A Plan For Managing Pain
Interviewed by Rasa Fournier
Wednesday - October 27, 2010
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Dr. Kerrey Barton Taylor
Pain medicine specialist and co-owner of Aloha Pain Sports and Spine Medicine
Where did you receive your schooling and training?
I have a background in osteopathic medicine from the Arizona College of Osteopathic Medicine. I completed my internship at Mesa General Hospital in Arizona. My residency training was in physical medicine and rehabilitation at the Medical College of Wisconsin. My sub-specialty training was a fellowship in pain medicine at the Medical College of Wisconsin.
How long have you been practicing?
About seven years. I’ve been practicing in Hawaii for about four years. My husband, Dr. Chris Taylor, and I opened our own practice in March. We met in residency training and have always wanted to open a practice together. We share a similar philosophy in caring for patients.
What do you do here at Aloha Pain Sports and Spine Medicine?
Our goal is always to decrease pain and increase function. We want to help people get back to their lives. That means different things for different patients, depending on what the problem or “pain generator” is. We both have a strong background in musculoskeletal medicine and interventional pain procedures, so we treat a lot of spine and muscle conditions - a lot of low-back pain, neck pain, disc problems, degenerative spine conditions, people after spinal surgeries and people trying to avoid surgery as long as possible - all different causes of spine pain. We treat conditions such as shoulder injuries, problems associated with nerves, the hip, knee and ankle. We also treat chronic pain conditions from many different medical conditions including cancer pain, fibromyalgia, diabetic neuropathy and arthritis.
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Can you talk about some of the treatments for pain?
First, I look for the “pain generators.” Where is the pain coming from? What is the structure? What are the conditions? For example, if someone has a low-back problem, I look at what treatments have already been tried. Have they been effective? I look at the mechanics of their spine. Atreatment approach could include an interventional procedure, such as an epidural steroid injection. If the problem is due to muscle tightness, then there is a plan for that, such as physical therapy or a focused home-exercise program. Sometimes, soft tissue injections are appropriate. Sometimes, medications are helpful. I treat pain from a biopsychosocial approach, which means that I treat it using physical, psychological or social modalities that are going to be the most effective treatment to help somebody. Pain is different than any other medical condition. Part of the pain pathway goes through the mood and pain center in the brain, and people “experience” pain, they don’t just respond to it like other medical conditions.
What do you mean by pain being an “experience”?
The pain signal is a complex process. Many areas in the brain are involved in the experience of pain, including areas that are involved with the emotions and mood. That’s the challenge with it. If an individual has high blood pressure or vision changes, it isn’t really an emotional experience. If people have pain, they can’t just leave their pain at home and go on with daily life. Pain is debilitating. Pain is isolating. Pain is very misunderstood. People can look good on the outside, but they don’t feel good on the inside, and that makes a pain condition even more isolating because other people cannot comprehend their pain. After two weeks most people are “done with having pain,” and if they still have pain, they can begin to get sad, depressed, fatigued, anxious, irritable or any combination of these conditions. Mood is affected by pain due to the way we process the pain signals.
If there is pain associated with a loss of activity or function, that also can cause depression and irritability. If there is a financial change involved, such as a work injury, that also can increase irritability, depression, stress or other mood changes. Pain conditions are tough emotionally because pain doesn’t always just go away, and eventually people stop telling their pain story to others, and they lose their support system. The problem with even telling their pain story is that many people don’t understand the pain because they are not experiencing it. Others do not know what to do with that information because they can’t always see the painful condition. Some conditions clear up with a little bit of treatment, but when it continues and becomes chronic, that is an extremely difficult condition to try to live with. If you look at an individual with, for example, fibromyalgia, you can’t always tell that they are functioning through this “wall of pain” just to get through the day or an activity.
To not have other people really understand what pain is, it’s one of the toughest things people go through.
What is fibromyalgia?
It’s a condition that has many different pain components. Individuals experience widespread pain, a heightened response to pain and other conditions associated with it such as insomnia, fatigue, chronic muscle aches and pains and mood changes.
It is chronic, and symptoms can change daily with things such as weather, time of day, stress and physical activity. Since the symptoms and severity can vary, individuals can have a hard time managing the pain.
Is there pain that can’t be helped?
No, we try to help everybody who comes through our clinic. We work closely with other physicians and with practitioners such as physical and occupational therapists, massage therapists, chiropractors and osteopathic manipulation physicians, acupuncturists, martial arts, spiritual hands-on healing - whatever can help. I always feel that the body is trying to bring itself back to a balance. Each person is unique and therefore each requires an individualized treatment plan. There is always a plan.
What is the biggest challenge in working with pain?
Trying to increase function and quality of life when people have had pain for many years. A big challenge is helping someone emotionally and mentally feel better. The depression, the anxiety, the phobias, the loss of family, friends, jobs, function - all of that is very hard for people. A significant challenge is educating people: Pain is very misunderstood, especially with chronic conditions. People are pretty strong. They will continue to try to function through pain, but pain will chip away at the strongest person over time, so it is very important to support them and provide good treatment for their condition.
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