Groundbreaking Treatment for Pain Management

In response to numerous subscriber requests, information about several Cleveland Clinic Pain Management programs is included herein.  Consistent with the treatment of other complex diseases, treating patients for chronic pain requires a comprehensive and multidisciplinary approach. 

The following article highlights information on the Chronic Abdominal Clinic, the only one of its kind
in the country.

Chronic Abdominal Pain Clinic Provides a Wide Range of Diagnostics and Treatments

Cleveland Clinic Department of Pain Management and Cleveland Clinic Digestive Disease Institute have launched a new Chronic Abdominal Pain Clinic that provides comprehensive and cost effective medical diagnostics and treatments for patients with chronic abdominal pain (CAP).  An estimated 6 million Americans have CAP.  However, primary care physicians find it difficult to pinpoint the source of CAP in many patients following a physical examination and standard medical tests.

 “CAP, which we define as chronic abdominal pain that has been ongoing for more than six months, has always been a major health problem,” says Maged Rizk, MD, Cleveland Clinic gastroenterologist, who serves as the Chronic Abdominal Pain Clinic’s first administrator.  “Unfortunately, due to physician frustration and patient frustration, a clear way to identify possible causes of CAP has remained elusive.”

 More common in women than in men, CAP can be triggered by rare or uncommon gastrointestinal issues, abdominal nerve disorders or psychological issues that may not be detected by standard diagnostic tests such as a CAT scan, a colonoscopy, or an endoscopic procedure to examine the stomach.

 “The problem is when physicians find nothing, they may prescribe pain medications,” says Arthur McCullough, MD, department chair of Gastroenterology and Hepatology, and staff physician in the Department of Pathobiology and Transplantation Center at Cleveland Clinic.  But for some patients, the pain doesn’t go away because its source has not been addressed. “The patient may have an uncommon condition or disease that can only be detected by specialized tests which we can do at the Chronic Abdominal Pain Clinic.  We believe this clinic is the only one of its kind in the country.”

 At the Chronic Abdominal Pain Clinic, CAP patients undergo a thorough evaluation that includes standard and appropriate specialized medical tests to find the source or mechanism of a patient’s chronic abdominal pain.  More importantly, the Chronic Abdominal Pain Clinic enables collaboration among medical and surgical specialists and subspecialists from a wide range of disciplines to deliver the most appropriate treatments and follow-up care for CAP patients.  The medical disciplines include gastroenterology, urology, hepatology, pain management and clinical research.  What’s more, CAP patients can also benefit from innovative treatments developed by Cleveland Clinic’s medical
research initiatives.

The Chronic Abdominal Pain Clinic will treat patients like Barbara Stewart.  For more than half of her life, the 52-year-old Toledo, Ohio woman suffered from chronic pancreatitis, but doctors could not determine what was causing it. Recently, however, she sought treatment at Cleveland Clinic where physicians conducted advanced tests that unveiled an anatomical issue with her pancreas.

 “My pancreatitis would create tremendous pain throughout my abdomen and my back,” says Stewart. “I was on a lot of opiate pain medications but my quality of life was not good.”  She was forced to quit her full-time job as a nurse practitioner and go on disability.  At Cleveland Clinic, she was seen by Leonardo Kapural, MD, PhD, director of pain management clinical research at Cleveland Clinic’s Department of Pain Management. He used spinal cord stimulation to treat pancreatic pain.  Through a stimulator device implanted in the body, low-level electrical signals are delivered to the spinal cord to block pain signals from reaching the brain.  “The spinal cord stimulator made a big difference in my life,” Stewart says. “It has reduced my everyday pain by about 75 percent and my intake of opiate medications has been cut by about 80 percent.”

 While there have been impressive advances in pain management treatment, Nagy Mekhail, MD, PhD, chair of Cleveland Clinic’s Department of Pain Management, says the most important breakthrough in pain medicine is the concept that chronic pain is a disease, not just a symptom. “Research has shown there are changes that occur in the spinal cord and brain that can facilitate the sensation of pain even after a patient recovers from disease or an incident,” observes Dr. Mekhail. “For example, you can have a patient who has completely recovered from an episode of shingles, a viral infection that causes a painful rash.  Even when the infection is completely gone, some patients can still feel pain. This occurs because there has been an activation in the pain processing nerve cells in the brain and spinal cord that leads to stimulation and the perception of pain.”

To refer a patient to the Chronic Abdominal Pain Clinic, please call Cleveland Clinic Specialty Services Access Line at 216-738-5439.  This line is staffed from 7a.m. – 11p.m., 7 days a week.