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Pain and Stress Management in the Hospital By Jason Bazilian, L.Ac., M.T.O.M. The chronic pain patients at the Knollwood Center, a psychiatric and chemical dependency hospital in Riverside, California, are plagued by stress. At this in-patient and out-patient facility, daily acupuncture treatments are provided for all pain-track patients. Patients arrive at the hospital suffering from pain and stress that are managed medically throughout the detoxification process from drug or alcohol addiction. Patients' stress manifests itself as feelings of anxiety, depression, nervousness, insomnia, nausea and many other psycho-emotional and physical complaints. Additionally, familial, economic and social stresses are particularly magnified throughout the course of the detoxification phase of the treatment program. These among other issues are addressed on a daily basis with an integrated, team approach. The specific population, due to their complicated chronic pain conditions coupled with their chemical and/or alcoholic addiction, is extremely difficult to treat. Multiple back surgeries, chronic intense migraines, fractures and fusions are just some of the maladies patients present with in this hospital setting. In addition to their physical discomfort and associated stress, these patients are further debilitated by years of related lifestyle factors, including irregular diet, sleep and exercise patterns. These actors serve to create further disharmony, pain, sickness and discomfort and complicate their ability to cope with day-to-day stressors. Traditional Chinese Medicine (TCM) patterns commonly observed include severe liver and kidney yin vacuity, liver depression qi stagnation, spleen qi heart blood vacuity, damp-heat, blood stasis and dampness and phlegm By utilizing acupuncture, massage, the National Acupuncture Detoxification Association (NADA) ear protocol, electric stimulation, and other bioelectric modalities such as Transcutaneous Electrical Nerve Stimulation (TENS), interferential, and vasopneumatic therapy five days a week, Dr. Peter Yuen and I have been very successful at helping this specific patient population to alleviate their pain, stress and related mental, emotional and physical complaints. Acupuncture has an almost immediate effect on calming, relaxing and centering the patient. In addition to the aforementioned methods of treatment, patients are taught relaxation techniques such as deep diaphragmatic and abdominal breathing, exercises and stretching so they may learn alternative ways to cope with normal daily stress. Furthermore, to adequately address all of the chronic pain and chemically dependent patients' needs at the hospital, acupuncture and Chinese medicine is one part of a comprehensive team approach, which also includes psychology, psychiatry, Western medicine, an extensive group and individual counseling program, and the Alcoholics Anonymous/Narcotics Anonymous 12-Step process. Of course, it takes many days and sometimes weeks or months for this challenging patient population to establish and maintain a more regulated and balanced lifestyle. While at Knollwood Center, patients receive intensive daily management by acupuncture, Traditional Chinese Medicine, bioelectric medicine, and other methods to achieve this balance and improve health status. Ultimately, because of additional emphasis on self-coping mechanisms, patients may continue to maintain balance through practice and regularity of learned strategies when they leave. Not surprisingly, many patients engage in personal approaches to managing their pain and stress that already incorporate certain principles common to TCM theory. These individualized and varied approaches can often provide insight toward better understanding the underlying mechanisms of their TCM patterns and disease processes. Many times, they also provide an appropriate starting place from which to reinforce their personal stress relief techniques, and to begin to teach and integrate new TCM-based strategies of relaxation, breathing, stretching, exercise and overall stress and pain reduction. Listening to our patients is an essential skill not only in beginning to diagnose and treat patients' TCM patterns, but also in ultimately gaining a deeper knowledge of how patients learn to self-cope. Paying attention to their self-coping mechanisms, such as those listed below, can be integral to the diagnostic process in this challenging and complex patient population. In the next issue of Oriental Medicine, I will be comparing and contrasting this specific patient population and setting with the patients that I observed at an integrated Chinese and Western medicine hospital in Hunnan Province, China, during November and December of 1998. Jason Bazilian, L.Ac., MTOM, is a state and nationally certified acupuncturist and Chinese medical herbalist. He practices with Pacifica Rehabilitation at Knollwood Psychiatric and Chemical Dependency Hospital as part of an integrated medical tea, approach to chronic pain and chemical dependency. He is a graduate of Pacific College of Oriental Medicine and maintains a private practice in Redlands, Calif.
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