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The pain never goes away completely, but some days Richard Snider says he feels pretty good.

That's remarkable progress considering he was flat on his back for six months with back pain so intense he couldn't think straight.

The Veterans Affairs Medical Center couldn't ask for a better advocate than Snider, who raves about the care he has received in the Primary Care Chronic Pain Clinic following a 1997 car-truck accident that left him with a severely damaged spine, among other injuries.

The Niagara Falls resident's service in the Navy from 1968 to 1972 made him eligible for VA care after his insurance coverage was exhausted.

Though drugs and other treatment have helped relieve the pain, the team approach the clinic uses also has helped him deal with it psychologically and face the fact his life will never be the same.

"I was used to being active, and all of a sudden I can't do anything," said Snider, 50, who managed a restaurant. He now can go for short walks, but is largely house-bound with little hope of substantial improvement.

"That's difficult to accept, but they helped me deal with it and showed me there are options other than sitting around feeling sorry for yourself," he said.

Another pain-clinic client, Joseph Elmer of Kenmore, does his best to speak without opening his mouth.

Such is the jaw pain he experiences as the result of complications from being struck in the jaw by a hockey puck while playing for a U.S. Army team in Germany in 1985.

Still, through a combination of therapies including drugs and self-hypnosis and other relaxation techniques, he's often able to get the pain reduced to the bearable level.

The ability to overcome pain received a major test in Elmer's case last summer when his 15-year-old son, Bob, committed suicide.

The emotional pain added "major league" to the physical pain, said Elmer, 39.

"Everything (in the body) works as one," and the jaw pain, which had been under control, again went off the scale, apparently because of the tightness and tension he was experiencing from dealing with the tragedy, he said.

Once again he is getting the physical pain under control through therapy and relaxation techniques he has learned at the VA.

The VA apparently was ahead of many other hospitals in dealing with pain. New procedures for dealing with pain went into effect Jan. 1 for facilities accredited by the Joint Commission on Accreditation of Healthcare Organizations, but the VA has had a pain oversight committee since 1994 and since 1996 has recognized pain as the "fifth vital sign" (in addition to temperature, respiration, blood pressure and pulse).

Relieving pain aids the healing process, and it has been shown that there are fewer blood clots and other complications among patients whose pain has been relieved, said registered nurse Kathy Graham, a member of the pain-clinic staff.

Pain is rated on a scale of 0 (no pain) to 10 (the worst pain imaginable). The clinic treats those with chronic pain, which is pain that has lasted six months or longer.

The patient alone determines the amount of pain. Pain in the 4 to 6 range requires a hospital response. Pain rated 7 or over is considered a "pain emergency," and the hospital must respond and change the treatment within an hour, Graham said.

Patients range in age from 20 to 85, and the average is 15 years of pain, with back and neck pain the most common.

"Chronic pain becomes the disease," said Dr. Delano Ramsoomair.

In addition to the discomfort, pain leads to depression, inactivity, anger and other reactions, he explained.

Drugs might be the first step, and the fear of patients' becoming addicted to narcotics is largely unfounded, said registered nurse Patrick Goeller.

With no history of substance abuse, very few patients become addicted, he said.

Which is not to say they won't become physically dependent on drugs. But that's different from addiction, "when the drug becomes the focus of your existence," Goeller said.

A variety of other treatment options are available, including physical therapy, acupuncture, relaxation techniques, self-hypnosis and biofeedback.

"Keeping the Promise" is a regular feature of The Buffalo News.

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