DOCTOR IN PROFILE
Speaking of Pain
A chronic pain consultant marries meditation with medication to improve the lives of her patients
By Patricia Nicholson
Chronic pain consultant Dr. Jackie Gardner-Nix combines meditation with medication to help patients alleviate some of their symptoms and cope with their conditions.
About 40% of Dr. Gardner-Nix’s patients suffer from lower back pain, while 15% have continual headaches and migraines. Smaller numbers have conditions such as fibromyalgia, arthritis and multiple sclerosis. The problems stem from accidents, injuries and chronic disease.
“These people tend to be really severe cases who are in continuous pain, and who have often been in pain for anywhere from two to 20 years,” says Dr. Gardner-Nix, who splits her time between the anesthesia departments at Toronto’s St. Michael’s Hospital and Sunnybrook and Women’s College Health Sciences Centre.
Despite working with the strongest pain drugs available, helping her patients remained a challenge. “I still wasn’t doing very well in reducing their pain scores and reducing their disability,” she says. “There was more to it than just using medication.”
Dr. Gardner-Nix explains that pain is received from the affected area by the thalamus, but its intrusiveness is influenced by higher centres of the brain. She had noted that mindset and emotional state could influence pain, and that she could sometimes talk agitated patients down from high pain levels just by speaking calmly to them.
“We now know it is most likely that there is such a thing as a pain-prone personality,” Dr. Gardner-Nix says. She estimates 80% to 90% of her patients have psychologically traumatic backgrounds. Many also face huge struggles with insurance, lawyers and long-term disability.
About three years ago, Dr. Gardner-Nix investigated meditation to help manage her own stress. She took a seven-day course by Dr. Jon Kabat-Zinn (PhD) of the University of Massachusetts medical school, on mindfulness-based stress reduction (MBSR).
The course was intense, but Dr. Gardner-Nix left with the resolve to meditate daily.
“The best way I can describe meditation is, instead of falling asleep, falling awake,” she says. “And being right here, right now when you meditate. It instills calmness and happiness and, because when you do that you have a less cluttered mind, you become much more productive.”
Dr. Gardner-Nix soon realized many of her patients might benefit from MBSR. However, they were unable to manage the physical requirements of classes because of their pain conditions.
“It was just too difficult for them to be accommodated in those courses, so I decided to construct my own,” she says. “I called it mindfulness-based chronic pain management classes.”
The specialized classes had shorter meditation periods, and modified the walking and yoga meditations to suit the participants’ needs. They also included discussion and mental exercises geared toward relieving pain, rather than general stress.
Dr. Gardner-Nix launched the course two years ago, and now teaches two classes a week at Sunnybrook and one at St. Michael’s, plus a drop-in maintenance class on Saturday mornings. Ontario patients outside Toronto can join the Sunnybrook classes via teleconferencing. All of the courses are oversubscribed.
“It tends to lead people toward feeling happier, more accepting of their status,” Dr. Gardner-Nix says. “They respond to the medications better in many instances, and in some cases they’ve been able to reduce their medication needs and increase their activity.”
Some of Dr. Gardner-Nix’s patients have had remarkable success. One patient with severe head pain had been using very high doses of opioids plus an anticonvulsant and some oxygen, as well as a walker. She took the meditation course twice via teleconferencing. During the second round, she began using meditation for exacerbations of pain, instead of her short-action breakthrough pain medication.
“Over a period of two months she was able to reduce her medication to one-tenth of its original dosage,” Dr. Gardner-Nix says. “She came off the anticonvulsants, she discontinued the oxygen, she changed from a walker to a cane and she’s going back to work.”
Her patients’ improvements have made a difference for Dr. Gardner-Nix, too. Since her patients began taking her meditation courses, the number of patient voice mail messages she receives has dropped by 75%, and she has been able to discharge 100 of her 250 pain patients back to their family physicians.
New patients referred to her are required to take the course, in addition to individual consultation. But she gets referrals just for the courses, as well.
“My conventional medical role is 50%, and now the rest of it is running these classes,” she says.
With the help of some friends with broadcasting experience, Dr. Gardner-Nix recorded some of the course meditations on a CD for her patients to use outside of class. Its success inspired her to create “Pain Speaking,” a four-CD boxed set that provides a meditation package as well as information about pain.
The first CD educates patients, their families and health-care providers about what pain is, what pain clinics can offer and what medications are available. The second opens with a discussion on meditation and cognitive behavioural therapy. The other CDs contain the same meditations offered in Dr. Gardner-Nix’s classes, including a body scan, visualizations, walking meditation and yoga meditation. The set is available through the pain clinics and gift shops at St. Michael’s and Sunnybrook hospitals, and online at www.painspeaking.com.
Some of her patients say as soon as they hear her voice on the CDs, they begin to feel better.
“I joke with them that my voice can get your pain score down and render you less disabled. I don’t constipate people, and I don’t nauseate people. The side-effects profile is very, very good,” she laughs.
“Compliance might be an issue, because committing to 20 minutes every day rather than popping a pill in your mouth might be a little less likely.” But she adds those who have done it have invariably found it beneficial.
Dr. Gardner-Nix also offers a course at Sunnybrook specifically for health-care professionals.
“The physicians in my current group include specialists from the hospital and family physicians, and they don’t think it’s hocus pocus. They feel it’s really cutting-edge,” she says. “I think physicians will come to realize that this is very important.”
Patricia Nicholson is a Medical Post staff writer.