A Battle of Nerves: Alaska clinics research new pain management methods.

• Author: Kvapil, Rachael
• Position: HEALTHCARE

Pain management requires patience, as pain is inherently subjective, its sources often superimposing and shifting. So says Dr. Luke Liu, founder and CEO of the Neuroversion clinic in Anchorage. Battling pain is his mission, yet he knows the enemy cannot be cured or conquered, only tamed. Calling the field "management" recognizes the limitations of medicine in the face of life's oldest sensation.

Physicians distinguish between acute and chronic pain.

According to the US Centers for Disease Control, acute pain is often defined as pain lasting four weeks or less, experienced by patients of all ages due to various conditions, including post-surgical recovery. In comparison, chronic pain lasts three months or more and can be caused by a disease or condition, injury, medical treatment, inflammation, or even an unknown reason.

According to Liu, pain management starts with identifying sources. Chronic pain, he says, is a summation of physical, psychological, and social factors that can potentially produce associated complications such as depression, anxiety, chronic fatigue, decreased physical function or disability, poor quality sleep, excessive use of medication or alcohol, general dependent behaviors, adverse reactions from extended medication usage, and social isolation. Liu says his team's highest priority is identifying any specific treatable pain generators and providing palliative therapies.

"We aim to break the vicious cycle of chronic pain and improve their physical and psychosocial well-being," says Liu. "We focus on improving the patient's function and quality of life instead of just masking the pain symptoms."

Dr. Claire Stoltz, medical director at Tanana Valley Clinic (part of Foundation Health Partners), adds that the functional goals of pain management are often individual to the patient. She says some patients want to attend family events, others want to live independently for as long as possible, while other patients want to maintain active lifestyles.

"This is going to look different for each patient," says Stoltz. "Very rarely does pain management mean a life completely free of pain, but we continue to work towards limiting the impact that pain has on the patient."

Holistic Approach

As a family physician, Stoltz sees people for both acute and chronic pain. Chronic forms include orthopedic causes, central sensitization syndrome, fibromyalgia, chronic migraines, and neuropathic pain. At Neuroversion, Liu says staff treat conditions ranging from sports- or work-related injuries to cancer pain, musculoskeletal pain, and visceral organ pain. The most common pains are headaches, neck pain, and low back pain. More rarely, the clinic encounters complex regional pain syndrome or myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Frequently, they treat conditions not typically classified as pain issues, such as post-traumatic stress disorder and long-haul COVID.

Once physical examination and imaging...