From www.MayoClinic.com  
Special to www.CNN.com

When Darcie Voigt was 6, a lawnmower blade sliced through her left foot, severing all her toes and cutting off most of the flesh on the ball of her foot. It took five operations and a skin graft to repair the damage and preserve stability in the remaining bones and muscles. The treatment, which included hours of physical therapy, was a success. Two years after the accident, Darcie not only was walking — but also had taken up riding.

Darcie discovered her passion for horses in a 4-H program, and she immediately signed up for riding lessons. With her injury, though, learning to ride was a challenge. "Riding is all about using your foot, and I can't use my foot. I needed to use my knee to hold my foot in place. So I just had to learn, had to be stronger," she says.

Unfortunately, the thing that gave Darcie the greatest joy also wreaked havoc on her injury. Although the wounds had healed, the part of her foot the surgeon had salvaged was extremely sensitive. By age 13, Darcie was in constant pain. Doctors advised her to give up riding, but she couldn't.

And, despite the pain, she had become an accomplished rider. At 18, she entered her first professional rodeo competition, specializing in barrel racing, in which riders vie for the fastest time while completing cloverleaf patterns around barrels.

"It is a personal choice to be an observer or an active participant — she chose to be the latter," says Steven Kavros, Darcie's podiatrist at Mayo Clinic, Rochester, Minn.

The pain worsens

A few years later, Darcie's pain became too intense to ignore. The nerves severed in the accident had clustered into a mass called a neuroma. Amputations — surgical or accidental — are often complicated by the formation of neuromas that cause severe pain.

Local anesthetics and corticosteroids injected directly into the most painful part of Darcie's foot only numbed the pain temporarily — within a month, the pain always came back. Strong painkillers, such as opioids, were even less helpful. The doses Darcie needed to relieve the pain made her too drowsy to function.

As a last resort, Darcie's doctor told her they could try a different type of shot — a neurolytic injection. This injection, intended to destroy the nerves responsible for pain, carries a risk: It sometimes makes pain worse. Darcie took the chance, and lost.

Before the neurolytic injection, her pain ranged between a 6 and an 8 on a widely used 0 to 10 pain scale. After the injection, her pain was at a constant 10 — the most extreme level of pain. Worse yet, her doctors told her the pain might always be there and her only option was to learn how to control it.

Her luck finally changed when she found out about the Pain Rehabilitation Center at Mayo Clinic in Rochester, Minn. The three-week outpatient program gave her new tools to manage her pain.

Pain rehabilitation: Help for chronic pain

Pain rehabilitation programs address chronic pain as a multifaceted condition — not just a physical, behavioral or psychological problem. Participants have usually tried other treatments, such as injections, surgery, medication or physical therapy, with limited or temporary success. In pain rehabilitation programs, these physical treatments take a back seat to learning and self-discovery. Participants look at how pain has affected their lives and find ways to regain control.

"Our patients typically have been busy and active people who have experienced significant declines in functioning at work, at home, in their social lives and with their emotions," says Christopher Sletten, Ph.D., a psychologist at the Mayo Clinic Pain Rehabilitation Center.

Darcie fit that description. "By the time I got home from work, I was so tired I didn't want to move. I was running on empty that whole time," she says.

Her pain rehabilitation program ran Monday through Friday for three consecutive weeks. Her days started at 7:45 a.m. and ended at about 4:15 p.m., with one- to two-hour blocks of time devoted to:

• Classes and small group discussions on healthy lifestyle choices — nutrition, physical activity and sleep

• Stress management

• Physical therapy and occupational therapy

• Chemical education, which explores the roles of prescription drugs, illegal drugs, alcohol and nicotine in chronic pain

• Biofeedback and relaxation

• Individual counseling to identify situations and behaviors that worsen pain