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MUSC launches state's only chronic pain rehab program

It's designed to help people reduce their reliance on medication, feel better through therapy and get back to enjoying life

patients
Rosa Hardee, Nancy LaPrince Fordham and Mark Amundson are among the clinic's first patients. Photos by Cindy Abole
Mikie Hayes and Jenna Lief | HayesMi@musc.edu | April 19, 2018

America is fighting the deadliest drug crisis ever. And with Americans consuming considerably more opioids than any other country, nearly 60 percent more than Canada, the No. 2 consumer, according to the United Nations International Narcotics Control Board, the problem doesn’t necessarily lie with illegal drugs. Prescribed opioid painkillers are actually at the heart of the issue. Two-hundred-fifty-nine million prescriptions were written for opioids in 2012, reports the American Society of Addiction Medicine. That's more than enough for every adult in the United States to have their own bottle of prescription opioids.

Part of the underlying problem is the fact that chronic pain is a real problem, affecting an estimated 100 million people in the U.S. alone. Doctors don’t want their patients to suffer and mean well when they write prescriptions for pain medications. Kelly Barth, D.O., a psychiatrist and internal medicine physician at MUSC who concentrates her efforts on the management of patients taking opioid medications for chronic pain, said patients with this type of persistent pain can have a worse quality of life than patients with cancer, adding that chronic pain can negatively affect their daily lives in countless ways.

Properly treating pain while not creating addiction is a delicate balance — one that has not been struck particularly well. The increase in the number of opioid prescriptions written coincides with a high number of drug overdose deaths, said Barth. Today that number surpasses the total number of gun homicides and motor vehicle crashes combined. And as a result, the pendulum has swung. With data showing that Americans consume greater than 75 percent of the global supply of oxycodone and 99 percent of hydrocodone, it’s no wonder that the Federal Drug Administration has cracked down on the prescribing of opioids, declaring opioid misuse, abuse, dependence and overdoses have reached epidemic levels over the last decade.

In an effort to address both problems, MUSC has launched South Carolina’s first comprehensive chronic pain rehabilitation program. With half of opioid prescriptions in the U.S. written for chronic pain, opioid misuse and chronic pain often go hand in hand. As a result, doctors like Barth and patients alike sought more inventive and targeted forms of treatment to address chronic pain and opioid addiction.

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Dr. Kelly Barth, Shayna Epstein, Dr. Jeff Borckardt and Dr. Patrick Cawley celebrate the clinic's opening.
Barth brought the multidisciplinary program to fruition and now oversees it. She believes the new rehab program will provide patients with a more effective approach. Its objective is to aid patients experiencing chronic pain who have been prescribed long-term opioids to address it. Already, the program has distinguished itself from others because it focuses heavily on eliminating patients’ reliance on opioid medication that resulted from prior treatment.

Barth explained that in order to address the nation’s overreliance on opioids, it is necessary to address what’s creating that reliance, which, she says, is chronic pain. The program “decentralizes” the use of opioids, while providing evidence-based non-opioid pain treatments and “giving patients the support they need to recover in a civilized way.”

The Centers for Disease Control and Prevention recommends non-drug approaches such as physicial and psychological therapy to address chronic pain. Barth said MUSC’s program not only includes opioid reduction and elimination and medication management, but also cognitive behavior therapy, physical and occupational therapy, biofeedback and nutrition education. These evidence-based treatments are modeled after those employed at a highly successful rehabilitation program in Jacksonville, Florida, and also follow CDC guidelines.

Specific goals for recovery include patients reducing or discontinuing the use of pain medications and education is also a major component of the program, as patients learn stress management, relaxation techniques and coping skills and improve the ability to self-manage chronic pain. Ultimately, Barth said, patients will be able to reduce their reliance on both opioids and health care professionals, moving more towards a model of “wellness rather than illness.”

Barth said the first eight patients successfully made it through the program. Each feels lucky to have been a part of it.

Mark Amundson, 60, participated in the program after recently having been diagnosed with idiopathic neuropathy, a chronic disease in which nerve damage interferes with the functioning of the nervous system. Prior to MUSC opening its program, he sought treatment at medical institutions across the country and became reliant on the opioid medications that doctors continuously prescribed him. However, even taking these prescriptions, his pain was excruciating. He said his legs and thighs “burned 24/7.” So, when MUSC launched its rehabilitation program, he enrolled immediately, eager to resolve his pain and receive better treatment.

Amundson, one of the first cohort of patients, touched on some of the reasons he is such a fan. “It has been an unusual experience in the best way. It’s not just about the patient approach. This is bedside manner. There seems to be a feeling, a commitment, and a sense of the patient’s need. It’s not just an office visit — trust me, I’ve seen enough doctors, but it’s different here. Everyone is focused on the program.”

The three-week rehabilitation program runs from 8 a.m. through 5 p.m., Monday through Friday and is organized so that patients are given individual attention from multiple specialists each day. Amundson feels that this type of overarching approach provided the biggest benefit for the “physical side of his disease.” He said the multiple factors that were contributing to his lacking health were not only assessed but addressed on a daily basis, which he credits with helping him get to where he is today.

“I still have pain, but I’m not standing on the corner saying, 'Hey do you have pain relievers?'” Instead, he said he is able to resist the urge for pain medication and confront his pain with methods taught in the program. In this way, he feels “a sense of accomplishment.”

Rosa Hardee, who like Amundson was a part of the program’s first run, has benefitted as well. Since 1997, the 52-year-old has suffered from a host of physical ailments. She said she has suffered with arthritis flare-ups, lupus and leukemia, and throughout, she has received infusions, undergone painful bone marrow tests and was prescribed countless opioids such as oxycodone.

In calling to mind these past 21 years, Hardee explained that the only thing that helped her were the opioids. In contrast, she added that during her treatment at MUSC, she received helpful advice from researchers, occupational therapists and physical therapists on how to handle her pain without relying on medication.

“It was so rewarding to be here,” she explained. “Everyone was so kind and interesting, you know. It was a different experience for me at my age. I thoroughly enjoy not wanting to be an old drug addict, and I was so happy that they were able to help me stop taking the oxycodone.”

“Although Rosa did not actually develop addiction,” Barth said, “she, like many patients, fears becoming addicted to their opioids.”

Damian Millet, a patient nurse coordinator with the program, said the type of intensive approach that these patients received is particularly effective because it offers patients a hands-on experience with health care providers from multiple disciplines, all of whom are there to see patients succeed and return to a more functional life. They are busy eight hours a day, he said, and get a lot of personal attention in group settings. They make a great deal of progress in just three weeks.

“It is an intense education process, as they build coping skills and learn how to live with pain. Lynn Kimball and I are here with the patients all day,” he said of his fellow RN. “And every day, the M.D.s review their medications. The patients work in a group setting with psychologists three times per day, the occupational therapists once a day and physical therapists twice a day. This is all in an effort to taper them off opiates and positively improve their functioning and quality of life.”

The program is working. After years of taking prescriptions with little benefit, Amundson and Hardee are relieved to have taken such positive steps toward recovery after only three weeks at MUSC and feel blessed to have been a part of the program. They believe it has changed their lives for the better.


To find out more about the Pain Rehabilitation Program or to enroll, email Lynn Kimball or call 843-792-6895.

Surprisingly, opioids may increase risk of chronic pain (Medical News Today, April 19, 2018) 

Figuring out an exit plan for patients stuck on opioids to manage pain (MUSC News, Sept. 6, 2017)

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