MUSC's Institute of Psychiatry is offering a new pain medicine service for patients who suffer from both chronic pain and mood disorders.

The Psychiatric Pain Medicine Consultation Service, directed by Edward A. Workman, M.D., will evaluate both the chronic pain and the psychiatric condition and aggressively treat them with medication management, therapies and/or nerve block. Patients will be referred, as needed, for additional services such as physical therapy, group or individual psychotherapies and biofeedback.

“Many chronic pain patients suffer from psychiatric disorders which must be treated and put into remission before any real and lasting progress can be made in their ability to cope with chronic pain,” said Workman. Following are two case reports of how pain medicine has helped people return to normal and productive functioning:

Case #1

Nerve damage pain (neuropathy) Ms. A is a 48-year-old woman who had worked with the same furniture company for more than 20 years, doing various jobs. Her last job involved running a machine that guided pieces of lumber into a saw system.

Unfortunately, three years ago, her blouse sleeve was caught on a jagged piece of wood, and her right hand was pulled into the saw, amputating her index and middle fingers. Although she was rehabilitated for work and her job was redesigned to accommodate her handicap, and she received aggressive treatment with nerve blocks and physical therapy, Ms. A continued to have severe daily pain which had a shooting and burning sensation from her elbow to her finger stumps.

Her pain had become so severe that she had missed more than 40 days of work during the past year and was considering retirement on partial disability. Worse still, as her pain continued, she became more and more depressed, losing her energy and interests in her hobbies, becoming unable to sleep through the night, and finding herself crying uncontrollably for little apparent reason.

After a psychiatry pain medicine evaluation, she was diagnosed with pain-induced major depression, and chronic regional pain syndrome type II (causalgia). Her mood disorder was treated with anti-depressant medications (which also improved her sleep and pain tolerance), and her nerve damage pain was treated with a medicine called mexilitine, which is an oral form of the agent lidocaine (which dentists use to numb your gums prior to dental work. She was also referred for counseling to help cope with loss of her former level of functioning.

After 12 weeks of this intensive treatment, Ms. A was working full-time without any absences in two months, and reported developing new hobbies, regularly sleeping through the night, and feeling positive about the future.

Case #2:

Musculoskeletal pain (myofascial pain)

John was a truck driver for a shipping firm with a near perfect work record, until he was in a severe accident in which he was thrown from the truck cab down a ravine into a creek where he was briefly pinned under water.

Although his unstable fractured spine was repaired with a fusion, John has been unable to return to any gainful work six months after the injury. This was due to severe dull aching back and leg pain (unresponsive to ibuprofen and Tylenol), which became unbearable with even minimal walking or lifting, and panic attacks in which John became severely, suddenly, and unexplainably anxious when he went outside his home, experiencing shortness of breath, rapid heartbeat, fear of losing control, and fear of pain escalation.

A complicating factor involved John's taking six to eight Percocet tablets (a level II narcotic pain killer) per day, which resulted in his being stuporous most of the time when he was not in severe pain, and his near constant arguments with his doctors due to his wanting more and more of his agent.

A psychiatric pain medicine evaluation diagnosed John with pain-induced panic disorder with agoraphobia (fear of open spaces), opiate dependence, and myofascial pain syndrome related to initial shearing of muscle tissue and scar formation from the surgery he required. A treatment plan (involving detoxification from opiates, initiation of new non-narcotic pain killers designed to target scar tissue, appropriate medications for panic anxiety, and cognitive therapy to help improve coping with pain) was developed and put into action.

Six months later, John was not back on his old job, but he spent an average of 20 hours per week in his own small engine repair shop and reported that he could now go shopping and drive his car without anxiety attacks. He also reported that he no longer used narcotics and that his pain was "still there," but it was at a level he could live with, and he never felt "drugged out."

For more information about the Psychiatric Pain Medicine Consultation Service, call 792-0068.