LEWIS' FORMULA FOR TRACKING PAIN IMPRESSES ACADEMY

Dr. Joan Lewis practices in an area most doctors fear to enter.

She prescribes narcotics for people with chronic, severe pain. In six years
of private practice at her Pain Management Clinics of New Mexico Inc.,
Lewis has developed a new program for pain management and tracked more than
500 patients. She uses a formula to measure a person's pain and graphs
progress (or its lack) over time as they respond to therapy. Elements of
the formula are subjective and objective.

Lewis asks patients on every visit to rate their pain on a 0 to 1,000 scale.

And the clinic tests the patient's range of motion in degrees and measures
grip strength. Using a Standard Field Sobriety Test, she gauges mental
acuity and agility, which reveals the effects, if any, of pain medication.
She also uses blood tests to watch for possible liver damage from the
drugs. Next she charts the subjective pain scores and the objective
range-of-motion scores, along with the dosage of medication. Resulting
graphs reveal that the typical patient will initially experience some
relief, followed by a return of pain. She then increases medication until
the patient again shows pain relief and range of motion improves. After
that, most patients reach a plateau, when they still have pain, but they
can function again.

Lewis then begins to wean them from the medication, reducing the dose over
time and allowing the body to take over its own pain management. Her theory
is: Treat the pain, and the brain begins to understand how lack of pain feels.

If you can regain that lack of pain, the brain realizes this is normal.

The brain takes over, and the patient no longer needs opioid
medication. For severe injuries or disease, a patient will always need
medication to allow them to be as functional as possible, she says. The
system allows Lewis to spot addicts or malingerers because a patient trying
to falsify data can't remember all 38 values Lewis measures in
range-of-motion tests.

Their results are erratic. For a paper on her program, Lewis received an
award for Outstanding Contribution to the Interdisciplinary Pain Management
Literature for 2000 by the American Academy of Pain Management. The academy
also proposes a faculty appointment to its University of Integrated
Studies. Dr. B. Eliot Cole, of the academy, visited Lewis' clinic last
year. "The use of multiple ranges of motion measurements and the
performance of the Standard Field Sobriety Test is pure genius," he wrote
Lewis. "Your ability to correlate range of motion and toxicity to the
amount of medication taken is brilliant." He said he was convinced "that
you are really on to something quite amazing." Cole wants to use Lewis's
techniques as an objective tracking component for the National Pain Data Bank.