Poppy's Chronic Pain Forum Archives
Page Three
Page Three
- Is It All In Your Head?
- It Hurts So Badly - Repetitive Stress Injury
- Tumeric
Is It All In Your Head?
Yes, but that doesn't make the pain any less real
Pussy Bompensiero is a mob hit man with a back problem. There's nothing medically wrong with the fictional character on HBO's "The Sopranos," but the stress of his job is murder on his back.
Pussy may be fictional but his ailments aren't. Tens of millions of Americans are suffering from rashes, headaches, sour stomachs, back pain, panic attacks and other conditions for which doctors have no explanation.
More and more often, physicians are laying down their stethoscopes and uttering words guaranteed to make any patient recoil in shock and fear: "There's nothing medically wrong with you."
It's a polite way of saying, "It's all in your head." But if there's no physical explanation for a backache, does that mean it isn't real? Most physicians would agree that pain with no discernible source is real, but they couldn't begin to tell you why. And they can't begin to tell you how much they wish you'd bother someone else with the problem. In the absence of a medical diagnosis, you're a "pussy" in the eyes of physicians.
Hypochondriacs are ruining it all for us neurotics. Hypochondriacs believe they have illnesses they don't have. The rest of us don't believe we "have" anything, but we still suffer with mysterious pains, rashes, fatigue, hyperventilation and other ailments.
So is your pain real? In the immortal words of President Clinton, it depends on what your definition of "is" is. If by real you mean something you can point to like a broken bone, then, no, it isn't real. If by real you mean something you can't point to but can see the effects of, like a broken heart, then, yes, it is real.
Defining the reality of pain is a little like defining the existence of a supreme being. If it can't be observed or measured, does it still exist? "Absolutely," says Dr. Caroline Carney Doebbeling, board certified in both psychiatry and internal medicine at the University of Iowa. "Pain without an identified source is very real. Science just hasn't advanced to the point it can tell us where it's coming from."
"Psychosomatic" used to be the umbrella term for pain without medical origin. It's Latin for "nuts, but insured." Doctors pretty much took a patronizing attitude toward their well-insured but kooky clients. But as "psychosomatic" cases increased geometrically over the past few years, a lot of medical cynics had to stop rolling their eyes and pay attention. For instance, irritable bowel syndrome (IBS), a common disorder of the intestines with no known cause, now makes up 12 percent of all primary care visits (and a whopping 50 percent of all referrals to gastroenterologists), according to Dr. Richard Gervitz, professor at the California School of Professional Psychology in San Francisco. IBS is marked by crampy pain, gassiness, bloating, constipation and its snotty-nosed twin sister, diarrhea. About 40 million people have been diagnosed with the syndrome.
There is no medical origin for IBS, yet its physical effects can easily be measured. With colonoscopy (using long, thin, flexible tubes containing a tiny, lighted video camera to look inside the colon) gastroenterologists often see "spastic" colons in IBS sufferers. If the pain is all in their minds, then why are their colons flipping like mackerels on the deck of a boat?
Gervitz is at the forefront of research proving connections between mind and body. The word "psychosomatic," loaded as it is with the baggage of the imagined, has been replaced with "psychophysiological." Psychophysiology tracks the physiology of psychologically induced pain. By hooking up IBS sufferers to sensitive instrumentation, for example, researchers have shown how the brain signals the stomach to stop digesting food and assume a fight-or-flight readiness, explaining why digestion is just another word for toilet among those with the syndrome.
The data is in: You're not crazy. You really are having that headache; Pussy really is experiencing that back pain. Research has proved beyond question that measurable physiological activities take place during unexplained pain. That headache for which your doctor can't determine the physical source? It produces the same kind of muscle tension, blood pressure and oxygenation as headaches that do have physical sources.
According to Dr. David Sobel, a primary care physician with Kaiser Permanente and author of the highly respected Mind-Body Health Newsletter, only 16 percent of people who visit their physician for common maladies like nausea, headache and stomach upset are diagnosed with a physical, organic cause. The rest are classified as having a somatic disorder, the expression of bodily symptoms when you're under psychological distress -- or, as Sobel puts it, "the body speaking its mind."
And when the body speaks, it curses. You can wash out its mouth with soap, but it simply doesn't respond to direct commands. You didn't will the rash onto your body when your spouse left you; you can't will it away. This is perhaps the most frustrating part about the mind-body connection, and what Sobel sees as the danger of simplifying the relationship. "It's not true that if you simply think better thoughts your pain will go away," he says. "It's far more complex than that. There is lots of evidence that a positive state of mind increases the chance for healing, but it doesn't guarantee it."
Psychophysiological treatment doesn't necessarily involve learning how to think good thoughts. It's more about learning how to control largely involuntary processes like heart rate, blood pressure and muscle tension. The preferred method is biofeedback, in which patients are hooked up to devices that pick up electrical signals from the muscles, triggering a flashing light every time they tense up. To relax tense muscles, the patients have to slow down the flashing light. By associating sensations from the muscle with actual levels of tension, they learn to undo detrimental physiological effects.
Not only can our minds make our bodies sick, our bodies are more than willing to return the favor. Doebbeling, at the University of Iowa, believes the mind and the body are so intertwined that it's hard to tell which one has the wheel of the car. The only certainty is that whoever's in control has one hell of a back-seat driver.
Take a patient who comes in with symptoms of depression. Does she have a psychiatric disorder with medical symptoms or a medical disorder with psychiatric symptoms? Doebbeling doesn't know until she does a medical work-up. The classic symptoms of depression are fatigue, an inability to concentrate for very long, sleeping too much or too little and constant rumination. But guess what? Those are the same symptoms of hypothyroidism. "Thyroid hormones serve a homeostatic function," says Doebbeling, "regulating body temperature, energy levels, alertness and cognition."
In other words, your body is just as apt to make you depressed as your mind -- and not just because you don't like what you see in the mirror.
Doebbeling approaches psychophysiology like a snake handler, respectful of the beast's existence but fearful of its ability to mislead. "I support psychophysiology," she says. "It's contributed a lot to our understanding of pain. But I think there's a tendency to relabel unpalatable conditions. It's a lot more socially acceptable to say you have chronic fatigue syndrome than major depression."
Doebbeling sees three pegs in the mind-body connection: mental health, physical health and psychosocial health (which includes everything we do as social beings with our job, family and friends). Each influences the other. For example, a female patient came to Doebbeling complaining of a mysterious stomach ailment. After an expensive battery of tests proved there was nothing medically wrong with the woman, Doebbeling found a "psychosocial" explanation: Her husband was beating her.
Somatic disorders like Pussy's backache or the battered woman's stomach disorder are forcing the medical industry to pay more attention to the mind-body connection. "Twenty percent of the patients are eating up 80 percent of the medical costs," says Gervitz, who predicts "mind-body specialists" will eventually be ubiquitous in physician offices and -- surprise! -- covered by HMOs. "Managed care is getting eaten alive by the expensive tests that are being run on patients with somatic disorders," he says.
There aren't any records of people dying from somatic disorders, but there's plenty of evidence that they die from asinine treatments. "Death from hepatic failures in IBS sufferers isn't that rare," says Doebbeling. "The pain and discomfort can be so unbearable that some ... gravitate to dangerous treatments like massive vitamin dosages that overwhelm their livers."
Gervitz reports that the medical community has become much more open to psychophysiological research and treatment. "I was always condescended to by physicians," he said. "It was always, 'Sure, give me your card, I'll call you.' Now it's, 'Here, have a seat -- can I get you some coffee?"
The medical community is just beginning to understand how our thoughts, feelings and behaviors affect us physically. There are more and more challenges to Western medicine's insistence on treating physical health separately from mental health. In the future people will no longer ask, "Is it all in my head?" because the answer is, No, it isn't all in your head. It just starts there.
It Hurts So Badly - Repetitive Stress Injury
- - Jennifer Sullivan - -
I had just started wearing an attractive pair of beige velcro splints on my forearms to combat repetitive strain injury (RSI) when I learned of the ironic existence of Sorehand an e-mail discussion list on which typing victims type out tales of typing-induced misery.
I was new to the world of "cumulative trauma disorder," an umbrella term for a condition where muscles and tendons in the upper body -- the neck, shoulders, chest, arms, wrists and hands -- can become strained, irritated or pinched. And like many keyboard junkies diagnosed with RSI, my doctor said my traumatized limbs also showed signs of early carpal tunnel, a constriction of the nerve as it passes through the wrist.
As an online news reporter, my title could just as easily have been "thinking typist." I was terrified that the excruciating pain in my shoulders and wrists would end my career, not to mention my life; sometimes I couldn't even use a fork without a jolt of agony ricocheting up my arm.
But no one seemed to have a solution. My employer, like thousands of Net companies, handed out photocopied line drawings of rigidly proper typing postures that would help us avoid RSI -- but once I had it, they didn't have much advice. Doctors suggested everything from massage to glucosamine sulfate, a seashell derivative sometimes used to treat arthritis, to crying more (release the tension, you know) -- none of which soothed the stabbing pain. Soon, I was taking time off work, learning voice recognition software and asking strangers to open my Odwalla bottles to avoid the wrist pain.
Around 1.8 million workers each year experience musculoskeletal disorders, according to the Labour Department's Occupational Safety and Health Administration (OSHA); but those numbers are from 1997, eons ago in Internet time. And the category includes a ton of back problems, says Gary Orr, ergonomist at OSHA. Orr counted 250,000 cases of "repeated trauma," which includes the sound and vibration-induced. Of that there are 90,000 cases that involved time off from work. Carpal tunnel sucks away the most workdays -- 25 on average -- even more than amputations and fractures. The government doesn't have great records on how many of those injuries are related to computer use; many employers don't report the cause of injury or even the occupation of the injured worker, says Orr.
But OSHA is getting more serious about RSI. In November it proposed a national ergonomic standard - basically a guideline for properly aligning workstations to workers -- that it says will each year spare 300,000 workers from injuries and save the U.S. economy $9 billion.
This is music to the ears of the folks on Sorehand, many of whom not only commiserate about pain management, but are actively working to increase awareness of RSI. Since the summer of 1998, a group of about 100 people who originally met on Sorehand have been preparing for International RSI Awareness Day. Under the slogan "Because work shouldn't hurt!" organizers in cities stretching from Brazil to Canada and from Spain to New Zealand chose Feb. 29 -- the only nonregular day of the year -- to speak to local legislators and hold panel discussions and press conferences about RSI.
"It began with a desire to increase awareness about this injury," says International RSI Awareness Day chairwoman Catherine Fenech, who runs an RSI support group in Toronto and describes herself as an "injured worker activist." She got tendinitis working on a cash register that was too high for her and now has a permanent disability. "I want to keep people from making the same mistakes I made," she says.
I didn't turn to Sorehand for activism, but for comfort and, of course, that miracle cure that had to be out there. On the list I found 800 people from around the world who have been conversing since 1994 about possible remedies. About a dozen people a day post suggestions and questions: Would a foot mouse solve the problem? What about rolfing? Or arnica gel under the tongue? Giving up driving?
But between the hopeful healing aids and worker's comp advice, there are disquieting posts about lost jobs, two-pencil typing, multiple failed surgeries, toxic levels of supposedly helpful herbal supplements and people who can't even comb their hair. It terrified me. Would this be my future?
A Sorehand member, who asked not to be identified, recalls a four-month period in which he "worked 10- to 12-hour days for six and seven days per week" learning a software product for which he was writing technical training materials. "The stress was intense," he says, and enough to bring on a life-changing repetitive strain injury. "I don't work in technology at all anymore," he says now. He limits his time online to less than an hour a day and uses the phone instead of e-mail whenever he can. "I received retraining in sales," he adds. "I'm looking for a job in the ergonomics and workplace wellness industry."
Deanna McHugh, a programmer at the University of California at San Francisco who maintains the list, somehow remains upbeat. Even though there is a steady stream of newcomers detailing their deteriorating conditions, she says, "Every time there's a success story on list, I get hope."
Reading through the posts, it's clear that not all repetitive strain injuries and carpal tunnel cases are caused by computer use; a wide range of assembly-line workers, cashiers, stock clerks, cooks and teachers are affected. Injuries can even be caused by sports, playing instruments or recreational Net surfing, says Dr. Robert Markison, a hand surgeon and RSI guru at the University of California at San Francisco. "Greater than 61 percent of work-related injuries appear to be upper limb strain. A high percentage of that -- we don't know how high -- is from computing," says Markison. "[But] not all of it is work-related strain. People have made nonessential computing a growing part of their life with the Internet."
Markison thinks the more recent surge in RSI and carpal tunnel cases is at least "partly brought on by our undue fascination with the computer interface ... We are the blind consumers of ill-fitting goods," he says. Today's visual-centric computers require a head-forward user position, which Markison says might be OK for a pig -- but humans aren't built to handle that posture for extended periods of time. He argues that designers of everything from PCs to PDAs to cell phones should have to study human anatomy, and that just as clothes come in different sizes, and glasses come in different prescriptions, technology devices should be fitted by body type.
But while Markison points a finger at product designers, some folks on Sorehand point right back at Markison's medical community. Fenech, the RSI support group leader, says even when she was diagnosed with tendinitis, her doctor didn't explain that it could take years to heal, so she thought it was fine to work part-time. "I thought you had to be completely disabled to get workman's comp," she says.
Like a lot of my injured comrades, I found that my doctors weren't sure what to do. My pain had spread from my shoulders and neck down to my fingertips, while doctors prescribed all the usual treatments: physical therapy, anti-inflammatory drugs, acupuncture, massage, meditation and voice recognition software. I kept a "pain diary," recording the stabs and twinges between visits to the doctor, but no patterns emerged. (Some days when I didn't type I hurt more than on days when I did.) Then I took three months off my job as a Web site reporter.
Eventually, I stopped reading the Sorehand posts -- they were just depressing me more. I figured, like many suffering this malady, that I should renegotiate my relationship with technology. Do I have to e-mail when I can call? Do I need to work 10-hour days? Am I ever really too busy to take a two-minute break? Maybe, I thought, what we need is a cultural shift.
Neurologist Frank R. Wilson, author of "The Hand: How Its Use Shapes the Brain, Language, and Human Culture," says he visited a workplace where designers use computer-aided design (CAD) systems and were experiencing RSI problems. "They were young, talented, educated, motivated, healthy and physically active, vigilant and self-critical, etc. What was wrong?" he wrote via e-mail. "My answer: eaten up by the machine; complete loss of autonomy. They weren't artists and designers any more; as far as the company was concerned, they were computer operators. Death."
According to OSHA, fewer than 30 percent of general industry employers have effective ergonomics programs in place. The new standard proposed by the Clinton administration in November would make employers more responsible for ergonomics and training, but nothing will become final before the end of the year.
Will proper ergonomics prevent injuries like mine? "People get injured on ergonomically correct instruments all the time," says Dennis Ettare, a biofeedback practitioner at Biofeedback Associates of California, who eventually set me on the path to recovery. Ettare and others criticize typing alternatives like voice recognition software or a foot mouse, which he says can become just another device that triggers pain, and even cause repetitive strain-like symptoms in the voice or feet.
Ettare, who has treated patients from almost every major Silicon Valley company, thinks that ergonomics are only a sliver of the problem. He says that the speed of computers and the demands of the workplace are as responsible for many people's chronic pain as bad posture.
"We are overwhelmed by multitasking and the fact that we are now the slowest link among our tools," he says. Once you hit "enter," most computers are ready for more. There is almost no processing time between tasks, and that is something that can be "misinterpreted by the brain," says Ettare. "It assumes the worker is in danger" and the sympathetic nervous system starts firing impulses into their muscle spindles telling the diligent worker's body to get away, while they remain desk-bound.
I had heard about Ettare from other RSI sufferers at several dot-com parties, and thought I should give him a try. I sat in a chair in his office as he strapped a fanny pack around my waist that burst with wires leading to electrodes; these he attached to my neck, shoulders, arms, hands and back. I felt like a character out of a bad cyberpunk novel as the fanny pack transmitted signals to a computer, which showed live graphs of the amount of tension in my muscles. Of course, my tension level was off the charts.
Using his "muscle learning therapy," a technique based on biofeedback, he retrained me to sit, type, write and walk using only those muscles necessary to do the job. I started feeling better and soon I posted my own hopeful pain reliever to Sorehand -- but no one responded.
Deborah Quilter, author of the "Repetitive Strain Injury Recovery Book," cautioned that she has seen patients like me get better temporarily, but "as time goes on, more and more things start going wrong ... I'm not sure there's a universal method that will work for everybody."
I've left my keyboard-pounding job for part-time work, while I heal and incorporate Ettare's method into my work. And I'm careful: I never type more than half the day. I wear a bag around my waist instead of my shoulder. I hired a housecleaner and stopped cooking. And, of course, I still swap tips with RSI veterans, about difficulties shaking hands, or opening jars. And though I'm slowly getting better, I certainly haven't found a miracle transformation back to full-time, pain-free typing.
Mine is a largely open-ended story -- and one that is undoubtedly similar to many that Fenech and the organizers of International RSI Awareness Day will broadcast around the world on Tuesday. It's crazy to think of all these pained typists e-mailing plans back and forth -- but maybe their efforts will educate a few people and perhaps even spare some from RSI.
"I wish that someone had told me [what I was risking], when I was 12 years old and sprawled across an overstuffed chair, typing on a too-small keyboard for hours on end," says another RSI victim wanting anonymity. She had hand surgery on both her wrists last year. "I make it a point, now, to educate people I see with bad typing habits. I honestly hope that someday soon, the study of proper ergonomics is included in middle school and high school health curricula; I'm nearly positive, and my doctor agrees, that it was the bad habits reinforced over so many years that caused such a terrible case of RSI so early in life."
- - - - - - - - - - - -
About the writer:
Jennifer Sullivan is a consultant to the Electronic Frontier Foundation and a freelance writer
TUMERIC/TURMERIC
Tumeric is a mild aromatic stimulant. Its chief use is in the manufacture of curry powders. It is also used as an adulterant of mustard and a substitute for it. Tincture of Turmeric is used as a colouring agent. It dyes a rich yellow.
Part used and where grown:
The vast majority of tumeric comes from India. Tumeric is one of the key ingredients in many curries, giving them colour and flavour. The root and rhizome (underground stem) are used medicinally.
Historical or traditional use:
In Ayurvedic medicine (the traditional medicine of India) many different species similar to tumeric are used. It was prescribed for treatment of many conditions, including poor vision, rheumatic pains, coughs, and to increase milk production. Native peoples of the Pacific sprinkled the dust on their shoulders during ceremonial dances, as well as using it for numerous medical problems ranging from constipation to skin diseases. It was used for numerous intestinal infections and ailments in Southeast Asia.
Active constituents:
The active constituent is known as curcumin. It has been shown to have a wide range of therapeutic effects. First, it protects against free radical damage because it is a strong antioxidant. Second, it reduces inflammation. It accomplishes this by reducing histamine levels and possibly by increasing production of natural cortisone by the adrenal glands. Third, it protects the liver from a number of toxic compounds. Fourth, it has been shown to reduce platelets from clumping together, which in turn improves circulation and helps protect against atherosclerosis. There are also numerous studies showing a cancer-preventing effect of curcumin. This may be due to its powerful antioxidant activity in the body.
Tumeric was once a cure for jaundice. Doctors are now using tumeric "curcumin" for inflammatory conditions:
arthritis, osteoarthritis, acute infections.
Also for health conditions caused by free radical damage:
cardiovascular problems, arterial damage, heart disease, and others. Tumeric is also used in the treatment of certain cancers.
Many studies have shown the antioxidant, anti-inflammatory, and anti-cancer powers of curcuminoids in the herb tumeric. In a double-blind test, people with rheumatoid arthritis who received curcumin benefited equally to people who took the drug phyenylbutazone (popular prescription drug which can have side effects). In another study, 10 people received 500 mg of curcumin every day for a week had a measurable lowering of free radicals in their body. Still other medical studies have shown that curcumin with its curcuminoids can block the growth of cancer cells. Tumeric / curcumin has been used in Ayurvedic medicine for centuries.
How much should I take?
Many people take 400 mg of curcumin three times per day in capsules or tablets.
Tincture can be used in the amount of 0.5-1.5 ml, three times per day.
Tumeric as a spice can also be incorporated into the diet as a way to promote health.
Are there any side effects or interactions?
Tumeric is extremely safe. It has been used in large quantities as a food with no adverse reactions.
Uses of Tumeric:
¥ arthritis, osteo-arthritis, rheumatoid arthritis
¥ atherosclerosis
¥ bursitis
¥ high cholesterol
¥ digestive problems
¥ liver protection
¥ heart disease
¥ obesity
¥ inflammation
People who should avoid taking tumeric:
¥ people with childbearing / fertility problems
¥ people with blood clotting problems
¥ people taking anti-coagulant medication
¥ people with symptoms of gallstones should avoid tumeric
Tumeric is also known as:
Curcumin, Curcuma longa, Indian saffron, Saffron, Curcuminoids
Link: ¥ Turmeric ¥