THE PAIN SCIENCE CENTER AT PRAIRIE LAKES SPECIALITY CLINIC A New Approach to an Old Problem

therapist Eric Fjeldheim, DPT, one of fewer than 40 fellows in the US to complete the Fellowship in Pain Sciences through Evidence in Motion. Although the Pain Science Center is part of the PLHS rehabilitation department, Fjeldheim says its approach to pain is unlike other therapies.

“People will say ‘I’ve already tried PT and it didn’t work,’” says Fjeldheim. “ Or they’ll say ‘I’ve seen PTs and massage therapists and doctors and chiropractors and none of it helped.’ And it’s frustrating for everyone involved, including medical professionals. But what they have to understand is that this is a much more holistic, multidisciplinary way of looking at pain.”

“It’s very much an individualized care plan,” agrees Dot McAreavey, Director of Rehabilitation Services and Wound Care. “We start with a very thorough evaluation. The pain science comes in when everything checks out and the pain doesn’t make sense from a physiological standpoint. Once we have a better idea what is going on, a big part of our role is guiding patients to the right resources to handle their unique issue.”

BY ALEX STRAUSS

Pain is one of the most common issues driving people to seek medical care.

The CDC estimates that as many as one in four adults suffer from chronic pain. And yet, researchers are still teasing out the complex web of factors that underlie it. Understanding the root causes of pain and developing individualized plans to reduce or eliminate it is the goal of the new Pain Science Center at Prairie Lakes Specialty Clinic in Watertown.

Located within Rehabilitation Services, the new center is the brainchild of pain specialist and physical

The Making of a Pain Scientist

Fjeldheim studied exercise science at the University of Sioux Falls and earned his Doctorate in Physical Therapy from the University of Saint Mary in Leavenworth, Kansas. A native of Watertown, he came back home to practice in 2016.

“As I got into my clinical practice, I found that there was a group of patients whose pain didn’t always make sense from a musculoskeletal standpoint,” says Fjeldheim. “If you have someone who sprains an ankle, the pain is usually isolated to the ankle. But I was seeing people where all their scans would look good and they would still have pain in their ankle or they developed pain in the entire leg.”

And Fjeldheim was not alone. He heard other healthcare providers also express frustration about patients they couldn’t seem to help.

“It’s that 5 to 10 percent of patients with seemingly unexplained pain that kept me up at night,” says Fjeldheim. “There was a gap between what they teach in school and how to really be an awesome therapist. I needed to figure out how to help these people. I needed to think outside the box.”

Fjeldheim completed his Therapeutic Pain Specialist certification in 2018 and went on to complete his 350 hour fellowship program during the pandemic. Although Fjeldheim is the only therapist at PLHS with fellowship training in pain science, McAreavey says all approximately 18 members of the rehabilitation department, including the receptionist, now have some pain training.

“We are all able to speak the same language,” says McAreavey. “That strengthens what Eric is trying to do here because he now has a whole team of people supporting him.”

Three Types of Pain

“Before we really learned more about pain, we believed that we should always be able to find a reason for pain on a scan,” says Fjeldheim.

And they usually can. Tissue-based or nociceptive pain, like that caused by a broken bone, accounts for the majority of pain. When the injury is repaired and the body heals, the pain clears up. Peripheral neuropathic pain, such as with carpal tunnel or sciatica, involves the peripheral nervous system. Fjeldheim says traditional approaches can work with both of these types.

But the pain that stumps so many medical providers and drives people to places like the Pain Science Center is nociplastic pain. The NIH defines nociplastic plain as “pain that arises from altered nociception” despite no clear evidence of injury or disease.

“Essentially, the central nervous system becomes exquisitely sensitive to information coming from our bodies and from the environment for some reason,” says Fjeldheim. These are the patients whose pain inexplicably worsens when the weather is damp or they’re under stress.

Fjeldheim says nociplastic pain requires an entirely different approach from other types of pain. Patients may be asked about their sleep, their stress, their diet and other lifestyle factors as well as their thoughts, attitudes, and beliefs about their body. They may even undergo sensory processing testing.

“What is tricky is that everyone’s pain is different. You are rarely going to treat two people the same,” says Fjeldheim. “In medicine, we like things to be black and white. But there is a lot of gray in the complex pain world.”

Treating Pain, Saving Lives

“Before Eric came to town, we didn’t have much to offer chronic pain patients other than physical therapy or turning to injection,” says Aaron Shives, MD, a