The Foundation is delighted
to announce that Ed Covington MD, internationally known expert on
the psychosocial aspects of pain, has agreed to join our Scientific
Advisory Committee. He is highly published.
This is a recent article
published in the May 5 issue of PEOPLE MAGAZINE about Dr. Covington’s
extraordinary accomplishments at the Cleveland Clinic Foundation.
Mind Over Misery
At
a cutting-edge clinic, some victims of chronic pain learn to live
again.
Left
jab, right cross, left hook: Hannah Terrell pummels a punching
bag in full-out fury, her red boxing gloves set off by a pink
T-shirt and pearl earrings. No, this isn't a gym, and Terrell
isn't training for a shot at Laila Ali. The Vanderbilt University
sophomore is a patient at the Cleveland Clinic's Chronic Pain
Rehabilitation Program, where hitting the big bag is part
of her therapy — a way of purging half a lifetime's
worth of anger and frustration. Since shattering her left
ankle in a fall 10 years ago, Terrell, now 20, has endured
five surgeries and physical anguish so punishing that she
sometimes could not stand upright for more than a few minutes.
Last fall "I was crying all the time," she says.
"I skipped classes because I was knocked out by medications.
My body was out of control." Her suffering is all too
common, for Terrell is among millions of Americans tormented
by chronic pain. A recent study published in the Clinical
Journal of Pain shows that the majority of patients receive
inadequate treatment.
"Emotionally
it was getting pretty hard to deal with," Hannah Terrell
(getting biofeed-back treatment at Cleveland Clinic) says of
her affliction.
(Michelle Litvin)
In part this is because all too few physicians are trained specifically
in pain management. Even excellent doctors tend to regard pain
as a byproduct of illness or injury; they try to treat it with
drugs, from aspirin to opiates. "All of us would rather
have someone take away our pain with an injection than be taught
how to live with it," says Dr. Edward Covington, director
of the Cleveland Clinic program. But meds often offer only brief
or partial relief, and when prescribed improperly their side
effects (ulcers from analgesics; dopiness from narcotics) can
be nasty.
Covington, 56,
is helping to pioneer a more comprehensive — and, experts
say, effective — approach. "Ed is a leader in his
field," says Dr. Jeffrey D. Rome, medical director of
pain rehabilitation at the Mayo Clinic in Rochester, Minn.
The Cleveland program is one of a handful in the U.S. that
attack intractable pain not only with carefully calibrated
pharmaceuticals but also with exercise, biofeedback, self-hypnosis,
psychological counseling and family therapy. That regimen
is based on a growing body of research showing that pain is
"intensely affected by emotions, fears and beliefs,"
says Covington, and that treating it as a mere symptom is
not always enough. In chronic cases, says Covington, pain
can cause permanent neurological changes. "Pain becomes
an evolving, perpetuating problem," he explains. "A
disease."
That was certainly
the case for Terrell. An athletic girl who loved field hockey,
she was 10 when she plunged 15 ft. off a zip line —
a backyard cable ride strung between two trees. Despite years
of operations, nerve damage set in and her agony became unbearable.
Painkillers (Celebrex and Percocet, among others) worked only
intermittently. "Pain defined her, it ruled her life,"
says her mother, Sally, 45, a homemaker. By last fall the
child-development major was falling behind in her classes
and dropping out of campus social life. "I missed my
old self," Terrell says. "I felt helpless."
She
discovered the Cleveland Clinic in December, after years of
shuttling from specialist to specialist in several states.
Told by a surgeon that she needed yet another operation, Terrell
consulted a California pain counselor, who suggested that
she try a new strategy — one available just a few miles
from the Chagrin Falls, Ohio, home she shares with her mother
and her father, Steve, 46, a financial consultant. "It
was really my last resort," Terrell says. "I'd tried
everything."
So have
most patients at the Cleveland Clinic's all-day program, which
offers a three-to-four-week course to a dozen sufferers at
a time. They learn that the mind-body phenomenon of pain can
be modified by psychological or external events.
Dr.
Edward Covington says his clinic encourages the pain sufferer
to "be less of a patient and more of a person."
(Michelle Litvin)
An
adrenaline rush, for example, can minimize pain. "That's
what allows you to score a touchdown with a broken leg,"
says Covington, a psychiatrist and married father of three who
got his medical degree at the University of Tennessee and came
to the Cleveland Clinic in 1979. On the other hand, he notes,
brain-imaging studies show that fear or anxiety increases pain.
"Some areas of the brain reflect the sensory component
— the 'ouch' factor," he says. "Others reflect
emotional suffering."
Covington "understands
that you can't be in pain for any significant period and not
become depressed or anxious," says Dr. Hubert Rosomoff,
medical director of the University of Miami's pain rehab center.
Former patients agree. Spinal fusion surgery had left Darlene
Davis, 46, with severe pain in her limbs, back and head, forcing
her to quit her nursing job. "I was so depressed, it
was like living inside myself in a hellhole," she recalls.
Thanks to Covington, Davis is working at her family's window
company and now makes the clinic sound like Lourdes on Lake
Erie. "A woman came in with a cane and dumped it the
second day," she says. "A woman in a wheelchair
was walking. But it isn't the physical transformations that
are so amazing, it's the emotional ones. You see people become
alive again."
For Terrell that process was not easy. At Cleveland the staff
pushed her to be more active — learning to put into
practice the philosophy of "working through your pain."
By the end of the first week she was jogging, swimming and
lifting weights. "It wasn't that she did not have pain
but that her pain didn't get worse once she started to work
out," says physical therapist Maribeth Gibbon. "Her
confidence in her body increased." Along with counseling,
exercise helped her clear a major barrier: fear. "One
of the most important things we do is send people to the gym,
where they find themselves doing things they didn't think
they could do," says Covington. "They think, 'Maybe
I'm not quite as helpless as I thought I was.' "
But during her second week Terrell suffered a setback during
a session in which 50 ex-patients discussed how they managed
their pain. The dispiriting word was "managed."
Though many who spoke were upbeat ("I have such a desire
for life that I did not have," said one woman who suffers
from excruciating cluster headaches), the reality that their
pain — and hers — might never disappear made Terrell
slump lower and lower in her seat. A few hours later, in a
family therapy session, she broke down. "My pain is not
going to go away," she sobbed. "I can't deal with
it."
By the end of the
third week, however, she had righted herself. And on Jan.
17 she was discharged to return to school. Covington prescribed
a battery of medications — including an anti-depressant,
two anti-epileptic drugs known to fight pain, and Ultram,
an analgesic. But she was also assigned activities such as
walking, yoga and relaxation exercises.
"I'm still
in pain, but when I find myself slipping back, I can catch
myself and try to calm down," she says. "We talked
in the program about how you have to allow yourself a bad
day every once in a while." Now the good days are more
frequent. Terrell regularly walks to class. Not only does
she stand and schmooze at parties, but she has been known
to dance. "It's nice," she says, "to feel a
little bit more normal."
