November 20, 2017

By the time patients enter the Pain Treatment Program at The Johns Hopkins Hospital, they have been living with chronic pain for years, even decades.

Psychiatric comorbidities such as depression, anxiety and post-traumatic stress disorder make matters worse by perpetuating a cycle of inactivity, sleeplessness and catastrophizing, which in turn can increase pain and push patients toward escalating use of opioids. Seventy percent of patients in the inpatient clinic of the Pain Treatment Program are addicted to narcotics.

The inpatient Pain Treatment Program, in the Department of Psychiatry and Behavioral Sciences, is a last chance for many of these patients. The program, which also has an outpatient component, was one of the first in the nation to concurrently treat physical pain and psychiatric comorbidities. It is now one of the country’s only remaining psychiatry-based inpatient multidisciplinary clinics for chronic pain.

“Our goals are function and rehabilitation,” says Glenn Treisman, psychiatrist and director of the Pain Treatment Program. “Pain almost always decreases if we focus on those goals.”

The clinic is staffed by psychiatrists Jennifer Payne and Traci Speed, as well as specialized nurses and a social worker. They work with occupational and physical therapists to develop treatment plans and monitor progress. Initial assessments can include neurological tests and consultations with the physical medicine and rehabilitation team to determine if therapies such as nerve blocks can help with regional pain. 

Patients stay, on average, 29.1 days. In that time, they are treated for their physical and psychological conditions, weaned off opioids, guided through occupational and physical therapy, and counseled about behaviors, relationships and mindsets in group and family therapy sessions.

“About two-thirds of our patients get much better or well,” says Treisman. One man, Treisman says, had used a wheelchair for 15 years, and spent hours each day lying on the floor and watching television because that was the only way he could get comfortable. He now walks without assistance and holds a job. Of the remaining third of the program’s patients, most do not succeed because they leave before they are ready, Treisman says. 

Many patients resist at first. “They don’t want to get out of bed,” says Treisman. “They don’t want to go to group therapy. They want relief now, instead of recovery later. We teach patients to take a longer-term approach to pain management instead of expecting an immediate fix.”

The program has just nine inpatient beds. About 45 percent of its patients are from states other than Maryland, says Treisman. “The Hopkins clinic always has a waiting list, and I think it fills a huge need,” he says. “The benefits are enormous, but it’s a long-term investment.”