HOLLI W. HAYNIE

Dr. Kit Mays and Dr. Moacir Schnapp consult over a patient in the O.R.

By the time most patients reach the Mays and Schnapp Pain Clinic and Rehabilitation Center, they have already seen multiple specialists and undergone numerous treatments. It’s unbearable enough to suffer from pain, but becoming discouraged after getting passed around for extensive exploration, all of which fails to provide relief, is the most debilitating. That’s when physical pain can seep into the emotional and psychological realms, becoming a much more complex condition to treat. As the oldest and only accredited comprehensive pain center in the Mid-South, the Mays and Schnapp multi-disciplinary team offers patients a light at the end of the tunnel, a holistic approach to treatment and rehabilitation.

“We’re not really a pain clinic, we’re a pain relief clinic,” said Dr. Kit Mays, anesthesiologist, “and it’s such a delightful thing to relieve pain.”

Chronic pain is a pervasive medical condition that affects one in five Americans, with chronic back pain taking first place. According to the International Association for the Study of Pain (IASP) chronic pain disables more people than cancer or heart disease and costs the American people more than both combined. Pain costs an estimated $100 billion a year in medical costs, lost working days, and workers compensation. As technology advances and the population grays, the complexity of aches and pains continue to grow. Cancer patients, while having more treatment options, also have more pain.

Mays and Schnapp work to educate physicians and the public about the nature of pain, expelling the myth that just because something is healed or the surgery is done properly, it will stop hurting. While surgeons have great technical expertise at removing pathologic problems, explained Mays, there isn’t a way “to restore normal function, normal physiology, which is really what we specialize in.”

Mays and his partner, neurologist Dr. Moacir Schnapp, are pioneers in pain management, spanning a 28-year relationship dedicated to education and the development of cutting-edge rehab technologies. They treat pain from cancer, ruptured discs, shingles, spinal stenosis, arthritis, nerve pain and fibromyalgia. In fact, Mays and Schnapp have developed and patented rehabilitation devices to treat reflex sympathetic dystrophy (RSD), which can follow severe nerve damage.

Nerve pain is one of the most vicious types of pains anyone can have, Schnapp said, which makes it difficult to treat. For years, physicians had the mistaken assumption that clipping a nerve would eliminate pain. However, a large population of patients comes to the clinic with phantom pain.

“The nervous system is very complex and the same way that you learn to ride a bicycle, you can actually learn to hurt,” explained Schnapp, for which they treat with a combination of medication, nerve blocks and rehabilitation devices.

All under one roof, the Mays and Schnapp clinic houses an advanced ambulatory surgery center, physical therapy department, psychological support and physicians’ private practice. The clinic was also the first comprehensive center in North America to receive accreditation for the treatment of severe chronic pain and the only one in the Mid-South with CARF (Commission on Accreditation Rehabilitation Facilities) accreditation in all areas of adult outpatient rehabilitation.

Staying on the cutting-edge is important to Mays and Schnapp, who have acquired some of the latest bio-imaging technologies such as the VeinViewer by Luminetx™, recently featured in Memphis Medical News. It’s a device which uses a combination of near-infrared light and patented technologies to image vasculature and project their location onto the surface of patients’ skin, assisting with procedures such as PICC line insertions and treatment for varicose veins. The clinic is the first pain center in the world to integrate the technology into patient care.

Schnapp is quick to maintain, however, that there is no substitute for listening to a patient and offering a kind touch and reassuring words. These are the single most important things a doctor can give someone with chronic pain.

“We’ll probably never be able to reproduce or mechanize the soothing effect of real human touch; the role of a rehab therapist goes far beyond what gadgets can do,” he said.

But devices are essential to rehabilitation and as they advance, so can the level of care. Devices have been around for years that slowly and rhythmically flex and extend a patient’s knee, Schnapp said, but they’re limited in that they lack the flexibility to learn and adjust to an individual’s specific needs such as pain, the amount of joint and muscle stiffness, and the rate of improvement.

“Consider an alternative device that not only moves the knee but can also sense the person’s changing pattern of breathing, pupillary dilation and sweating, all indicators of stress and pain,” explained Schnapp.

Devices with that kind of capability are in the field of robotics. Robotic devices, Schnapp said, can learn from a patient’s behavior, giving a patient the choice of how much to hurt and how much to push. This would immediately increase compliance.

“The more control we give the patients over their own rehab, the better the results,” he said.

Over the years, Schnapp and Mays have developed and tested rehabilitation devices specifically designed for patients who suffer from severe pain, but they have been limited by the available technology. They are hoping the robotics field will close the gap. Their collaboration with the Shadow Robot Company of London promises to develop newer models of rehab devices for patients who suffer from neuropathic pain.

“The expanding field of robotics, with their exquisite sensors, micro motors, and custom made software has opened a totally new field, so far underutilized,” said Schnapp. “The cross pollination of thoughts between our physicians and Shadow Robot’s engineers has so far led to many ideas and a few great concepts, which we are developing at the present time.”

Utilizing a true team approach to care, as soon as patients walk in the door at the Mays and Schnapp clinic, they are being observed and analyzed by experienced people on multiple levels. Patients fill out questionnaires, are examined by a therapist, talk with a psychologist and are interviewed by the nurses. Even the way they interact with family is evaluated. By the time the doctor comes in, joint opinions are being formulated, all of which lead to a comprehensive diagnosis. It’s the coalescing of different specialties, different people with different perspectives that make the comprehensive pain center successful.

“We realize none of us can do everything,” said Mays, “but all of us, together, can do almost anything.”



August 2007