The Bay Area Pain & Wellness Center is committed to the comprehensive and integrated treatment of complex pain problems. Our evaluation process involves a consultation with one of our pain specialists as well as a consultation with a psychologist and physical therapist. Our goal is to treat the whole person. Our programs consist of education, rehabilitation, behavioral management and medication management.

Your treatment will be under the leadership and supervision of your pain specialist. He or she will work closely with all of your providers in an interdisciplinary approach.

• Expressive Arts for Health
• Alternative Movement Therapies
• Cognitive Behavioral Therapy
• Family Education
• Functional Restoration Program
• Expressive Arts for Health
• Healthy Living Pathway
• Medication Optimization
• Mindfulness-Based Stress Reduction
• Nutrition Education
• Physical Therapy
• Vocational Counseling Services

We believe that traditional approaches to pain management were based on outdated models of treatment and that effective management of pain was rarely, if ever achieved by taking these approaches. At the Bay Area Pain & Wellness Center, we hope to change the practice of pain medicine by incorporating the latest care techniques in a sophisticated manner which addresses the entire person, not just the symptoms themselves.

What should I expect? Because we are attempting to create a change in the way that pain management is practiced, we would like to provide you with some basic concepts about our process that can help you understand our multidisciplinary approach to an often-complex pain problem.

Recent Injuries or Pain First, if you have recently injured yourself or developed pain (within the last six months), you are likely experiencing acute pain. Our approach to acute pain problems includes a full evaluation of the likely causes of your pain. This evaluation will include a review of available records and/or test results from previous doctor visits. This review process will outline which tests or treatments have already been done, other doctors' opinions and recommendations, and your response to their treatments. We will also have you complete a questionnaire before your visit.

Our evaluation will include a physical examination. At the end of the visit, we will give you our best diagnosis. Occasionally, we may reserve judgment until you receive additional testing to help us make a more informed analysis of your pain problem. Once we have established what we believe to be your diagnosis, we will then provide you with information about our philosophy of care for this problem and information about what to expect in terms of treatment. If we feel that we have a good idea of the cause of your pain, we may also recommend specific medical treatments at the end of your first visit. These treatments may include prescriptions for medications, therapeutic or diagnostic injections, and/or physical therapy. Once we have established what we believe to be your diagnosis, we will then provide you with information about our philosophy of care for this problem and information about what to expect in terms of treatment.

Treating a person as a whole also means looking out for your emotional well being. It is our experience that pain often creates huge emotional stressors for people since it disrupts their lives in terms of the normal activities of living, including family, job and financial responsibilities. We believe that these emotional consequences can intensify the experience of pain, and we also know that having support in managing the emotional and social consequences of pain can help an acute problem heal faster and more completely.

Because we attempt to treat the whole person, and not just the affected body parts, we may send you to meet with our medical psychologist as a part of the initial evaluation. By doing this, we are not implying in any way that your pain is not real or is caused by mental factors. If you have had pain for quite a while, we will still make every effort to determine the underlying causes of the pain and to remedy these to the best of our ability. Often after significant time has passed we cannot offer a quick "fix" to the problem. This may be due to several reasons.

First, some types of pain are caused by several underlying problems rather than just one cause. In these cases, a simple fix may not be helpful, and it might lead to a worsening of your pain problem.

Secondly, when pain has lasted beyond the expected and normal healing phase (usually three to six months), the body changes in ways that makes the cause of your pain more complex. In some situations, your entire nervous system becomes involved in the experience of pain, not just the area where you feel the pain. In other situations, multiple systems of the body become involved, including muscles, nerves, bones, ligaments, tendons and discs. A pain problem that is the result of multiple causes is obviously more difficult to manage from a medical perspective and often requires a shift in the way the problem is treated.

What if My Pain is Chronic? People with chronic pain problems (pain that has lasted for more than six months and is likely to be ongoing) must be managed in a very different way than people who have just been injured or have just experienced the first symptoms of pain. If a "cure" is no longer possible, we feel the best approach is to work with patients to help them learn to manage their pain more effectively. In our experience, the effective management of pain requires a very well designed plan that includes many different levels of intervention. We believe that the best way to understand our approach is to compare pain to other chronic illnesses like diabetes or high blood pressure. Both of these other conditions must be managed over time, primarily by the patient. Either of these conditions can be life-threatening if they are not properly managed. The goal of treatment is to educate patients about how to change their lifestyles so that the conditions are stabilized and do not create significant disruptions in their lives. We want to help you develop your own tools for managing pain so that you can both reduce your usual pain and avoid excruciating flare-ups.

When the physician sees you for your first visit, he or she will attempt to understand the causes of your chronic pain and whether or not your previous treatments were appropriate and sufficient. If your doctor does not feel that he has enough information,

you may be asked to complete more testing and assessment. Because of the complex nature of most chronic pain problems and the often dramatic effect that it has had on your life, your care may include participation in a multidisciplinary treatment plan. This will include education (on the causes of your pain and effective ways to manage your specific condition), psychological services (to address the emotional consequences of your pain and the effect on family), and physical rehabilitation (to help you get stronger and stay fit).

At the end of your medical evaluation visit(s), your doctor may refer you to one of our psychologists for an assessment of behavioral or emotional factors that are likely caused by your pain. After your visit, your physician and psychologist will discuss your case and develop the most effective treatment plan for your particular pain problem. They may also give you educational materials to take home and read on your own about things you can do to manage your pain in addition to trying the treatments recommended by your doctor. Our years of experience have taught us that the best pain management occurs when both the doctors and the patients work together to manage the disease of chronic pain.

A message from Peter Abaci, MD and John Massey, MD, the co-founders of the Bay Area Pain & Wellness Center (BAPWC).

Dr. Massey decided to become a chronic pain management physician when he was teaching and practicing at Stanford University. He saw the problem that was associated with chronic pain in the community around him in the patients he was seeing and he wanted to help..

Dr. Abaci decided to practice pain management as an anesthesia resident when he was given the challenge of trying to wake up each of his patients from anesthesia without any pain. As he pursued that as a career, and started working with not acute pain, but chronic pain and came to realize what a very complex process that was.

Pain Management in America is broken. Physicians and other clinicians are taught mainly to use medications and injections to find the pain generator and try to stomp out pain. The unfortunate thing about that model is it doesn't work. It leaves patients helpless and dependent on a system that really doesn't serve them well.

The typical person that comes to BAPWC has had some type of injury to their spine or extremedy. Often times, nerves have been damaged. Often times, people are on a lot of medications or have had a lot of injections or surgeries before even getting here. When Dr. Abaci or Massey meet some body for the first time they have a physical therapist go over a very thorough evaluation identifying where their structural problems are, identifying what we can do, to help them exercise again.

The purpose of our gym is to teach patients how to move again, how to restore their bodies and how to regain function back in their lives. So when a person is in pain, they are often afraid to move because it hurts and the purpose of our gym is to take them through a process so they can develop a comprehensive exercise program that they can use long term. People come in here in walkers and canes and they leave without them. We use a lot of yoga, chi gong and tai chi; teaching you that you can exercise again.

Continue to Founders 2

Art therapy for most people sounds really strange, but it's magical. It's a way of getting in touch with someone's feelings and emotions and expressing them in a medium that's different than talking about them. It's very common to see some body with a horrible pain management problem that hasn't been able to tell someone what's going on with their body and yet all this information comes out and you can actually look at it together. Go over the art together and start problem solving how to fix it.

Occupational Therapy is very important because we all need to function on a day-to-day basis. We need to be able to take care of ourselves. We want to be able to put our shoes on, comb our hair, and we want to look good. In order to do that and once we've been injured in a traumatic way we often need the training to be able to do these simple tasks once again.

The goals of our center are simple: it's to provide this type of care in this type of environment to as many people as possible.

We sincerely believe the way pain management is being practice by in large with medications and injections are wrong. Being anesthesiologists, they practiced that way and know very well what the end point is and there's not hope there. The hope is actually in becoming free of the medical system, free of medications, free of the burdens of your disability and that is what we have at BAPWC.

Functional restoration is an intensive interdisciplinary group process of education, psychotherapy, and physical reconditioning through exercise and functional activities. The process results in reformation of neuromuscular, sensory and cognitive patterns that influence the individual patient's thinking, perception and physical response to pain. An individualized care plan provides each patient with a "tool kit" of methods to manage chronic pain and return to a productive lifestyle. An integrated interdisciplinary treatment model has been shown to be superior to physical therapy and psychotherapy provided separately in terms of functional and emotional gains.

The functional restoration program meets five days a week for group-oriented education and individualized exercise. A typical day involves participation in five one-hour activities including physical conditioning, psycho-educational groups, vocational counseling, medical follow up, and education in nutrition and wellness. There are approximately 200 hours of contact time in an eight-week program. Abbreviated programs are offered, and are structured based on individual needs.

Patient functional progress and program participation is reevaluated weekly at our interdisciplinary team conferences. Case managers and claims adjusters are welcome to attend in person or by teleconference.

For individuals that live too far away to travel daily, we provide coordination with local hotels to offer special package rates and services for our patients.

Since 2001, our program has helped improve the quality of life for our graduates, with many returning to normal activities of living, including both family responsibilities and employment.

* providing each patient with a range of tools that can help them confidently and more effectively manage pain,
* helping return the patient to their highest functional level and to meaningful activities through increased fitness and strength, and
* increasing a patient's sense of emotional well-being and independence, and
* establishing achievable goals within the workplace that enable injured workers to return to productive employment.

Effective Communication

We believe that the successful resolution of a complex case includes full communication between all involved parties including the case manager, adjuster, attorneys and referring physicians. Our team meets regularly to evaluate the progress of each patient, and weekly reports are provided to involved parties. In the event of problems with compliance, lack of progress or early discharge, it is our policy to immediately alert the case manager and/or adjuster.

Integrated Services

Our multidisciplinary team provides integrated care targeted toward specific functional and psychosocial goals for each patient. Formal weekly team meetings and informal daily team interactions help keep a thoughtful structure to the program and allow flexibility for the individual learning process.

After Care

Most graduates complete the program having made substantial and measurable improvements in function, strength and emotional well being. To help support our graduates in maintaining these gains, we have incorporated an after care program that includes bi-monthly participation in a peer-led alumni support group. We also encourage early authorization of independent gym memberships for each patient so that they can seamlessly transition from the Functional Restoration Program to an independent exercise program designed specifically to help maintain their physical gains.

Commitment to Quality

We are committed to maintaining the most positive and effective atmosphere for learning at the Bay Area Pain & Wellness Center. Through our initial multidisciplinary evaluation process, we accept only those patients who appear motivated and able to succeed. In the event that full participation is not optimal, we attempt to identify barriers to full participation and help the patient to overcome these barriers. In the event that this is not achieved, we proceed to early discharge in a non-judgmental manner with full documentation provided to payers along with recommendations for continued medical care.

It is well documented that the longer someone is in poor health, the harder it is to accomplish these goals. Historically, patients were not referred for functional restoration until all other traditional medical care had been exhausted. We were often seen as a “last resort” in the lineage of care provided. For our patients from 2001 through 2006, the average length of disability was three to five years from the date of injury. Many had undergone multiple surgeries and were habituated to medicines that were rarely in their best interest. We developed our original programs to successfully treat this population. Still, it has been our hope that with continued education to patients and payers that we become an integral part of the initial medical care plan. We feel strongly that with EARLY INTERVENTION we can prevent the onset of chronic impairment and avoid unnecessary medical procedures or expenditures.

There currently exists screening tools to identify those patients who might not do as well with traditional medical care. These screening tools can be used at the onset of an injury and the patient so identified can be given more specialized care. Our Early Intervention Program is designed to treat patients within the first year of an injury. The earlier we can become involved, the easier and less costly it is to make real and lasting changes for patients. By combining physical rehabilitation, drug detoxification

and education in healthy alternatives with medications for pain control, patients can gain control of their pain, and return to a meaningful and fulfilling lifestyle.

In healthcare, how often do we say, “I wish I could have prevented that from happening.” Here we have a clear choice and alternative to offer patients who might be better treated outside of the typical doctor’s office. Patients do have an alternative to chronic narcotics, endless prescriptions for physical therapy, or repetitive injections or surgeries. By providing high quality, focused, integrated health care early, we can positively change the outcome for many people. The key is Early Intervention.