Sacramento Pain Clinic

Compass Center Success Stories

Compass Success Stories

Below are actual case studies that exhibit sucessful Compass program outcomes. Click here to better understand the tests listed in the Testing Outcome section of each Study.

Case Study #1: B.A.

This patient is a good example of reducing medication dependence use via the use of biofeedback and relaxation therapies, finding an exercise program that does not hurt, and increasing function with a prompt return to work.

Date of Injury: 9/13/01 | Last Day Worked: 10/23/06

History: 38 y.o. male, s/p arthroscopy on the right shoulder times two, returned to work on modified duties; however, while on prescription opiates had near MVA involving several people (10/23/06) then placed on TTD to manage increasing opiate dependence.

Multidisciplinary Assessment: He has poor reaction to medications, pain 8/10, disrupted function, constant sleepiness/fatigue, history of failed PT and several injections to area of pain. 

Plan: Plan was to reduce opiate dependence over course of 6 weeks concomitant with psychological support 1x/week, followed by entrance into 6 week FRC for improvement of coping skills and functional improvement.

Functional Improvement: Patient was able to return to work and placed as Permanent and Stationary 4/27/07 without any opiate medications on the Monday following program graduation. Patient developed several coping strategies to manage pain including development of appropriate physical exercise routine, biofeedback and relaxation routines.

Testing Outcome

  Before After
Pain Tolerance 40 75
Coping Skill Assessment 35 80
Pain Disability Index (PDI) 50 11
Pain Beliefs Inventory (PBI) 60 61
Pain Locus of Control (PLC) 36 62
Global Pain Assessment 79 61
Self Perceived Functional Impairment 63 16
Pain affecting performance of ADL (Cooking) 8 5
Pain affecting performance of ADL (Cleaning) 19 21
Pain affecting performance of ADL (Bathing) 2 0
Pain affecting performance of ADL (Dressing) 25 0
Pain affecting performance of ADL (Participation in Community) 21 0
Pain affecting performance of ADL (Driving) 82 8
Nijmegen anxiety scale 26 5

 

Medications Necessary

Before Program After Program
Norco 10/325 6-8 per day Norco d/c’d
Fentanyl 50 mcg/hr q72 Fentanyl d/c’d
Cymbalta 30 mg q.d. Cymbalta 60 mg q.d.
Triazolam h.s. Triazolam d/c’d
Trazadone 50mg h.s Trazodone 50mg d/c’d

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Case Study #2: R.K.

This case emphasizes Functional Restoration as an alternative to treating pain with medications only, and a prompt return to work.

Date of Injury: 12/1/98 | Last Day Worked: 7/2000

History: Prior anterior cervical discectomy and fusion at C4-5 and C5-6, with “gag” symptom in throat and radiating pain/numbness in left upper extremity with decreased fine motor control. Referral to another pain clinic focused treatment on increasing medication regimen. As a result, patient showed increased dysfunction, isolation and frequent E.R. visits to manage flare up pain.

Multidisciplinary Assessment: Chronic post surgical condition, with multilevel cervical degenerative disc disease, opiate dependence, Actiq addiction, major depression, does not have clear understanding of chronic pain andlack of coping strategies. She was functionally deconditioned with severe limitations in ADL management, poor/protective postures and muscle spasm.

Plan: Decrease opiate dependence followed by entrance into FRC to develop coping skills and increase function with ultimate goal of return to work.

Functional Improvement: She was able to meet all goals of decreasing medications, increasing strategies to manage pain without visits to E.R., and return to work immediately following program.
Estimated cost of drugs at 2005 dollars over lifetime would be $1,500,000. Currently she remains opiate free, working fulltime 2 years after the program.

Testing Outcome

  Before After
Global Pain Assessment 68 52
Global Perceived Functional  Assessment 78 74
Pain affecting performance of ADL (Cooking) 73 68
Pain affecting performance of ADL (Cleaning) 58 67
Pain affecting performance of ADL (Bathing) 44 11
Pain affecting performance of ADL (Dressing) 0 12
Pain affecting performance of ADL (Participation in Community) 75 50
Pain affecting performance of ADL (Driving) 81 75
BDI 18 9
BAI 6 6

 

Medications Necessary

Before Program After Program
Lexapro 30 mg q.d. Lexapro 30 mg daily
Duragesic 50 mcg q 48 hours Ultracet as needed
Percocet 10/325, 1-2 t.i.d. Tizanidine 4mg, 1-2 3x/day as needed
Actiq 800 mcg 4-5 times daily Maxalt 10 mg 1 daily prn
Bisacodyl 2 h.s.  
Diazepam 10 mg h.s.  
Carisoprodaol gel  
Sombra gel  

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Case Study #3: C.M.

This case highlights how significant functional gains are achievable despite a chronic pain condition.

Date of Injury: 8/4/05 | Last Day Worked: 1/19/06

History: 43 y.o. right hand dominant, s/p right carpal tunnel surgery, right Dequervain’s tenosynovitis, right volar wrist tenosynovial hypertrophy, right radial carpal wrist arthroscopy and synovial debridement, with ligament debridement and repair. Following surgery, she had changes in color, hyperhydrosis and edema, loss of muscle mass, increased hair and nail growth, with brittle nail beds.

Multidisciplinary Assessment: Diagnosis of CRPS (RSD) appropriate in right arm. Depression related to condition.  Status of work currently halted, at risk of stopping indefinitely.  She had elevated psychological distress with negative coping strategies, isolation. Perceived pain 100/100, perceived impaired function 100/100. Severe impairment of all Activities of Daily Living (ADL), typical day spent watching TV, history of failed therapy with significant reductions in functional use of right hand.

Plan: 8 sessions of psychological counseling prior to entering into Functional Restoration Program. She entered Compass Center for Functional Restoration 2/12/07 with goals of teaching coping skills, improvement in functional use of hand, and vocational training.

Functional Improvement: Functional training combined typing exercises and biofeedback with desensitization routines. An emphasis on continuous communication with the employer was encouraged ultimately enabling the patient to return to work immediately following the program.

Testing Outcome

  Before After
Pain Tolerance 15 80
Coping Skill Assessment 5 95
Pain Disability Index (PDI) 70 22
Pain Beliefs Inventory (PBI) 35 65
Pain Locus of Control (PLC) 18 62
Global Pain Assessment 100 47
Global Perceived Functional  Assessment 100 53
PADL Cooking 100 46
PADL Cleaning 100 62
PADL Bathing 100 64
PADL Dressing 100 48
PADL Participation in Community 100 68
PADL Driving 100 50
Nijmegen 43 22
HVLT 20 12

 

Medications Necessary

Before Program After Program
Hydrocodone 5mg bid Hydrocodone d/c’d

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Case Study #4: G.C.

This case highlights someone who was not able to return to her previous job, but found another career despite not qualifying for Vocational Rehabilitation.

Date of Injury: 3/3/05 | Last Day Worked: 4/13/05

History: 34 y.o. female, post Laminectomy syndrome L5-S1, severe depression. While working as a shipping clerk, she fell and aggravated a prior surgery. She was evaluated by a QME and declared appropriate for a 3 level fusion.  Instead, with advice from a reputable surgeon instructing her on possible complications, she was advised to develop coping skills as an alternative.

Multidisciplinary Assessment: March 2007 she was evaluated by the multidisciplinary team. Results: medically not appropriate for surgery given at least 3 level degenerative discs, currently over dependent upon medication for pain control. Psychologically: displayed depression with lack of coping skills, isolating herself from family and friends. Functionally: no consistent therapy routine, high to severe perception of ADL impairment, poor experience with past therapies, and no vocational direction.  

Plan: Recommendation entrance into Compass FRC to reduce dependence upon medication, belief change, exercise program for flare ups, and vocational direction.  She entered the FRC in March 2007 and began to change her belief about the necessity of surgery for her improvement.

Functional Outcome: While in the program, she also developed confidence with her exercise program which enabled her to control flare ups and was guided to investigate at least 3 different options for a new career. After choosing one career direction, she gathered and completed information about the requirements for schooling during the program.  She enrolled in school to become a surgical technician and began classes the Monday following the program.

Testing Outcome

  Before After
Pain Tolerance 30 80
Coping Skill Assessment 20 85
Pain Disability Index (PDI) 53 39
Pain Beliefs Inventory (PBI) 42 64
Pain Locus of Control (PLC) 58 64
Global Pain Assessment 55 27
Global Perceived Functional  Assessment 89 23
Pain affecting performance of ADL (Cooking) 13 4
Pain affecting performance of ADL (Cleaning) 35 17
Pain affecting performance of ADL (Bathing) 35 3
Pain affecting performance of ADL (Dressing) 63 8
Pain affecting performance of ADL (Participation in Community) 76 42
Pain affecting performance of ADL (Driving) 62 45
BDI 78 61

 

Medications Necessary

Before Program After Program
Hydrocodone 6-8/day Hydrocodone 5/500 BID prn
Ambien h.s. Ambien d/c
Cymbalta q.d. Paxil 40 mg q.d
Exedrin PM 4-5 h.s.  

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The Tests Used to Measure Improved Function

The Pain Tolerance scale is a subjective assessment from 1-100.

The Coping Skills assessment is a subjective assessment of skills learned that enable a person to reduce pain or improve function.

The Pain Disability Index (PDI) quantifies degree of self-reported disability across several functional activities using a scale of 0 for no disability to 10 for total disability. Research has shown that level of self-perceived disability is related to employment status, medication use, and depression. (Out of a maximum possible score of 70, the mean for people who experience disability because of pain is 41.1 [12 s.d.]).

The Pain Beliefs Inventory (PBI) is a 14 question protocol with a Likert scale of 1-5 (Agree to disagree) used to explore pain-related cognitions. Although primarily used as a hypothesis-gathering extension of the clinical interview, a global score can be obtained. (Scores have demonstrated a range from 14 to 70, with a mean of 45 [7.8 s.d.] for patients presenting at a pain clinic. Preliminary research suggests that higher scores [≥ 53] are generally reflective of more adaptive pain-related attitudes and beliefs than lower scores [≤ 37]). 

The Pain Locus of Control Scale (PLOC) measures the degree of self-perceived personal control regarding a pain condition using a Likert scale. (Published norms indicate that the mean for the Internality scale, indicating a sense of personal control over the pain experience, is 32 [12 s.d.] for pain clinic adult outpatients and 52[10 s.d.] for adult non-patients).

Research has shown that in general those with more sense of personal control cope more adaptively with stressful situations and, more specifically, that chronic pain patients with an internal locus of control report decreased pain intensity, less mood disturbance, more active coping strategies, and better compliance with treatment. In contrast, those with less self-efficacy rely on maladaptive pain coping strategies, have lower self-perceived control of pain, feel helpless to deal effectively with their pain problem, and have greater psychological distress.

The Global Pain Assessment is a Visual Analog recording of perceived overall pain on a daily basis. This scale is given in conjunction with the PADL scale below.

The Global Functional Impairment Assessment is a Visual Analog recording of perceived overall impact on life of the above pain rating. This scale is given in conjunction with the PADL scale below.

The Pain Activity of Daily Living Scale (PADL) is a Visual Analog recording of perceived impairment in accomplishing every day tasks secondary to pain. Self perceived impairment is rated from 0-20 (little to no impairment), 21-40 (some impairment), 41-60 (moderately impairment), 61-80 (high impairment), and 81-100 (severe impairment). Improvements in scores reflect actual improvement in perceived daily function.

The Nijmegen scale is a series of questions emphasizing frequency of anxiety related symptoms to physical breathing behaviors.  A score equal to or above 19 indicates a significant correlation (p< .05) between hyperventilation patterns and anxiety symptoms. Treatments involving emphasis upon proper breathing, relaxation, and biofeedback are assisted by this rating.

The HVLT is a word-list learning and memory test. A list of 12 nouns is read to the examinee who attempts to recall as many words as possible. This task is repeated two more times for a total of three learning trials. After a delay of 20-25 minutes, a delayed recall trial is administered. Finally, a series of yes/no recognition trials are administered containing the 12 target words and 12 non-target words.

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