The Pain Institute in Chicago was formed in June 1994 as a center for management and research in chronic pain. The Institute's principal doctors, David Flemming, M.D. and Michael Gainer, Ph.D., independently began researching effective treatment modalities for reflex sympathetic dystrophy (RSD) in 1989. They arrived at a number of similar techniques which lead to long term remission for many - even those labeled intractable in later stages of the disease. These techniques integrate conventional medicine, neuromuscular retraining and psychotherapy. The cornerstone of therapy is activation of the patient's own innate, natural healing resources. This is achieved by using specialized visualization, guided imagery and progressive relaxation exercises in conjunction with standard medical and physical treatment.
Dr. Gainer published early observations in April, 1992, in an article which received the Crasilneck Award of the American Society of Clinical Hypnosis. Dr. Flemming placed his clinical report in the annual meeting of the American Pain Society in the same year. Because of their mutual interest in developing effective treatment for RSD, Dr. Flemming and Dr. Gainer joined to form The Pain Institute in Chicago.
Since the initial development of this treatment approach for RSD, Drs. Flemming and Gainer have developed treatment protocols based on these principles for a wide variety of chronic pain conditions. The treatments have been expanded to include adjunctive therapies such as massage therapy, movement re-education and therapeutic exercise.
Our multidisciplinary staff includes medical specialists, neuromuscular and myofascial therapists and psychologists. This team provides effective and up-to-date treatment programs for chronic pain, tailoring specific interventions to patient's individual needs and resources. Our treatment philosophy includes self empowerment and the belief that, in order to be most effective, various health care resources must be provided in a seamlessly integrated, holistic system. Because of the special difficulties associated with the treatment of chronic pain, a truly integrated approach is essential for successful treatment. The Pain Institute has integrated programs to respond to the unique difficulties of treating chronic pain, such as reflex sympathetic dystrophy, fibromyalgia, chronic backache, headache and other problems.
Each of the multidisciplinary team members provides the most up-to-date and effective methods available within their respective fields. What sets The Pain Institute's programs apart is our approach to the integration of these services in a comprehensive package that addresses the patient as a whole person with unique and individual needs.
In response to the need of many patients for intensive therapeutic intervention, The Pain Institute offers a number of intensive treatment programs. Patients enrolled in the intensive program often stay at nearby hotels and participate in therapy at our outpatient facility for three to five hours daily for week-long enrollment periods. In this way, patients can enjoy the benefits of intensive treatment without the confinement or cost of inpatient hospitalization.
To understand how various factors affect chronic pain, it is helpful to understand how various environmental influences affect our bodies in everyday, normal functioning. These influences are easier to understand if they are separated into three categories. There are 1) physical, 2) chemical and 3) psychological factors that affect bodily functioning.
Some medical scientists have suggested that we think of the human body as functioning in specialized "states." These states consist of certain bodily "configurations" which allow people to successfully adjust to changes in their environment. For example, we all have certain body states for sleeping, eating, conversing or any number of different activities. People are born with a certain number of "preset" states and develop others as they are needed for survival or adaptation to the environment.
Each of these states consists of specific neurological (chemical), psychological and physical factors. Together these factors form what scientists call "neuro-psycho-physiological" or NPP states. Importantly, if any one of these factors change, the entire state must change as well.
For example, we assume a certain NPP state when we sleep. Neurologically or "chemically" the brain is being influenced by certain chemicals which cause the sleep state. Psychologically, consciousness changes and physiologically, relaxation occurs. It is easy to see that if any one of these factors is disturbed, the sleep state will cease. If for example the person has drunk coffee before sleeping, the neurological condition will change preventing sleep. Similarly, if the person is psychologically anxious or physically tense, the entire sleep state will be disturbed.
Psychotherapy relies heavily on this principle for treating emotional problems such as anxiety, which has strong physical components. Anxiety attacks are accompanied by a number of physical changes such as racing heartbeat, hyperventilation, sweating, dry mouth, etc. They also have very specific neuro-chemical aspects such as the release of adrenaline. And of course there is the psychological experience of terror. Modern medicine recognizes that by treating any one of these aspects, the whole of the anxiety state can be changed. Physical interventions might include exercise, massage or relaxation techniques. Chemical interventions include various medications, and a wide variety of psychological techniques have been developed to accomplish the same goal.
It is essential to note that the patient or practitioner does not have to confine him or herself to one of these aspects as the sole focus of treatment. Since there are three areas of influence on bodily functioning, it stands to reason that this equates with three possible avenues of therapeutic intervention. It is important to know that all three of these avenues can be taken at the same time and without conflict! In fact, when all of these avenues are pursued with equal vigor, and in a coordinated fashion, the most favorable therapeutic effects occur no matter what disease is the focus of treatment!
A person in chronic pain also is experiencing an NPP state. And accordingly, most chronic pain sufferers can identify various influences affecting their pain. Chemical influences include medicine, tobacco or caffeine. Physical influences may include changes in the weather or physical manipulation by physical therapists. Emotional stress is a powerful psychological influence for many patients.
Because of the extreme complexity of most chronic pain conditions, it is essential that all of the possible therapeutic influences be explored and that every avenue of possible intervention be addressed.
Chronic pain affects every aspect in the lives of its sufferers. Living in chronic pain is, in fact, living with an extremely complex NPP state. It is important that chronic pain sufferers work in, and receive support for, their treatment in all areas which influence their pain.
It is for this reason that The Pain Institute developed integrated treatment protocols for chronic pain. In our programs, a physician evaluates and makes recommendations for chemical interventions, the psychologist for psychological interventions and a variety of physical therapists work to influence the physical aspects of the person's pain. Most importantly, we seamlessly integrate these program aspects into a coordinated unit so that we treat not only the person's pain, but the person in pain as a whole.
The Pain Institute's staff presented a symposium on the integrated treatment of Reflex Sympathetic Dystrophy at the 37th Annual Scientific Program of the American Society of Clinical Hypnosis, in March, 1995 in San Diego, California. The symposium was entitled Hypnotherapy for Reflex Sympathetic Dystrophy. The Papers that were presented included:
Flemming, D. C. (1995, March). Reflex sympathetic dystrophy: An overview of medical and psychological features. Paper Presented at The 37th Annual Scientific Meeting of The American Society of Clinical Hypnosis, San Diego, CA.
Flemming D, C. & Gainer, M. J. (1995 March) Hypnotherapy for reflex sympathetic dystrophy: Outcome data for 30 treatment cases. Paper Presented at The 37th Annual Scientific Meeting of The American Society of Clinical Hypnosis, San Diego, CA.
Flemming, J. R. (1995 March). Hypnotic phenomena and hypnotherapeutic techniques in massage therapy for reflex sympathetic dystrophy. Paper Presented at The 37th Annual Scientific Meeting of The American Society of Clinical Hypnosis, San Diego, CA.
Gainer, M. J. (1995, March) Hypnotherapy for reflex sympathetic dystrophy:Theoretical and practical considerations. Paper Presented at The 37th Annual Scientific Meeting of The American Society of Clinical Hypnosis, San Diego, CA.
The following is a bibliography of other publications and conference presentations on reflex sympathetic dystrophy by members of The Pain Institute's clinical staff.
Flemming, D. C. & Flemming, J. R. (1992, October). Treatment of reflex sympathetic dystrophy with hypnosis and massage therapy. Poster presentation at The Annual Meeting of the American Pain Society, San Diego, CA. Flemming, D. C. (1992, December). Behavioral management of reflex sympathetic dystrophy. Paper presented at What's New in Anesthesia: Annual Educational Meeting of the Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL.
Flemming, J. R. & Flemming, D. C. (October 1993). Reflex sympathetic dystrophy: Treatment with massage therapy and hypnosis. Workshop presented at American Massage Therapy Association's 50th Anniversary National Convention, Chicago, IL.
Gainer, M. J. (1992). Hypnotherapy for reflex sympathetic dystrophy. American Journal of Clinical Hypnosis, 34(4), 227-232.
Gainer, M. J. (1993). Somatization of dissociated traumatic memories in a case of reflex sympathetic dystrophy. American Journal of Clinical Hypnosis, 36(2), 124-131.
Gainer, M. J. (1994, March). Hypnotherapy for somatization in dissociative disorders. Paper presented at The 36th Annual Scientific Meeting and Workshops on Clinical Hypnosis, Philadelphia, PA.
Gainer, M. J. (1994, March). Hypnotherapy for reflex sympathetic dystrophy. Paper presented at The 36th Annual Scientific Meeting and Workshops on Clinical Hypnosis, Philadelphia, PA.
Gainer, M. J. (1994, September). Ego-state therapy for somatization in the dissociative disorders. Paper presented at Explorations in Unity and Multiplicity: An Interdisciplinary Symposium on Dissociation and the Self, Pittsburgh, PA.
Gainer, M. J. (in press). Pain in Transformation: Phenomenological Reflections on Psychotherapy for Reflex Sympathetic Dystrophy. In R. Knowles, E. Murray & A. Barton (Eds.) Duquesne Studies in Phenomenological Psychology, Vol. V. Pittsburgh, PA: Duquesne University Press.
David Flemming, M.D. Director of Medical Services. Dr. Flemming received his medical training at Charing Cross Hospital Medical School, London, and became board certified in anesthesia before emigrating to the United States. In the mid-70's he joined the faculty of the University of Pennsylvania and Children's Hospital of Philadelphia. Later, while on the faculty at the University of Wisconsin, he developed an interest in the management of chronic pain and co-directed the pain center within that university. In addition to his work with The Pain Institute, he is Clinical Assistant Professor in the Department of Anesthesiology and Critical Care at the University of Chicago.
Michael J. Gainer, Ph.D. Director of Psychological Services. Dr. Gainer received his Doctorate in Clinical Psychology from Duquesne University (Pittsburgh, PA). Before joining The Pain Institute, he was Assistant Professor of Psychology in Psychiatry at the Northeastern Ohio Universities College of Medicine (Rootstown, Ohio), was a Staff Psychologist at Akron General Medical Center and practiced with Akron Psychiatry Associates. While at Akron General, Dr. Gainer provided primary psychotherapy in the Trauma and Recovery program, a nationally-recognized center for the treatment of trauma-related psychiatric conditions. Dr. Gainer's work in the treatment of dissociative disorders and psychosomatic conditions has been recognized internationally. He was awarded the Crasilneck Award of the American Society of Clinical Hypnosis for the first article ever on the successful hypnotherapeutic treatment of RSD.
Joy Flemming, M.A. Administrative Director, Director of Adjunctive Services. Ms. Flemming holds a B.A. degree from the University of New Hampshire and a M.A. from the University of Akron. She is Nationally Certified in Therapeutic Massage and Bodywork and received massage training at the Chicago School of Massage Therapy and Neuromuscular Therapy with Paul St. John. She has been in private practice specializing in chronic pain, musculoskeletal disorders of musicians, and the use of creative visualization and massage therapy in the treatment of chronic pain.
Benjamin Perkus, M.A. Psychotherapist, Director of Research. Mr. Perkus received his Masters in Psychology from Duquesne University, where he is currently a doctoral candidate. His doctoral research (ongoing) is on the relation between pain and dissociative disorders. He completed his internship training at the Center for Psychological Services at the University of Ottawa, Canada. Prior to coming to the Institute he was the Clinical Coordinator at the Pain Management Center of Central New York. He has received specialized training in clinical hypnosis, imagery for chronic pain, and biofeedback.
Beth Forristall, M.F.A. Certified Massage Therapist. Ms. Forristall received her massage training is from the Chicago School of Massage Therapy, with additional training from St. John's Neuromuscular Pain Relief Seminars. Ms. Forristall is certified in Bodywork for the Childbearing Year, offering nurturing touch and therapeutic massage for pregnant and post-partum women.
Jennifer Hunter, B.A. Certified Massage Therapist. Ms. Hunter has a B.A. in Psychology from Purdue University. She received her massage therapy training from The Chicago School of Massage Therapy and is Nationally Certified in Therapeutic Massage and Bodywork. Ms. Hunter has a special interest in working with performing artists and utilizes creative visualization along with massage therapy to enhance performance confidence.
Carol McRaith, M.A. Certified Massage Therapist. Ms. McRaith has a B.S in biology from Notre Dame and received an M.A. in Community Counseling from Loyola University. Ms. McRaith also has completed internship training in family therapy. Her massage therapy training is from Chicago School of Massage therapy.
E-mail: dflemming@mem.po.com
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