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Proper pain management can and should be provided

By ETHEL M. SHARP

© St. Petersburg Times,
published June 26, 2001


Have you ever walked down the aisle of a drugstore and observed the array of pain relievers? All the over-the-counter drugs, plus the many prescribed drugs, point to the fact that pain -- to one degree or another -- affects all of us.

If there is comfort in numbers, we should all be glad to know that when it comes to pain, we're not alone, no matter how old we are. About 50 percent of our country's population seek treatment each year for pain. To my dismay, I became one of them.

I thought I would be among the least likely to be vulnerable -- working out three times a week and walking two miles every other day -- but my lower back was vulnerable in an accident and I emerged with a herniated disc, two bulging discs and constant pain for nine months. I found out back pain is a national health concern, with an estimated 30-million people suffering from it. Nearly 9-million new cases are reported each year of people seeking treatment for lower back pain.

I thought I knew all about pain and know many who suffer with all kinds and levels of pain, but knowing and living with ongoing pain is unique -- it puts you in touch on a new level with what another person is going through.

Many of you who give spouse and parent care, as well as older people who live alone or those in hospitals, skilled-nursing or assisted-living facilities, experience relentless and overwhelming pain from a number of sources: the symptoms associated with many diseases such as arthritis, osteoporosis or cancer, to name a few, or it could be from accidents, surgery, chemotherapy, any number of disabilities, plus all kinds of medical interventions and invasions. Others suffer from mental anguish, caregiver exhaustion, emotional fatigue, ongoing grief and depression.

Unfortunately, few physicians are well-trained or skilled in pain management, which is a reflection on our medical schools. Some people think age means we have to live with pain. Many older people don't report it to their doctor because they think it is normal. Proper pain management can and should be provided to us.

As caregivers or retirees, we need to emphasize to our physicians that our pain needs attention -- we're not just complaining -- and we want proper pain management. We must be listened to, believed and taken seriously. We also must be assured that proper pain treatment will be provided even at the very end of life.

Don and Bev Clifford talked to me about their shared experience of pain. Don injured his leg in World War II and had four surgeries over the years.

"I have neuropathic pain, and they call it RSD -- Reflex Sympathetic Dystrophy -- or nerve damage. There's no cure. Just to have something touch me was unbearable. Over the years I have gone for all the therapies and to a pain clinic. The pain medications made me a little goofy, but I tried to be upbeat and have a smile on my face. I wanted to go out often just to take my mind off it. I had pain 24 hours a day. No one knows how you feel. I even thought about suicide."

As with family caregivers, Bev was under pressure. "I felt helpless. There's nothing you can do. This past year I also had surgery for cancer."

Pain is a complex, damaging process and needs to be addressed for itself and not necessarily in association with an injury or disease. It's easier to prevent than to treat. I know from experience that it's difficult to sit, stand, walk; you lose your appetite. It robs you of your energy and concentration and creates enormous stress -- you have to work at focusing. Chronic pain is persistent and can last weeks, months or years.

As Don put it, "I couldn't be independent anymore. It interfered with sleep, and I lost interest in hobbies and everything. I was depressed. I started to go to group therapy out at the VA hospital, and tried to talk and think positive."

Our pain message to ourselves and our attitude do have great impact on our ability to tolerate pain and the way we handle it. Understanding pain helps us to control it. Our memory of past pain, the general state of our outlook and stress level, personal upbringing, cultural attitude, spirituality, age, fears and anxiety all have impact on our personal pain. A positive emotional state can work for us to help diminish negative pain messages.

Numerous medical studies and research point to the fact that when positive surgical preparation and suggestions are given to patients, there is decreased blood loss during surgery, less post-op pain, a faster return of appetite and functions, and a shorter hospital stay, which means an economical benefit. Effective pain management means medication, attitude and other therapies. With coordinated pain rehabilitation, the breaking of the pain cycle can begin.

I didn't want to undergo surgery if it could be avoided, even though the pain limited my every movement. In my quest for relief from pain, I elected to go instead for alternative medicine in hopes that it would promote a natural healing process. I opted to go to a colleague of mine, Jeanne Bangtson, a chiropractic physician who advised individualized, aggressive treatment.

Pain can be measured, so I first had to fill out questionnaires on my pain plus a pain-rating scale, along with selecting words that best described my pain. Over the months I proceeded to see the medical doctor, the chiropractor, have massage therapy, ultrasound, interferential probe, traction and acupuncture. Finally, after many months, I arrived at the point where I was healed enough to start a walking program, which I'm still building. There is improvement every day. Next is water aerobics, and full exercise is on the horizon. Even though this pain experience was overwhelming at times, I have met many people who endure unrelenting pain every day who are looking for relief.

Don Clifford expressed it best: "I was desperate when my daughter, Sue, invited me to a prayer meeting. This gave me a great deal of comfort, and eventually I went to a healing Mass where the priest and some other people prayed over me. I felt a warmth come over me, and I felt very much at peace. That was November 1999, and I have had no chronic pain since. I still have problems, but no ongoing pain."

Hundreds of studies published in mainstream medical journals show that people who attend religious services, pray and read Scripture heal faster and cope better with chronic pain and illness; are less prone to depression, suicide, alcoholism and other addictions; have lower rates of cancer, heart disease and other major illnesses; recover better from surgery and sickness; and live longer. Almost 85 percent of Americans believe in the healing power of prayer.

To believe that health of mind, body and spirit are linked -- that our faith can promote mental and physical wellness -- is powerfully significant. It becomes even more significant when the rewards of active religious beliefs are recognized by science.

Science now is finding evidence that suggests belief in God and practiced religious faith have a positive effect on health and well-being of mind and body.

There are some principles that we need to keep in mind for quality pain management:

Obtain a quality assessment of your pain. Have a physical exam and go over a good comprehensive history about your degree of pain.

Have specialized tests done. There are imaging techniques such as X-rays, computerized tomography (CT scan), magnetic resonance imaging (MRI), bone scans and ultrasound that will help pinpoint the problem.

Know that it is possible to diminish the suffering that is relentless with pain. Easing emotional pain eases physical pain. Discuss troubled relationships and spiritual questions.

Achieve the best balance between comfort and pain by trying deep breathing and relaxation response. Take deep belly breaths -- those deep enough to cause your abdomen, rather than your chest, to rise and fall. Concentrate and fill the deepest part of your lungs with oxygen. This will affect your heart rate, blood pressure, anxiety level. Just taking a few deep belly breaths stops your involuntary response to stress and pain.

Relaxation response is when you take at least 20 minutes, remove all distractions, lie flat, put a pillow under your head, remain still, focus your thoughts on the present moment, imagine every muscle in your body is becoming relaxed and free of tension and stress, go limp and concentrate on deep breathing. At the end of 20 minutes, feel your relaxation. Repeat as needed.

There is always a severe setback with pain, and with pain is created a sense of vulnerability. If you're vulnerable, you can empathize more clearly with others' suffering.

Remember, caregivers, make the present moment count!

- Ethel M. Sharp is executive director of Aging Matters Inc., a non-profit network for family caregivers and elder care. You can write to her c/o Seniority, the St. Petersburg Times, P.O. Box 1121, St. Petersburg, FL 33731. When seeking more information, please enclose a stamped, self-addressed envelope and include your telephone number, with area code.

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