Chicago Ballet teacher Gayle Parseghian thought she might never dance again after a back injury while moving heavy furniture left her with unrelenting pain.
But an intensive, four-week "boot camp" got the 55-year-old dancer from Toledo, Ohio, back to the barre. The program at the Rehabilitation Institute of Chicago taught her to manage the chronic pain that had tormented her for more than a year.
"It affects your relationship with your spouse, your family, your friends, your boss," she said. "It's like you're trapped in your body and you can't get out. It's a feeling of being completely out of control."
New research suggests chronic pain affects the brain's ability to rest, disrupting a system that normally charges up some brain regions and powers down others when a person relaxes.
The early findings could explain the sleep disturbances, decision-making problems and mood changes that often accompany chronic pain. And they could explain why the boot camp approach worked for Parseghian.
The Chicago program, affiliated with Northwestern's medical school, attacks pain on three fronts - biological, psychological and social. It doesn't claim to cure chronic pain, but instead gives patients tools to lessen its hold on their lives.
Patients spend Monday through Friday stretching, exercising and moving in new ways. They meet with a physician, an occupational therapist, a physical therapist, a biofeedback therapist, a clinical psychologist and a movement specialist.
They may address depression or sleep problems or adjust their medications. And they learn from the other patients in the program.
Getting all of these things under one roof differs from most approaches to treating chronic pain, said Dr. Steven Stanos, the program's medical director.
Patients know the drill. In the fragmented world of health care, they bounce from internist to chiropractor to massage therapist to surgeon - with none of the experts sharing information.
Parseghian spent a lot of money attempting to get relief - she tried herbal patches, vitamins, prescription narcotics and a battery-operated device that uses electrical impulses to block pain. Nothing worked.
Surgery would have been next. She was in a surgeon's waiting room when she read about the boot camp.
If acute pain is the body's alarm system, alerting to injury-causing dangers, then chronic pain is an alarm going haywire, screaming a warning long after the danger has passed.
The American Pain Society estimates millions of Americans are in chronic pain from backaches, jaw pain, headaches and fibromyalgia, a mysterious syndrome marked by muscle pain and fatigue. Sore spines alone cost billions of dollars each year.
In 2005, Americans with aching backs and necks spent $20 billion on prescription drugs and another $31 billion for outpatient doctor visits, according to a recent study in the Journal of the American Medical Association. Total spending on spine treatments increased 65 percent from 1997, adjusted for inflation. But rising alongside that was the proportion of people with spine problems who reported limited function.
Such spending with such poor results gets insurance companies' attention.
Chronic pain patients' medical and pharmacy bills "show up on our radar," said Dr. James Cross, Aetna's national medical policy chief. The patients are "frustrated and clearly suffering" and "looking for an answer," he said.
Although boot camp-style programs cost up to $20,000, Cross said that's cost-effective compared to the procedure and pill merry-go-round. The company cites studies showing patients who have completed boot camp programs experience lasting pain reduction and lower stress. Aetna also believes patients completing the programs are less likely to seek other expensive treatments.