How to get Organized

	Michael Finley "Dealing with Chronic Pain" Reprinted from his "What Ails You?" columns for Twin Cities Business Monthly
		© 2003 by Michael Finley
	Daring to say the word pain Just saying the word pain is painful. The eyes frown, the forehead pinches, the mouth puffs open in a grimace and closes in a tiny moan of dismay. Ask people what’s the worst thing that can happen to them, and many will say pain before they say death. “Pain is usually one of three kinds,” said Jeffrey Rome, medical director of the comprehensive pain and rehabilitation center at the Mayo Clinic in Rochester and co-author of Mayo Clinic on Chronic Pain. “Acute pain is triggered by injury damage and generally does not last long. Cancer pain stems from tumors pressing on nerves or impinging bloodflow, or arises from cancer treatment. And chronic or benign pain is persistent pain that may not have an apparent cause, and thus defies definitive treatment.” Chronic pain can occur almost anywhere, and under any number of guises: arthritis, lower back pain and sciatica and other kinds of bone and joint pain, peripheral neuropathy, intestinal cystitis, pelvic floor pain, repetitive stress injuries, irritable bowel syndrome, persistent headache and fibromyalgia. Ordinary chronic pain like everyday arthritis is a hassle, but endurable. Chronic pain syndrome (CPS) is when your pain incapacitates you on a daily basis, and presents serious obstacles to ordinary living. Accordingly to a 1999 National Pain Survey, 48 million Americans suffer from chronic nonmalignant pain. That’s one in five Americans, many trudging daily off to work where we are expected to put our best face forward and smile, smile, smile. For the complete report, click on CLICK TO PAY “The lord of mankind” The ancients described pain variously as a substance, a fire or a spirit that moved around inside us. The Bible tells of a pain-ameliorating sponge lifted up to Jesus on the cross. In the Middle Ages, doctors discovered opium, laudanum, and morphine. In the 1600s Rene Descartes presciently depicted the dynamic of as “the pulling of a thread.” In 1897, aspirin was first concocted from willow bark. But by the 1950s, Albert Schweitzer still termed pain "the most terrible of all the lords of mankind." It was still not until the 1960s that scientists learned that the body produces its own natural painkillers, called endorphins. This discovery allowed doctors to reverse-map a biology of pain, delineating the neural pathways fanning out through the body like an upside-down tree, and conduct messages of sensation to the brain. Pain is sensed at the outlying “leaves” of the tree, the countless pain receptors at the tips of peripheral nerve cells; but it is interpreted and felt in the “taproot” of the thalamus. “We used to think the nervous system was immutable, that you could never go back once something changed” said Miles Belgrade, clinical associate professor in the U of MN's Department of Neurology in the Medical School and medical director of Fairview Pain Management Center. “We know now that’s not true.” A vocabulary of distress One problem with pain is that we don’t feel it all the same, so our vocabulary for it is subjective, like our vocabulary for colors. There is no way to be certain what I mean by green is the same thing you mean by it. Likewise, we rely on various scales to calibrate how much pain a person is in. Doctors use 1-10 scales, descriptor scales (“Is your pain aching, burning, stabbing, or throbbing?”), even picture scales like this, for children to describe their pain level: Probably the worst aspect of chronic pain is that it distorts behavior. People in pain become angry and depressed, irritable and self-destructive. They cycle through more emotions in a day than most of us do in a week. Being in pain wears you down and, unless you are able to establish a psychic beachhead against it, it trashes your sense of self, and the way others see you. “There are some worse things than pain,” said Belgrade. “The loss of a child, the loss of function, the experience of deep depression.” But when you’re hurting that’s not easy to hear. Patients do best who have an internal locus of control, meaning their worldview is that they are a player in their own lives, as opposed to an external locus of control, which is the view that one is at the mercy of uncontrollable forces. It’s not much fun being a pain doctor either. “Chronic pain is not curable, and doctors are frustrated with that,” Belgrade said. The best providers are compassionate but able to “switch it off” when they need to, to sleep at night. The paradox of narcotics It would be easy if doctors could just dispense narcotics and kill the pain. They routinely prescribe narcotics for people with acute pain, like terminal cancer, but they are loath to turn patients with decades of life ahead of them into addicts. “Some 30 percent of our pain patients deviate from protocol by misusing medication,” said one doctor. “This is not to say they are all addicts. Often the problem is poor impulse control brought on by the discomfort. But the problem is real.” A few doctors are inching toward the possibility that narcotics can be a part of someone’s life long-term. A Saint Paul-based pain clinic has had to fend off accusations it is over-medicating patients. But there is strong clinical evidence that narcotics can be helpful with chronic pain without resulting in addiction, if prescribed and monitored on a careful, case-by-base basis. But this is terrain providers are reluctant to tiptoe onto. No one wants to turn patients into drug addicts or arouse unwelcome attention. Even where there is no arrest and no evidence of physician wrongdoing, investigations send a chill through the medical community. Pain in the workplace What can you do for colleagues and employees with chronic pain? First, be sensitive to it. People in pain want desperately to maintain ordinary lives. Employers can help by being understanding about medical appointments, and occasional time off. Second, work to eliminate pain in the workplace. Ergonomic chairs and desks, frequent stand-up/sit-down breaks, an environment that will not drive people who are hurting insane. Third, according to physician assistant and psychologist Jay Tracy at Chronic Pain Program at Sister Kenny Institute at Abbott Northwestern Hospital in Minneapolis, and author of a new book, Pain: It’s Not All In Your Head (Trafford, 2003), have a heart. “The person in pain wants to get back to work more than you can imagine,” Tracy says. “People with chronic pain syndrome tend to be very hard workers, who have taken care of others. Now they’re hurting. We should be very slow to judge them.” Finally, refer employees to pain specialists. “Oftentimes, people with back pain see a spinal surgeon, discover surgery can’t help, and they think they have nowhere to go,” says David Schultz, medical director for the Twin Cities network of Medical Advanced Pain Specialists (MAPS) clinics. Pain treatment has come a long way just in the last five years. About half of all patients are able to resume “being themselves, more or less,” Schultz said The other half undergo, if they wish, intensive residential training in how to live with pain and maintain a positive attitude. Until a breakthrough continues, the people in pain stagger on. Friends and colleagues never understand the daily struggle. But as people in support groups ruefully remind one another: Living in pain means being stronger than everyone else. How to live with pain Accept the fact of your pain Set specific goals of work, hobbies and social activities towards which you will work Let yourself get angry at your pain if it seems to be getting the best of you Pace your activities Get in shape, and keep fit Learn to relax, and practice it Time your medications, then taper off them Have family and friends support only your healthy behavior, not your invalidism Be open and reasonable with your doctor Adapted from a pamphlet by Richard Sternbach, “How Can I Learn to Live With Pain When It Hurts So Much?,” Michael Finley