New Jersey Jewish News
MetroWest Feature Story
A national showcase for a local pioneer in pain management
Matthew, an 18-year-old suffering severe pain associated with his cerebral palsy, walks into the office of Dr. Gary
Walco for treatment.
Walco hypnotizes him, suggests there is a “dimmer switch” Matthew can control, and then tells him to turn the switch down.
When Matthew comes out of the hypnosis, he exclaims, “Wow!” Walco says, “Details, please.” And the teenager explains how the treatment has just managed to control the pain he has lived with throughout his life.
Hypnosis and image visualization are just two of the tools in Walco’s arsenal for managing pain in his young patients. President of the Jewish Congregation of Kinnelon and a resident of Kinnelon, Walco is director of the David Center for Children's Pain and Palliative Care at Hackensack University Medical Center. The David Center is the only pediatric pain service in the country directed by a psychologist.
On March 29, Walco will be one of four healthcare professionals featured in The New Medicine, a two-hour documentary hosted by the late Dana Reeve, widow of Christopher Reeve. It will focus on alternative treatment methods in hospitals that begin to treat the person as a whole and that embrace the idea that the mind has a role to play in healing the body. The New Medicine will air on March 29 on PBS at 9 p.m. Matthew is one of two patients Walco is shown treating in the film.
The pediatric clinical psychologist has spent his career working on children’s pain issues and has established himself as a leader in the field. He is founder and chair of the Special Interest Group on Pain in Infants, Children, and Adolescents of the American Pain Society and a charter member of the Special Interest Group on Pain in Childhood of the International Association for the Study of Pain. He has been a principal author of policy guidelines and has conducted numerous studies on pain assessment and pain management in children, leading to a number of professional publications.
“The issue, in a nutshell, is that across the board, pain is under-treated,” said Walco during a recent telephone interview from Hackensack Hospital. “And it is much more severely under-treated in children than in adults. The data bear this out.”
He offered a sweeping condemnation of the field. “It’s absolutely amazing how many reasons people find to not be more aggressive in treating pain. Ninety-nine percent of the reasons are stupid.” He believes in this so strongly that he has written an article, published in The New England Journal of Medicine, on the ethics of treating pain.
He described one procedure, bone marrow aspiration, as “gruesome” because of the level of pain involved for children. “It’s not something for which sedating agents or anesthesia is used,” he said, explaining that the procedure involves taking a needle and boring it into the hip to extract the marrow. “Lidocaine is used so the patient doesn’t feel the needle go through the soft tissue. But the bone is not anesthetized. The minute the needle hits the bone, the patient feels everything.”
In addition to hypnosis and image visualization, Walco embraces other alternative routes to pain management, including yoga and acupuncture. But not every alternative healing method appeals to him. “It depends what’s going on and what’s available. In my case, I only offer things that have fairly good data to support them. The studies on therapeutic touch are not as convincing as those for acupuncture.”
Walco entered the field after one of the first studies involving hypnosis showed that it could help children get through such procedures as bone marrow aspiration without feeling the pain. “I wanted to see if I could use the same strategies to help kids for pain other than in procedures.” He got a grant in the 1980s to study pain management in children with sickle cell anemia and never looked back.
Although alternative treatments for pain might draw skepticism in some corners, Walco doesn’t run into much resistance at Hackensack. “People see me as the expert,” he said. “Part of it is that because I’m in a medical culture, I speak the language. And I have academic credentials. I’m a full professor of pediatrics. If you go in and say this is what I would do and I don’t care about the medicine, you’ll never get anywhere.” Walco treats children with cancer and blood disorders, rheumatologic disorders, orthopedic problems, headaches, gastrointestinal problems, and, on occasion, genetic disorders and cerebral palsy.
He claims it is the rare child he cannot help, usually those whose parents “won’t rest until they’re convinced they’ve hit every possible angle — major doctor shoppers.” People who are difficult to help are those whose don’t understand that sometimes chronic pain has less to do with the area where the pain occurs than with the way the brain and spinal cord are processing sensation. Usually, he is able to help children within three to four sessions, he said.
Both he and Muffie Meyer, producer and director of The New Medicine, said they enjoyed their experience working together. “They got it,” he said. “They did not have their own agenda — they just wanted to portray things as they were.”
The documentary concludes that the field still has a long way to go. Walco agrees, but said it has already come a long way from days “when thoracic surgery was done on infants without anesthesia.” The medical students he works with reflect that change. “There’s a shift in what I’ve seen over the years in terms of [students] getting pain management. There’s nothing that thrills me more than hearing a third-year pediatric resident say to a medical student, ‘Let me fill you in on how important pain management is,’ even if they’re only doing it because they’re scared to death I’ll get ugly with them if they don’t.”
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