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Johns Hopkins

Johns Hopkins Pediatric

Putting Pain in Its Place

June 6, 2014 

Alyssa Parian, MD

Akhil Chhatre works closely with surgeons to craft individualized plans to combat spine pain. “It can be an isolating and scary process for patients,” he says, “but we have the resources to help them.”

Two days before New Year’s 2001, Janis Harris got into her car to run some errands. Realizing that she’d left something in the house, she put the car in park—or so she thought—and headed back to fetch the item. Suddenly she saw her car rolling backwards. Harris attempted to jump in and put on the brakes, but the car dragged her, and she ended up with punctured lungs, broken ribs and unbearable shoulder pain.

“I couldn’t breathe or talk,” recalls Harris, who lives in Waynesboro, Va. She managed to crawl into the house and call her husband, who quickly called 911.

And so begins the saga of Harris’ chronic pain. Initially, she needed her lungs inflated and many rounds of cortisone shots to manage her discomfort. It would take years of physical therapy before she could walk again, and even so, she was left with persistent, severe pain in her back, shoulders and legs. Then, in 2007, Harris was diagnosed with an autoimmune disease that triggered new pain in her joints.

Her internist prescribed 60 mg of morphine twice a day and 15 mg of oxycodone four times a day. Although the narcotics initially subdued the pain, they later stopped working, and by 2013, the pain had become unbearable. A friend advised Harris to see Akhil Chhatre, director of spine rehabilitation at The Johns Hopkins Hospital. He well remembers the day Harris, 67, arrived.

“She had terrible back pain, and the narcotics clearly weren’t helping,” Chhatre says. Harris had inadvertently become addicted to drugs that he says should be used only for acute—not chronic—pain. Yet even those in acute pain on narcotics, says Chhatre, can easily get hooked. Either way, he says, “Not everyone is willing to admit they have a problem. We need to establish the diagnosis and then set boundaries.”

After discussing a comprehensive nonsurgical care plan with Harris, Chhatre launched a “detox” strategy to begin weaning her off the narcotics. After about five days, recalls Harris, “I was out of my head with pain.” But Chhatre encouraged Harris to enroll in the month-long Johns Hopkins Comprehensive Inpatient Pain Management Program. The structured program includes four classes a day focused on physical therapy, mindfulness and nutrition. There, physical therapists, nurses and social workers offer tactics on how to manage pain without drugs. Harris completed the program in March, which she says proved challenging as she was weaned off the narcotics. But commiserating with the other 11 patients, and staff—and family support—she says, bolstered her spirits. Throughout her stay, Chhatre visited often but did not prescribe any medications.

“The beauty of this program,” says Chhatre, “is that we can offer a variety of treatment options in one place, and we’re always accessible.” Patients in need of pain management represent about 35 percent of his practice. And Chhatre works closely with surgeons to help manage postoperative pain. “Whether it’s acute disc issues, tumors, arthritis or fractures, we come up with a care plan based on each person’s needs.”

Two months since her return home, Harris says her pain persists, “but now I visualize that I’m not in agony.” Chair exercises have also helped.

“Before,” says Harris, “I was in bed 24 hours a day for many months. Now I’m going out to restaurants with my family. I’m reclaiming my life.”

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