Pain is one of the most common reasons people seek healthcare, and chronic lower back pain is a leading cause of disability, affecting an estimated 560 million worldwide. Recent research has shown that pain is both physical and emotional and can lead to diminished quality of life, social isolation, depression, and anxiety.
Danielle L. Sarno, MD, director of Interventional Pain Management in the Department of Neurosurgery at Brigham and Women’s Hospital, has made it her mission to reduce chronic pain among patient populations by increasing access to interdisciplinary pain care and linking patients to pain management resources. She has authored numerous spine and pain care publications and has presented her research nationally and internationally.
“We see a large amount of stigma attached to chronic pain,” Dr. Sarno says. “As a pain medicine specialist and physiatrist, I can help reduce the stigma by providing pain education for the community and supporting patients and their families. I act as a ‘home base’ to help patients navigate available resources in today’s complex medical system.”
A Multipronged Approach to Treating Chronic Lower Back Pain
According to Dr. Sarno, the most effective way to treat chronic lower back pain involves a combination of physical, pharmacological, psychological, and integrative therapies—an approach that is central to the way the Brigham’s multidisciplinary Spine Center works.
“The brain and body are connected, so as pain management specialists, we must address the medical, emotional, cognitive, and environmental causes of pain,” she says. “The emerging field of pain psychology therapies, including pain reprocessing therapy [PRT], has shown that helping patients change their beliefs about their chronic back pain can lead to sustained pain relief.”
Dr. Sarno pointed to the fear of pain as one such belief that can be changed. “Fear can lead people to avoid movement, which contributes to the cycle of muscle weakening and further pain.”
Functional Integrative Restoration for Chronic Pain
To help people who suffer from chronic pain but have not found long-term solutions from conventional pain care, Jennifer Kurz, MD, of Mass General Brigham’s Physical Medicine and Rehabilitation Department and Dr. Sarno established the Functional INtEgrative Restoration (FINER) program. FINER’s mission is to decrease pain interference, improve function and quality of life, provide meaningful connections, and ultimately limit excessive healthcare utilization, all while addressing the root causes of chronic pain.
This novel, not-for-profit, eight-week program consists of free weekly virtual educational talks and workshops from experts in chronic pain and integrative medicine. The program also includes smaller interactive group sessions co-hosted by Drs. Kurz and Sarno. The sessions engage participants more fully in the practice of transforming their pain experience.
FINER introduces participants to pain neuroscience, evidence-based pain psychology strategies (including cognitive behavioral therapy, acceptance and commitment therapy, mindfulness-based stress reduction, Empowered ReliefTM, and PRT), and lifestyle medicine strategies. Sessions are conducted in a supportive, judgment-free manner where participants can feel comfortable sharing intimate details about their journey with pain.
“The program empowers participants to improve lifestyle factors, reframe negative thoughts around pain, and engage in mindfulness practices, which can help reduce the suffering associated with pain,” Dr. Sarno says.
In the words of one program participant, “The support and empowerment that I’ve been offered in the FINER program helped me realize that I have more power over my pain than I ever realized. I’ve been able to increase my activities using positive thinking and being realistic with my goals.”
Revealing Significantly Improved Mean Changes
As research director for FINER, Dr. Sarno notes that preliminary data presented at the World Institute of Pain 11th World Congress revealed statistically significant improved mean changes for patient-reported pain interference, feelings of helplessness, and kinesiophobia. Along with positive qualitative results, such as validation of the pain experience, changed perception of pain, support from a chronic pain community, improved knowledge of pain conditions, and empowerment to implement lifestyle changes, the program may be helpful for people with chronic pain.
Encouraged by the program’s results, Dr. Sarno continues to study and refine the approach in collaboration with Daniel Barron, MD, PhD, and his Pain Intervention and Digital Research Program as well as Zacharia Isaac, MD. These efforts include digital phenotyping and more robust outcome measures to characterize changes in participants’ functional status.
Equitable Pain Management for All
In keeping with Dr. Sarno’s professional focus on health equity (she is chair of the Diversity, Equity & Inclusion Committee in the Department of Neurosurgery, leads a mentorship program for students who are underrepresented in medicine, and serves in a patient navigation program to reduce inequity in neurosurgical specialty care), the FINER program is open to everyone, not just patients at the Brigham.
“We established FINER during the COVID-19 pandemic as a virtual program to reduce barriers to care,” Dr. Sarno says. “For many people with chronic pain, having to travel to and pay for an in-person pain management appointment can be challenging. We are hoping to embed this program into our health care system.”
“It is gratifying to know that the Brigham fosters collaborative approaches to improving access to resources and reducing inequities in specialty care through programs like this,” she concludes.