Back From Holidays - With A New Focus

Dear Faithful Readers. I apologize for my lack of contact over the past few weeks. I have been on holidays at a fairly remote cottage, with no real internet access.  That is no excuse, though. I didn't even let you know that I was going to be away. Thoughtless. I am sorry.

I have been doing some hard thinking about the focus of this blog. And I think it is time to get more more detailed and provide more practical help for the millions people who are forced to live every day in pain.

Over 90% of my patients, over the past 25 years, have been individuals who suffer from long-term (or chronic) pain caused by one or more physical injuries. Their physical injuries are usually caused by car or work accidents. Their pain is physical, real and often very disruptive to most parts of their daily lives.

This group of people, who live every day in pain, also have to deal with many additional stresses - stresses and losses related to loss of work, financial strains and conflicts with insurers, worker's compensation and lawyers. This is a whole extra load that can make it even harder to cope with pain and limitations.

The combined impact of the physical injuries, never-ending pain, stresses and losses often triggers even further problems involving poor sleep, irritability, and stresses in their families. I would like to offer some help.

I am hoping that The Chronic Pain Letter can provide some practical help and hope to this very deserving group. My heart goes out to you.

Yours with care,

Michael

Fibromyalgia, Chronic Pain, Physical Evidence

The International Association for the Study of Pain (IASP) is the top scientific organization in the field of pain research. An awesome group. (A brief description and historical review can be found in the book Unbelievable Pain Control).

A recent issue of PAIN: Clinical Updates (published by IASP) gives a brief, but pithy, summary of new research in fibromyalgia. These updates are available for reading from this link.

Here are some findings cited by Dr. Claudia Sommer, from the Neurological Clinic, University of Wurzburg, Gernmany.

New evidence from functional imaging studies provide additional evidence of brain dysfunction in people with fibromyalgia. She cites studies to indicate sensitization in central parts of the brain, plus evidence of defective pain inhibitory systems. This evidence comes from MRI, fMRI and PET scan studies. 

Dr. Sommer also examined why treatment is often limited in its effectiveness. One possible reason is that there may be sub-types of fibromyalgia. Each sub-type may need a different combination of treatments to be effective. This research is in the early stages, but promises to help doctors and scientists pinpoint the most effective treatments for this complicated and often disabling condition.

A summary of how far we have come in our understanding of chronic pain and fibromyalgia can be found in the Epilogue: We Have Come A Long, Long Way of the book Unbelievable pain Control. Please check it out.

And stay tuned. The next posting will follow-up with more research findings.

Yours with care,

Michael

Brain Changes, Chronic Pain, Inspiration, Art

The cover of new issue of  PAIN  has a picture of charcoal grey guitar on a sea of blue.

This was one of many paintings completed by a woman after a stroke and serious injury to her brain. Here is a statement from the artist:

"I was not previously interested in art. But after my stroke, I had this incredible urge to paint. When I am feeling well, i can paint for hours. ...  I use the warmest colors possible. It's good for me, makes me feel better. I am energized in front of my paintings, as if in another world."

The article shows several of the artists impressive paintings. Amazing when you think that this person had no previous talent or experience. She had completed over 120 paintings, some the size of whole rooms.

Interestingly, painting warm colors made her come alive, with energized spirit and mood. Painting dark colors made her chronic pain worse, almost instantly.

In this article (Pain, 2010, 150, 121-127), the authors use this incredible example to help us understand how changes in the brain can affect us in such unexpected ways.

In the meantime, we are treated to a truly inspirational story of hope amidst tragedy.

Check it out and prepare to be moved.

Yours with care

MIchael

Help for Chronic Pain & FM - Free Book for Pain Group Leaders

I would like to offer a FREE copy of my book, Unbelievable Pain Control, to leaders and organizers of support groups for people who live in pain.

This is no trick. No strings attached. No sales pitch and no follow-up emails. This offer is made in recognition of the many people who put much of their limited energy into helping others in pain.

One caveat, though. For now, I can only make this offer to the first 50 people who send an email request to me at michael@renfordbooks.com.

You can find out details about this book from the website, www.UnbelievablePainControl.com including a full listing of the Table of Contents.

Please don't be scared off by the strong title. It has several meanings, all drawn from the experiences of people who live every day in pain. Mostly, this title comes from the story in Book One, which is based on the real-life accomplishments of a remarkable individual.

Remember - Caring is Good Medicine (Bill  Moyers)

Yours with care

Michael

Chronic Back Pain - Is Deconditioning a Cause??

Doctors and scientists, all over the world, are still struggling with this question. And more generally, struggling to find a cause or causes of chronic pain.

Scientists are still trying to find out why some injuries go on to produce long-term or chronic pain, while many are resolved with time and treatment. In general, 10-20% of low back, neck, head, knee and shoulder injuries become chronic, even under the best and most comprehensive of treatment programs.

There are many theories attempting to explain this pattern. Thousands of studies have compared people whose injuries become chronic, with those whose injuries and pain heal within a short time. This approach, although the most common, can produce confusing results.

A recent Topical Review, in the journal Pain, focused on the possible role of deconditioning, or lack of physical fitness. The article, Cause or Effect? Deconditioning and chronic low back pain (Pain, 2010, 149, 428-430), was written by Verbunt, Smeets and Wittink, all from The Netherlands.

Here, the authors reviewed the evidence for the view that deconditioning is a cause of chronic low back pain. This view is prevalent among health care professionals that regularly treat patients with various types of chronic pain.

Interestingly, this review found "...minimal research evidence that patients with chronic low back pain suffer from disuse and physical deconditioning, before or after the onset of acute or chronic low back pain (page 430)".

This conclusion will shock many clinicians. It seems so obvious that deconditioning must play a role. Often, people in pain can do very little exercise, especially exercise that would lead to good conditioning.

The take home message here, is not that physical conditioning is not important. It is a necessary component of any treatment program. It is necessary, not just for the treatment of any type of chronic pain, but for almost all health care problems.

I am a keen supporter of exercise. I am an avid hockey player and ski and run whenever I can. All of the people in pain that I know, would love to be able to be more active. I know that, if they could, they would.

Yours with care

Michael

Surgery Without Anesthesia - Lessons for Chronic Pain & Fibromyalgia

Surgery without anesthesia. Can these unbelievable feats help people who live every day in pain? I believe they can. You can read about in my new book, Unbelievable pain Control.

Many years ago, I had the pleasure of meeting Dr. Victor Rausch. Actually, I was a student in a workshop he led for the Ontario Society of Clinical Hypnosis. He was quiet and very intense. This was part of his power and charisma, I believe. Later on, he helped with the book I was writing, by sending me videotapes of himself undergoing complex dental surgeries, without anesthesia or medication. Previously, he had documented undergoing abdominal surgery (without anesthesia) in a well-known journal.

It is clear, from Dr. Rausch's work that his control over pain has nothing to do with willpower. He does not try to force himself to feel no pain or to overpower the pain. In fact, such an approach would lead to more pain and less control.

This is a common message to my patients as I try to help them in their battle with long-term pain. The message is - If you go to war with  pain, pain will always win.

Unfortunately, this is how some people who live with chronic pain and fibromyalgia try to manage. People with limitations want to be able to do more. This is understandable. And sometimes, forcing yourself to do more is the only option available. But, forcing yourself to do more will not reduce your pain or lessen your suffering. It may help your life by catching up a little, or doing some very important activity. Only you know whether or not your activity was worth the extra pain it caused.

What is important is your approach. You want to work with your injured body, not against it. You want to be as realistic as possible about your pain and limitations and make informed decisions the best you can. Dr. Rausch did not try and pretend that surgery was any less painful that it is. He makes sure that he knows exactly what he is up against and then prepares himself for the task ahead.

Few people would even consider surgery without some sort of medication. But, we can all learn from Dr. Rausch's accomplishments. He has made an incredible contribution.

Stay tuned. I will be writing more about his fascinating topic in posts to come.

Yours with care,

Michael

Severe Chronic Pain - Life Threatening?

For many of my patients, life as they had known it is over. Following injury and pain, life will never be the same. This is a very serious matter. Long-term pain can create intense suffering, as well as serious and permanent losses in people's lives.

But, does chronic pain really influence life and death?

Some recent scientific studies suggest that severe chronic pain can have a strong influence. One recent study, for example, was brought to my attention by a newsletter (Pain Monitor, May 2010) from the American Pain Foundation and the blog Pain Topics (April 8, 2010).

They highlight a credible study, Severe chronic pain is associated with increased 10 year mortality, published in the European Journal of Pain (2010, volume 14, 180-186). This large study was conducted in Scotland, by Drs. Torrance, Elliott, Lee and Smith, from the University of Aberdeen. In this study, 5858 individuals were studied over a 10 year period. These individuals suffered from a variety of long-term pains, including back, neck, arthritic, or chest pains. The severity of their chronic pain was assessed using the Chronic Pain Grade scale, developed and published by Drs. Von Korff, Ormel, Keefe and Dworkin (Pain, 1992, 50, 133-149). This is a well-known and accepted measure in the scientific study of pain.

This study found that severe chronic pain, defined as a chronic pain grade level 3 or 4 (out of 4), was associated with an significantly increased risk of death over a 10 period. This increased risk was for circulatory system deaths, respiratory deaths as well as for all deaths. The survival curves plotted by the authors were quite striking. These findings held true, even after factors such as age, sex, education, income or the presence of long-term limiting illnesses were ruled out.

The authors note, interestingly, that "... it is either the high intensity of their pain and/or the associated disability that is the key to this increased mortality". Chronic pain grades 3 and 4 both include high disability components. These individuals would also experience high levels of loss and stress in their lives associated with high disability and pain levels. For the patients we see with chronic pain, significant stresses are directly connected to both the pain and disability that they experience.

As the authors point out, this is not an isolated finding. Other studies have also pointed to connections between chronic widespread pain and increased cancer and cardiovascular mortality. More research needs to be done, of course, to investigate these very serious health issues.

This kind of research is vitally important. It highlights the importance of treatment for people who struggle to live every day in pain. They need treatment to help reduce their suffering, their limitations and losses, and the serious risks to their overall health.

On behalf of people who live every day in pain, I ask you to share these important findings, so that much needed treatments can become more available to all.

Yours with care

Michael