COOK- Anyone living with chronic pain knows the routine. You wake up already bracing yourself. You ration your chores. You weigh every bend, twist, or reach because the price for doing the simplest things is always higher than it should be. For many in the North Country, the struggle has been compounded by the long drive to Duluth for specialized care.
Cook Hospital is hoping to change that story.
The hospital has opened a new Pain Management Clinic through a partnership with Community Memorial Hospital in Cloquet, bringing two fellowship-trained specialists to Cook on a regular schedule. The new clinic gives local patients access to advanced pain interventions much closer to home.
The work is led by two certified registered nurse anesthetists from CMH, Glen Palokangas, APRN, CRNA, NSPM-C, and Chad Johnson, APRN, CRNA, NSPM-C. If they look familiar, that's because they've been coming to Cook Hospital for the past eight years in their roles as anesthetists.
The pair completed identical training, including a yearlong fellowship in nonsurgical pain management.
“We historically have treated patients in Duluth. We were in private practice for quite a few years doing anesthesia and pain management,” Johnson said. “In 2019 we went to University of South Florida for a year for that (fellowship) training.”
Palokangas and Johnson now work full time at CMH in Cloquet while providing outreach services to Cook. For years, they said, referrals have been coming from Ely and Scenic Rivers providers, sending patients down to the Duluth area for care. The new clinic will keep many of those patients much closer to home.
“We’re going to be here for some of the patients that are in the Northland to be able to save them some trips,” Palokangas said. “They’ll still probably have to see us in Cloquet for some of the specialized care that we do, some of the procedures. But for our first initial visits, we can still do procedures here.”
Their work reflects how pain medicine has evolved far beyond the days when primary care physicians offered a handful of pills and sympathy. Pain is complex. It affects nerves, joints, muscles, sleep patterns, and mental health. It shapes how people interact with their families and friends. It steals the enjoyment from daily life.
“We’re not specifically medication managing people,” Johnson said. “We’re digging into more root causes of what’s causing somebody’s pain.”
Modern imaging helps. So does experience. And increasingly, new tools help clinicians target the specific nerves or tissues involved.
“With improvements in imaging with CT scans, MRI scans, X rays, and then our ultrasound machines we can use to find and target specific nerves causing pain,” Palokangas said.
The pair treat everything from persistent spine pain to joint degeneration, muscular issues, and peripheral nerve injuries. They perform epidural steroid injections in the cervical, thoracic and lumbar spine, address facet joint pain, treat arthritis-related discomfort in knees and hips, and use guided injections to isolate and calm inflamed nerves. Diagnostic injections also help them identify pain generators before choosing a longer lasting treatment.
Some techniques are new enough that many patients have never heard of them.
“One of the newer improvements, or I should say breakthroughs, are peripheral nerve stimulation, which is a non medication to trick the brain into not feeling a painful stimulus,” Johnson said. “That’s basically a word for tricking the brain into not feeling pain.”
The goal is not always to eliminate pain entirely. Instead, the focus may be on restoring function, reducing flare-ups, and giving patients back meaningful parts of their day.
“It can just change people’s lives with some of the things that we can do that are so simple,” Palokangas said.
Patients arrive with a wide range of experiences. Some have lived with pain for years, scaling back activities little by little. Others have tried conservative care without success. Many are exhausted from the emotional toll. What they often want most is for someone to take their pain seriously.
“Patients like to be heard. Not just kind of push them off as not really a big deal, because pain is. It affects your mindset and everything, especially if it hampers sleep,” Johnson said.
Palokangas agrees.
“For us, we know pain is real. That’s what we do,” he said. “Pain can stem from all kinds of different things, and we just have to kind of figure out where their source is.”
They see the ripple effects of chronic pain on work, relationships, and mental health. They also hear how family members sometimes struggle to understand what a loved one is going through.
“Depression is a very common thing that goes hand in hand with chronic pain,” Johnson said. “You can’t do the stuff that you normally want to do because you’re always hurting. You go into a depressed state. Definitely affects personal relationships.”
“Behaviors change. People start isolating themselves,” Palokangas added.
When patients finally come in, the team works through a conversation-driven evaluation that considers function, mobility, and daily routines. Palokangas said people often describe chores that now take twice as long, hunting seasons cut short or simple drives made difficult because turning the head has become too painful.
Those are the signs that something needs attention, and often the signs that patients have delayed care for too long.
As thorough as the clinic is, it does not operate as an immediate walk-in service. Patients need to begin with their primary care provider to rule out conditions that require different care, such as fractures or tumors.
“Primary care will do specific things like rule out patients that we don’t want to see,” Johnson said. “Say you’re having back pain and they just do a simple X ray and then they find out that you have a fracture in your back or you have a tumor in your spine. Those things should be dealt with right away.”
Insurance works the same way it does for any other specialty service, and patients are not left guessing about approval.
“Our nurses do all the prior authorization with insurance companies. We don’t do procedures if insurance doesn’t cover it,” Johnson said.
“Our team takes care of all that so they don’t get any financial surprises,” Palokangas said.
Physical therapy, occupational therapy, and behavioral health referrals are also part of the clinic’s approach. Pain rarely stays in one lane, and neither do their treatment plans.
“We use all the disciplines to work as a team together to get the best results,” Johnson said.
While they emphasize realistic outcomes and sometimes face limits to what medicine can solve, both clinicians describe their work as deeply meaningful.
“It’s rewarding and humbling,” Palokangas said.
“I don’t think it’s the hardest job,” Johnson said. “It’s definitely got some challenges to it when people have chronic pain, but that’s the challenge that we’re up for.”
For the people who have spent years managing pain alone or navigating long drives for specialty care, the new clinic represents something simple and long overdue. A place to be heard. A place to be evaluated thoughtfully. A place that understands what chronic pain really means. And above all, a place that is finally close to home.