Cover Story

By the time patients reach psychologist Mark B. Weisberg's office, they've often been treated by three to six other clinics. What Weisberg and his colleagues at the Minnesota Head and Neck Pain Clinic offer that other clinics don't is an understanding of the mind-body connection.

"We have no question that pain is both physical and psychological in every patient," says Weisberg, a co-owner of the multidisciplinary practice, which includes two other psychologists, two physicians, five dentists specializing in craniofacial pain, a neurologist and a physical therapist.

The team treats a variety of conditions, including migraine, cluster and tension headaches, temporomandibular disorders (TMD) and neck and shoulder pain, fibromyalgia, tinnitus and chronic fatigue syndrome.

During a typical intervention--say, with a patient who has headaches and TMD pain--Weisberg takes a physical history, asking patients to discuss their symptoms in great detail: the location, frequency and intensity of the pain; what medications they have taken; and why they think previous treatments haven't worked. He then completes a family and vocational history to determine if relationship or work factors may be contributing to the patient's pain.

He also tells patients why they are seeing a psychologist. "Some patients think that because they are seeing a psychologist, we've concluded that the pain must all be in their heads." He confutes such notions by educating patients about the field of psychoneuroimmunology, with examples of how stress can adversely affect the endocrine, immune and nervous systems.

When it comes to treatment, Weisberg takes a three-tiered approach, working with other team members. His first level of intervention is to teach patients cognitive techniques to help them prevent pain. In the case of headaches and TMD, this may include identifying and preventing a patient's muscle habits such as jaw thrusting and teeth clenching. He may also help them identify and manage stresses that cause them to tense up or have other physical reactions that lead to repetitive-motion injury. Relaxation training and habit reversal is important here.

For patients with more complex pain, Weisberg adds the next layer of treatment: brief, focused intervention for specific stressors at work or home that exacerbate pain symptoms.

The third layer of treatment is for those patients with the most complex and chronic symptoms. In these cases, Weisberg determines whether a patient's emotions may be setting off autonomic nervous system responses that aggravate physical symptoms. He tackles those issues through such strategies as hypnosis and brief, focused psychotherapy.

The clinic's integrative approach extends to how medications are used. "Our orientation is to use medications with the least side effects and that are least disruptive to a person's daily functioning," he explains. "Pain medications can be effective in breaking the pain cycle, but we want to help the patient learn many supplemental ways of dealing with their pain."

He works closely with the clinic's physicians to recommend psychotropics as needed and sometimes to carefully taper patients off painkillers they're prescribed before coming to the clinic. "Eventually, many of our patients reduce the amount of medication they need as their self-care efficacy increases," Weisberg says.

Insurance companies regularly pay for Weisberg's services, recognizing that the clinic's approach to pain treatment reduces the need for a patient to see a variety of specialists and undergo expensive diagnostic tests.

"We've established special relationships with the insurance companies," says Weisberg. "They've come to realize that an integrated approach ultimately saves them money."

--S. MARTIN