Pain is universal. This can be traced from the first toothache evidence in fossil remains of a human jawbone to today's pharmacies packed with a huge spectrum of over-the-counter medications. Millions of people seek treatment for pain every year. In Pain Management Solutions, author Debra S. Cole explores issues related to different types of pain and offers a visionary five-stage approach to pain management. Cole provides a holistic process to help patients address pain issues due to injury or medical conditions. A comprehensive tool, Pain Management Solutions addresses current pain treatments and considers the various stages of the process of dealing with pain: The crisis stage of pain The fix-it stage The management stage The rebuilding stage The resolution stage Presented in a complete and easy-to-understand manner, Cole offers strategies for coping with pain to help patients rebuild their lives. This guide provides hope and inspiration for anyone who struggles with both physical and emotional pain.

PAIN MANAGEMENT SOLUTIONS

MANAGING PAIN IN STAGESBy Debra S. Cole

iUniverse, Inc.

Copyright © 2012 Debra S. Cole
All right reserved.
ISBN: 978-1-4759-4617-8

Contents

Acknowledgments.....................................................viiAdvance Praise for Pain Management Solutions........................ixPreface.............................................................xiIntroduction A Brief History of Pain Management.....................1Chapter One Current Pain Treatments.................................9Chapter Two Crisis Stage of Pain....................................23Chapter Three The Fix-It Stage......................................41Chapter Four The Management Stage...................................61Chapter Five The Rebuilding Stage...................................87Chapter Six The Resolution Stage....................................103Summary.............................................................111Resources...........................................................113Sources.............................................................117

Chapter One

Current Pain Treatments

Pain- we all feel it in one way or another throughout our lifetime. As much as we try to avoid getting hurt it is inevitable. From something simple such as stubbing a toe to a major life altering event, pain is very much a part of life.

Pain is the human body's way of alerting us that something is not correct either physically, physiologically, emotionally, or a combination of these. Humans have survival instincts that include innate mechanisms by which we learn to avoid potentially dangerous situations. In many cases pain is a protective device. For example, while chopping up onions, the knife starts to cut your finger and the pain that is immediately felt tells you to stop chopping. A pinched nerve in the back is a common complaint that many people experience and too often they will simply live with the pain and carry on without investigating. Meanwhile, pain can also be an indicator that an infection has occurred in the body such as an abscess in the leg (that can cause acute pain). It may even be a telltale sign in a person who has undergone back surgery at some point that something has changed. If there is pain, there is a reason, even if the reason is the misfiring of pain receptors that can produce pain sensations without an actual cause.

There is a common scale used to measure pain, a 0-10 scale with 10 being excruciating pain. When an individual's pain level is measured as being 5, this is considered as becoming disruptive to the person's life. In the case of chronic pain, decreasing the pain level down to the 1-5 range makes it manageable, and therefore is the goal.

The body truly is a magnificent biological machine as it produces natural pain killers such as norepinephrine and serotonin; both are opioid-like chemicals. Serotonin is a monoamine neurotransmitter that is synthesized within the neurons of the central nervous system (CNS) as well as in the cells of the intestinal walls. Norepinephrine is a catecholamine (chemical compounds emanated from amino acid tyrosine) and plays the role of both a hormone and a neurotransmitter. This basically is a precursor of adrenaline (epinephrine), which is secreted by the adrenal medulla. Epinephrine, in conjunction with norepinephrine, forms the basis of emotional and physical responses to stress. (http:// healthknowledge.wetpaint.com/pages/Depression)

Unfortunately, for many people, pain can be exceedingly underhanded. No longer is it a warning mechanism, it becomes persistent and increasingly a torment that impedes an individual's quality of life. This is the situation for 116 million Americans according to a 2011 report by the Institute of Medicine of the National Academies (IMNC). On June 29, 2011, the IMNC released "Relieving pain in America: A Blueprint for the Transforming Prevention, Care, Education, and Research." In this report, it discusses how chronic pain is costing the United States up to $635 billion every year. Pain affects more Americans than cancer, heart disease and diabetes combined. (The full report can be read at the following link: http://books.nap.edu/openbook. php?record_id=13172&page=21.)

According to the American Academy of Pain Medicine's website, http://www.painmed.org/Workforce/DownloadAsset. aspx?id=3372, there are four common types of pain:

• Low back pain (27 percent)

• Severe headache or migraine (15 percent)

• Neck pain (15 percent)

• Facial ache or pain (4 percent)

In a Time magazine health special (March 7, 2011), Dr. Mehmet Oz revealed the enormous cost associated with chronic pain. Chronic pain costs the United States an estimated $50 billion every year with $5 billion in health costs. There are annually 93 million workdays lost because of lower back pain.

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It isn't difficult establishing that chronic pain is a serious problem in the United States. Fortunately, medical doctors recognize that pain is not a symptom; it is a disease in itself. There is no shortage of doctors who would agree that relieving pain that occurs immediately after an injury or surgery is rather simple; chronic pain is not so simple.

Patients often complain that their pain will not go away, and if treated it stays away only while on the medication they were prescribed. Historically speaking, if a person experienced any form of pain, he or she was given a prescription and other treatment options were limited. Thankfully, medical science has come a long way and has taken a broader look at pain treatments, or in some cases, pain management.

The human body is very complex and many of its systems are intricately interwoven; one area of the body may be in distress, yet the physical pain is felt elsewhere. There has been a significant shift in thinking that pain is not just a sensory experience because in many cases it is also an emotional experience. Considering the complexities of the human body, it makes sense that when treating or managing pain there needs to be a multi-disciplinary approach to helping the patient.

Many people have turned to complementary or alternative medicine. The difference between these two is that complementary therapies are designed to co-exist with mainstream medicine whereas alternative medicine uses natural versus mainstream ways to heal. Many physicians today will not dispute that complementary therapy such as massage therapy is highly beneficial to a patient experiencing pain, but others are still reluctant to accept the benefits of naturopathy. Meditation and acupuncture are frequently used by an increasing number of Americans.

Another reason why those experiencing chronic pain seek help outside of mainstream medicine is because those living with chronic pain are twice as likely to suffer from anxiety or depression.

Many doctors who work in this field believe that unless acute nerve damage is present, pain cannot be measured by using traditional diagnostic tools. Pain diagnosis can be predicted related to a specific injury; however, physicians also rely on what patients can tell them about their pain.

In the case of individuals having their body violated and injured either by a physical or sexual assault, there is a huge gap in how they receive pain management. Also, those who have been traumatized by having to lose an appendage, for example, often experience pain and must make a lifestyle change.

Medical school does teach rudimentary pain management; however, the numbers of physicians who have extensive training in pain management are few.

Current Treatments

Today there is a wide variety of chronic pain treatment and management options, most of which are explained below.

Medications

Medications to treat pain have been a standard practice for many decades. Doctors will prescribe a pain medication that is tailored to the needs of each patient. For example:

• Celebrex Oral is a non-steroidal anti-inflammatory medication used in treating arthritis and acute pain.

• Dilaudid Oral is prescribed to help alleviate moderate to severe pain by working in the brain to help change how one's body feels and responds to pain.

• Flexeril Oral is often used alongside with physical therapies to decrease muscle pain.

• Lyrica treats pain caused by nerve damage due to shingles and diabetes.

• OxyContin Oral is used to relieve moderate to severe ongoing pain. Like Dilaudid, it works in the brain to alter how the body feels.

• Percocet Oral is a narcotic that can relieve severe pain.

• Ryzolt Oral relieves ongoing moderate pain for those who require all-day relief. Similar to narcotics, this medication works specifically on certain nerves in the brain.

• Savella is commonly used in treating fibromyalgia; it is a serotonin and norepinephrine reuptake inhibitor, similar to an anti-depressant.

(The above examples are intended to be only a vague description of each medication and by no means are they to be construed as a comprehensive description of what ailments they treat.)

Prescribed medications are generally the first line of defense against pain because they can provide immediate results. Locating the pain's antecedent is imperative for further treatment.

Individuals can develop an addiction to or physical dependence upon pain medication. For example, OxyContin (trade name for the narcotic oxycodone hydrochloride) is perhaps one of the most widely abused pharmaceutical medications. Percocet is another prescribed medication to which many become addicted. Pain medications are powerful and it is up to the doctor to carefully monitor each patient very closely when prescribing narcotics, (or any medication that has possible ill-effects) and, it is important for the patient to comply with the narcotic agreement, taking medication only as prescribed.

Some topical pain relief creams are available as over-the-counter medications, others are available by prescription. Topical creams are designed to provide pain relief from sore or aching muscles. These are sometimes used in conjunction with prescription medications.

Injection Procedures

Steroids can be taken orally or via an injection for pain due to inflammation. In some cases doctors will use an epidural steroid injection to improve their patient's quality of life. Anesthetics are also used via injection for some types of pain. Let's examine this a little deeper.

Trigger point injections (TPI) are an option for some pain sufferers. TPIs are used to treat tension headaches, fibromyalgia, myofascial pain syndrome, as well as treating painful muscles. A small needle is injected into the patient's trigger point which contains a corticosteroid (local anesthetic). The trigger point is rendered inactive therefore relieving pain. Depending on an individual's needs, several areas may be injected at one doctor's visit.

Cortisone injections can help in the relief of pain and inflammation in a specific area of the body. They are more commonly given in joints such as the elbow, fingers, wrist, shoulder, hip, ankle and spine.

Soft tissue injections are generally given to bursitis patients and these injections are usually corticosteroids.

Epidurals are often use in patients who suffer with degenerative disk disease. An epidural steroid injection is administered into the epidural space of the spine, where very sensitive nerve roots are located. The medicine then travels to other levels of the spine, eliminating inflammation-causing substances and reducing inflammation.

Nerve block injections are used to treat lower back pain and to help diagnose the exact cause of back or neck pain.

Viscosupplementation (SYNVISC) replaces damaged joint fluid with a substance that cushions and lubricates almost identical to healthy joint fluid. As a result, this treatment is effective in relieving pain due to osteoarthritis. SYNVISC is injected into the knee joint over a period of three doctor visits at a rate of one week apart.

Nerve Stimulation

Nerve stimulation is a therapy that has been borrowed from the field of anesthesiology; it shares the goal of preventing pain signals from reaching the brain. An implantable device is surgically placed into strategic area in order to stimulate nerves to mask pain.

A non-surgical means for nerve stimulation is another option and this is done by attaching electrodes on the outside of the skin. For instance, they can be placed on at the hip to deliver a low-voltage electrical current to subside hip pain.

Another technique known as facet joint denervation involves inactivating nerves in the joints that enable the spine to bend and twist. Neck pain treatment is an example: using needles, radio

waves are passed through the skin to heat the tissue at the tip of joint therefore inactivating specific nerves.

Radiofrequency Ablation (RFA)

Radiofrequency ablation of a nerve is a procedure that can be used on some patients to help reduce certain kinds of chronic pain by preventing transmission of pain signals. RFA involves the heating of a portion of nerve tissue to cause interruption in pain signals therefore reducing pain. This procedure is sometimes called radiofrequency lesioning.

Alternative Pain Treatments

Spinal decompression therapy is used in many alternative clinics. Over a decade ago NASA noticed that astronauts were relieved of low back pain when they were in anti-gravity environments. They found that spinal disc heights were increased during space missions. With these scientific findings spinal decompression therapy was developed for some pain sufferers. Decompression machines allow the health care provider to position your spine and target an area for decompression by gently stretching the spine.

Acupuncture

Acupuncture is one the oldest healing practices in the world. It has been known to help reduce pain through the stimulation of specific points on the body. Acupuncture is comprised of a series of procedures involving the stimulation of anatomical points on the body using a variety of techniques. The acupuncture technique that has been most often studied scientifically involves penetrating the skin with thin needles that are manipulated by the hands or by electrical stimulation.

Traction Therapy

Traction therapy is a treatment that restores spinal joint movement. This is accomplished through sustained and mechanical motion by stretching muscles and ligaments thus alleviating increased tension and irritation throughout the spinal column. When successful there is pain relief.

Chiropractic

Chiropractic is a health care discipline that emphasizes diagnosis, treatment, and prevention of mechanical disorders of the musculoskeletal system, especially the spine. Chiropractic works under the hypothesis that these disorders affect general health via the nervous system.

Laser Therapy

Laser therapy is a popular choice in alternative therapies for pain relief. Low-level laser therapy (photo-bio stimulation) is simply defined as light exciting or activating cells. The application of red and near infrared light over injured areas can relieve both acute and chronic pain. It improves blood circulation, promotes anti-inflammatory effects, is an anti-edematous and it has analgesic effects.

TENS

TENS is an acronym for transcutaneous electrical neural stimulation. This safe method works by stimulating the sensory nerves with an electrical charge as a means of relieving pain. This FDA-approved approach works by cutting pain signals off at the point of origin preventing pain signals from reaching the brain. TENS triggers the release of the body's natural pain-fighting endorphins. This method comes with none of the side effects that medication-based treatment can sometimes bring.

Massage Therapy

Massage therapy involves a range of non-invasive manual techniques (strokes, gliding, rubbing, kneading and pressure) applied to the soft tissues and joints of the body. The purpose of massage therapy is to relieve pain and to reduce swelling, as well as to maintain, rehabilitate, and improve physical function. It achieves excellent results for discomfort stemming from stress, muscular overuse, and many chronic pain syndromes.

There are several other alternative therapies that are used in various pain treatment/management programs. Some of these include:

• spinal and non-spinal joint mobilization;

• exercise, stretching, yoga;

• rehabilitation therapy;

• moist heat therapy;

• cold therapy;

• therapeutic ultrasound;

• myofascial release therapy;

• muscles and soft tissue stretching and;

• physiotherapy.

A few non-herbal supplements such as glucosamine, chondroitin and bromelain are also used for pain relief in those who suffer from osteoarthritis.

And finally, there are biofield therapies which include therapeutic touch, spiritual healing, qigong and johrei. A Time Magazine article entitled, "Beyond Drugs", says that a study published in 2010 in the International Journal of Behavioral Medicine reviewed sixty-six studies of such therapies. The authors of this study, Shamini Jain of the UCLA Division of Cancer Prevention and Control Research and P.J. Mills, a psychiatrist at the University of California, found strong evidence that biofield therapies can reduce pain intensity.

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Global Industry Analysts (GIA) in a January 10, 2011 web release statement stated that the pain management market will continue to rise due to an aging population, increasing cancer rates, and a growing number of surgical procedures. GIA claims that higher demand for more efficient medications and medical devices for pain treatment are driving the pain management market. (http://www.prweb.com/releases/2011/1/prweb8052240. htm)

Interestingly, according to GIA, the Unites States is the largest market for pain management worldwide.

(Continues...)

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