WolfEagle1499's blog: "Chronic Pain"

No Pain, No Pills How to keep your aching back or trick knee from ruining your life. Adapted From Mayo Clinic on Chronic Pain, Second Edition. http://www.rd.com/content/managing-chronic-pain-without-medication/ When Darcie Voigt was 6 years old, a lawn mower accident took all the toes on her left foot, along with the fatty cushion on the bottom of the forefoot, which normally acts as a shock absorber. The young girl from Mantorville, Minnesota, learned to walk again -- but pain was a constant presence in her life. By her early 20s, Voigt noted that the damaged nerves in her foot hurt all the time, even while she slept. Injections of anesthetics and corticosteroids numbed the pain temporarily, so she tried other medications, including opioids, but she wasn't satisfied with the effects. "The drugs brought the pain down from the over-the-top, pulling-your-hair-out level, but they made me feel cloudy, and I was worried about becoming dependent on them." So in January 2000, when she was 23, doctors tried a different type of injection, meant to destroy the nerves that caused her discomfort. But it backfired. She hurt worse than ever. Millions of Americans live with chronic pain. And while some are helped with medication and other treatments, many continue to suffer. Doctors told Voigt that her pain wouldn't go away and she must learn how to control it. "I was shocked, and very angry. I didn't understand why they couldn't fix a simple pain from an amputation." Later that year, she signed up for a pain rehabilitation program at Mayo Clinic in Rochester, Minnesota. "Right away they said they weren't going to give me a drug to make it go away, but they would teach me how to manage the chronic pain." And they did. She learned to control her pain by using stress reduction, time management and bio-feedback. She identified traits, such as her perfectionism, that made her condition more difficult to handle. She learned the importance of a healthy diet for increasing energy, and she began using biofeedback and breathing exercises to reduce stress. It's had a huge effect: "I used to clench my jaw a lot, and I could feel the tension throughout my body. Now I close my eyes, concentrate on relaxing my muscles, and breathe in and out deeply." Voigt does this often, at least four to six times an hour, every day. Before, Voigt rated her pain as a 10 on a 1-10 scale. These days, it's a 4. The only drug she takes is Tylenol. "I realized that the pain wasn't going to go away, so I've figured out what I need to do to make my life as full as I can. It's about listening to how my body reacts and slowing myself down." Now 29 years old, she's married and an avid rodeo competitor. Changing her reactions to stress helped Voigt conquer her pain. It could work for you too. Here, more natural ways you can get some much-needed relief. A Sharp Approach Acupuncture is one of the most studied unconventional medical practices, and it's gaining acceptance in Western medicine for treatment of some conditions. Researchers at the National Institutes of Health (NIH) say there is evidence the practice helps relieve postoperative dental pain and it's also useful in treating nausea after surgery and chemotherapy. In addition, acupuncture may help with stroke rehabilitation, headache, addiction, menstrual cramps, tennis elbow, myofascial pain, osteoarthritis, low-back pain, carpal tunnel syndrome and asthma. Move a Muscle Exercise is key when it comes to easing pain. Why? It prompts your body to release endorphins, which block pain signals from reaching your brain. These feel-good chemicals also help alleviate depression and anxiety, both of which make chronic pain more difficult to control. Regular exercise promotes weight loss, which in turn can relieve pain by reducing stress on your joints. Similarly, as you improve flexibility, you'll find that joints extending through their full range of motion are less likely to be plagued with aches and pains. Plus, you'll have more energy, sleep better and decrease your risk of high blood pressure, diabetes and stroke. High-Tech Relaxation During a biofeedback session, a therapist applies electrodes and other sensors to various parts of your body. The sensors are hooked up to devices that monitor and give you feedback on body functions, including muscle tension, brain-wave activity, respiration, heart rate, blood pressure and temperature. Once the electrodes are in place, the therapist uses relaxation techniques to calm you, reducing muscle tension and slowing your heart rate and breathing. You then learn how to produce these changes yourself, outside the clinical setting. The goal? To help you enter a relaxed state in which you can better cope with pain. It seems to be most effective for tension headaches, migraines and pain related to muscle tension. A Better Back Chiropractic care is one of the most common complementary therapies in this country. Today, chiropractors often work with medical doctors as part of the treatment team. Though they can't prescribe drugs or perform surgery, they may use some standard medical procedures. And their services are increasingly being covered by insurance. Studies indicate that spinal manipulation can effectively treat uncomplicated low-back pain, especially if the pain has been present for less than a month. Some practitioners say chiropractic manipulation can treat disease other than musculoskeletal problems; however, more research is needed to support this. Retrain Your Brain It's been around forever, but recently hypnosis has seen a resurgence among physicians, psychologists and other mental-health professionals. We don't know exactly how it works, but experts believe hypnosis alters your brain-wave patterns in much the same way other relaxation techniques do. A review of studies supported the value of hypnosis for treating cancer pain and nausea, and NIH researchers agree that hypnosis can help with other conditions -- such as irritable bowel syndrome and tension headaches -- that can lead to pain. Lessen the Stress As Voigt learned, reducing stress, however you do it, can make a huge difference in relieving physical discomfort. Try massage, meditation, yoga or whatever works for you. Deep breathing from your diaphragm, as opposed to your chest, is a do-anywhere de-stressor. Try to do it for 20 minutes every day. To practice, lie down or sit comfortably with your feet flat on the floor. Rest one hand on your abdomen, one on your chest. Inhale through your nose while pushing your abdomen out. Slowly exhale through your nose while gently relaxing your abdomen. (If you can't breathe through your nose, do it through your mouth.) Make each breath a wavelike motion. And if your mind wanders, bring your attention back to relaxation. The Sex Solution When pain invades your life, you can still have a healthy sexual relationship. It begins with communication, so talk to your partner about how you feel and what you need. Be creative, and willing to make changes (buy a new mattress or bed if pain has forced you to sleep apart, and explore new ways to express your sexuality). Adapted from Mayo Clinic on Chronic Pain, second edition, Copyright © 2002 Mayo Foundation for Medical Education and Research, published by Mayo Clinic Health Information. Additional material from MayoClinic.com. Last Updated: 2006-05-30

7 Back Pain Breakthroughs http://www.rd.com/content/chronic-back-pain-breakthroughs-/ Are you hurting? Here's help. By Michael J. Weiss End Back Pain Agony Ouch, that aching back! If you've ever moaned in agony from back pain, rest assured -- albeit uncomfortably -- that you're not alone. About eight in ten Americans will suffer from it at some point in their lives. After colds, it's the No. 1 cause of missed work. It's a major drain on the American economy, costing more than $90 billion a year in medical bills. Yet a cure for the common backache is as elusive as ever. Part of the problem is the complexity of the spine, a miraculous structure of bone and cartilage that surrounds nerves linking the brain to the rest of the body. The lower back, called the lumbar region, bears most of a person's weight on five vertebrae separated by disks that work like shock absorbers to provide cushioning and flexibility. Muscles and ligaments supply further support. But over time, the effects of aging decrease bone mass and muscle elasticity, and contribute to disk degeneration, leaving the lower back vulnerable to injury -- and millions of people susceptible to pain. Back pain can originate from many sources, and treatments are just as varied, from conservative approaches like exercises and massage, to more risky prescription medications and surgery. Unfortunately for many patients, these choices often provide only temporary relief, and some have debilitating side effects. But the search for a magic bullet continues, and we may be closer than ever. Doctors and scientists are reporting success with these new and coming-soon treatments that can ease back pain for some sufferers while offering hope to all. New Neurostimulator: A Miracle? Barbara Sweeney's back hurt for 20 years. The 63-year-old hospice chaplain from Silver Spring, Maryland, had been on an agonizing odyssey of doctors' visits and treatments. Painkillers, physical therapy, epidural shots, even methadone: Sweeney had tried them all, getting little relief. In 2000 neurosurgeons diagnosed her condition as stenosis, a narrowing of the spinal canal, which pinches the nerves. Over the next five years, she underwent two spinal fusions to relieve the stress on her back nerves. But instead of lasting improvement, Sweeney experienced new pains, and her doctors were mystified. Back pain had gradually taken over her life. She could no longer stand up straight without hurting and needed a cane to walk. "I felt like I'd grown old before my time," she says. "I'm a fighter, but it was hard not to get depressed." Then, in the fall of 2006, she heard about a "pain pacemaker," an implantable device introduced by Medtronic in 1969 and modeled after its heart pacemaker. Over the years, the company had refined the device, formally known as a neurostimulator, by making it increasingly smaller and longer lasting. One of its latest models, the RestoreAdvanced neurostimulator, can operate for nine years with a battery recharge only once every four to six weeks. The size of a pocket watch, the device works by sending mild electrical impulses along the spinal cord, blocking pain signals to the brain. "We're still not sure why stimulating nerves provides relief, just that it does," says Richard Kuntz, MD, president of Medtronic Neuromodulation in Minneapolis. With her options dwindling, Sweeney scheduled a pacemaker implantation last February. Zachary Levine, MD, a neurosurgeon with the Washington Brain & Spine Institute, made a two-inch incision in Sweeney's right hip, where the neurostimulator was implanted. Through a smaller incision in the middle of her back, Dr. Levine delicately fed a lead with eight electrodes to points along her spine, and down to the device. With Sweeney sedated but still responsive, Dr. Levine chatted with her to pinpoint where the neurostimulator lead provided the most benefit. Within an hour, Dr. Levine closed the last stitch, and Sweeney experienced something she hadn't felt in decades: well-being. "The relief was immediate," Sweeney says. "The pain was gone." Since then, she has thrown away her cane. She now sleeps through the night, and in the spring, she started a water exercise class. "I feel like a new woman," she says. "I'm finally able to do things I couldn't do for years." She pauses, carefully patting a gentle swelling in her lower back. "This little device," she says, smiling broadly, "turned out to be a miracle." Infrared Belts: Reducing Pain Infrared rays were discovered in 1800, but it took another two centuries to figure out how to harness their power to reduce back pain. The Lumbar Wrap, created by Canadian inventor Lawrence Gordon of IR Wraps, resembles the black support belts worn by people who frequently lift heavy loads. The device uses low-level infrared energy -- the same type of heat used to warm food in restaurants -- to improve blood circulation and promote healing. In a small study in 2006, researchers at the Rothbart Pain Management Clinic in Ontario found that the Lumbar Wrap reduced painful symptoms by half. The 39 adults in the study, who had suffered lower back pain for more than six years, found relief with daily therapy over the course of seven weeks, and reported decreasing pain levels when turning and bending in different directions. Gordon invented the belt after hurting his own back while training horses, and says other back pain sufferers have felt better wearing the belt while sleeping or doing daily activities. One potential side effect: Prolonged use can cause a relatively harmless browning of the skin. And at $2,335, the Lumbar Wrap isn't cheap. Gordon is trying to get his invention approved as a medical device in Canada and the United States, in the hope that it will become more widely available, through doctors, chiropractors and pain clinics. The Magic Spine Wand Scientists estimate that about 7 million cases of lower back pain are caused by strain or injury to spinal disks, often striking weekend warriors who overdo it when exercising or tackling home improvement projects. In the past, treating disk-related pain involved physical therapy or epidural steroid injections to reduce inflammation. For serious cases of herniated, or "slipped," disks, patients resorted to surgery, despite the hazards of infection and no guarantee of a cure. While some patients will still need surgery, doctors have been developing less invasive methods to reduce painful disk pressure on adjacent nerve roots. One of the most advanced decompression techniques, percutaneous diskectomy, involves removing a small amount of tissue from the disk nucleus through a tiny puncture in the skin. Some compare it to releasing air from a bulging tire. Doctors can choose from several recently introduced probes. The Stryker Dekompressor scoops out disk material through a needle, creating a space that draws the disk back to its normal alignment. The ArthroCare SpineWand sends out an electrical charge that creates a highly focused plasma field to vaporize and extract tissue. With either instrument, the procedure lasts less than an hour, and patients can go home with only a small bandage over the needle insertion site. Best of all, at least two-thirds of appropriately selected patients experience positive results. "The relief is instantaneous," says Netsere Tesfayohannes, MD, director of the Interventional Pain Management Center at Georgetown University Hospital in Washington, D.C. "You know right away whether the treatment has worked." Flexible Fusion for Greater Movement Each year, some 200,000 Americans with degenerative disk disease undergo spinal fusion surgery. The procedure stabilizes the vertebrae with metal rods and screws to allow a bone graft to fuse the vertebrae together. It can provide dramatic and long-term relief. But there's a price. Spinal fusions limit a patient's range of motion and can require follow-up surgery to alleviate stress on the vertebrae adjacent to the fused area. But a new process called the Dynesys Dynamic Stabilization System uses bendable materials to provide support and greater movement. The system consists of flexible plastic tubing that surrounds a cord and spacers. During the surgery, doctors attach the device to both sides of the affected vertebrae. "The goal is to restore stability while preserving motion," says Reginald Davis, MD, head of neurosurgery at Greater Baltimore Medical Center, who's performed the surgery more than 200 times. "I've had success with patients from 21 to 75." The Dynesys system was approved for spinal fusion by the FDA in 2004, but in Europe, where the system has been on the market for a dozen years, it's most commonly used to provide flexible stabilization of the vertebrae without bone fusion. Dr. Davis has joined a study involving 400 U.S. patients to determine its effectiveness for this use. He hopes the study will show the system's ability to restore natural movement -- without the need for follow-up surgery. "In Europe," says Dr. Davis, "the new mantra for treating back pain is, Refuse to fuse." Stem Cells to the Rescue Many therapies for degenerative disks treat only the symptoms, not the cause of the back pain. But at England's University of Manchester, Stephen Richardson, MD, has proposed a radical and promising approach: using the patient's own stem cells to create a healthy back. Developed in conjunction with German biotechnology company Arthro Kinetics and an English medical charity called the Spinal Foundation, Dr. Richardson's therapy uses bone marrow cells to regenerate damaged intervertebral disks. Doctors would extract and mix the cells with a special gel that's based on a type of human collagen and then implant the substance during minimally invasive surgery. The stem cells should then produce new disk tissue with the same properties as the original, but without the damage. "It's completely safe because we're using the patient's own stem cells," says Dr. Richardson, who is a researcher in the University of Manchester School of Medicine's division of regenerative medicine. "The patient could go home the same day of the procedure." Researchers hope to start clinical trials after two years and bring a product to market within five years (though others think it will take longer). Dr. Richardson believes the stem cell technique "will revolutionize the treatment of lower back pain" by addressing both cause and symptoms with one therapy, rather than consigning sufferers to a lifetime of pain-killers and physiotherapy. "What we envision is a one-stop shop for treatment," he says. "You'd come in, get these cells implanted into your spine, and end up with regenerated new tissue. And that would be it, for life." Grow a New Backbone Many elderly people experience back pain from osteoporosis and serious bone fractures. But what if frail bones could grow stronger -- as strong as new bone? That's the idea behind site-directed bone growth (SDBG). A patient with diseased or damaged vertebrae undergoes a minimally invasive outpatient procedure and receives an anabolic drug to accelerate natural bone growth at precise locations. The strengthened bone, in turn, lessens the back pain. "The novel idea is to target new bone to specific sites," says Agnès Vignery, PhD, a professor of orthopedic surgery at Yale University Medical School who developed SDBG with clinicians at Unigene Laboratories in Fairfield, New Jersey. "Most drugs affect the whole body. But our treatment increases bone mass just where it's needed." Already, investigators have demonstrated success with SDBG in experiments involving mice and rats. In 2005 the Unigene team filed for patents, with plans to start clinical trials involving humans in the next two years. And though Vignery refuses to speculate how soon the therapy may be ready for people, she's excited about SDBG's potential to remedy a wide array of ailments. It's All in Your Bed If all else fails or involves too many needles for your liking, consider getting yourself a better bed. A study by researchers at Oklahoma State University found that simply getting rid of a worn-out mattress could significantly reduce back pain and stiffness. A scientific team led by Bert Jacobson, EdD, reports that people who suffered from back pain experienced relief by switching to a new mattress, and that the relief continued long after acquiring the new bed. "Most people treat their mattresses like a rented mule," observes Jacobson, head of the School of Educational Studies. "They'll sleep on a bed long after the support has given out. We found a positive relationship between a new mattress and lower back comfort." In the 2006 study, Jacobson's team examined 59 men and women of all ages for four weeks with their old mattress, and four more weeks with new ones. Then the researchers analyzed the participants' daily assessment of their back discomfort, spine stiffness, sleep comfort and sleep quality. The subjects reported improvements in each area when they'd slept on new, medium-firm mattresses. Those who entered the study reporting the highest levels of back pain experienced the greatest improvement. While it sounds like cheerleading from bedding companies -- and the study was partly sponsored by a trade group, the International Sleep Products Association -- Jacobson points out that the research was approved by a university review board and insists that the findings stand up to scrutiny. "Here's a possibility for relief without taking drugs, having surgery or getting manipulated," says Jacobson. "And all you need to do is trade in your old bed." That's the kind of painless treatment that anyone can take lying down.

A Letter to Normals from a Person With Chronic Pain
author UNKNOWN

Having chronic pain means many things change, and a lot of them are invisible. Unlike having cancer or being hurt in an accident, Most people do not understand even a little about chronic pain and its effects, and of those that think they know, many are actually misinformed. In the spirit of informing those who wish to understand: These are the things that I would like you to understand about me before you judge me. Please understand that being sick doesn't mean I'm not still a human being. I have to spend most of my day in considerable pain and exhaustion, and if you visit, some times I probably don't seem like much fun to be with, but I'm still me, stuck inside this body. I still worry about school, my family, my friends, and most of the time, I'd still like to hear you talk about yours, too. Please understand the difference between "happy" and "healthy". When you've got the flu, you probably feel miserable with it, but I've been sick for years. I can't be miserable all the time. In fact, I work hard at not being miserable. So, if you're talking to me and I sound happy, it means I'm happy. that's all. It doesn't mean that I'm not in a lot of pain, or extremely tired, or that I'm getting better, or any of those things. Please don't say, "Oh, you're sounding better!" or "But you look so healthy!" I am merely coping. I am sounding happy and trying to look normal. If you want to comment on that, you're welcome. Please understand that being able to stand up for ten minutes doesn't necessarily mean that I can stand up for twenty minutes, or an hour. Just because I managed to stand up for thirty minutes yesterday doesn't mean that I can do the same today. With a lot of diseases you're either paralyzed, or you can move. With this one, it gets more confusing everyday. It can be like a yo-yo. I never know from day to day, how I am going to feel when I wake up. In most cases, I never know from minute to minute. That is one of the hardest and most frustrating components of chronic pain. Please repeat the above paragraph substituting, "sitting", "walking", "thinking", "concentrating", "being sociable" and so on, it applies to everything. That's what chronic pain does to you. Please understand that chronic pain is variable. It's quite possible (for many, it's common) that one day I am able to walk to the park and back, while the next day I'll have trouble getting to the next room. Please don't attack me when I'm ill by saying, "But you did it before!" or "Oh, come on, I know you can do this!" If you want me to do something, then ask if I can. In a similar vein, I may need to cancel a previous commitment at the last minute. If this happens, please do not take it personally. If you are able, please try to always remember how very lucky you are, to be physically able to do all of the things that you can do. Please understand that "getting out and doing things" does not make me feel better, and can often make me seriously worse. You don't know what I go through or how I suffer in my own private time. Telling me that I need to exercise, or do some things to "get my mind off of it", may frustrate me to tears, and is not correct. If I was capable of doing some things any or all of the time, don't you know that I would? I am working with my doctors and I am doing what I am supposed to do. Another statement that hurts is, "You just need to push yourself more, try harder". Obviously, chronic pain can deal with the whole body, or be localized to specific areas. Sometimes participating in a single activity for a short or a long period of time can cause more damage and physical pain than you could ever imagine. Not to mention the recovery time, which can be intense. You can't always read it on my face or in my body language. Also, chronic pain may cause secondary depression (wouldn't you get depressed and down if you were hurting constantly for months or years?), but it is not created by depression. Please understand that if I say I have to sit down, lie down, stay in bed, or take these pills now, that probably means that I do have to do it right now! It can't be put off or forgotten just because I'm somewhere, or I'm right in the middle of doing something. Chronic pain does not forgive, nor does it wait for anyone. If you want to suggest a cure to me, please don't. It's not because I don't appreciate the thought, and it's not because I don't want to get well. Lord knows that isn't true. In all likelihood, if you've heard of it or tried it, so have I. In some cases, I have been made sicker, not better. This can involve side effects or allergic reactions, as is the case with herbal remedies. It also includes failure, which in and of itself can make me feel even lower. If there were something that cured, or even helped people with my form of chronic pain, then we'd know about it. There is worldwide networking (both on and off the Internet) between people with chronic pain. If something worked, we would KNOW. It's definitely not for lack of trying. If, after reading this, you still feel the need to suggest a cure, then so be it. I may take what you said and discuss it with my doctor. If I seem touchy, it's probably because I am. It's not how I try to be. As a matter of fact, I try very hard to be normal. I hope you will try to understand. I have been, and am still, going through a lot. Chronic pain is hard for you to understand unless you have had it. It wreaks havoc on the body and the mind. It is exhausting and exasperating. Almost all the time, I know that I am doing my best to cope with this, and live my life to the best of my ability. I ask you to bear with me, and accept me as I am. I know that you cannot literally understand my situation unless you have been in my shoes, but as much as is possible, I am asking you to try to be understanding in general. In many ways I depend on you, people who are not sick. I need you to visit me when I am too sick to go out. Sometimes I need you help me with the shopping, the cooking or the cleaning. I may need you to take me to the doctor, or to the store. You are my link to the "normalcy" of life. You can help me to keep in touch with the parts of life that I miss and fully intend to undertake again, just as soon as I am able. I know that I asked a lot from you, and I do thank you for listening. It really does mean a lot. ------------------------------------------ My Thanks to Jim for sharing this with me. Take it from another Chronic Pain Suffer, this is SO TRUE!!!!!! broken_gargoyle

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