Persistant Pain

Here is an article from Pennlive.com

Persistent pain? Find help in traditional and nontraditional treatments
by SANDY ECKERT for Body & Mind
Wednesday March 04, 2009, 8:00 AM
Cynthia is always in pain.

She can be so stoic that many people don't know she suffers from chronic pain. It's obvious only on the infrequent days she uses her stylish cane. But close friends can tell when Cynthia's pain worsens. It's the way she moves or the slight grimace she tries hard to wipe off her face or when she says, "I need a little rest."

She is stoic because she doesn't want anyone to exclude her from an activity thinking that she can't do it. And people who say, "How are you?" don't really want to hear about her pain, Cynthia said. "They just can't relate to it."

Cynthia is one of about 61 million Americans who suffer from chronic pain, which can result from hundreds of disorders, including arthritis, back pain, cancer, headaches of any type, burns, muscle spasms, shingles, phantom pain from a missing limb and fibromyalgia.

"Pain that persists like this is a disease," said Ted Kosenske M.D., a pain specialist at Cumberland Valley Pain Management in Carlisle. "I think the nervous system gets rewired, and I think fibromyalgia is a type of chronic pain involving a brain disorder. With treatment the average chronic pain patient gets about a 22 percent improvement."

Nora Porter, M.D., uses guided imagery for pain in her Chambersburg practice. To relax a patient Porter asks her or him to focus on a well-liked place, say the beach. Once a patient is comfortable, Porter has him or her visualize an image of the pain. "If you can get an image -- can say it's like a wire with sparks coming out -- we can ask what can stop sparks. Maybe an insulator or duct tape," Porter said. In demanding intense focus, guided imagery is similar to meditation, hypnosis and biofeedback, Ostrov said.

Hypnotism puts people in a trance that "allows access to parts of the mind that aren't available consciously, and that allows for healing that doesn't happen without a trance," said George Hunter, a York psychologist and hypnotist. Hypnosis helps people move their focus from the pain.

Acupuncture, hypnosis and other complementary treatments, like chiropractic, electric nerve stimulation and hydrotherapy work for some people, just as certain drugs work for some people, Ostrov said.

Harrisburg acupuncturist Becky Thoroughgood said, "Western medicine is familiar with acupuncture as a pain treatment. It is a holistic method based on the premise that people have meridians that carry vital energy, called qi [chi], which can be blocked for physical or emotional reasons. Acupuncture gets to the underlying cause, so it would work after the needles are out."

Cynthia was diagnosed with fibromyalgia and osteoarthritis 10 years ago, after experiencing chronic pain and fatigue. The persistent pain in her low back, knees and right hip sometimes spikes and can keep her in bed for as much as a week. "There was no precipitating event to cause the pain," Cynthia said. "So my family doctor hospitalized me at Mechanicsburg rehabilitation hospital HealthSouth Rehabilitation of Mechanicsburg, where I received prednisone treatments and a good education on how to work around my limitations."

The front-loading washer and dryer in her basement are set on risers to make them high enough for Cynthia, and she must put the laundry basket on a chair because she can't bend to the floor to get clothes from the basket. She folds laundry on a table that adjusts to counter height.

Barbara Ostrov, a rheumatologist at Pennsylvania State University Hershey Medical Center, now manages Cynthia's pain. "Most common is back and musculoskeletal pain, and most of that is due to osteoarthritis, a wearing down of cartilage and the growth of bone spurs that try to heal the cartilage loss. About 50 percent of those between 50 and 60 years old have it, and the number goes up with age. "The American College of Rheumatology's standardized treatment is
weight loss and being active with muscles and joints," Ostrov said.

After taking glucosamine for three or four months Cynthia's knee started clicking, and she quit. Her current osteoarthritis medicines include a prescription non-steroidal anti-inflammatory medicine called Rheumatol, and Tramadol, pain medicine. Over-the counter nonsteroidals include Aleve and aspirin, Kosenske said. For Cynthia's fibromyalgia, she takes Flexeril, a muscle relaxant, and the sleep medicine nortriptyline because the lack of sleep and pain are related. Another aid is a lidocaine pain patch, but Cynthia doesn't use them continually because a three-month supply costs $1,600.

In keeping with Ostrov's recommendations, Cynthia has lost weight and is active. She did yoga now and then for a couple years, but a month ago "it put me in a pain that I never had before, except after surgery," she said. "Now, I do gentle stress exercises." Tai chi has given way to more knee pain, but she takes short walks -- and remembers when she couldn't walk from one end of the Harrisburg Mall to the middle. Reflexology, acupuncture, biofeedback, meditation, guided imagery, hypnotherapy, hydrotherapy are among several complementary, or alternative, treatments for chronic pain.

Cynthia finds that a monthly reflexology treatment helps control her arthritis inflammation. "And when I do it regularly, meditation helps," she said. "I believe in a strong mind-body connection. If I get my mind in a good space, my body does pretty well."

Tips for receiving alternative, or complementary, care:

• Find a complementary-care doctor by talking with your family physician about the treatment you'd like to try and asking for a recommendation.

• Make a list of practitioners and their credentials, certifications and licenses.

• Find out the treatment's cost and see if your health insurance covers it.

• Make a list of questions to ask the first time you see the complementary care doctor. (Do the treatment benefits outweigh the risks?)

• Give the doctor your health history, including any prescriptions and supplements you take.

• After the first visit, decide if you want to go ahead with treatment and with the practitioner.

Source: National Center for Complementary and Alternative Medicine, Mayo Clinic Guide to Alternative Medicine

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