Q. I have a terrible lower-back problem. After trying pain killers and physical therapy, eventually I had surgery, which may have made it worse. What should I do?

A. Chronic pain can be one of the most vexing problems people face today. Modern medicine continues to find better ways to keep our hearts, lungs and kidneys going longer. That's the good news. It also means we end up putting more miles on our bones and joints. The problem is, they wear out and become painful. Other common sources of debilitating chronic pain are headache, abdominal pain and pelvic pain.

Over time, chronic pain has a tendency to consume our lives. It is physically and emotionally draining and often makes it impossible to maintain our personal and professional relationships. Eventually, even the strongest of us can succumb to financial ruin, social isolation and major depression.

This month, in the Hawaii Medical Journal, our clinic published the results of its three-year pilot study treating patients suffering from severe chronic pain and depression. At the request of HMSA, Manakai O Malama Integrative Healthcare Group and Rehabilitation Center contracted to provide a 12-week intensive outpatient program. Five groups of up to 10 people received psychotherapy, meditation, therapeutic movement and acupuncture each week. They also received an introduction to ho'oponopono by a Native Hawaiian practitioner and lectures on diet and lifestyle.

The study demonstrated a marked improvement in both quality of life and activities of daily living. There were also significant reductions in strong pain medications. Not only did the majority of graduates feel better and return to work while taking less medication, one year later, most had continued to make forward gains. Depression and anxiety in particular continued to improve even after the program was over.

The focused integration of health services delivered in a well-coordinated group format appears to give participants the tools and confidence to maintain and continue the healing process independently. It is deeply gratifying to reclaim one's health and independence. We know we have succeeded when our patients tell us: "Now I feel free!"