You touch a hot stove and retract your hand. You feel a stab in your chest and make a beeline for the emergency room. You lift some heavy boxes and your back throbs for days.

Unpleasant though it may be, pain plays a valuable role, warning us of an injury. Melvin Gitlin, professor and vice chairman of the Miller School of Medicine’s Department of Anesthesiology, Perioperative Medicine and Pain Management, likens acute pain to an alarm system for the body. “A signal is sent to the brain, which alerts the person to the fact that there’s something wrong. If you break a foot, for example, the pain is the message that you shouldn’t walk on it.”

But not all pain serves a positive function. In some cases—when a vertebral disk is compressed, when diabetes causes extensive nerve damage, or when a tumor impinges on a nerve—the pain does not go away. Instead, the alarm continues to sound, causing unrelenting, or chronic, pain. About 50 million Americans suffer from chronic pain, a number that includes but exceeds those who have breast cancer, AIDS, and nearly all other serious or terminal diseases combined, according to a 1999 Harris survey. Of this group, two in five experience pain so severe they’re unable to work. Most chronic pain sufferers visit multiple doctors before finding one who can treat them with any degree of success.

The Miller School’s Department of Anesthesiology, Perioperative Medicine and Pain Management is striving to change these statistics. Although the University has long offered pain management through various divisions, David Lubarsky, the Emanuel M. Papper Professor and chairman of the department, has created a centralized multidisciplinary program—the Pain Management Center—in which pain specialists address the unique problems of individuals with chronic pain.

Six months after a head-on auto collision, Rebecca Mayden was so riddled with pain and muscle spasms that she divided her time between her wheelchair and bed, relying on her husband to transport her to the bathroom. The Fort Pierce mother of three resisted the efforts of six doctors to increase her narcotics but relented when the pain became so unbearable she contemplated suicide. She lived in a drugged state for several months.

Today, Mayden manages a horse barn, thanks to the care she’s receiving at the UM Pain Management Center. Her multifaceted treatment regimen, which took doctors a few months to fine-tune, includes interventional procedures, various pharmacological agents (systemic and topical), and aquatherapy.

“I was really depressed when I came to the pain clinic because I expected more of the same: five minutes in and out the door, here’s your pain medication, now go home,” Mayden recalls. “Instead, it was ‘How can we help you get your life back?’ I had hope again. I had a life.”

“Most people don’t realize that chronic pain is a disease state.” Lubarsky says. “We assume that if something hurts, it’ll go away if you ignore it. Chronic pain doesn’t operate like that. Changes occur at the cellular level in the way nerve cells communicate with each other. So what a pain management program has to do is unwind that phenomenon.”

Lubarsky’s commitment to pain management is reflected in his recruitment of two of the country’s leading specialists. Salahadin Abdi arrived in 2006 from Harvard University, where he was director of the pain center at Massachusetts General Hospital, to serve as chief of the UM Pain Management Center. Melvin Gitlin, former chairman of anesthesiology at Tulane University and one of the pioneers of pain management, joined the department last year as professor and vice chairman. They work alongside Dennis Patin, chief of anesthesiology and pain management at the Sylvester Comprehensive Cancer Center. Patin specializes in the implantation of devices that relieve pain by interfering with the transmission of sensation to the brain. Also in the center are assistant professors of clinical anesthesiology Ivan Antonevich and Vivek Mehta.

While the pain center’s experts employ all approaches to pain, including narcotics, their primary goal is to provide as high a quality of life as possible. In cases of intractable pain, this usually means combining approaches to reach a level where the smallest amount of narcotic medication is needed. As Norma Chavez will tell you, even slight relief can make a world of difference in mobility and function. It took Chavez four surgeries in three years to realize the pain that afflicted her hands, then her elbows, and then her neck, hips, and knees was not going away. She had to quit her job as a clinical laboratory supervisor and go on medications that left her foggy and confused. Even nerve blocks—spinal injections of steroids and anesthetics—provided little relief. “You can’t imagine the pain,” she recalls.

Under the care of Abdi, Chavez’s pain has decreased from above 10, or excruciating on the pain scale of 0 to 10, to the more bearable 7 and 8. Every four months she visits Abdi, who injects steroids and local anesthetics directly into various painful areas. And while the relief isn’t permanent, it lets Chavez reduce her pain medications. With the help of anesthetic patches, aquatherapy, psychological counseling, and a hand-held machine that delivers electrical pulses to areas of pain, she’s able to enjoy the time she spends with her seven grandchildren.

“One of the most important things a pain doctor has to do is let patients communicate the experience they’re having,” Gitlin explains. “With chronic pain syndromes, the complaints can be vague and people are often told the pain is in their head. You can’t take a blood test or an X-ray for pain. It’s a very subjective phenomenon, and it affects the various components of the central nervous system.”

Cancer pain, according to Patin, is one of the most complex because it involves the pain caused by the disease itself, or from several sites of disease, as well as by inflammation. Even treatment may cause pain, since surgery, chemotherapy, and radiotherapy may lead to neuropathy—nerve fiber damage that results in a range of sensations.

While much is known about the molecular and biological causes of neuropathic pain, it remains the most resistant to treatment. Abdi’s basic research focuses on teasing out the causes of this pain and determining how and why various approaches alleviate it. In particular, he’s investigating the mechanisms through which the same cancer drugs that cause pain can, in lower doses, reduce that pain. In another project, he’ll be collaborating with a visiting acupuncturist from China to determine how this ancient pain relief method works at the most basic level. He is also studying the basic mechanisms of spinal cord stimulation and of pulsed radio frequency treatment of dorsal root ganglion—a group of peripheral nerve cell bodies—for treating neuropathic pain.

Gitlin is looking at basic questions about why acute pain goes away in some people but becomes chronic in others. And with Keith Candiotti, associate professor of anesthesiology, Gitlin also is looking at specific genetic markers to determine why certain people are more susceptible to pain.

While people have historically considered pain a part of life they have to live with, current thought recognizes the serious toll that chronic pain takes on all aspects of life.

“Fortunately, many patients realize that they do not have to suffer with pain,” Abdi says. “A lot of surgeons and primary care physicians are also beginning to realize that pain is a disease of its own and are starting to send patients to pain centers early on. It’s important we reach these people as early as possible because chronic pain causes fundamental changes in our body and mind.”

Pain Treatment Pyramid

The Miller School of Medicine’s Pain Management Center treats a broad spectrum of chronic pain problems at the University of Miami Hospital, Jackson Memorial Hospital, the Miami Veterans Affairs Medical Center, and the Sylvester Comprehensive Cancer Center’s Miami and Deerfield Beach clinics. Each patient is evaluated and a plan devised for pain relief.

Dennis Patin, chief of anesthesiology and pain management, likens the pain treatment options offered at the center to a pyramid. The least invasive approaches—exercise, aquatherapy, physical therapy, acupuncture, and hypnotherapy, as well as cognitive and behavioral therapies—form the base. The next level up is medication, including acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin; opioids such as morphine; muscle relaxers; and anticonvulsants, antidepressants, and antianxiety medications. The University’s specialists also prescribe patches, topical medications, and transcutaneous electrical nerve stimulation therapy (TENS), a device that delivers low-level electrical signals to the site of pain to “scramble” normal pain signals.

If those options don’t work, Patin and his colleagues may turn to minimally invasive approaches such as epidurals, in which anesthetics and steroids are injected into the spinal column, or nerve blocks, injections that prevent the transmission of pain from its physical origin to the brain. Some patients also benefit from spinal cord stimulators, implanted devices that emit low-level electrical signals to interfere with the brain’s ability to perceive pain. Trigger point injections, which deliver pain medication to sore joints and muscles, and intrathecal pumps, implantable devices that carry medication directly to the spine, can help deliver relief to targeted areas.

In certain cases, the UM Pain team may also use a neuroablation technique to alleviate persistent pain. For example, if a patient’s pain from pancreatic cancer or another abdominal malignancy can’t be relieved through other means, the physicians can perform a fluoroscopy or CT-guided neurolytic celiac plexus bloc, which involves destroying the entire complex of nerves that innervate most of the upper abdominal organs such as the pancreas, stomach, and liver.

Joan Cochran is a freelance writer in Boca Raton, Florida.