the clinic, she says, gave her a day with less pain. “That’s huge if you’re in this situation,” Huskisson says. “It gives you tools. That was the whole part of it for me,” she adds. “I wanted it to give me strategies for dealing with my pain.”

The Comprehensive Pain Program (CPP) began in September 2018 as an integrative approach to addressing chronic pain. The program combines traditional methods of pain management with group psychology sessions, group medical visits, culinary medicine demonstrations and therapies including massage, Reiki, yoga, physical and occupational therapy, and acupuncture.

The CPP offers alternatives to pharmaceuticals for managing not only pain but the complications it causes for those suffering from it. Chronic pain can aggravate many facets of a person’s life – their work, family and social relationships. It often goes along with mental health challenges such as anxiety and depression. With that added stress, it’s hard for a person to reach an optimal level of comfort and function.

Some participants, like Huskisson, come to the program because they want to relieve their pain as much as possible without relying on highly addictive, prescription opioids.

Others in the CPP have taken opioids or other pain drugs for years, some at very high doses to be effective. Many of them will continue to do so, even as they add the program’s therapeutic components.

The program is designed to optimize the use of traditional medical treatment and give participants insights and awareness strategies to help them “reframe” their approach to life with chronic pain, says Dr. Jon Porter, the CPP’s medical director and a pain specialist. A key goal is to enhance participants’ sense of self-agency and ability to manage better while living with, in many cases, extreme discomfort.

“Pain is a medical term,” Porter says. “It doesn’t begin to capture the experience of individuals who have chronic pain in terms of the impact is has on so many aspects of their lives. We think the word ‘suffering’ better describes the experience of our participants, and that’s a universal human experience.”

That understanding informs the CPP’s holistic approach, he says.

“While we won’t be surprised that some participants experience significant relief during their time in the program, our focus is on optimizing function, as well as comfort.”

About four years ago, UVM Medical Center convened a planning group to talk about options other than opioids for managing patients with chronic pain. The group found no other comprehensive programs specifically for pain across the country, so the medical center came up with this unique approach.

“We knew we needed to try something different,” says Maureen Leahy, a planning group leader and the medical center’s director of neurology and psychiatry.

At the time, primary care physicians had few tools to help patients with chronic pain – other than more opioids – and little chance of making them better, Porter says. They were frustrated with writing multiple prescriptions for these patients while seeing them for 15-minute visits – too short a time to adequately address the challenges they faced, Porter says. This “transactional” approach, he says, has failed patients and providers.

“It’s not that everybody’s not doing the best they can,” Porter says. “We’re just not getting the best outcomes for our patients.”

Most people with chronic pain who use opiate medication are taking them as prescribed and aren’t addicted or using illegal drugs. These medications, though, do present serious consequences to their health. If they try to go off their medication or reduce the dose, they risk possible psychological instability. Their doctor must work with these patients with thoughtful care and collaboration, Porter says.

The chance to give other pain sufferers an alternative to starting down that opioid path is the biggest benefit of the CPP, Leahy says.

“What we’re finding is that it’s more of an opportunity, if introduced early enough, to keep people off and it may help people reduce” opioid use, says Laurel Audy, a registered nurse and Reiki practitioner, and a CPP group co-facilitator who prescreens program participants.

At the clinic on Tilley Drive, designed with pastel colors and low lighting for those with sensitivity, the group sessions drive the structure. The CPP takes patients only on referral from their primary care doctors in the UVM health network. To qualify for referral, a participant must have experienced at least three months of pain that has interfered with at least one aspect of life – such as causing family stress, an inability to work or isolation.

The CPP currently has about 50 participants in two different tracks, which last either eight or 10 weeks. It’s likely to increase capacity in the coming months, Porter says.

“We do feel confident that people can function better and find more ways to do what they want to do,” he says, “with genuine support, optimizing medical treatment and making use of integrative therapies not formerly used in traditional medical settings.”

This story was reported by Carolyn Shapiro, with the UVM Health Network.