Results of treatment of chronic low-back pain at the Portland Pain Center.

We have evaluated 100 consecutive patients with low-back pain admitted to the Portland Pain Center. The average patient had been disabled for about 6 years, and had had an average of two surgical attempts to improve his symptoms. Most of the patients considered had open claims with their Workmen's Compensation carriers. Significant gains were demonstrated in drug reduction, general well behavior, and increased range of motion and exercise tolerance. The Pain Center setting provides a multidisciplinary approach to the treatment of chronic low-back pain. Significant increases in functional capacity are demonstrated.

Perspectives on surgical indications. Implications for controls.

Surgical indications do not forecast outcomes as well as they should. A review of the literature demonstrates a significant rate of overutilization of coronary angiography, coronary artery surgery, cardiac pacemaker insertion, upper gastrointestinal endoscopies, carotid endarterectomies, back surgery, and pain-relieving procedures. The tendency appears to be a reduction in developing specific indications, and the evolution of a "last resort" concept. Arguments against this approach and a plea for the development of tighter focused indications are presented. Implications for cost saving and reduction in suffering are discussed.

Transcendental meditation, mindfulness, and longevity: an experimental study with the elderly.

Can direct change in state of consciousness through specific mental techniques extend human life and reverse age-related declines? To address this question, 73 residents of 8 homes for the elderly (mean age = 81 years) were randomly assigned among no treatment and 3 treatments highly similar in external structure and expectations: the Transcendental Meditation (TM) program, mindfulness training (MF) in active distinction making, or a relaxation (low mindfulness) program. A planned comparison indicated that the "restful alert" TM group improved most, followed by MF, in contrast to relaxation and no-treatment groups, on paired associate learning; 2 measures of cognitive flexibility; mental health; systolic blood pressure; and ratings of behavioral flexibility, aging, and treatment efficacy. The MF group improved most, followed by TM, on perceived control and word fluency. After 3 years, survival rate was 100% for TM and 87.5% for MF in contrast to lower rates for other groups.

Multidisciplinary treatment of chronic pain at the Northwest Pain Center.

The Northwest Pain Center is a three-week multidisciplinary day care pain management program which has been operating since 1972. Experience shows that pain problems result in excessive use of medical resources, inappropriate medication use, and possibly unnecessary surgeries. Significant depression and family disruption are common. In spite of powerful incentives that maintain pain behavior, most important being the compensation and disability systems, more than 70 percent of patients maintain objective physical gains resulting from pain center treatment. Studies attempting to differentiate long-term successes from long-term failures provide implications for treatment and evaluation strategies. Areas of need are identified in public and professional education, and necessary future research.

A therapeutic milieu for chronic pain patients.

Traditional means of treating chronic pain have been unsuccessful in a discouraging number of cases. Pain centers have appeared within the last few years, offering a more comprehensive view of the whole pain problem. Pain centers address pain as a multifaceted event with social, economic, physiological, and psychological representations. In addition, the pain center constructs an atmosphere that provides every opportunity for reduction of pain, while minimizing those factors that tend to encourage its expression. Such a venture calls for a multidisciplinary approach; it further demands a rather sophisticated grasp of numerous factors which do not necessarily lend themselves to discussion with a single vocabulary. This paper will attempt to describe a number of conceptual models of chronic pain and to demonstrate how each of these models is addressed therapeutically in a multidisciplinary pain center millieu.