Whether chronic or growing, JBER clinic solves ... The Puzzle of Pain

by Airman 1st Class Kyle Johnson
JBER Public Affairs

3/19/2015 - JOINT BASE ELMENDORF-RICHARDSON, Alaska -- It was supposed to be a routine steroid injection, but before she could depress the plunger, the electrocardiogram (or EKG) flatlined, telling Air Force Maj. Nichelle Renk her patient no longer had a heartbeat.

Unable to flip the patient over - standard procedure to mitigate an asystolic vasovagal reaction - due to the cramped room, Renk and her team began moving equipment, Tetris-style, to shoehorn a gurney into the tiny space.

Before they did so, the patient shuddered and came to.

It was a fairly common and potentially lethal complication; a puzzle demanding a solution.

"We are always looking for that and are very good at treating it if something does happen," said Renk, a 673d Medical Group Pain Management Clinic element leader and interventional pain management specialist.

The team's ability to work in the cramped conditions was a testament to the quality of service the pain clinic offers, but the protocol was just a bandage - the procedural room needed treatment.

So the pain clinic did what the pain clinic does. They solved the problem.

To increase the clinic's capacity and efficiency, they requested renovation, and enhanced both operating environment and staff.

They added two new operating rooms for procedures, one of which allows medical staff to easily and quickly handle emergency situations. This ensures maximum patient safety at all times - and increases the clinic's operating space by a badly needed 25 percent.

Additionally, a new case manager, pain psychologist, and two licensed vocational nurses joined to the staff, beefing up the total to 14 members.

Renk said the goal is to have a staff of 22, but as they started with fewer than a half-dozen, she is happy with the progress they have made thus far.

Whether the problem is a cramped procedure room or chronic back pain, the JBER pain clinic pieces together solutions to new problems every day, and sees more patients than any other pain clinic in the Air Force.

In order to be seen at the pain clinic, a patient must have been experiencing pain for more than six months with little to no relief, Lewis said.
"When [patients] are here, they're happy, they're smiling, they're hopeful," Renk said. "That's the key thing."

"It was so painful to brush my teeth and put on my combat boots every morning," said one patient in an Interactive Customer Evaluation comment. "I am active duty, and 'down time' puts my unit and the mission on hold. Dr. Renk took care of me so I can take care of the mission. Words are not enough to explain how much relief I have right now. Thank you all so much."

Because of positive feedback the pain clinic is receiving through ICE, the clinic and its doctors have nabbed several awards since January.

"Sometimes we can only improve the pain for a period of time," Renk said. "But our hope is to improve the daily experience of pain and improve function."

"Chronic pain is very different from acute pain," Renk said. "With acute pain, there is something anatomically wrong, but with chronic pain, there's actually a transformation to a disease of the nervous system. Our job is to try to stop that process as best we can."

Renk said by offering a multidisciplinary approach to pain management, the clinic has been able to treat patients very successfully with very little medication.

"We only have 22 percent of our patients on any kind of narcotics," Renk said. "The average [for a pain clinic] is 95 percent."

"Medication treats symptoms; we treat the problem." said Air Force Master Sgt. William Lewis, flight chief for Anesthesia Services with the 673d Surgical Support Squadron.

However, puzzling out each patient's individual problem isn't a static process.

The staff members strive to treat every patient they see as an individual.

Underneath the medical gown is not just a patient with a problem, but a person in pain.

"We listen to your symptoms, perform an examination to identify exactly what the issue is, and tailor a treatment plan specifically for that problem," Lewis said. "That's what the pain clinic does."

Every person's problem is unique, and the pain clinic strives to offer a unique solution for each individual - not by stamping a prescription and sending them on their way.

"There's no right way to treat patients. Everyone's different," Lewis said. "That's why we have a huge toolbox of options to offer patients."

By constantly looking for new tools to put in that box of treatment plans, both inside and outside the hospital room, the pain clinic strives to give patients their best hope for recovery.

"I think they sometimes come to us hopeless, and through encouragement, giving them options and being positive, I think we're giving them hope."