Poppy's Chronic Pain Forum Archives

Poppy's Chronic Pain Forum Archives



This is a place for articles that may require reading more than once.




Poppy's Chronic Pain Forum


"I can't give solutions to all of life's problems, doubts, or fears.
But I can listen to you, and together we will search for answers.

I can't change your past or the future with its untold stories.
But I can be there now when you need me to care.

I can't keep your feet from stumbling.
I can only offer my hand that you may grasp it and not fall.

Your joys, triumphs, successes, and happiness are not mine.
Yet, I can share in your laughter.

I can't keep your heart from breaking or hurting.
But I can cry with you and help you pick up the pieces and put them back in place.

I can't tell you who you are.
I can only love you and be your friend."



What is Pain?


 Pain is a sensation that hurts. It may cause discomfort, distress or agony. It may be steady or throbbing. It may be stabbing, aching, or pinching. However you feel pain, only you can describe it or define it. Because pain is so individual, your pain cannot be "checked out" by anyone else. Pain may be acute or chronic. Acute pain is severe and lasts a relatively short time. It is usually a signal that body tissue is being injured in some way, and the pain generally disappears when the injury heals. Chronic pain may range from mild to severe, and it is present to some degree for long periods of time.

What Do I Tell Those Caring For Me About My Pain?

If you are feeling pain, you need to be able to describe it to those who are trained to help you. Some people find pain very hard to explain. Try to use words that will help others understand what you are feeling. Your doctor and others who are caring for you need to know:
  • Where do you feel your pain?
  • When did it begin?
  • What does it feel like? Sharp? Dull? Throbbing?Steady?
  • How bad is it?
  • Does it prevent you from doing your daily activities? Which ones?
  • What relieves your pain?
  • What makes it worse?
  • What have you tried for pain relief? What helped?
  • What did not help?
  • What have you done in the past to relieve other kinds of pain?
  • Is your pain constant? If not, how many times a day (or week) does it occur?
  • How long does it last each time?

Pain has different effects on different people. Be sure that those who are caring for you know about the effects. Don?t hesitate to talk about your pain to those who can help you. You have a right to the best pain control you can get. Relieving your pain means you can continue to do the everyday things that are important to you. Remember, only you know what you are feeling.

Some of the Effects of Pain

Symptoms accompanying your pain:
nausea, headache, dizziness, weakness, drowsiness, constipation, diarrhea, perspiration
Emotional effects:
depression, crying, mood swings, irritability, suicidal feelings
Lifestyle changes:
work, recreation, interpersonal relationships, ability to get around, self-care activities

How Can I Describe How Bad or Intense the Pain Is?

Understanding how bad your pain is helps your doctor decide how to treat it. You can rate how much pain you are feeling by using a pain scale like the one below. Try to assign a number from 0 to 5 to your pain level. If you have no pain, use a 0. A 5 means the pain is as bad as it can be. As the numbers get larger, they stand for pain that is gradually getting worse. You may wish to make up your own pain scale using numbers from 0 to 10 or even 0 to 100. Be sure to let others know what pain scale you are using: for example, "My pain is a 7 on a scale of 0 to 10" You can use a rating scale to answer:
  • How bad is your pain at its worst?
  • How bad is your pain most of the time?
  • How bad is your pain at its least?
  • How does your pain change with treatment?

How Can I Remember All the Details About the Pain I Have, and What I Do To Relieve It?

You may find it helpful to keep a record or a diary about your pain and what you try for pain relief. The record helps you and those who are caring for you understand more about your pain, the effects it has on you, and what works best to ease your pain. Items that should be included are:

  • The number from your rating scale that describes your pain before and after using a pain-relief measure.
  • The time you take pain medicine. Any activity that seems to be affected by the pain or that increases or decreases the pain.
  • Any activity that you cannot do because of the pain.
  • The name of the pain medicine you take and the dose.
  • How long the pain medicine works.
  • Any pain relief methods other than medicine you use such as rest, relaxation techniques, distraction, skin stimulation, or imagery.

Can Anxiety Or Depression Cause Pain?

No, but these feelings can make the pain seem worse. People often have an emotional reaction to pain. You may feel worried, depressed, or easily discouraged when you are in pain. Some people feel hopeless or helpless. Others feel alone or embarrassed, inadequate or angry, frightened or frantic. People with pain have many reasons for feeling anxious or depressed even when they are not in pain. Try to talk about your feelings with your doctors, family members, friends, a member of the clergy, or other people who have chronic pain. Talking with family members is often helpful, even though this might be hard for you to do at first. Just understanding that others feel the same way as you do might help you deal with your pain.

If you feel that these informal ways to lessen your anxiety or depression are not helpful, you may wish to talk with a counselor, a mental health professional who is skilled at dealing with such problems. The social services department at your local hospital is another source of information about people who can help you deal with anxiety and depression. Another option is to ask your doctor about medication. Sometimes, medicine such as antidepressants or tranquilizers can be helpful. Some of these medicines relieve pain in addition to their antidepressant effects.

How Does Fatigue Affect My Pain?

Fatigue can make it harder for you to deal with pain. When you are tired, you may not be able to cope with the pain as well as when you are rested. Many people notice that pain seems to get worse as they get tired. Lack of sleep can increase your pain. Be sure to tell your doctor if you have not been sleeping well because of pain or worry.

How Is Pain Treated?

When treating pain, the doctor will usually try to treat the cause of the pain first. There are several ways to relieve pain:
With medicine, also called ''pharmacological pain relief."
You should ask your doctor or pharmacist for advice before you take any medicine for pain. Medicines are safe when they are used properly. You can buy some effective pain relievers without a prescription. For others, a prescription from your doctor is necessary. Without medicine, sometimes called "noninvasive measures." These usually have very few side effects, and they can be combined with medicines. Methods may include skin stimulation and techniques such as distraction, relaxation, and imagery.
Nerve blocks, or "neurological pain relief."
Blocking the pain messages that are sent by nerves to the brain (with surgery or injection of local anesthetic into the nerve) can sometimes be used when nothing else works to relieve pain.

There is no one best way to relieve pain, but something usually can be found to help every patient.

Are There Any General Guidelines for Relieving Pain?

It is important to try to prevent the pain before it starts or gets worse by using some pain-relief method on a regular schedule. If pain begins, don't wait for it to get worse before doing something about it. Learn which methods of pain relief work best for you. Vary and combine pain relief methods. For instance, you might use a relaxation method at the same time you take medicine for the pain. Know yourself and what you can do. Often when people are rested and alert, they can use a method that demands attention and energy. When tired, they may need to use a method that requires less effort. For example, try distraction when you are rested and alert; use hot or cold packs when you are tired. Be open-minded and keep trying. You may find that some things that sound as if they could not possibly work, might be helpful. Be willing to try different methods. Keep a record of what makes you feel better and what doesn't help. Try each method more than once. If it doesn't work the first time, try it a few more times before you give up. Keep in mind that what doesn't work one day may work the next. Also, you might need help in figuring out the best way to use a certain technique. But don't get discouraged if a certain method does not work for you. People are different, and not all the methods will work for everyone. Most importantly, always ask yourself: Which is more bothersome - the pain or the method of making it go away? Does pain relief allow me to do what is important to me and those I care about?





People in Pain Rarely Become Addicted When Narcotics Work Well


Properly prescribed narcotic drugs rarely give patients a high, just relief from pain.

*****By Randy Stearns, ABCNews.com*****


Chronic pain *the kind that lasts more than 30 days* takes an enormous physical and emotional toll. As many as 130 million Americans deal daily with moderate to severe pain, due to illnesses such as cancer, serious injuries and conditions like migraine headaches. Many of these people worry about the risks of taking narcotic drugs to relieve their pain. In our "just say no" culture, even patients in debilitating physical distress sometimes feel they shouldn't take strong drugs because they might become addicted. And many doctors resist prescribing narcotics like morphine because they see patients as addicts waiting to happen.

Indeed, narcotics are powerful medicine. These analgesic drugs, which are derived from opium or produced synthetically, are designed to alter a patient's perception of pain. In some people, narcotics produce euphoria, mood changes, confusion or deep sleep, in addition to pain relief. And repeated use of narcotics does sometimes lead to physical dependence. If the dosage is suddenly reduced or curtailed, the patient may experience unpleasant physical reactions. To avoid withdrawal symptoms, physicians recommend gradually reducing narcotic medication, to allow the body time to adjust to chemical changes. A small number of patients may become psychologically addicted to narcotic drugs and require further therapy to end their dependence.

Genuine addiction is rare. In most cases, however, the benefits of pain relief from narcotics far outweigh the risk of addiction. "Very few people truly develop addictions," says Dr. Lloyd Saberski, director of the Yale University Center for Pain Management. For patients with no history of substance abuse, the risk is very small: Recent studies have shown that fewer than one-half of 1 percent of such patients become addicted to their painkillers. When prescribed appropriately by doctors who know how to use them, Saberski says, narcotics are both safe and effective.

Nevertheless, even patients with terminal conditions may refuse to take drugs that could give them a more comfortable, normal life. Fear of addiction, Saberski believes, "is more a sociological than a medical concern." Despite clinical studies and patient testimonials, many physicians worry that writing a prescription for narcotics will expose them to lawsuits or sanctions from government regulators. Instead they prefer to prescribe less-powerful painkillers, which patients assume are absolutely safe. In fact, says Saberski, narcotics may be safer for treating chronic pain than commonly prescribed or over-the-counter analgesics, such as the nonsteroidal anti-inflammatory drugs (NSAIDs). When taken regularly over long periods, NSAIDs can cause permanent damage to the liver and kidneys.

U.S. Drug Enforcement Administration Classifications for Controlled Substances

Schedule I Substances:
Medical use and have high abuse potential.

*Heroin, marijuana, LSD, peyote and mescaline.

Schedule II Substances:
Drugs with high potential for abuse and severe psychic or physical dependence liability includes: certain narcotic drugs and drugs containing amphetamines or methamphetamines.

*Opium, morphine, Dilaudid, methadone, Demerol, cocaine, Percodan, Preludin, Ritalin, Amobarbital, Pentobarbital, Secobarbital

Schedule III Substances:
Drugs with lower abuse potential includes: compounds containing limited quantities of narcotic and non-narcotic drugs.

*Doriden, Noludar, Chlorhexadol, Phencyclidine, Sulfondiethylmethane, Sulfonmethane, Nalorphine, Benzphetamine

Schedule IV Substances:
Drugs with still lower the potential for abuse.

*Barbital, Phenobarbital, Methylphenobarbital, Beta Chlor, Chloral Hydrate, Placidyl, Valmid, Equanil, Paraldehyde, Petrichloral, Methohexital

Schedule V Substances:
Drugs with the lowest potential for abuse includes: over-the-counter preparations containing moderate, limited quantities of narcotics, generally for antitussive and antidiarrheal purposes. These drugs do not require a prescription.

"Never doubt that a small group of thoughtful, committed citizens can change the world; indeed it's the only thing that ever has." ---Margaret Meade



Skepticism About Pain Only Adds To It


*****By Dr. Gabor Mate*****

One of the fundamental psychological needs of human beings, ranking second only to the need to be loved, is the need to be listened to, heard and acknowledged. Obversely, there are few experiences as embittering as having others deny the truth of one's narrative.

Nowhere is this more true than for chronic pain sufferers. Many thousands of them are faced with the skepticism of people with power over their lives such as insurance administrators and medical doctors.

I have seen adults with chronic pain - men and women - burst into tears as they recount stories of being disbelieved by insurance adjustors, worker's compensation board adjudicators and doctors.

Beyond the psychological trauma such disbelief inflicts, I consider it a major contributor to the maintenance, and sometimes even the causation, of chronic pain.

It's understandable that insurance employees would do their best to prevent fraudulent claims from succeeding. But the vast majority of chronic pain histories contain no element of conscious falsification. The very hint of it is deeply wounding and strongly reinforces the physical pain/emotional pain/physical pain cycle.

I believe insuring agencies would be rewarded with substantial savings in the long term if they educated their employees more thoroughly about chronic pain.

On the part of medical doctors, the suspicion and fear is of drug-seeking behaviour. This is coupled with an impression, wholly erroneous, that the administration of potent analgesic medications of the morphine type, generally known as opioids, would lead many patients to addiction.

As to the first concern, a knowledgeable physician should have little difficulty identifying all but a tiny number of drug seekers. Most chronic pain patients begin by turning first to their family doctor, who knows them, is familiar with their medical history and therefore is not likely to be duped. Also, drug seekers have known characteristices that are fairly easily recognized.

The second concern, the fear of narcotic addiction when opioids are given for pain control, is based on old information, now discredited. Medical evidence has shown over and over again that opioids prescribed for pain, even for long periods, don't lead to addiction except in a tiny minority who generally have had previous substance abuse problems.

In one study of more than 2,300 patients given opioid therapy for severe headaches, only three met the criteria for addiction. In another report, a recent review of thousands of patients revealed only three or four cases of addictive behaviour and, again, only in individuals with histories of addiction.

As a Canadian pain specialist stated recently, "the world literature shows that the incidence of addiction is infinitesimally small." He bluntly called the overblown concerns about addiction "paranoia."

While narcotics are no panacea and should be only a small part of any treatment plan, their appropriate administration can do much to help chronic pain sufferers regain balance and function in their lives. I have been giving one such patient, a parapalegic with a cycstic growth in his spine, high doses of morphine for years. Without this, he cannnot even get out of bed. With the morphine he is able to get around in his wheelchair and engage in other activities. His dose of the narcotic has needed only minor adjustments.

My advice to chronic pain sufferers, inadequate as it may be, is to do the research, find the authoritative journal articles on opioid use in chronic pain, and pass such information on to your family doctor. With this, as with many other conditions, it is up to the patient to educate the doctor.

Dr. Gabor Mate is a Canadian general practitioner living in Vancouver, British Columbia.






Mitral Valve Prolapse



Causes and Risks:

Mitral valve prolapse (MVP) is one cause of mitral regurgitation (leakage of blood from insufficient valve closure). It occurs in about 2 out of 1,000 people overall. (It affects about 5 to 7% of women between 14 and 30 years old). Mitral valve prolapse is a common syndrome with a wide range of symptoms. Some forms of MVP seem to be hereditary.

Common Symptoms:

  • Chest pain
  • Fatigue
  • Palpitations, extra heart beat
  • Lightheadedness, dizziness
  • Shortness of breath
  • Anxiety and/or panic attacks
  • Headaches
  • Low exercise tolerance
  • Mood swings

Chest Pain

The chest pain associated with MVP presents itself in many ways. The pain may be brief in duration, or persist for hours. People describe the pain as sharp, heavy, shooting, sticking, or as pressure. At times it can be incapacitating, occurring repeatedly. Often the chest pain is atypical of angina pain caused by narrowing or constriction in the coronary arteries. Sometimes, however, the pain mimics angina. Many MVPers believe chest pains signal a heart attack. MVPS is not known to cause a heart attack. In general, severe narrowing and blockage of a coronary artery that supplies an area of heart muscle with blood causes a heart attack. This may lead to permanent damage of a portion of the heart muscle. MVPS neither narrows nor blocks coronary arteries, nor causes permanent damage to the heart muscle. You ask, "How can I be sure the chest pain is not from coronary artery disease?" The answer to this relates to your original diagnosis. To first determine if heart disease is present, your physician considers your cardiovascular risk factors such as: age, sex, family history, blood lipid profile, smoking history, as well as your symptoms and results of diagnostic testing. Periodically, he follows up with testing such as an exercise stress test to reassure you the chest pain is not caused by coronary artery disease.

Fatigue

Fatigue is usually present to some degree. It may be episodic and severe, or relatively constant. Usually fatigue begets more fatigue the less you do, the less you feel like doing. The cause of the fatigue may relate to blood volume changes noted with exercise, to a high resting heart rate, or to other physiological factors to be discussed shortly.

Palpitations, Extra Heart Beats, Forceful Heart Beat, Pounding Heart, Heart Flutter

People describe palpitations extra beats as a pounding sensation in their chest. Others say they feel a flipflop or fluttering. Arrhythmias disturbances in the heart rhythm such as atrial extra beats (PACs), or premature ventricular extra systoles (PVCs) can cause palpitations. While some people feel each beat, others do not notice them. Often, after extra beats, people have a sensation that their heart stopped for a few seconds. Skipped or extra beats are very common among MVPers and the general public. Sometimes they occur following the use of caffeine, alcohol, tobacco, or certain medications. Other times, emotional stress may cause extra beats. Sometimes they happen for no apparent reason. In any case, these beats are relatively common, and should not be a cause for alarm. An explanation of the heart's electrical system may help to understand extra beats.

Lightheadedness, Dizziness

Lightheadedness, dizziness, or both can occur when first standing up. This feeling is usually associated with a sensation of a forceful heart beat or palpitations. These symptoms may be related to decreased intravascular volume and metabolic neuroendocrine abnormalities.

Shortness of Breath

This is usually described as the inability to take in a deep breath. It may occur at rest or with activity. The shortness of breath has not been found to be related to cardiac heart, or pulmonary lung abnormalities.

Anxiety and/or Panic Attacks

Although the relationship is not clear, many MVPers suffer from anxiety or panic attacks. The symptoms described are more consistent with panic disorder, the anxiety disorder studied most often in MVP patients. People have recurrent, spontaneous anxiety attacks that consist of various combinations of symptoms similar to some MVPS symptoms. These symptoms include:

fatigue, fainting, dizziness, chest pain, lightheadedness, rapid heartbeat, heart palpitations, and shortness of breath. The degree and mechanism of association between MVPS and anxiety disorders remains unclear. While some believe the symptoms cause anxiety attacks, others believe extraneous factors trigger attacks. They may occur anywhere, at anytime, even in the middle of the night. Whenever anxiety attacks do occur, they are frightening.

Headaches

Headaches sometimes occur in the form of migraines and are accompanied by nausea and blurred vision. Some people describe their headaches as nagging or dull.

Other Symptoms

MVPers report other symptoms. Common ones include:

  • chronically cold hands and feet
  • gastrointestinal stomach disturbances
  • problems with memory or a feeling of fogginess
  • inability to concentrate
  • mood swings
  • problems sleeping
  • numbness or tingling of the arms or legs
  • arm, back, or shoulder discomfort
  • difficulty swallowing
  • lump in the throat

Frequently, these symptoms are frightening, discomforting, frustrating, annoying and incapacitating. Certainly, they affect one's life style. Expect symptoms to be more intense during emotional stress, when you are overly tired, after unaccustomed physical activities, during menopause, or during menstruation. It is not unusual for the symptoms to disappear spontaneously for months--even years and reappear again.

The following table lists factors that increase the intensity or frequency of MVPS symptoms. Data collected at the Mitral Valve Prolapse Program of Cincinnati (MVPPC), along with responses to the questionnaire in the first edition of Taking Control were used to compile the list.

Factors that can increase the intensity or frequency of MVP symptoms:

  • Emotional stress
  • Excessive fatigue
  • Unaccustomed physical activity
  • Being anxious or nervous
  • Caffeine
  • Medicines with stimulants
  • Sweets
  • Being in a hot, dry environment
  • Dehydration
  • Flu, cold, or other illnesses
  • Lack of sleep
  • Alcohol
  • Smoking
  • Skipping meals
  • Rushing around
  • Lying on the left or right side
  • Menses
  • Menopause

Symptoms begin at any age. Most people, however, notice symptoms between the ages of 20 to 30. The exact cause likely relates to several factors and remains unclear. Often, MVPers who have been without symptoms, become symptomatic after an illness, injury, pregnancy, or emotional stress such as a divorce. While symptoms occur more in females, many also occur in male MVPers. Frequently, chest pain, palpitations, fatigue or anxiety attacks initially prompt them to seek medical help. Many people with MVPS believe the more symptoms they have, the more severe is the prolapse buckling back of the valve. This is not the case. In the mitral valve prolapse syndrome, there is no correlation between the degree of prolapse and the severity of the symptoms.




Poppy's Chronic Pain Forum


Email: poppyschronicpainforum@yahoo.com