By the time Marilyn Bard finished telling her story at Montreal’s MUHC Pain Centre, the desk before her was littered with wet tissues. The 59-year-old grandmother had been pummelled by pain in her whole body for years. Simple tasks such as hanging the wash caused sharp pain to run along her arms. Her neck and head throbbed with an intense pain she never thought possible. When she visited her doctor, he told her there was nothing wrong. But the day she couldn’t even hold her newborn grandson in her arms, she knew there was.
Bard sought a second and third opinion. The final diagnosis: rheumatoid arthritis, psoriatic arthritis, fibromyalgia and occipital neuralgia. The neuralgia required two separate surgeries to remove nerves from the back of her head. Doctors treated her arthritis with cortisone shots and painkillers. But the pain in her joints was never eradicated, and the neck pain returned.
Visibly, it took a heavy toll. “I looked like my grandmother!” Bard says. Worse, the chronic pain was threatening her 19-year marriage. Her husband believed she could conquer the pain if she tried hard enough and had to shoulder everyday chores.
Finally, in 1999, Bard’s neurologist convinced her to visit the MUHC Pain Centre, so called because of its affiliation with the McGill University Health Centre. Founded by doctors Ronald Melzack, Joseph Stratford and Mary Ellen Jeans, it has treated hundreds of patients successfully since opening its doors in 1974.
With low expectations, Bard joined the centre’s group-therapy class and for the first time talked to others who understood her pain and offered strategies to deal with it. To her surprise, she began feeling better right away—and it lasted. She learned how to relax by releasing tension in each part of her body, starting with her toes then progressing upward, and she was switched to more effective painkillers. Her pain was ranked nine out of ten—ten being the most painful—when she began at the centre. Now, on good days, it barely registers a one.
“When I visited my three grandchildren in Calgary not long ago,” says Bard, “I was lifting them up, swinging them around and running with them. I was doing things I’d never done before!” Chronic pain—any recurring or persistent pain—can last months or a lifetime. Surveys show about 2.5 million Canadians suffer moderate to severe chronic pain. In the United States it disables to some degree some 86 million people, at an annual cost of $90 billion to industry and business. “Persistent pain is so destructive,” says Melzack. “It causes damage to those who suffer from it and to everyone around them, too.”
Melzack’s fascination with pain began in his early 20s while working on his Ph.D. in psychology at McGill. Immediately after graduating, he spent three years at a multidisciplinary pain clinic in Oregon. There, he began work on a questionnaire based on the rich vocabulary of one of his early patients, whose left leg had been amputated but whose “phantom” limb caused her agony. Melzack’s pain questionnaire was devised to determine a patient’s perceptions of the intensity of pain, and is now used at the pain centre as well as at hospitals worldwide. Leaving Oregon, Melzack travelled to Europe for two years of research and was then invited to the Massachusetts Institute of Technology, where he met physiologist Patrick Wall. Together they developed a new theory of pain that overturned a 300-year-old understanding of how pain works.
“The Gate Control Theory,” which they published in 1965, describes how nerve gates at each level of the spine’s vertebrae either let pain pass through or damp it down. A person’s thoughts, expectations, outside stimuli such as rubbing a sore spot and even cultural conditioning, they suggested, can reduce the pain signal.
Back in Montreal, Melzack corralled experts from different disciplines—anesthesiology, psychology, neurosurgery and nursing—and cofounded the pain centre, basing its treatments on a multidisciplinary approach with specialists collaborating on a variety of aids and innovative treatments. All shared the common belief that the pain anyone feels is real.
For Catherine Berardinucci, 44, of St. Eustache, Que., the pain began after an accident on a water slide. As she readied her inner tube to head down the slide, a man behind her gave it an impatient shove. To her horror, she heard loud cracking noises from her neck as she landed, spinefirst, at the bottom of the chute. Rushed to hospital, she was diagnosed with severe whiplash.
Berardinucci was sent home in a neck brace. After two weeks the only reminder of the incident was tingling fingertips. Then, three years later, unbearable pain suddenly gripped both her arms. Tenosynovitis was diagnosed. Yet the more she read, the more certain Berardinucci was that she didn’t have the condition.
After months of pain and little progress, she was finally given a magnetic resonance imaging test.
It revealed permanent spinal-cord damage as a result of the accident. She learned that surgery to improve her range of movements could leave her a quadriplegic, but she decided to take the risk. Depressed, taking morphine and antidepressants, she didn’t want to go anywhere, do anything.
While she awaited surgery, her family doctor referred her to the MUHC Pain Centre, where she described the accident and her hitherto unsuccessful treatments. The centre decided it could help. Berardinucci was given nutritional information and relaxation techniques, and at group therapy she learned strategies to help manage her pain by getting out of bed and doing one activity—however small —each day. Doctors tried various medications, seeking the right fit. At every step, she was encouraged by the nurturing atmosphere that permeates the centre.
BY ALISON RAMSEY