Chronic, endless pain overwhelmed Carey Robinson.
It gripped his mind and paralyzed his body. It prevented him from doing what he loves. It threatened to change his life.
“Had I not sought additional help and learned there were other ways to manage my pain besides opioids, I’d still be on them and in a rut,” said Carey Robinson. “I was so fortunate to have care providers who treated me as a human being, not a paycheck or a reason to come to work. We became a team, and together, we’ve worked really hard to get to this point.”
Robinson, 61, lives in Kremmling, Colorado. He’s been in the restaurant and food industry since he was 15.
“It’s a creative outlet to some extent,” he said. “I’m a musician, too, which gives energy. I can create in both areas.”
But being creative while dealing with pain can be difficult. A car accident in the 1980s left pain that lingered for 30 years, and a more recent fall compounded that pain.
“I fell down some steel and cement stairs until boom, there I was on my tailbone,” said Robinson. “I fractured my coccyx (tailbone) and have been in living with the pain ever since. It hurts to sit and lay down.”
Having taken opioids to manage his pain from the car accident for some time, he figured that’s what he had to do to deal with the pain.
Frustrated, however, with the care provider he’d been seeing for some time, Robinson decided to make a change and made an appointment with Dr. Brian Siegel at UCHealth Pain Management Clinic in Steamboat Springs.
“It wasn’t that far from Kremmling, and I got in relatively quickly,” said Robinson. “They accepted the medications I was on, so it was a good transition.”
During that first appointment with Siegel, Robinson shared his medical and medication history. At that time, Robinson was taking two long-acting pain medications, four short-acting pain medications, ibuprofen and a muscle-relaxer.
“When we first see a patient, we ask about their current pain scores on a scale of 1-10, as well as their level of function,” said Siegel. “With some patients, even over the course of time, their pain scores don’t go down even with increased medication and their functionality doesn’t improve. That’s when we know the medication isn’t doing an effective job of managing the pain. This certainly seemed to be the case with Carey.”
Siegel said chronic and acute pain, both of which Robinson was dealing with, are different beasts.
“One reason people have chronic pain is because of unresolved trauma pain,” he said. “Oftentimes, there is something traumatic in the patient’s past – be it a car accident, a physical injury or even an emotional situation – that is too severe to overcome. When we’re able to zero in on what that traumatic event is that is causing the patient pain, we can begin to look at whether medication is an effective way to manage the pain. We’ve learned over the years that opioids, alone, really shouldn’t be used with chronic pain, because they’re not getting to the root of the pain.”
Siegel coordinated Robinson’s next appointments and follow-up care with Stace Toye, a certified physician assistant, and Amy Goodwin, a licensed professional counselor and behavioral health counselor at UCHealth Pain Management Clinic.
“The positive energy I experienced with Stace and Amy was great,” said Robinson. “Everyone in that office has the same upbeat attitude to a certain degree. It spreads like wildfire, in a positive way.”
Robinson quickly developed a level of trust and confidence in Toye and Goodwin over the course of multiple appointments.
“Amy made me feel like someone cared about what I was dealing with,” said Robinson. “I became comfortable with her quickly and felt secure enough to open up to her about my family of origin and my past. It got to the point that I could say anything to her and it wouldn’t be taken the wrong way. And I got a big hug every time we met – that was a big deal for me.”
Goodwin said Robinson was very curious and interested in exploring the different sources of pain and stress in his life.
“He was vulnerable with me in acknowledging his stressors and was willing to process through them with me,” she said. “The better we can manage stress, the better a patient can become at managing pain.”
According to Goodwin, there are two pathways for pain messaging in the body. One pathway goes from the injured tissue to the brain, where it gets interpreted for intensity. The other pathway communicates how bad the injury is and sends signaling back down to the tissue. The intensity of pain is influenced by regions in the brain that regulate for “volume control.” These regions can increase or decrease the intensity and amount of pain experienced. The volume control valve is influenced by both physical and emotional pain messages.
“We try to work on both pathways,” she said. “The tissue injury needs to be stabilized and addressed. Additionally, we also need to turn down the brain’s response to the injury. Your body’s distress signaling is the same no matter the source of pain, tissue injury or emotional distress. The better someone becomes at managing stress and distress, the better the person is able to manage their own pain.”
Over the course of appointments, Goodwin and Robinson’s conversations changed from talking about pain being a symptom of an injury to more awareness of the tissue injuries and how they impact the patient’s life. Robinson began to understand his pain in a different way.
“Carey was a complex pain patient, with multifaceted injury sites in his tailbone, back and wrist,” said Goodwin. “In talking about his current regimen, he began to recognize that opioids are dangerous and can affect and exacerbate deterioration in other areas of his life. The pain was impacting his ability to work and be a musician.”
“He consistently reported to me at our visits the frustration of inconsistent and ineffective pain relief with his medications, said Toye.
In meeting with Toye, someone who Robinson says he hit it off with “like peanut butter and jelly,” alternative treatment modalities began to be discussed. Initially, Robinson wasn’t interested.
“I wasn’t sure massage or acupuncture or dry needling would really do anything for me,” he said. “But they actually did. It wasn’t more drugs and there was no invasiveness to the treatment.”
Robinson responded positively to the treatments. In 2018, he made the decision to work to get off his pain medications, albeit with a little apprehension and nerves.
“Carey was at the point where he was coming in and saying, ‘What can I do to help myself?” said Goodwin. “Usually the conversation is, ‘What can you, medical provider, do for me?’ This was a very empowering place for Carey to get to, as outcomes for that mindset are pretty darn hopeful.”
“Once I began to understand that I didn’t need medicine to counter the pain, that was a big breakthrough,” said Robinson. “And these things worked.”
Trust in oneself
Because Robinson was responding positively, the team began to taper his medication, particularly the opioids.
“Most people have good intentions with wanting to taper down their medications as they realize what they’re doing isn’t the best thing for them. Most say, ‘Sure, that’d be great,’ but actually doing it can be difficult,” said Siegel. “Carey had to trust that he made the right decision to be opioid-free, and he found that trust in himself.”
“There were times where he struggled during the tapering process, but he had a team supporting and encouraging him,” said Toye. “Remarkably during this, he had surgery for an orthopedic injury, but navigated his perioperative, seven-day course of medication and continued to decrease his opioid use.”
“I knew I needed the medication after the surgery because there was tissue pain, but after that, I knew I didn’t want opioids anymore,” Robinson said. “It felt phenomenal to come to that realization because it was me saying it. Me. I made the decision.”
Make the appointment
Today, Robinson is back to work in Summit County, working as a seafood manager in a local grocery store. He takes ibuprofen and a muscle relaxer as needed and wears a supportive elastic band around his lower back for additional support. He is no longer taking opioids.
“I’d been taking them for years, but they weren’t working any more. What was the point to continue them? I knew there were other ways to work through my pain,” said Robinson. “Dr. Siegel, Stace and Amy showed me there was another way to manage it. They’re the ‘House of Healing,’ where if one allows, they will share their love through professionalism and kindness with you, the patient.”
“People are diverse and because of that, pain affects everyone differently,” said Siegel. “It’s not a cookbook recipe when you’re working with patients experiencing pain. It needs to be more individualized.”
Siegel said a more coordinated, interdisciplinary approach to pain management is an old concept, but more important than ever in present day treatment.
“We have all the people and tools in place for a more comprehensive program – behavioral health, counseling, case management, physical therapy, massage, acupuncture,” he said. “Everyone in our office – from the person who answers the phone to the nurses and practitioners – works to make change possible for our patients. Carey was successful in making a change in how he manages his pain.”
Robinson encourages others to pick up the phone.
“Just make the appointment,” he said. “There are other ways to alleviate pain than opioids.”