Demystifying pain

Experts at the Center for Pain and Wellness get to the root of the problem

Tucker Parris was driving cross-country from Virginia to San Diego, where he was stationed in the Navy, when he was involved in a nearly fatal, service-related auto accident in Flagstaff, Ariz. He broke his neck and a vertebrae in his lower back and spent the next year recuperating in a hospital in San Diego.

“The only thing that saved me was that I was in good shape and had enough muscle mass to compensate for the loss of blood,” says Parris, who was 19 at the time.

The once-healthy young man had been such a fine athlete he was assigned to battle harsh and dangerous conditions in his job as a Naval aviation rescue swimmer on search and rescue helicopter missions. Now, however, he was wracked by “ferocious” pain. Even though he was able to resume work in the military and was honorably discharged, Parris was left with a nagging ache in his lower back that worsened over the years. Eventually he was gripped in such agonizing pain that he couldn’t sleep, his mobility began to deteriorate and he walked with a pronounced limp.

“Aside from the debilitating back spasms, the worst part was that I lost my identity,” he says. “I was always physically active and enjoyed physical hobbies like running, but I had to stop everything when the pain took control of my life.” His search for relief was compounded by the fact that he was deeply reluctant to take heavy-duty narcotics because he had seen people on painkillers become addicted. For nearly a decade he bounced from one doctor to another, desperate for an alternative but often having his concerns dismissed—until he found the UCI Health Center for Pain and Wellness.

Her approach was different from the outset. At their first meeting she and her team spent more than an hour with him, seeking to uncover clues that other doctors had possibly overlooked. “Pain is very challenging to treat, especially when it becomes chronic,” Gulur says.

A subsequent MRI revealed that Parris had an undiagnosed compression fracture at the base of his spine. Because it had been untreated for so long, the injury damaged nerves throughout his entire spinal column. Parris underwent a radiofrequency nerve ablation, a procedure in which the nerves are cauterized so they stop sending pain signals to the brain. He felt relief immediately. An hour after his first treatment, he says, “my wife saw me walk like a normal person for the first time in three years.”

Today, his pain is considerably less severe, and he is able to get a full night’s sleep. “I have to go in for periodic tune-ups because the nerves eventually grow back,” says Parris, now 32, who lives with his wife in Huntington Beach and works in a family business. Under the moniker TAP Forge, he is now able to devote much of his time to the physically demanding hobby of bladesmithing, which involves forging and hand-carving knives. “In many ways, I feel like Dr. Gulur gave me my life back,” says Parris.

The Center for Pain Management, led by Gulur, employs a suite of different strategies to customize a comprehensive care plan aimed at alleviating acute or chronic pain, whether it is caused by cancer, arthritis, headaches or serious injuries. “We do a thorough assessment and then map out a treatment plan that includes various modalities, because no single treatment is completely effective,” Gulur says. “That’s what sets us apart— we take the time to understand the right plan for the patient.”

Generally there are two types of pain: nociceptive pain, which is throbbing or aching pain caused by inflammation in the organs and musculoskeletal system, and neuropathic pain, when the nerves are damaged and the pain feels more like a burning sensation as it radiates from one side to the other and disrupts sleep.

“Neuropathic pain is more challenging to treat and get under control,” says Gulur. “And not all pain is equal, which is why each type should be targeted with different treatments. Many patients have a combination so you have to target both. Unfortunately many patients wait too long to come in, and by that time the pain has taken up residency and become chronic.”

Consequently, pain specialists at the center take an approach that employs a combination of medications, physical therapy, biofeedback, massage and leading-edge interventions like radiofrequency nerve ablation or transcutaneous electrical nerve stimulation (TENS) therapy, which uses electrical shocks to dampen nociceptive pain. They’re also looking at new medications and novel interventions that include spinal cord and peripheral nerve stimulators to relieve nerve pain, stem cell therapy and platelet-rich plasma treatments to rebuild damaged tissue and bones, and cooled radiofrequency that targets nerve pain.

In the future, Gulur and her colleagues hope to personalize treatments even more by using blood tests that identify genetic markers to determine which medications will work for individual patients.

They’re careful to monitor patients who are taking opioids—which include OxyContin, Demerol and Dilaudid—to prevent addiction or accidental overdose. In 2012 there were more than 1,800 opioid-related deaths in California, and nearly three-quarters of them were linked to abuse of prescription pain medications.

“We do risk assessments as well as educate patients about safe storage and disposal,” Gulur says. “We want their pain treated while making sure it is being done in a safe way.”

Patients also find relief at the UCI Health Susan Samueli Center for Integrative Medicine, which offers several approaches that complement traditional pain management techniques. These include acupuncture, osteopathic and therapeutic massage, restorative yoga and classes in Egoscue movement, which helps people with joint pain.

Mindfulness-based stress reduction is also taught at the center. “While its primary purpose is to help people manage stress, mindfulness was originally introduced for pain management,” notes Laurie Macaulay, the Samueli Center’s associate director.

“The good news,” Gulur concludes, “is that we now have a wide array of tools to relieve suffering and get people back to normalcy.” Normalcy is just fine with Parris. “The pain is tolerable,” he says, “and I can actually function. Because of UCI Health doctors, I now have the freedom and independence that I fought for in the first place.”

Learn more about pain management at ucirvinehealth.org/pain.

— UCI Health Marketing & Communications
Featured in UCI Health Live Well Magazine Winter 2016