The Pain Science Center at Prairie Lakes Healthcare System; A New Approach to an Old Problem

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 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."

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 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 family medicine specialist at Watertown's Brown Clinic. Dr. Shives has referred a number of chronic pain patients to the pain specialists at PLHS. 

"A lot of them are reluctant at first because they have tried and failed at just about everything else," says Dr. Shives. But he cautions other referring providers not to be deterred by skeptical patients. 

"I explain that this is a special type of physical therapy that is different from other things they've tried," says Dr. Shives. "You are treating the brain as well as the body. A good number of patients see improvement. If you can get a patient's pain down from a 7 or 8 to a 2 or 3 and help them reduce or get off of medication, that is a big win." 

Fjeldheim says treatment at the Pain Science Center relies on three pillars. The first focuses on educating patients about pain neuroscience, including the role that things like post-traumatic stress and adverse childhood events may play. The second pillar involves finding ways to give patients a more restful sleep. And the third pillar is about getting more movement. 

Fjeldheim hopes to eventually assemble a multidisciplinary team to tackle pain from all angles. "As a PT, I'm not doing cardiac catheterizations and saving lives that way," he says. "But we can save a lot of lives by helping people get off or reduce their pain medications and reclaim pieces of their lives. We can have a massive impact on the wellbeing of society."