The Health Blog

Let us look at the so-called ’store-front window of the pain supermarket’ to see the range of individual treatments, their advantages, disadvantages and factors which would prevent their use as well as their approximate costs and where these treatments can be obtained.

Take for example, Mary, 33, an ex-kindergarten sister, who had exhaustively sought relief for a chronic back pain problem.

‘Mismanagement by the medical profession has made my life miserable with unbearable pain for the past five years!’ was how she angrily described her problem.

Mary had a long history of lower back pain which had involved two operations in which the individual vertebrae or spinal bones were fused together. Despite the operations on her lower back she was dissatisfied about the continuing level of pain and how it was disrupting her life.

She also complained of severe pain in the neck and shoulders. Her misery was made complete by deterioration of the cartilage at the back of both kneecaps known as chondromalacia patellae.

When admitted to hospital, her pain symptoms were related to her long-term orthopaedic problems and what she described as ‘the lousy cards life’s dealt me’.

After her surgery things had gone spectacularly wrong, with numerous post-operative complications including wound infection. When her knees began to fail, she began swimming to relieve the-pain. But the swimming brought on a painful condition of both shoulders — ‘frozen shoulder’.

She was then re-admitted to hospital where she was told that her original fusion operation was a failure. The second fusion operation was carried out in an attempt to correct the pain in her lower back.

This was as unsuccessful as the first operation in relieving her pain and she was then referred to a psychiatrist. Shortly after this she became acutely suicidal with homicidal thoughts towards her child.

Mary was transferred from a private hospital to the in-patient pain programme with a three-month history of depressive symptoms including persistent lowering of mood, tearfulness, difficulty in getting to sleep, waking early, loss of energy, poor appetite, a weight loss of seven kilos and loss of interest in everything, including physical activity. She had also ‘frightened off her treating psychiatrists — so difficult was she to

manage. b

Initially, Mary was very prickly, with a caustic tongue, very difficult to manage and very defensive, suspicious and hostile towards doctors after her past experiences.

After her first week in the pain program she was still difficult but coming around to the viewpoint that she might as well try any last resort to climb out of the depths that she had fallen into due to her chronic pain experience.

The breakthrough for Mary came with one of the main features of the pain program — patients being given the opportunity to experience a number of different techniques including laser acupuncture.

Within the first few sessions she noticed an improvement in her pain levels. She reported that her pain was becoming more and more acceptable and within the four weeks of the pain program she had minimal levels of pain.

Now, instead of depressing everyone, Mary was a general inspiration for new in-patients. On discharge, she was having weekly treatment. After six months, she had progressed to having treatment monthly.

Today she has continued to improve. Her previous constant demands for pain medication and treatment became far less and her relationship with her husband and son are greatly improved.

She is still taking medication but it has fallen to controllable levels. She is very happy with the results of the treatment and has now gone back to being involved in a kindergarten part-time.

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Migraine headaches are classically described as ‘excruciating’. In many cases, these are thought to be an allergic reaction to some types of food such as citrus fruit, cheeses, peanuts and red wine.

Acute migraines are sometimes accompanied by nausea and double vision and are usually described as being ‘a high intensity, throbbing sensation’.

They are normally experienced on one side of the head, usually the same side during each attack. Some experience what is known as ‘prodromal symptoms’. That is, flashing lights, nausea and sometimes tingling in parts of the body before the beginning of the actual head pain.

Commonly these headaches last from one to several hours and respond to sleep and appropriate and early treatment.

Less common variants can last for up to several days at a time. In some sufferers the headache can be experienced on both sides of the head. The headache may be accompanied by severe disturbances of bodily sensation — numbness and tingling — and even paralysis.

Parts of the vision of the affected eye may be lost causing partial vision in the affected patient. In some the nausea can be extreme with nothing able to be held down.

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Knowledge gaps about pain sensation, and its severity, existed until only recently. To a large extent, this was because most of the research was done on experimental animals rather than on actual chronic pain patients. There was thus no deep understanding of the difference between acute and chronic pain. (See Chapter 3 for a more detailed explanation.) There was also an over emphasis on pain’s physical and mechanical causes based on the widespread, but wrong, assumption that pain is purely a sensory experience. The emotional and psychological factors involved in pain were relegated to secondary importance.

Different definitions

Even specialists from different fields of pain management and research define pain in different ways. A recent international conference of pain specialists provided a fascinating range of definitions of the word ‘pain’.

1. Neurophysiologists understand ‘pain’ as being the appropriate response of specific pathways within a nervous system.

2. To experimental psychologists ‘pain’ is a behaviourial response to a stimulus.

3. Neurologists understand that ‘pain’ means the patient has perceived just that experience.

4. Clinical psychologists believe that an individual may complain of pain whether or not a physiological stimulus is identified.

5. Psychiatrists understand that ‘pain’ means a patient is in distress, which is expressed as a disagreeable somatic (body) sensation.

6. Acupuncturists usually define ‘pain’ as a complaint of a disagreeable sensation. The word pain is used to describe a subjective perception of distress. It is not a simple sensation like a primary sensation. Accompanied by a greater emotional response than any of these, pain is complex and subject to individual interpretation.

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T he word pain comes from the Latin word poena or the French word peine. It is important to realise there are many different types of pain. For example:

Jill’s trigeminal neuralgia

Jill had trigeminal neuralgia a lightning-like pain in the face and mouth, which is so severe that it makes some sufferers feel as though they want to kill themselves. ‘My pain feels like someone is jabbing my face with a red-hot electric needle. The worst thing about the pain is that it’s so unpredictable. I never know what’s going to set it off— swallowing, laughing, or talking. Even the smallest thing can set it off. I try to stay home and go out as little as possible.’I don’t use make-up. I don’t wash my face. I don’t even brush my teeth. Sometimes I don’t have any pain for days.Then I find myself starting to worry about when it may start up again.’

Mary’s post-operative pain

‘After surgery to remove the gallstones, I felt miserable. The pain near the incision was sharp. It seemed to spread all over my body. The nurses gave me some pills which took the edge off the pain and by about three days after the operation, the pain was mostly gone.’

Rudl with terminal cancer

‘At first, I didn’t mind the thought of dying, so long as it wasn’t too painful. But, then I began to worry about all those drugs they were giving me. They were making me groggy and confused. I couldn’t think properly or even feel like I was alive. There were times when I didn’t take the pills because I wanted to be alert for whatever was left of my life.’

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