Pain has become part of life for the people who come to the Carroll County Center for Pain Management and Rehabilitative Medicine in Westminster.
Some were injured on the job. Some have arthritis, some have cancer. Rehabilitation means regaining the ability to work, perhaps at a different or modified job; dealing with arthritis flare-ups; or learning to manage the pain so they can maintain the highest possible level of activity.
The center is a partnership of several surgeons, Carroll County Physical Therapy and Carroll County General Hospital, said Dr. M. Mike Massumi, the center's medical director since March 1992. Dr. Massumi has a private practice in physical medicine and rehabilitation in Lutherville, and he spends two days a week at the center.
Dr. Massumi's philosophy of pain management is to look at the whole person, although he shies away from the term "holistic" because, he says, it has come to connote naturopathic. The center uses a combination of painkillers, physical and occupational therapy, behavior modification, self-hypnosis, meditation to help people get back to work or everyday living.
"A lot of these individuals need a multi-disciplinary approach," Dr. Massumi said.
"They don't need to go to a surgeon necessarily, they don't need to go to a psychiatrist necessarily, they don't need to go to a physical therapist, but they need to go to all of them, in a format where somebody can decide or assist them in deciding how these [professionals] can help. Thus, the need for a pain center," he said.
Older people with progressive arthritis make up about 25 to 30 percent of the center's patients. Workers injured on the job represent 20 to 25 percent.
Dr. Massumi said most of the rest are people whose insurance companies or family doctors want another opinion or who need nerve studies to find the source of their pain.
Back injuries lead the list of on-the-job injuries, Dr. Massumi said. He sees back injuries in people who do physical work, but also in white-collar workers whose jobs require more lifting or who haven't done any heavy work for a while, then one day move a desk or a filing cabinet.
"A lot of these injuries are unfortunately to people who are very [physically] unfit," Dr. Massumi said.
In cases where physical or occupational therapy can help, the patient is sent next door to Carroll County Physical Therapy, an affiliate of the pain and rehabilitation center.
For injured workers, "The goal is to get them back to work," said Todd L. Herring, executive director of the therapy center. People with job-related injuries may report for physical therapy every day. "Therapy becomes their job," he said.
The four physical therapists use free weights, dumbbells, stationary bicycles and treadmills, and cervical and lumbar traction equipment. They also have a sand pit and shovel for workers who must use shovels on the job, wooden boxes of varying weights and an isokinetic machine that can compare functioning in a good leg or arm to that of the injured limb.
"There's all kinds of feedback for the patients as they exercise" with the isokinetic machine, Mr. Herring said. "They can see how they're doing."
The physical therapy staff also works with employers and sometimes visits job sites to see if tasks can be modified to accommodate an injured worker. That can mean wrist rests for victims of carpal tunnel syndrome. Or it may mean a bricklayer can lay brick, but cannot carry the load of bricks from the stack to the building site.
The occupational therapist works with patients who have lost the ability to perform daily living activities such as being able to use a knife and fork, Mr. Herring said. Occupational therapy also includes "energy conservation," doing the activity in the most efficient way, he said.
Arthritis can create vicious circles for its victims, Dr. Massumi said. Physical activity causes pain, so the person becomes less active, which means that physical activity causes more pain.
Victims of progressive arthritis cannot expect a cure.
"Treatment for arthritis is usually to slow down or arrest the process," Dr. Massumi said.
He can give them nonsteroidal anti-inflammatory medicines and muscle relaxants. Some need anti-depressant drugs or nerve blocks. Arthritics and other victims of chronic pain can be helped to manage the pain through self-hypnosis or meditation.
Physical therapists can treat arthritis patients with warm gel packs, ultrasound or hot paraffin, which bring warmth to hard-to-heat joints, Mr. Herring said. The patients also have exercises to stretch the joint.
"Sometimes we can get rid of all the pain, sometimes not," Mr. Herring said.
Sometimes the only way to end difficult pain -- such as pain generated in the spinal cord that doesn't respond to treatment -- is to cut a portion of the nerve, Dr. Massumi said.