Putting the Brakes on Pain

For most people, growing older means at least a few aches and pains. After years of wear and tear, joints deteriorate and stiffen, making certain activities more difficult and, in some cases, impossible. Other parts may not work quite as well as they used to, either, resulting in decreased stamina, increased shortness of breath, and other problems. Add a major, chronic illness or two into the mix—along with the unintended, and sometimes uncomfortable, consequences of many of today’s medical treatments—and you’ve got a recipe for misery.

In fact, pain affects an estimated 100 million in the U.S. alone. It is such a widespread problem, that there’s a special annual observance dedicated just to the symptom: September is Pain Awareness Month.

Pain Relief

Managing pain and discomfort is a major focus at Capital Caring Health (CCH). With more than four decades of experience caring for advanced illness (palliative care) and hospice care patients, we have a holistic approach that treats the whole person—physically, emotionally, and spiritually—anywhere along life’s path.

“Helping patients have a better day, a better quality of life, lies at the core of all we do,” says Michael Byas-Smith, MD, Medical Director for CCH’s Interventional Symptom Management Program and Capital Caring Health’s Center for Pain and Palliative Care. “Our commitment to relieving pain and discomfort starts with the most effective, conservative approaches and extends all the way to sophisticated, surgical interventions.”

Prior to joining CCH, Dr. Byas-Smith spent 22 years at Emory University School of Medicine in Atlanta, Georgia, as Director of the Winship Cancer Institute Cancer Pain Clinic.

The source of pain and discomfort for many of CCH’s patients arise from a serious or life-limiting condition. The most common medical conditions are cancer, followed by dementia, and co-occurring conditions including congestive heart failure, neuropathy, osteoarthritis, and chronic obstructive pulmonary disease. According to the National Cancer Institute, nearly 80 percent of patients with advanced-stage cancer have moderate to severe pain that negatively affects their functional status and quality of life.

Compounding the problem are the side effects of drugs and treatments, which can produce new issues including swelling, nausea, shortness of breath, even depression.

Tackling Advanced Pain
Most symptom management begins in the home, where more than 90 percent of CCH palliative and hospice patients receive care. Each dedicated care team—composed of a physician, nurse practitioner, nurse, social worker and more—coordinates with the patient and family to make sure pain is treated and manageable.

When pain becomes more severe and the most common treatment—medication—is no longer effective, Dr. Byas-Smith and his staff can take management to the next level through one of CCH’s two clinic sites: the Center for Pain and Palliative Care in Aldie, Virginia, and Sibley Memorial Hospital in Washington, D.C.

If possible, the team will first observe the patient to evaluate limitations, mobility problems, and other major issues that may affect treatment options and outcomes. They then use advanced imaging techniques to arrive at the most precise diagnosis and a targeted intervention for better pain control.

Specific interventions include:

• Lymphedema therapy to relieve the pain from swollen, stretched, fluid-filled tissues, often the result of lymph node removal as in some cases of breast cancer.
• Sympathetic nerve blocks and neurolytic procedures (another type of nerve block).

• Intrathecal pump therapies, whereby an implanted pump delivers medication directly to the spinal cord.
• Epidural and major joint injections to reduce pain and improve mobility.

• Injections for axial spine fractures.
• Ascites and pleural effusion management to treat fluid build-up that may accumulate in the lungs, chest cavity, and abdomen.

The result is often a superior approach to the long-term use of general oral or intravenous analgesic/pain relievers and opioids.

Clinical Trials and Research
In addition to seeing current Capital Caring Health patients at the two pain clinics, Dr. Byas-Smith also treats inpatients at MedStar Georgetown University Hospital, INOVA’s Loudoun and Fair Oaks hospitals, Fauquier Health Hospital, Haymarket Medical Center and Encompass Health Rehabilitation Hospital of Northern Virginia.

Patients receiving care from Dr. Byas-Smith may also be eligible to participate in a National Institutes of Health clinical trial evaluating the effectiveness of the drug resiniferatoxin to treat severe pain associated with advanced cancer.

“This could be a potential breakthrough in the way we treat pain in patients with advance-stage cancer,” Dr. Byas-Smith said. “The drug works by destroying pain fibers and is administered through a single injection into the spine.”

More information about this NIH clinical trial can be found here, including eligibility requirements for potential study participants.

Person-centered care
Care for physical pain may also include treatment for depression, emotional, and spiritual distress through our many types of counseling and support groups.

A focus on the “whole person” may be especially important for patients with dementia. Limiting noise and the number of different people who interact with the patient, evaluating his or her living situation and ability to communicate, and addressing other co-occurring illness are all part of managing pain and symptoms for this vulnerable group.

Regardless of the source, pain can affect every aspect of your life, from limiting simple daily activities such as mobility and the ability to sleep, to reducing your interest in family, friends, and other former sources of comfort and joy. Yet effective pain and symptom relief can help restore your quality of life so you can make the most of every moment you have with the people who matter the most to you.

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If you are a CCH palliative care or hospice patient, make sure to let your care team know about any pain and/or worsening pain. Even if you are not a CCH patient, you can still benefit from our expertise with interventional pain management. To learn more, call 800-869-2136 or click here.