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Paynesville Press - March 13, 2002

PAHCS starts pain clinic

By Michael Jacobson

Dr. Larry Strate has seen intense pain. Not just as a physician, but as a brother. His sister died of cancer in the most pain he's ever seen.

Now, through a new initiative that he's spearheading at the Paynesville Area Health Care System, he is trying to minimize pain in other cancer patients and chronic sufferers. The first patients in PAHCS's new pain clinic had their first appointments in late February.

The goal of the pain clinic is to service chronic pain, including chronic back pain, fibermyalgia, arthritic pain, and frequent migraines, said Dr. Strate, as well as pain in cancer patients.

The chronic pain sufferers and cancer patients will be handled differently, though treated in similar ways. Chronic-pain sufferers tend to have long, complicated medical histories, with patients trying all sorts of providers and all sorts of cures for their ailments.

Cancer patients, on the other hand, have a battle against an acute, life-threatening disease on their hands. "A lot of cancer patients die in pain, and most don't have to," explained Dr. Strate.

"There are things they can do before the pain starts," he added, like "using pain medication to stay ahead of the pain. If you get behind, it gets very difficult to catch up."

In either case, the treatment will be interdisciplinary and based on the individual case. Methods will include physical therapy, medication, massage therapy, meditation, biofeedback, group sessions for emotional support, nutrition, and old fashioned physical conditioning.

"There's a ton of stuff out there now," said Dr. Strate. "We'll use whatever works, and we'll learn as we go."

Cancer patients, despite the uncertainty of battling a life-threatening disease, have one advantage to most chronic pain sufferers. They know exactly what's wrong.

A lot of people with chronic pain have no cure, which is something they may have to realize before they can make the most of the pain clinic. This involves a major shift in mindset: from finding a cure to feeling as good as possible.

"A lot of people that end up in a pain clinic are people whose pain has severely diminished their ability to function and to enjoy life," said Dr. Strate. Chronic pain sufferers may have stopped working, enjoying hobbies, and started feeling depressed because of it, he said.

"We may not fix your pain. We're going to try to help you deal with your pain better and get your life back," he stressed.

A large part of treating chronic pain patients is dedicating time to them, said Dr. Strate. In the current climate with doctors on tight clinic schedules, it's often easier for them to treat chronic pain patients with some medication than take the time to really explore the problems and look at possible treatments. The pain clinic will make the time and develop the tools to do this.

Often, chronic pain sufferers do not have planned treatment because hey may switch providers after getting disillusioned with their progress or resort to going to the emergency room when their pain gets to be more than they can cope.

Chronic pain patients are often undermedicated, according to Dr. Strate, and increasing their dosages, and managing them differently, will be a treatment option.

Patients need to be referred to the pain clinic by their regular physician. Jo Strate, Dr. Strate's wife, who has experience in chemical dependency counseling, will serve as the case manager for the pain clinic, which will be held at the Integrated Health Center in Paynesville.

Jo Strate will conduct hour-long intake interviews, gather information on the patients' medical history, and schedule appointments for the patients with Dr. Strate. Once the initial evaluation is made, a treatment plan with different methods will be developed for the individual patient.

The interdisciplinary approach will not be unlike how PAHCS treats diabetes, another chronic condition. PAHCS has won state awards for its interdisciplinary approach, including its diabetes treatment.

Jo Strate will be doing regular follow-ups with the patients, coordinating their treatments and consulting with the care providers, and facilitating group sessions of chronic pain sufferers, where the patients can share ideas and lend each other support.

"One of the benefits (of the pain clinic) is that patients will deal with the same people for a long period of time," said Dr. Strate.

"They're going to get to know Jo real well," he predicted.

This is important, he explained, because in many cases minimizing the pain might require making life-altering adjustments. Building trust with health care professionals is key to that effort.

"When you're making hard changes in life, the better the relationship you have (with your health care providers) the better," he said.

The genesis of the pain clinic has been nearly six months in the making. The need for a pain clinic became obvious after the only one in the area closed in St. Cloud, said Dr. Strate. Now the nearest pain clinic is in the Twin Cities.

The future of the pain clinic at PAHCS will be demand driven, Dr. Strate added. Jo Strate will be working part-time as the intake person to start.

Dr. Strate, who spends most of his clinic hours at the Watkins Area Medical Clinic, will be dedicating a half day a week to the pain clinic at the Integrated Health Center in Paynesville for starters.

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