Feeling No Pain
by Amanda GallagherEnter a world of hurt - a place where an estimated 86 million Americans live in chronic pain. John Thompson is one of them.
Twenty years ago he was working at a construction site, bracing the second floor of a building. He stepped backward - onto nothing. "I fell about 10 feet and landed on my tailbone," Thompson said. "At first I didnít think it was anything serious, so I kept working. But the next day I couldnít get out of bed."
That one fall began a two-decade quest for the perfect pain management. The journey led Thompson through seven surgeries, a series of metal plates and a cache of drugs too long to list.
It ended at the Health Science Centerís University Center for Pain Medicine, where Thompson is now in the care of a pain medicine specialist who is a board-certified anesthesiologist. Thatís right, an anesthesiologist. The role of these doctors goes well beyond placing a magic mask of medicine over a patientís face prior to surgery. As a matter of fact, many would argue an anesthesiologist is the most important doctor in the operating room.
"The anesthesiologist is really in charge of a patientís complete physiological status during a surgical procedure," said Joseph J. Naples, M.D., professor and chair of anesthesiology at the Health Science Center. "Itís a risky business. What we use in anesthetics is the same stuff they use in Huntsville (on Texasí death row)."
That fact isnít lost on too many patients. According to a number of studies, most patients say their biggest fear before surgery is not waking up from the anesthesia. "Patients want to make sure they donít feel any pain, they donít want to recall any of the surgery and they want to make sure you are issuing them a round-trip ticket," Dr. Naples said.
Itís his job, and that of fellow anesthesiologists, to not only assess patientsí medical condition before a procedure, but to calm their fears. And most of the time those fears are unfounded. Doctors issue an estimated 40 million anesthetics a year. But only one in every 250,000 patients dies as a direct result of anesthesia, according to the American Society of Anesthesiologists.
"Anesthesiologists have been very proactive in patient safety and leaders in promoting safety in the operating room," Dr. Naples said. "Anesthesia, as it is given now, is very similar to how it was given 50 years ago. The difference is now we have high-tech monitoring devices and a greater interest in safety."
Those monitoring devices enable anesthesiologists to track a patientís blood pressure, breathing and heart rate. Anesthesiologists also monitor brain functions, replenish lost blood or fluids and respond to any medical emergencies during an operation.
But their work doesnít end with surgery. For some anesthesiologists, like James Rogers, M.D., it just begins. Dr. Rogers is a professor of anesthesiology and director of the University Center for Pain Medicine. Heís also responsible for changing Thompsonís life.
"After my accident, I had horrible, unrelenting pain. It was like having a wisdom tooth pulled without any anesthesia," Thompson said. "The pain was there 24/7."
Thompson had to quit his job in construction and build a new life out of physical therapy and a lot of medication. "It was a vicious cycle," Thompson said. "Iíd do my rehabilitation exercises, Iíd be good for a few months and then Iíd relapse. I was taking Vicodin and Valium for muscle spasms but the medicine wasnít even touching the pain."
Thompson said his doctor began to get a little suspicious. "He thought I was out to get medication," he said. So he began a statewide search for help. He sought specialists in Houston and Temple before finally finding Dr. Rogers at the Health Science Center.
"It is not unusual for a patient to see 20 or 30 doctors before they get to us," Dr. Rogers said. "Many patients said their doctors thought the pain was all in their heads. We donít treat them that way."
Perhaps thatís because Dr. Rogers understands his patients more than most specialists. Heís missing his left leg above the knee as a result of a motorcycle accident 25 years ago. After the amputation, Dr. Rogers suffered from what is known as "phantom pain" in the area of the missing limb. "Patients describe it as a crushing, stabbing, lightning-like pain. It feels like someone poured gasoline on the limb and torched it," he said. "In the days of my accident, no one really knew how to treat those kinds of problems."
Doctors originally saw pain as a symptom - treat the problem and the pain will go away. But as Dr. Rogers and his colleagues have learned, thatís not always effective. Instead, his team fosters a unique multidisciplinary approach to pain management - an approach that really works.
"Our clinic prides itself on the fact that we treat the whole patient. Not every patient gets a needle or walks out with a prescription," Dr. Rogers said. "We work closely with anesthesiology, physical medicine and rehabilitation, orthopedics, physical therapists, neurosurgery and psychology. We try to deal with the patient from as many angles as possible and weíve had a whole lot of success."
Thompson is just one of those success stories. The years he spent in a narcotic stupor ended when Dr. Rogers outfitted him with a spinal pump, which is a device implanted beneath Thompsonís skin that continuously injects small amounts of morphine into a targeted pain area.
"It helped me move from a 10-plus on the pain scale to a two or a three," Thompson said.
"We try to focus on what we can do to improve the patientís level of functioning," Dr. Rogers added. "If you have a patient who spends all day in bed and you can get him up to go to his kidsí school play or to go shopping, then youíve been successful."
Dr. Rogers and his team are successful - so successful that Good Housekeeping magazine recently listed the University Center for Pain Medicine as one of the Top 35 Pain Centers in the country. The same article listed Dr. Rogers as an exceptional practitioner.
"Some centers are block centers - they stick you with a needle and hope the pain goes away. Others deal more with medical management and write prescriptions," Dr. Rogers said. "We take a multidisciplinary approach. We listen to our patients, weíre concerned for them and we try to build them a better quality of life. Pain control is still very important, but the better goal now is to improve the level of functioning."
Thatís not what most people would expect from the "masked man" peering down at them before surgery. Many still believe an anesthesiologist is simply the doctor who knocks the patient out before a procedure. But Dr. Naples, Dr. Rogers and their team have proven otherwise, making a lifetime of difference for their patients. "Iíve been living with pain for 20 years. I missed out on a few good years, but Iím getting them back now," Thompson said. "Thank God I found Dr. Rogers."
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