Expanding Access to Personalized Pain Management in Winston-Salem

Growing Our Commitment to Exceptional Patient Care

At Carolinas Pain Institute, our mission has always been to provide compassionate, individualized care for patients living with chronic pain. As the need for specialized pain management services continues to grow throughout North Carolina, we remain committed to expanding access to personalized treatment options while maintaining the high level of attention and support our patients deserve.

The addition of Cherie Avants, DNP, APRN, NP, PMGT-BC, AP-PMN, and Carly Sullivan, NP, helps our team serve more patients with the timely, comprehensive care they need. By expanding our clinical resources, we can improve appointment availability, reduce wait times, and help patients begin evaluations and treatment sooner.

For individuals managing ongoing pain, having access to experienced providers means more opportunities to receive a thorough evaluation, discuss personalized treatment approaches, and develop a care plan tailored to their unique needs. These additions strengthen our ability to continue delivering compassionate, patient-focused pain management throughout the communities we serve.

Meet Cherie Avants, DNP, APRN, NP, PMGT-BC, AP-PMN

Cherie Avants brings a wealth of advanced practice nursing experience to Carolinas Pain Institute, with a clinical background that includes time at Atrium Health Wake Forest Baptist prior to joining our team. Her doctoral-level training as a Doctor of Nursing Practice (DNP) and board certifications reflect a deep, ongoing commitment to advancing her clinical expertise in pain management.

• Education: Doctor of Nursing Practice (DNP), Duke University School of Nursing
• Certifications: APRN, NP, board certified in pain management (PMGT-BC), Advanced Practice Pain Management Nursing (AP-PMN)
• Philosophy of care: Cherie believes every patient deserves a treatment plan built around their unique history, goals, and daily realities — not a one-size-fits-all protocol.
• Experience treating chronic pain: [Insert specific years of experience / prior practice settings/specialty focus to be confirmed by CPI before publishing]
• Compassionate approach: Patients and colleagues alike describe Cherie as an attentive listener who takes the time to explain conditions and treatment options clearly, empowering patients to feel confident and informed in their care.

Cherie is now accepting patients in our Winston-Salem office.

View Cherie’s full bio →

Meet Carly Sullivan, NP

Carly Sullivan, MSN, APRN, FNP-C, is a Family Nurse Practitioner who is passionate about helping patients improve their quality of life and manage chronic pain. Before becoming a Nurse Practitioner, she gained extensive nursing experience in neurocritical care, intensive care, travel nursing, and perioperative services.

• Background: Extensive nursing experience in neurocritical care, intensive care, travel nursing, and perioperative services prior to becoming a Family Nurse Practitioner (MSN, APRN, FNP-C)
• Patient care philosophy: Carly approaches every visit with the belief that patients should feel heard, respected, and actively involved in decisions about their treatment plan.
• Commitment to individualized care: Rather than applying a standard protocol to every patient, Carly takes time to understand each person’s pain history, lifestyle, and goals to build a plan that fits their life — not the other way around.

Carly is now seeing patients at Carolinas Pain Institute.

View Carly’s full bio →

Schedule an Appointment

Whether you’re seeking answers for chronic pain or looking for long-term treatment options, our expanded team is here to help.

Winston-Salem Office
145 Kimel Park Drive, Suite 330
Winston-Salem, NC 27103
336-283-2273

Request an Appointment

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Chronic back pain can affect nearly every part of your daily routine. Activities that once felt simple, such as walking through the grocery store, sitting at work, exercising, traveling, or spending time with family, may become more difficult when pain continues over time.

For many patients, the first steps toward managing spine pain include conservative treatments such as physical therapy, medications, activity modifications, or injections. While these approaches may provide relief for some individuals, others continue to experience symptoms that interfere with their comfort, mobility, and quality of life.

Advances in spine care have created additional options for patients who need more targeted treatment. Minimally invasive spine (MIS) procedures are designed to address specific sources of spine-related pain using specialized techniques that focus on the affected area while limiting disruption to surrounding tissues.

At Carolinas Pain Institute, our providers take a personalized approach to spine care. Before recommending any treatment, our team works to understand the source of your pain, evaluate your symptoms, and determine which options may be appropriate based on your condition and overall health.

If chronic back pain continues despite conservative treatment, learning more about minimally invasive spine procedures may help you better understand your available options.

What Are Minimally Invasive Spine (MIS) Procedures?

Minimally invasive spine procedures are advanced treatment techniques designed to address certain spinal conditions through targeted approaches rather than traditional open surgical methods.

The goal of minimally invasive spine treatment is precision. Instead of treating a broad area, these procedures focus on the specific structures that may be contributing to pain. Depending on the condition being treated, physicians may use specialized instruments, imaging guidance, and advanced techniques to access the treatment area.

A common misconception is that all spine pain requires major surgery. However, many spinal conditions require a careful evaluation to determine the most appropriate treatment approach. For some patients, minimally invasive options may provide a way to address specific sources of pain without the same level of disruption associated with larger surgical procedures.

Minimally invasive spine procedures may be considered when:

• A specific source of pain has been identified
• Conservative treatments have not provided enough relief
• Symptoms are affecting daily activities
• Diagnostic testing supports a targeted treatment approach

It is important to understand that minimally invasive spine procedures are not appropriate for everyone. The best treatment plan depends on your diagnosis, symptoms, medical history, and individual goals.

How Are Minimally Invasive Spine Procedures Different From Traditional Spine Surgery?

Many patients hear the term “spine procedure” and immediately think of major surgery and long recovery periods. However, minimally invasive techniques are designed differently.

Traditional spine surgery may require larger incisions and greater access to the spine depending on the condition being treated. Minimally invasive approaches use specialized methods to target specific areas while attempting to limit unnecessary disruption to nearby tissues.

A More Targeted Treatment Approach

One of the biggest differences with minimally invasive spine procedures is the focus on treating the source of pain.

Back pain can come from many different structures, including:

• Spinal discs
• Nerves
• Facet joints
• Vertebral structures
• Sacroiliac joints
• Surrounding soft tissues

Because different conditions can create similar symptoms, identifying the actual cause of pain is an important part of treatment planning. A targeted procedure is only considered when the provider understands what structure may be contributing to symptoms and whether that area can be addressed through a minimally invasive approach.

Less Disruption to Surrounding Tissues

Minimally invasive techniques are designed to reduce unnecessary disruption to surrounding muscles and tissues compared with some traditional approaches.

The goal is to focus treatment on the problem area while preserving as much healthy tissue as possible. However, every procedure is different, and your provider will explain the expected benefits, risks, and recovery process based on your specific situation.

Individualized Recovery Expectations

Recovery after a minimally invasive spine procedure varies from person to person.

Factors that may influence recovery include:

• The type of procedure performed
• The condition being treated
• Your overall health
• How long symptoms have been present
• Your activity level and rehabilitation plan

During a consultation, your provider can explain what you may expect before, during, and after treatment.

Who May Benefit From Minimally Invasive Spine Treatment?

Minimally invasive spine procedures are not designed as a universal solution for all back pain. They are considered for patients who have specific conditions that may respond to targeted treatment.

A comprehensive evaluation helps determine whether MIS treatment may be appropriate.

Your provider may consider:

• Where your pain is located
• How long symptoms have been present
• Whether pain travels into the legs or other areas
• Previous treatments you have tried
• Imaging or diagnostic findings
• How pain affects your daily activities

Patients who may benefit from evaluation include those experiencing:

• Chronic lower back pain
• Nerve-related symptoms such as tingling or numbness
• Pain caused by spinal narrowing
• Certain disc-related conditions
• Joint-related spine pain
• Persistent symptoms despite conservative care

The purpose of a consultation is not simply to recommend a procedure. It is to understand your condition and determine the most appropriate path forward.

Conditions That May Be Treated With MIS Procedures

Different spinal conditions require different approaches. Minimally invasive procedures may be considered for certain patients with specific diagnoses.

Lumbar Spinal Stenosis

Lumbar spinal stenosis occurs when the spaces within the lower spine become narrowed. This narrowing may place pressure on nearby nerves and contribute to symptoms affecting the lower back and legs.

Patients with lumbar spinal stenosis may experience:

• Lower back discomfort
• Leg pain
• Numbness or tingling
• Weakness
• Difficulty standing or walking for extended periods

Treatment recommendations depend on the severity of symptoms and the underlying cause. For appropriate patients, minimally invasive approaches may be considered as part of a personalized treatment plan.

Vertebrogenic Low Back Pain

Some chronic lower back pain originates from structures within the vertebrae, including the endplates located near the spinal discs. This type of pain may be associated with changes inside the spine that contribute to ongoing discomfort.

For appropriately selected patients, minimally invasive treatments such as basivertebral nerve ablation may be considered. This procedure targets the basivertebral nerve, which may play a role in transmitting certain types of chronic low back pain signals.

A thorough evaluation is necessary to determine whether this treatment option is appropriate.

Facet Joint Pain

Facet joints are small joints located between the bones of the spine that help provide stability and movement. Over time, these joints may become irritated due to:

• Arthritis
• Degenerative changes
• Previous injuries
• Repetitive stress

Facet joint pain may cause:

• Localized back pain
• Stiffness
• Discomfort with certain movements
• Pain that worsens with standing or bending

When evaluation identifies facet joints as a potential source of pain, targeted treatment options may be discussed.

Sacroiliac Joint Pain

The sacroiliac (SI) joints connect the lower spine to the pelvis. Problems involving these joints may contribute to pain in the lower back, hips, or buttocks.

SI joint-related pain may occur due to:

• Joint irritation
• Injury
• Inflammation
• Changes in movement patterns

Proper diagnosis is important because SI joint pain can sometimes feel similar to other types of lower back pain.

Why Diagnosis Is the Most Important Step Before MIS Treatment

A successful spine treatment plan begins with understanding what is causing your symptoms.

Many spine conditions share similar symptoms. For example, lower back pain with leg discomfort may be caused by nerve irritation, spinal narrowing, disc-related problems, or other conditions.

During an evaluation, your provider may review:

• Your symptoms and pain patterns
• Medical history
• Previous treatments
• Physical examination findings
• Diagnostic imaging

This information helps determine whether minimally invasive spine treatment may be appropriate or whether another approach may better address your condition. The goal is to treat the source of pain rather than simply manage symptoms.

What Happens During a Minimally Invasive Spine Consultation?

A consultation at Carolinas Pain Institute begins with understanding your experience with pain.

Your provider may discuss:

• When your symptoms started
• What activities increase or decrease discomfort
• How pain affects your daily life
• Treatments you have already tried
• Your goals for care

After reviewing your condition, your provider can explain possible treatment options and answer questions about the benefits, risks, and expected outcomes of each approach.

Having a clear understanding of your diagnosis and options allows you to make informed decisions about your care.

Frequently Asked Questions About Minimally Invasive Spine Procedures

Explore Minimally Invasive Spine Options at Carolinas Pain Institute

Living with chronic spine pain can be frustrating, especially when symptoms continue despite your best efforts to find relief. Understanding the source of your pain and learning about available treatment options can help you take the next step toward improved comfort and function.

At Carolinas Pain Institute, our team provides personalized evaluations and advanced pain management options for patients experiencing chronic spine conditions. If you are exploring minimally invasive spine procedures, our providers can help you understand whether this approach may be appropriate for your condition.

Contact Carolinas Pain Institute today to discuss your symptoms and learn more about available spine treatment options.

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Sciatica and herniated discs are two terms often used when discussing lower back pain and nerve-related symptoms, but they are not the same condition. A herniated disc can be one of the causes of sciatica, while sciatica describes the symptoms that occur when the sciatic nerve becomes irritated or compressed.

Understanding the difference between sciatica and a herniated disc can help you recognize your symptoms and know when to seek medical guidance. At Carolinas Pain Institute, our team provides personalized evaluation and treatment options for patients experiencing nerve-related pain, including sciatica pain relief and treatment in North Carolina.

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What Is Sciatica?

Sciatica refers to pain that follows the path of the sciatic nerve, the largest nerve in the body. The sciatic nerve begins in the lower spine, travels through the hips and buttocks, and extends down each leg.

When this nerve becomes irritated or compressed, it can cause:

• Sharp or burning pain in the lower back
• Pain that radiates into one leg
• Tingling or “pins and needles”
• Numbness
• Muscle weakness
• Pain that worsens when sitting
• Difficulty standing for extended periods

Sciatica is a symptom—not the underlying cause of the problem.

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What Is a Herniated Disc?

The spine contains soft cushions called intervertebral discs that sit between each vertebra. These discs help absorb shock while allowing flexibility and movement.

A herniated disc occurs when the soft inner material pushes through a tear in the tougher outer layer. If the disc presses against a nearby spinal nerve, it can lead to inflammation, pain, and neurological symptoms.

A herniated disc may develop from:

• Age-related disc degeneration
• Heavy lifting with poor body mechanics
• Repetitive spinal stress
• Sports injuries
• Falls or motor vehicle accidents
• Sudden twisting motions

Not every herniated disc causes pain. Some people have herniated discs without any symptoms at all.

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The Main Difference Between Sciatica and a Herniated Disc

Although these terms are often used interchangeably, they describe different things.

Sciatica	Herniated Disc
A symptom	A structural spinal condition
Caused by sciatic nerve irritation	Caused by damage to a spinal disc
Produces radiating leg pain	May or may not cause symptoms
Can result from several different conditions	One of the most common causes of sciatica

Think of it this way:

• A herniated disc is a potential cause.
• Sciatica is one possible result.

A herniated disc is not the only condition that can cause sciatica. Other causes include spinal stenosis, degenerative disc disease, bone spurs, piriformis syndrome, or spinal injuries.

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How Symptoms Differ

Common Sciatica Symptoms

Sciatica symptoms usually affect only one side of the body and include:

• Shooting pain down the leg
• Burning sensation
• Tingling
• Numbness
• Weakness in the foot or leg
• Pain that worsens while coughing or sneezing

The pain often follows a very specific path along the sciatic nerve.

Common Herniated Disc Symptoms

A herniated disc can produce symptoms depending on its location.

Symptoms may include:

• Localized lower back pain
• Muscle spasms
• Stiffness
• Pain with bending
• Radiating nerve pain
• Numbness
• Weakness

Some herniated discs never touch a nerve, meaning they may not cause any noticeable symptoms.

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How Symptoms Differ

Common Sciatica Symptoms

Sciatica symptoms usually affect only one side of the body and include:

• Shooting pain down the leg
• Burning sensation
• Tingling
• Numbness
• Weakness in the foot or leg
• Pain that worsens while coughing or sneezing

The pain often follows a very specific path along the sciatic nerve.

Common Herniated Disc Symptoms

A herniated disc can produce symptoms depending on its location.

Symptoms may include:

• Localized lower back pain
• Muscle spasms
• Stiffness
• Pain with bending
• Radiating nerve pain
• Numbness
• Weakness

Some herniated discs never touch a nerve, meaning they may not cause any noticeable symptoms.

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Can Sciatica Be Prevented?

While not every case is preventable, healthy habits may reduce your risk.

Helpful strategies include:

• Maintaining a healthy weight
• Exercising regularly
• Strengthening core muscles
• Using proper lifting techniques
• Avoiding prolonged sitting
• Practicing good posture
• Staying physically active throughout the day

These habits also support overall spinal health and may lower the risk of developing disc-related problems.

Experiencing Sciatica or Nerve Pain?

Understanding whether your symptoms are caused by sciatica, a herniated disc, or another spinal condition is an important first step toward finding relief.

At Carolinas Pain Institute, our providers evaluate the source of your pain and create personalized treatment plans based on your symptoms, health history, and goals.

If you are looking for sciatica pain relief and treatment in North Carolina, contact Carolinas Pain Institute today to schedule an evaluation.

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From pro racing to live music, Gears & Guitars returns with a celebration of the man who made it happen.

Dr. Richard L. Rauck was an early member of the World Institute of Pain, obtaining FIPP certification in its inaugural class in 2001, and served as WIP president from 2013 to 2015. In 2004, he founded the Carolinas Pain Institute, where he continued to mentor fellows and advance the practice of interventional pain management.

Beyond his professional accomplishments, Dr. Rauck was a civic leader and founder of the Winston-Salem Cycling Classic and the Gears & Guitars concert series, initiatives that combined international-level competition with community engagement.

Read more HERE or download the article above.

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Dr. Chris Gilmore, a leading pain physician affiliated with Carolina Pain Institute, was recently featured as a guest on CAROLINA Focus with Sharon Thorsland and Ed Billick, airing Sunday, December 14, 2025, on WBT.

During the episode, Dr. Gilmore discussed an exciting new frontier in migraine treatment-an innovative, drug-free therapy currently being evaluated in a national clinical trial for patients living with chronic migraine.

A New Approach to Chronic Migraine Relief

Dr. Gilmore is helping lead a nationwide study through Queen City Clinical Research focused on a small, implantable device placed just beneath the skin of the scalp. The device gently stimulates nerves associated with migraine pain and works continuously, offering a discreet, non-medication option for patients who have not found relief through traditional treatments.

This clinical trial targets chronic migraine, the most severe form of the condition, defined by 15 or more headache days per month. More than 3 million Americans live with chronic migraine, many of whom cycle through medications, injections, and therapies with limited success.

“This study represents a meaningful shift toward precision-based, long-term migraine management,” Dr. Gilmore shared during the discussion. “For patients who feel like they’ve tried everything, innovation like this brings renewed hope.”

Advancing Pain Care Through Research and Innovation

At Carolina Pain Institute, our physicians are committed to advancing pain care through research, clinical leadership, and patient-centered innovation. Dr. Gilmore’s involvement in this national study reflects our broader mission: expanding access to advanced treatments that improve quality of life for patients living with chronic pain conditions.

Community Health and Wellness Updates

The episode also included a seasonal health reminder shared by Ed Billick, featuring guidance from Atrium Health on ways individuals can help prevent the spread of illness during cold and flu season.

Listen to the Full Episode

To hear Dr. Gilmore’s full discussion and learn more about this groundbreaking migraine research, listen to the complete episode of CAROLINA Focus on WBT.

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An innovative approach to treating chronic migraine is gaining attention in Charlotte and beyond – and physicians connected to Carolina Pain Institute are helping lead the charge.

A recent article in The Charlotte Post detailed a national clinical study evaluating a novel medical device designed to reduce the frequency and severity of chronic migraines, the most debilitating form of headache disorder. Chronic migraine affects millions nationwide and is defined by 15 or more headache days per month – a life-altering burden for many patients. (The Charlotte Post)

What the Research Shows

The experimental therapy involves a small implant placed just under the skin of the scalp that gently stimulates nerves linked to migraine pain. Early results suggest this neuromodulation technique can cut monthly migraine days in half, offering meaningful relief for patients who haven’t responded to standard medical management. (The Charlotte Post )

Dr. Leo Kapural of Queen City Clinical Research – one of the study’s lead investigators – explained that while the research is still ongoing, this approach represents a promising shift in how severe migraines might be treated in the future. The Food and Drug Administration is overseeing the trial and will evaluate the therapy’s safety and effectiveness as results continue to accrue. (The Charlotte Post )

Chronic Migraine: A Local and National Challenge

Migraines aren’t just “bad headaches.” They often involve intense, throbbing pain accompanied by nausea, visual disturbances, and sensory sensitivity – symptoms that can make daily life difficult or even impossible for sufferers. Current preventive treatments don’t work for everyone, leaving many patients searching for new options. (The Charlotte Post )

The clinical trial behind this emerging therapy, registered as a multicenter, randomized, sham-controlled study, aims to test whether neuromodulation can meaningfully reduce headache days compared with a control intervention. (ClinicalTrials.gov)

Why It Matters to CPI Patients

Carolina Pain Institute is proud to support advancements like this – especially as local experts such as Dr. Chris Gilmore recently discussed similar migraine research on the CAROLINA Focus podcast with WBT. These conversations help bring national innovation to regional patients who are seeking relief.

For people living with chronic migraine in Charlotte and surrounding communities, studies like this represent hope for future therapies that go beyond medications and injections to deliver sustained relief. (The Charlotte Post)

Get Involved or Learn More

If you’re living with chronic migraine and interested in cutting-edge clinical trials or want to learn more about advanced treatment options, contact Carolina Pain Institute to explore your options. Our team stays active in research and patient care to bring the most promising therapies within reach.

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We are pleased to announce the opening of our Charlotte office! To schedule an appointment, refer a patient or to learn more about our services, contact us at 336-765-6181. Click here to download our Charlotte New Patient Referral Form.

We are excited to NOW provide exceptional care to both Winston-Salem and Charlotte communities! Our NEW Charlotte address is: 131 Providence Road, Suite 201, Charlotte, NC 28207. We look forward to seeing you soon.

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Dr. David Mount would rather listen than talk.

It’s not that he doesn’t have plenty to say. But on a patient’s first visit, he wants to hear what led the patient to his office.

The neuropsychologist has a keen interest in the mind/body connection and a focus on how pain affects the brain. (“Pain impacts self-esteem and personal well-being,” he says. “It can cause internalized agony.”) Patients come to him with a variety of physical conditions-diabetic neuropathy, rheumatoid arthritis, pain associated with an injury or surgery-and a variety of cognitive impairments that have resulted from a physical condition.

Patients from all over the country (and the world) seek him out through his Mind Body Institute Beyond, located in Winston-Salem, North Carolina. Most patients are referred by their medical doctor when a physical malady begins to impact cognitive ability-including memory.

And while Dr. Mount’s preference is to be consulted when a physician first begins talking to a patient about cognitive impairments, he says instead he’s often brought in when the physician is running out of ideas.

A little more conversation

No matter what stage he begins with a patient, it always starts with a story. “We start with a patient-centered evaluation,” he says-with him listening as the patient talks. “I want to hear their story, uninterrupted,” he says. “I don’t want them to self-edit anything.”

Dr. Mount employs counselors and therapists at his center, but he personally sees every patient who comes in.

Patients realize the power their words carry. In Dr. Mount, they’ve found a doctor who’s willing to listen to every detail of their pain journey-all the treatments tried, the loneliness that can accompany chronic pain, the heartbreak of not always being able to keep commitments. The doctor is ready to absorb it all.

“MDs only have so much time,” he says. “I have more time to invite a storytelling approach. And patients want to talk. They may have gotten the message before to ‘shut up’ about their pain. Once they start talking in my office, it’s often hard to stop.”

Once their story has been told, he asks how they’d rewrite it. “I don’t mean how they’d rewrite it without chronic pain,” he explains. “I ask how they’d deal with the pain differently.”

Experience can be an excellent teacher. Once patients begin to consider what they would undo if they were rewriting their memoir, they can begin to take control and formulate a plan.

Dr. Mount values the work MDs have done before they bring him into the mix, but he doesn’t just thank them for the referral and move on. He uses a collaborative approach that involves the patient and the referring physician.

His goal: to help patients with cognitive impairment that’s a result of pain. Often, the impairment is a result of pain medication. Reducing a patient’s medication is often among his prescriptions. That’s accompanied by nutritional education, stretching-which is often done in his office-and other holistic treatments.

He understands what his patients are going through. He’s been there himself.

When the doctor becomes the patient

Dr. Mount suffers from chronic pain in his neck and spine. It began in 2005 when he was new to Winston-Salem and went to a chiropractor for an adjustment. After getting what he considers “substandard care,” he realized he needed to educate himself on treatment options.

“I experienced anxiety, uncertainty and was questioning myself,” he says. “My work and social life were disrupted. I know about the stigma of feeling judged. Chronic pain will wear you down.”

He was losing sleep because of the pain-and was less likely to work out, too, though sports had always been a big part of his life. He wondered, “Why me?”

He tried the gamut of specialists-neurologists, acupuncturists, massage therapists-but wasn’t having success with any of them. That led to an “aha” moment: “The system I was moving through was broken. The specialists I was going to weren’t talking to each other. The system was fragmented, and the patient was suffering as a result.”

He also understands that patients must be involved and invested in their own care-and that following doctor’s orders is imperative. “Compliance,” he says, “is the mortar that holds the bricks together.”

Noncompliance often arises, he says, from the psychological effects of pain and pain medication. So, who better than a neuropsychologist to partner with patients on sticking to their treatment plan? “I can help reinforce compliance,” Dr. Mount says. That’s something else that referring MDs appreciate about their partnership with him.

“Compliance starts with attitude,” he says. “If you can improve the attitude, then you achieve improved outcomes.”

The best medicine

Pain is serious business, but that doesn’t mean treatment has to be. Dr. Mount believes that there’s real benefit to lightening up. Part of the work he does is humor therapy. “You’ll hear a lot of laughter at my office,” he says. (Laughter? Uninterrupted storytelling? Are you getting the idea that the Mind Body Institute Beyond is not your typical doctor’s office?)

Humor is, in fact, what led to his own relief. It’s how he began to navigate the fractured system that wasn’t getting him anywhere. He still sees many of the same specialists he did back in 2005 when the pain first began-but he maneuvers the system with a different mindset now, he says. He also practices yoga and mindfulness, takes supplements and is careful about eating right and getting enough sleep.

Dr. Mount knows chronic pain is a family disease. It impacts more than the person living with the pain; it weighs on entire families. “When you talk to family members [of patients], they’ll often use similar words to describe their situation,” he says. “‘Moody,’ ‘walking on eggshells,’ ‘unpredictable.’ People with chronic pain can perceive themselves as a burden to others-and that leads to self-isolation and depression.”

Measuring how far you’ve come

As a counselor, Dr. Mount values the conversational give and take he has with patients. But as a research scientist, he also wants to measure progress. At his second meeting with a new patient-after the initial storytelling session-he’ll do an assessment of where the patient is. If the patient is having memory issues, he’ll do neuropsychological tests to discover just how much memory function has been impaired.

Physicians have been receptive to his approach. Dr. Mount will share his assessment report with the patient and the referring physician. “I’ve had doctors say: ‘When I read your report, I learn something. There are things about my patient, who I’ve been treating for 20 years, I never knew that I learned from you.'”

That’s the power of storytelling. The in-depth report combines elements of the patient’s story with Dr. Mount’s detailed findings. It’s a comprehensive look at the patient’s pain history, what’s been tried, how effective it was (or wasn’t) and what side effects may be the result of prescription medication.

It’s much more detailed than the notes a doctor typically dictates. Again, it’s because Dr. Mount and his team dedicate time to active listening.

He has seen some patients in their mid-30s who have the memory function of someone who’s 65 or older. But the good news? The situation can be reversed, he says-often by reducing the number of meds a patient is on.

Then and now

Dr. Mount’s passion for studying and treating pain began during his residency at the University of Missouri-Columbia, where he worked extensively in physical medicine, rehabilitation neurology and internal medicine. “We were seeing the adverse effects of illicit drug use on pain management,” he says. “We saw the adverse effects of comorbid chronic disease-diabetes, heart disease, physical injury-on pain management, as well.” He focused his research on the effects of physical illness on cognitive memory, attention and learning new information.

More recently, he’s been interested in further exploring the brain’s ability to recover and “rejuvenate” based on different treatment intervention strategies. His current research interest is studying and comparing pharmacological and medical device approaches.

He uses the term “chronic pain brain” to describe the fog that’s sometimes felt as a result of too much or too many pain medications. Pain brain can be as problematic as the pain itself. It can lead to memory loss, sleeplessness and a host of other issues.

And the answer, Dr. Mount believes, isn’t different or more medication. It’s less. His prescription will likely also include more laughter, more talking, more stretching and moving and more engagement with life.

When patients are ready to tell their story, Dr. Mount is all ears.

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Wayne Cooper, a 72 year-old almost-retired attorney, lives in Marin County, California. He has suffered from low back pain and sciatica for nearly 20 years, keeping him from enjoying many activities and requiring daily medication. The Bay Area is hilly-and due to his back pain Cooper could only walk short distances and had to avoid inclines. He and his wife enjoyed bird watching, but those outings were also kept short to minimize pain. Even water aerobics had to be cut back.

Cooper tried many treatments and saw many specialists to relieve his pain. He regularly took 800 mg of ibuprofen several times a day. Smaller doses had no impact. When things got really bad, he would take hydromorphone. Over the years, Cooper had several epidurals and steroid shots, and made periodic attempts at yoga. Nothing brought relief from the pain. When the pain was severe, it would immobilize him. It could take hours or a day to reduce the pain from a 10 to a 6.

Cooper’s L4, L5 and S1 were in bad shape in part due to his upper spinal scoliosis, but because of the competing issues between his upper and lower back, specialists decided he was a good candidate for surgery. A new procedure called SPRINT PNS was suggested as an option because it was minimally invasive and typically offers long-lasting relief. Cooper saw no downside except that he would not be able to use the pool while the device was in place.

“I was told it could take a couple of weeks before I felt any difference,” Cooper says, “but I was pain free within a day!”

During the 60-day SPRINT therapy period, Cooper took neither ibuprofen nor any other medications for back or sciatic pain. The device was removed about six weeks later, and he has continued to experience relief from back and sciatic pain for three weeks and counting.

He says is now more active. After the SPRINT PNS was installed, he was able to take a hike of more than three hours with his wife and friends, including ascending a twisty, uphill trail. He likes to joke that the hike ended because the trail did, not because of pain. He’s able to go for longer bird-watching walks with his wife. Water aerobics sessions are pain-free and back on his calendar. Even cooking, which was impacted prior to SPRINT, is now more enjoyable, since uninterrupted standing also used to trigger his hip pain.

“I would absolutely recommend SPRINT,” Cooper says.

TO LEARN MORE ABOUT SPRINT VISIT: SPRTHERAPEUTICS.COM

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by Dee Emmerson, TCC Writer

Kevin hurts all the time since his accident. After learning how thoughts become automatic, he’s noticing that his pain gets worse with certain ways of thinking. Because this surprises and baffles him, he’s trying to pay attention to the relationship between his thoughts and his pain.

So far he’s identified several instances that result in a pain flare:

• When he dreads an upcoming situation.
• When he gets down on himself-for not doing enough or for handling a situation poorly.
• When he feels like a victim-if someone can’t fix his pain or doesn’t do what he promises.

Dr. Buenaver, a researcher at Johns Hopkins, believes we can reduce our pain when we understand the relationship between thinking, feelings, and behaviors. “It may sound simple, but you can change the way you feel by changing the way you think,” he says. (click to read)

Many of us with chronic pain hurt the worst when we’re upset or fearful, and Kevin is beginning to connect some of his thought patterns to negative filters. During a recent phone call with his case manager, his fears boiled up and quickly turned into: I can’t go back to work until the doctor releases me…what if I don’t get better?…I’ll lose my job…I won’t be able to pay the mortgage or car payment…I’ll lose everything!…What if my wife decides I’m not worth the trouble?… His pain skyrocketed in a matter of seconds.

With a smile in his voice, Kevin proudly relates how he stopped that freight train. “The fear blinded me for a minute, and then I realized this was how catastrophizing works. I thought back to what started it-a simple statement by my case worker that I would need a doctor’s release before I could return to work. I slowed down and decided to ask when I could get an appointment so the doctor could sign off on my progress, and my pain level dropped about 3 levels!”

We all have ways of thinking that impede our progress. Do you recognize any of these and how they make you feel?

Negative mental filter

How it looks: Filtering every activity/thought through something that bothers me.
Thinking: My pain was bad today, so learning pain management isn’t helping.
Feelings: I feel let down, hopeless, cynical.

Catastrophizing

How it looks: Exaggerating the consequences (it’s the worst that could happen).
Thinking: My spouse is so tired of my pain that he will probably leave me…I will be destitute…I will have to raise the kids alone…I will die alone.
Feelings: I feel fearful, worried, tense, anxious.

“Should” statements

How it looks: Trying to motivate ourselves or directing at others.
Thinking: I should have gotten more done today. Or… I should have known you’d forget to call me.
Feelings: I feel guilty, pressured, disappointed.

Arguing with reality

How it looks: Focusing on not wanting something to be what it really is.
Thinking: If I didn’t have pain, I would be happy.
Feelings: I feel disappointed, sad, hopeless.

Filtering

How it looks: Ruminating excessively on the negative part of a situation or disqualifying the good aspects of something.
Thinking: Even though I forgot about my pain while the kids were opening their presents, my life is still all about the pain.
Feelings: I feel cynical, doubtful, hopeless.

If you live with pain, a Coach can help you discover strategies to manage or reduce your pain …read more. Or, Coaching may be the perfect avocation for you to help others. TCC®U trains coaches and prepares students for national certification…read more.

*Names have been changed.

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