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Strategy stresses transition from patient to person
There are many reasons for chronic pain. It can be the result of an injury that never healed properly or caused by a health problem such as arthritis, lupus, or migraine headaches.
According to the Baltimore-based American Pain Foundation, one in six U.S. adults suffer from arthritis, and two-thirds of American adults will have back pain during their lifetime. More than 25 million suffer from migraines. As a result of pain, one in three adults lose more than 20 hours of sleep each month, and lost workdays account for more than $50 million a year.
Although acute pain, which can be controlled by medications, surgery, or treatment, and has a beginning and an end, chronic pain is ongoing. Most people who have headaches take an aspirin and it goes away. Imagine having a headache that never leaves and you must live with it the rest of your life, says Penney Cowan, founder and executive director of the American Chronic Pain Association in Rocklin, CA.
If a person does not experience pain relief three to six months after an injury, it is highly unlikely they will ever experience full pain relief, says B. Eliot Cole, MD, MPA, the administrator for the national pain databank of the American Academy of Pain Management in Sonora, CA.
Patient acceptance key to recovery
The person with chronic pain must accept some of the responsibility for their own recovery and maintaining their wellness, says Cowan. "That magical pill that will take all the pain away doesn’t exist. People have to learn with the help of the medical community and the best medical care possible to find a means that they can actually live with the chronic pain and that is possible," she says. Cole agrees. People with chronic pain must learn to cope, function, and manage their pain, he says.
If chronic pain is left unmanaged, the person experiencing the symptoms slowly deteriorates. Often they withdraw, isolate themselves, and just give up. "There are a number of people with chronic pain who feel that life is not worth living," says Cowan.
Pain and suffering go hand and hand. Suffering can lead to desperation, despair, depression, and suicidal thinking. Also, chronic pain can interfere with activities of daily living. People become physically weakened from doing nothing and are unable to shop for groceries or cook a meal, says Cole.
People who experience chronic pain need to be thoroughly evaluated by a medical professional so that they know that the cause of the pain is not life-threatening and won’t bring immediate harm, says Cowan.
Medical evaluation helps to uncover a means of managing the pain whether through medications or another technique — such as yoga — that can lower the pain intensity and improve the performance of activities of daily living, says Cole. "The therapies would depend on what kind of pain the person is experiencing. The diagnosis is critical. You first have to pin down why someone is hurting. The underlying pain problem would determine the therapy," he explains. For example, stretching techniques such as yoga, Tai Chi, or swimming would help with muscle spasms and muscle tightness and help to keep people limber.
Get patients involved
To gain pain management skills, it’s best to attend a multidisciplinary pain management program; however, such programs are difficult to find and can be expensive, says Cowan. "To be a part of the treatment team and assume some responsibilities for patients’ wellness, people need to learn certain skills, and that is where a good multidisciplinary team management program comes in," she explains.
When a pain management program is not available, the person can work with a physician, physical therapist, and people knowledgeable about complementary therapies to devise a management plan.
Pain management skills might include eating a nutritious diet and exercising to maintain optimum overall health, reducing everyday stress, recognizing emotions that will cause pain flare-ups and dealing with them in a timely manner, and learning skills such as biofeedback.
Patients experiencing pain need to be accurate observers of their condition, and as best they can communicate what they experience to the health care provider, says Cole. This includes learning the descriptive vocabulary for pain so they can describe it with terms such as tingling, stabbing, prickling, or burning. They also need to learn to rate the intensity on a pain scale and notice the correlation between what they are doing and their pain level over a 24-hour cycle. "If there is going to be a change in the treatment, it can reflect what is clinically going on," explains Cole.
However, when pain is chronic, it’s important for a person to accept the pain once he or she has been thoroughly evaluated by the medical community. "When pain is chronic, people must move from the patient role and become a person again," says Cowan. The role of patient brings with it the expectation that someone is going to take care of them and fix them, she explains.
Cowan went through a pain management program 21 years ago and still applies the basic skills she learned in the program, along with many other techniques garnered through daily living in order to remain a person rather than a patient. When pain is intense, she has found that certain relaxation skills help redirect her thoughts to something she can control rather than the pain in her body.
For example, during biofeedback sessions she learned a breath relaxation technique in which she imagines air filling her lungs. She visualizes it entering her body as soft, puffy clouds going into her lungs. During this visualization process, she cannot think about her pain because people have a one-track mind, says Cowan. "The technique allows my muscles to relax a little bit; and as we relax, our muscles’ blood flow is restored and the pain can quite often be reduced. That is one of the skills I use," she says.
To help chronic pain sufferers become per- sons not patients, Cowan founded the American Chronic Pain Association which provides training for support group facilitators and offers workbooks that teach coping skills that the groups use. Ongoing support is important, she says, because people have difficulty following an appropriate preventive strategy, even after participating in a chronic pain management program. (For more information on this support program, see box, p. 27.)
For example, participants know if they don’t do their stretching exercise every day, the muscles will lose the tone they worked so hard to achieve. Or, if they ignore signs of stress, the pain will become so intense it will be difficult to gain control, yet it is difficult to stay disciplined. "What individuals need is that continuing positive reinforcement," says Cowan.
When people are told to live with chronic pain it feels like the end of the world, yet they can control certain aspects of pain control, such as their stress levels. Although people with chronic pain have no control over certain things that may increase the pain, such as changes in the weather, they can control how they will respond to them, says Cowan. n
For more information on teaching people to manage chronic pain, contact:
• B. Eliot Cole, MD, MPA, Administrator, National Pain Databank, American Academy of Pain Management, 13947 Mono Way #A, Sonora, CA 95370. Telephone: (209) 533-9744. Fax: (209) 533-9750. Web: www.aapainmanage.org.
• Penney Cowan, Founder and Executive Director, American Chronic Pain Association, P.O. Box 850, Rocklin, CA 95677-0900. Telephone: (916) 632-0922. Fax: (916) 632-3208. Web: www.theacpa.org. The first year membership in the association is $30 and includes a 200-page workbook titled From Patient to Person, a quarterly newsletter, and a 10% discount on other materials. For an additional $7, people can purchase the facilitator guide, which gives them information on how to get a support group started.
The following organizations also can provide information on chronic pain management:
• American Academy of Pain Medicine, 4700 W. Lake, Glenview, IL 60025. Telephone: (847) 375-4731. Fax: (847) 375-6331. Web: www.painmed.org.
• The American Pain Foundation, 111 S. Calvert St., Suite 2700, Baltimore, MD 21202. Telephone: (410) 444-9200. Web: www.painfoundation.org.
• The American Pain Society, 4700 W. Lake Ave., Glenview, IL 60025. (847) 375-4715. Fax: (877) 734-8758 (Toll free). Web: www.ampainsoc.org.