The Pain Rehabilitation Center at Mayo Clinic in Rochester, Minnesota offers an annual three-week program wherein patients who suffer from chronic pain enroll for the purpose of getting off of their pain medications once and for all. Many of those who enroll in this program have tried everything they can think of to manage chronic pain like fibromyalgia and back pain without medication, but they have been unable to do so and seek out the center's guidance.
The program seems to be effective. Over 80 percent of those who enroll, according to the center's clinical director Wesley Gilliam, stay with the program until completion. Further, many who previously used opioids come back six months later to report that they have learned how to manage their pain to the point where they can say no to the drugs, and they have.
It is important to note, however, that a program like this may not be for everyone. Insurers may determine that such an approach is not "medically necessary" and may refuse to cover it. The team at Mayo tries to advocate for their patients, but they cannot guarantee that their efforts will be successful.
Mayo's program is a rarity in that it is one of the few that addresses the aspects of a person's pain, rather than the pain itself. In attempting to understand the emotional, social, and psychological effect that a person's pain is having on him or her, then it may be possible to reduce that person's reliance on his or her medications. And in light of the epidemic this country is currently experiencing, Gilliam says that we most certainly need more programs like this.
Gilliam explained to NPR that while opioids are good at "blunting" a person's pain, they were never meant to be used chronically. This is because "they are not effective in the long term." Gilliam went on to say that because opioids are depressants, and they soothe people who are in distress, then those who take them are not improving their functioning; they're simply calming their nerves. Gilliam calls this "chemical coping," and that managing one's pain does not change with its severity.
Gilliam also illustrated how it is that patients end up at Mayo. First, patients go to their primary care doctor complaining about their pain. The doctor then develops a treatment plan that encourages the patient to be active, to stretch, and that might also include an antidepressant or a nonsteroidal anti-inflammatory (NSAID) prescription. If, however, the patient continues to complain of chronic pain, then his or her doctor will refer the patient to a neurologist, pain psychologist, or pain anesthesiologist. If that still doesn't work, then the patient develops an interest in a pain program such as Mayo's.
Mayo does not approach pain like it is only something the patients imagine. Rather, the program tries to help people cope with their pain by showing them that their mood and anxiety exacerbates the pain, and that perhaps the patient's environment is working to contribute to his symptoms.