John Beale/Post-Gazette
Stacy Falcon of Greensburg has more to be happy about now that her pain is under control.
	Related article A change in attitudes about treating chronic pain

Everyone knows what it's like to have a headache. You wake up one morning and your head is pounding -- maybe you have hay fever; maybe it's that time of the month; maybe you had too much to drink the night before. You pop a couple of aspirin or Tylenol and a few hours later it's gone.

But imagine waking up with a headache and not being able to get rid of it for three years. That's the nightmare that Stacy Falcon lived with.

One morning she woke up "so stiff that it felt like my shoulders were up around my ears," says Falcon, 39, a hairdresser who lives with her husband in Greensburg. "I had headaches three or four days a week, on average."

Her work didn't suffer, she says, because "I forced myself to go through it" -- as most pain patients do.

"It was my personal life that suffered," Falcon says. At first she kept going out at night, but over time, she began saying no to invitations, even to vacations with her husband. She felt she was bad company.

For most of the week, her pain was at a number eight on a scale of zero to 10, where zero is no pain and 10 is the worst you can imagine. The Joint Commissions on the Accreditation of Healthcare Organizations, the national health-care facility review board, requires all accredited hospitals and nursing homes to use this scale. The Veterans' Affairs Department has long assessed pain as the "fifth vital sign," and many clinicians and facilities are following suit.

Chronic pain specialists classify anything over seven on the scale as severe pain.

		More information Here's what makes a good pain medicine program: Clinical mission to offer the most medically advanced services; practitioners must be available 24/7. Doctors should be board-certified in the subspecialty of pain medicine. Teaching mission to train new practitioners. The ideal is to have a fellowship program accredited by the Accreditation Council for Graduate Medical Education. A list of accredited programs can be found at www.acgme.org. Research to provide the most advanced therapies. When should a person with pain seek this help? "The patient has to take responsibility when they're not receiving appropriate pain relief or, more important, a diagnosis from the physician who's caring for them," says Dr. Jack Kabazie of West Penn Hospital. A typical patient entering his program is "a man who has low back pain and has been given ibuprofen and an opioid," neither of which is working well. Kabazie encourages folks to look at their pain as an illness. "It's the same thing as if a doctor couldn't get your blood pressure under control," he says. "How long would you stand for that before seeking another doctor?" Two local programs Among local pain management programs, two are worth a special look. Both are accredited. Institute for Pain Medicine, Western Pennsylvania Hospital. Director: Dr. Jack Kabazie. Located at West Penn, Allegheny General, Sewickley Valley, Ohio Valley, Forbes Regional and Westmoreland hospitals. 412-578-5635. Common diagnoses: Among men, work-related injuries; among women, diabetic peripheral neuropathy (nerve pain), herniated discs, neuropathic (nerve) pain, and malignant (cancer) pain. Also post-shingles pain. UPMC Pain Medicine Division. Director: Dr. Doris K. Cope. Locations: St. Margaret, Presbyterian, Magee-Womens, Pain and Rehab at Centre Commons in Shadyside. 412-784-5119. Common diagnoses: Each location has a team that works with different problems. St. Margaret offers high-tech interventions. Magee-Womens treats women's pain such as pelvic pain. Presby treats acute and post-surgical pain; and the Pain and Rehab Clinic helps rehabilitate individuals whose chronic pain has impinged on their work and social lives -- patients with unsuccessful back surgeries, headache, fibromyalgia, spinal stenosis, myofascial pain, neck pain and nerve pain.

With a four to five, "You're not sleeping through the night, you're not lifting your kid," says Robin Hogen, vice president of public affairs at PurduePharma, maker of OxyContin, which has become notorious because of its abuse but which, when used appropriately, has helped countless chronic pain patients get through their workdays with their sanity intact.

"With seven and up," Hogen adds, "many patients cannot cope with the pain and remain bedridden."

At level eight, Falcon forced herself not to stay in bed.

A lot of sufferers

Often it's the high-profile cases of medication abuse that grab the public's attention on pain treatment, notably the recent case of radio talk show host Rush Limbaugh, who became addicted to OxyContin, Lorcet and other pills while trying to treat back pain.

But he's just one of an estimated 30 million to 50 million Americans who's affected by chronic pain, defined as continuous pain lasting longer than six months. Such pain is blamed for $100 billion lost each year in disability and productivity.

Despite this, pain medicine is a relatively new clinical specialty.

Conventionally, physicians have thought of pain strictly as a result of an underlying disease, not as a disease itself.

Researchers now have documented how chronic pain differs from acute (or short-term) pain. While acute pain is the result of a healthy nervous system alerting the mind that something is wrong in the body, chronic pain more closely resembles an illness resulting from abnormal changes in the nervous system.

If acute pain is like a siren crying, "Fire!" then it knows when to shut off when help is coming. In chronic pain, the siren continues to blare and blare, even when the firefighter pulls the plug.

What's more, research is showing that untreated chronic pain triggers a cascade of fight-or-flight hormones that affect the immune system, organ function and moods.

"Chronic pain is an issue associated with depression and anxiety," says Dr. Cheryl Bernstein, a neurologist with anesthesiologist training who works at UPMC's Pain and Rehabilitation Clinic in Shadyside. "Often, we see people who have developed 'pain behaviors' -- the pain has become a part of his or her life.

"This is the hardest kind of patient to treat because it's difficult to separate the pain out from who they are.''

Studies also are showing that, when used appropriately, pain medications derived from the opium poppy plant or synthesized to behave like those derivatives, such as morphine and OxyContin, not only improve healing, but reduce the risk of depression.

This leads to the idea that an important factor in healing and well-being is a patient's degree of control over the pain: Lack of control may contribute to depression and anxiety. Patients who have most success in controlling pain often combine medication and/or surgery with practices like physical, occupational and psychological therapy, massage, exercise, yoga, relaxation response, biofeedback, acupuncture, nutrition, meditation or even prayer.

"The thing about dealing with chronic pain is, you can't talk about happiness or life's good things and the future when your face is showing how unhappy you are," says Richard Hunter, 72, of West Homestead, who had herniated discs for nearly 10 years before a largely successful nucleoplasty (a procedure that thermally treats the tissue) in 2001. Hunter now controls his pain with a very low dose of medication.

"If I didn't take it, it might not really hurt, but it would cause me not to be able to stand up straight. And once you start that, each day it gets more and more, and pretty soon you're all bent over."

A customer's advice

Like many pain patients, Falcon sought help for her pain when nothing she nor her primary care doctor did seemed to help.

Her doctor had diagnosed migraine, but the first-line drug treatments known as triptans, which stop the headache by constricting the blood-vessels where it originates, did not work.

She went to a neurologist who did a magnetic resonance imaging scan. "Everything was normal," she said.

So she lived with this for three years, until one day, one of her salon customers told her she looked bad. The customer, whose son is a pain medicine physician in Greensburg, told her pain specialists could help.

Falcon went to the son's clinic, where doctors diagnosed cervical facet syndrome, a disorder in which certain joints in the neck vertebrae become compressed and put pressure on the nerves.

It results from trauma such as whiplash, which Falcon had experienced twice, or from chronic stresses on the joints caused by bad posture.

The treatment of choice, she was told, is rhizotomy, a procedure in which a hot wire is used to make lesions, essentially burns, on the nerve in the neck whose compression is causing the pain.

Dr. Jack Kabazie, director of the Institute for Pain Medicine at West Penn Hospital, performed the hourlong, outpatient surgery. Falcon said she felt pressure, but no pain during the procedure.

While not all pain patients are candidates for surgery, Falcon responded well to it. Later the same day her neck was a bit stiff, and the next day she felt fairly well.

"Now I get up every morning without a headache," Falcon says delightedly, expressing gratitude to friends and family who encouraged her to keep seeking help -- not to give up, as many pain sufferers do.

"Just to be able to enjoy my weekends is a blessing."