Chronic Pain, Depression & Your Credability

In the olden days - maybe 10 - 15 years ago - individuals in pain were often denied funding, for treatment and loss of wages, because of depression. As a result many people tried to hide their depression. Even though, depression caused by pain, injury and loss is a legitimate and often additional injury.

Lawyers and doctors working for insurers would often make the following conclusions. For example ...


"There is no evidence for physical pain and injury. There are signs of depression and anxiety. Depression is the real problem."


It's true that depression can be a real problem. In fact, many people with serious injuries, pain and widespread losses, after a car or work accident, do suffer from depression and anxiety. 


The accident causes physical injuries, which can lead to long-term pain in about 15% of accident victims. As pain continues in a person's life, more and more stresses occur. Losses of work, financial losses, strains in marriages and families, sleep difficulties and losses of independence and self-esteem are some examples. Over time, the buildup of these stresses and your relentless pain can lead to depression.


It would be unusual for an individual under these pressures, to not become depressed.


If depression does occur, this does not diminish the reality of your physical pain. In fact, it adds to your credibility. Depression is only there because your accident has caused so much pain,  stress and loss in your life. 


Your doctors should recognize that you now have 2 major sets of injuries and limitations - painful physical injuries and depression. These combined physical and psychological injuries can both limit your ability to work. You deserve treatment for both. In fact, that is what good rehabilitation is all about.


There is no need to feel frightened that  depression will hurt your right to benefits or compensation of losses by a lawsuit. Both physical chronic pain and depression can be caused by accidents. They can both lead to disability, when serious.


These facts are slowly being accepted by doctors, lawyers, employers, insurers, courts, and government agencies, all over the world. Hopefully, the olden days are past.


Yours with care
MIchael

Accidents Victim with Chronic Pain - Simple Ideas to Help Your Credability

Chronic pain is now a well accepted injury following car and work accidents. Chronic pain has been accepted as a legitimate injury by scientists, doctors, the courts, disability insurers, worker's compensation and government agencies.

But victims of car and work accidents still never feel safe. You are still dependent on insurers to approve necessary treatments and provide financial security when you cannot work. This is a constant struggle.

Despite the recognition of chronic pain, worldwide, it is still best to assume that you always have to be ready to expalin yourself. Here are a few simple ideas that can help your credability.

First, learn about your injuries and symptoms. You are already the most knowledgeable person about your own body. You know far more, than even your doctor or family members. You live with your symptoms every moment of every day.

Create a short list on paper - the shorter the better. Memorize it. This is not because you don't already know it, but because you need to learn how to say it with as few words as possible. Short, concise and powerful. If others want to know more they can ask questions.

Practice talking out loud to yourself or to a mirror. Read from your short list and practice saying it with a clear and firm tone. Not aggressive, just firm and confident. Remember, you know what the truth is, no matter what anyone else thinks.

 It is not your job to convince others of how you feel. Your job is to tell the truth. That's all. The job of others is to trust you. This is especially important for family members and friends. They can always ask questions, or read the reports, if they are confused. 

If you are being challenged by someone in authority, such as an insurer, lawyer or even your own doctor, offer to have a report sent to them. Don't try to argue with professionals. If you sense that they don't trust you, only reports or evidence from professionals will help. Then, it is their job to read the reports and learn the facts.

I hope these ideas can make your life at least at little bit easier. I will return to this topic over and over again. It is an important one, for all accident victims, and for anyone who lives every day in pain.

Yours with care,

Michael

A Cure For Back Pain?

This title was used by Dr. Nicoli Bogduk in recent review of a very promising new treatment for chronic discogenic back pain (Bogduk, 2010). Dr. Bogduk ia  a prominent scientist from the University of Newcastle in Australia, well-known throughout the world for his pain research.


Dr. Bogduk described results from a new study by Dr. Baogan Peng (2010), documenting the success of a new treatment procedure for chronic discogenic back pain.


Here are some comments from Dr. Bogduk (2010):


"Peng et al. announced astounding results, unprecedented and unrivalled in the history of research into the treatment of chronic discogenic back pain."


"If the results of Peng et al. are true, this intervention will revolutionize the treatment of low back pain. Spinal surgery for back pain will be rendered obsolete."


Dr. Peng's treatment procedure involved a spinal injection of 1% methylene blue and 2% lignocaine. Results were evaluated in a scientifically rigorous, randomized placebo-controlled study, reported in the prestigious peer reviewed journal Pain. Their results showed that at 24 months, 19% of patients achieved complete relief, with 72% experiencing only slight pain and requiring no medication.


This study will need to be tested and repeated in other centres throughout the world. According to Dr.Bogduk, this will be relatively easy to do. In fact, his lab is already underway with another study of this promising new treatment.


Caution is in order, of course, along with much hope.  For the millions of people around the world who live every day in pain, sometimes hope is hard to find. Realistic hope even harder.


Congratulations to Dr. Peng and his colleagues. The scientists are very excited and that in itself is a huge accomplishment.


References


1. Bogduk N. A cure for back pain? Pain 2010: 149: 7-8.


2. Peng B, Panf X, Wu Y, Zhao C, Song X. A randomized placebo-controlled trial of interdiscal methylene blue injection for the treatment of chronic discogenic low back pain. Pain 2010: 149: 124-129.


Yours with care
Michael

Even Olympic Gold Medalists Struggle With Long-Term Pain

Tessa Virtue is " A beauty, and a (competitive) beast". This apt description comes from the headline of Rosie Dimanno's recent column in the Toronto Star (October 31, 2010, p. S3).


Yet, even a tough highly competitive superstar like Tessa Virtue can struggle with persistent pain. Even an Olympic Gold Medal winner.


What struck me from Dimano's article was how Ms. Virtue's struggle seemed very similar to what many of my patients go through in their fight with long-term pain. Here are some quotes from this article, in Ms. Virtue's own words.


"I wasn't admitting I was in pain because I thought, if i think I'm healthy, then maybe I will be.  That wasn't the case. Just to walk for 10 minutes was a struggle."


"I was told there was no reason for me to be in pain."


"At some point, you're thinking: suck it up, just do it. If there is no answer, then maybe I am just a baby."


According to Dimanno, Ms. Virtue was feeling a little embarrassed to complain since all of the experts were telling her she shouldn't have been feeing pain. She wondered if they were hinting that all of her pain was in her head.


How many of the millions of people who live every day in pain have felt like this? I'm betting almost everyone.


Ms. Virtue has now undergone a new surgery, in early October, to help solve this physical, not psychological, problem. We wish you well and thank you for your candor and bravery.


Yours with care
Michael

Fighting Words - Who Are The Doctors Trying To Help?

Secondary gain is a popular term used in reports written by doctors who work for insurers. It is often used when the doctor can find no evidence for deception or malingering, but still feels the need to diminish the credibility of the injured person.

There is no evidence for lying or conscious deception. So, the term secondary gain is used to say that the injured person is exaggerating, unconsciously. The person is not exaggerating on purpose, but can't help to psychologically magnify their symptoms in pursuit of some type of gain.

One of my patients was very angry when secondary gain was used to suggest that her injuries were caused by this psychological symptom. She identified the real issue, clearly,

"... my injuries have not led to any gains, only losses, that have been building ever since my accident. My benefits pay me only a small portion of what I used to earn when I could work. Every year, I lose more and more. And this does not even count how much my family has lost and suffered."

Losses usually far outweigh any real or potential gains, especially when an injured person has a long-term injury such as chronic pain. It is doctor who has the real gain - dollars, referrals and steady work from insurers.

Fortunately, it is not hard for judges and juries to see this pattern for what it really is.

Yours with care
Michael

Fighting Words Increase Disability & Loss

Remarks from doctors,, hired by insurers can backfire in a big way. They can hurt the injured person they are assessing. Some remarks can also hurt the insurer the doctor is trying to help.

These are fighting words and they can be very destructive. In fact, they can cause so much extra stress to the injured person that the injured person's injuries become worse. This can lead to even more disability and loss.

Is this really what insurers and defense lawyers want - more disability and loss in their claimants?

A clear example of fighting words was in a medical report I was reviewing, as I prepared for a trial. My patient's lawyer had asked me to be an expert witness in her trial, related to injuries she sustained in a car accident. Here are the fighting words...." she wore her fibromyalgia like a badge of disability".

My patient was crushed when she read this comment. Understandably her depression increased and her ability to cope with her severe pain decreased significantly.

Fortunately, my patient's lawyer loved the comment. He planned to use this (and many related comments by this doctor) to show his cruelty and total disregard for my patients suffering and losses. This lawyer was planning a field day when it came time to cross-examine this doctor.

People in pain deserve a little respect. All health care and legal professionals are obligated to show a little humanity. Otherwise, peoples' losses and suffering will escalate. Then everyone loses.

Caring is not only good medicine - it is also good business.

Yours with care.

Michael

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

Sleep Challenge for Women Who Live in Pain

The Zen of ZZZZZ, by Antonia Zerbisias, was an interesting take on the challenges of sleep for modern women (Toronto Star, May 2, 2010).

Antonia Zerbisias highlighted the recent work of powerful women in the media business. Adrianna Huffington (Huffington Post)and Cindi Leive (Glamour) challenged women to improve their lives by improving their sleep. They started with a provocative title, Sleep Challenge 2010: Women, It's Time to Sleep Our Way to the Top, Literally, and an inspirational charge: "A nation of sleepy women is even less capable of greatness" (Huffington Post, Jan 4, 2010).

The people I work with every day are struggling for a return to normal life. Living with injury and pain makes it difficult to get the daily responsibilities taken of. Many have lost their aspirations of greatness.

Yet, improved sleep can help powerful business women, as well as women (and men) who want to cope better with their pain and injuries. Poor sleep, not only interferes with greatness, it leads to lower tolerances for pain, a greater risk of depression (caused by pain), more fatigue and a greater difficulty focusing and concentrating.

Some of the best recommnendations from the Sleep Challenge were also the simplest: allow yourself to take the time to rest when you need to, recognize that more rest and more sleep will make you more productive, allow yourself to go to bed early to try and catch up on lost sleep, and encourage your family to support these steps. More simple strategies were outlined in an early post (April 12, 2010).

Take the time to improve your sleep. You deserve it.

Yours with care

Michael

Chronic Pain - Better Results with Trust & Caring

As I was watching the  CBS Sunday Morning show - a great show by the way -  I was reminded of a powerful idea.

Wes Moore was being interviewed by Russ Mitchell. He described how his mother's care and persistence helped save him from a life of crime. At a young age, he had run away from military school five times and was calling his mother to tell her he wanted to come home. Despite how difficult it was for her, hearing her son crying and pleading on the phone, she persisted. She told him he had to stay, not just for her (and him), but also for all the people who had helped and believed in him.

Wes Moore described that as a turning point for him. He realized how hard it was for his mother to stay firm with him. He realized how much she cared. He knew that she was not going to give up on him.

My mother put it this way, he said,"Kids need to know you care before they care what you think".

This powerful message also rings true in the every day life of people who live in pain. Patients, especially with long-term illnesses and injuries, need to know that their families, employers, doctors, lawyers, and friends will not give up on them.

As Mrs. Moore says, people need to know that you care before they will care what you think. Even professionals, with advanced degrees and successful practices, need to stay focused on this essential truth.

This connects to another powerful truth, from journalist and writer, Bill Moyers, " Caring is good medicine".

Sometimes, even the best medicine.

Yours with care,

Michael MacDonald, Ph.D.

Fox Bones Episode an Insult to People with Fibromyalgia

I was disappointed, last night, as I watched one of my favorite TV shows, Bones.  

 Episode 18, Predator in the Pool,  was very interesting. Booth and Brennan (Bones) caught the killer, a fourth-grade teacher, who had enacted revenge on a shady self-help guru, Jazz Gunn. Through his seminars, Gunn had promised a cure for pain and fibromyalgia. After taking his seminar nine times, the teacher did not feel any better and felt betrayed by Jazz Gunn and his false promises. An opportunity arose and she killed him. As she was confessing to FBI agent Booth, she stated that after killing him, she has since felt no pain. The clear implication being that her fibromyalgia was now cured.

This conclusion has some humor, but it is at the expense of millions of people who live every day in the pain caused by fibromyalgia. People with fibromyalgia, their families, doctors and scientists around the world have worked hard over the past 30+ years to document the legitimacy of this medical illness.  In 1987, the American Medical Association recognized fibromyalgia as a true illness and a major cause of disability. Despite this recognition, and years of scientific research, many in our society still think of fibromyalgia as a psychological problem. 

This episode of Bones helped to perpetuate this harmful myth. It is not a stretch to believe that the teacher with fibromyalgia would feel desperate and betrayed by the false promises of Jazz Gunn. People often do feel desperate for some type of relief for their never-ending pain. Unfortunately, there is no known cure at this time. Even revenge and murder cannot cure fibromyalgia. 

A Simple Solution to this problem, for the show's writer's, would have been for the highly intelligent Dr. Brennan to add that, "I guess she didn't have fibromyalgia after all".  This would have been consistent with the character's knowledge and avoided the implication that psychological factors, such as needing revenge, could cause fibromyalgia.

A Responsible Solution would be for the producers of Bones to apologize to the millions of people and their families that are  affected by fibromyalgia. This apology could help clarify that fibromyalgia is a true medical illness, not caused or cured by psychological factors.

Bones is still one of my favorites. I hope the writers and researchers can avoid such costly mistakes in the future. A little bit of extra background research can help all of us.

Yours with Care

Michael MacDonald, Ph.D.

Even Sports Heroes Can Suffer From Chronic Pain

Thank you to Nick Canepa from the San Diego Union Tribune. Your recent article, Back pain nearly drove Bill Walton to end it all, will help more than 50 million North Americans who live every day in pain.

Your inspiring article helps in two ways.

First, you explain that even a famous sports hero can suffer from chronic pain. Bill Walton, an all-time basketball great was living in unbearable pain after more than 36 surgeries. His was a clear example of physical injuries causing his long-term pain. No psychological causes here.

Secondly, you point out that even Bill Walton's enthusiastic personality was no match for his relentless back pain. At one point, his chronic back pain became so unbearable that he was ready to jump off a bridge, taking his own life. This tells us a little about how difficult it is for anyone to live in constant pain. All the more power to Bill Walton, for having the courage to admit this.

Depression is a common side effect of living every day in pain. It is hard for anyone to admit this. With depression, thoughts of ending one’s life come to mind. They are unavoidable. This is another reason why people in pain need all the love and support we can muster. Understanding and validation are important too. Thank you Nick Capepa.

Yours with Care

Michael R. MacDonald, Ph.D.

Better sleep, less pain, easier life

Sleep can be a big problem, sometimes, even when you are healthy.

Imagine trying to sleep when your back is aching, or when sharp pains are shooting down your arm. Imagine trying to sleep when your head and neck hurt even to touch the pillow.

Trying to find a comfortable position in bed. Trying to return to sleep each time your pain and injuries wake you up during the night. Trying to calm down after each disruption. Trying not to think about how long this has been going on – even though it may have been months or even years.

This is a small sample of life with chronic pain - at least the tip of the iceberg.

Fortunately, professionals who work in this field know the importance of sleep. For example, Professor Charles Morin, from the Université Laval in Quebec, Canada, has written an excellent review of insomnia research, Chronic Insomnia: Recent Advances and Innovation in Treatment Developments and Dissemination. He discusses how scientists have made great strides in understanding insomnia and in developing new methods of helping people.

Here are some simple suggestions to help your sleep and, hopefully, to help lessen your pain a little.

1. Don’t try to skip your pain medication at night. Your sleep medication can help your sleep, help lessen your fatigue the next day, help reduce insomnia related flare-ups of pain and help you cope better.

2. Plan and prepare for sleeping. Set a regular time for sleep. In the hours leading up to bedtime, avoid activities that cause you extra pain or extra stress. Avoid activities that are too interesting or too stimulating. Your goal is to wind down and relax.

3. Learning how to relax is important, but not always so easy when you live in pain. One of my patients found her own way to help settle into sleep. She goes to her husband and each of her children, smiles, hugs them and tells them she loves them. She doesn’t rush this. She wants the warm feelings to sink in. This is a nightly ritual they all enjoy.

4. Many people who live in pain are helped by anti-depressant medication. This makes sense, of course. If long-term pain doesn’t make you feel burned out, nothing will. This medication has a triple benefit and is not addictive. It can help with sleep (especially staying asleep). It can help you feel more in control of your irritability and moods. And, it can help you cope with and tolerate your pain better. This medication can also make life a little easier on your family (which helps you as well).

More help is available from the Canadian Sleep Society.

Stay tuned to this site and please sign up. I will be following up with more on this vitally important topic. More understanding and more suggestions are soon to come.

Yours with care,

Michael MacDonald, Ph.D.,

Chronic pain - A Verdict is No Cure

Some doctors, lawyers, insurance adjusters and everyday citizens still believe, that once your lawsuit, or your case with Workers Compensation is finished, you will be all better. Your pains will magically disappear and you can return to work and a normal life. Wouldn’t this be nice?

This scenario is depicted in the movies and television, sometimes. The case is won by a smart attorney. The accident victim is now rich. He walks out of the court room, throws his crutches away, and lives happily ever after. This is the American way, isn't it?

Life doesn’t work out this way though and never has. Scientists have studied this issue in numerous research projects over the years. The findings have been quite clear. Chronic pain does not end when your case is settled. This is true for individuals that suffer from chronic neck pain, chronic back pain, or any type of injury that leads to long-term pain.

Your life may be less stressful because the insurance companies and lawyers are out of your life. With less stress, your pain and injuries may be less aggravated. You may be able to sleep at little better. Your mind won't be plagued by endless intrusions, threats, and accusations. For this reason, it is very helpful to have your dealings with insurance companies end as soon as possible. But settlements and court victories, however useful in paying your debts, cannot cure chronic pain. A verdict is no cure.

Even if others stubbornly cling to their prejudices, it is important for you to be clear about this essential fact.

Please post your thoughts and ideas on this matter. It is very important. Your comments can help a lot of people.

Chronic Pain - Largest Investigation Ever

In 2000, the Workers Compensation Board of Ontario (now the Workplace Safety & Insurance Board) released a set of final reports under the project title of Chronic Pain Initiative. This was a huge investigation and to my knowledge, the largest ever done.

Over 11,500 scientific studies were reviewed. This, on its own, tells you the scope of chronic pain as a serious health problem. Ten years ago, there were already over 11 thousands investigations done. Today, with the increasing awareness in public and scientific circles, that number has mushroomed. There are still many scientific questions regarding the exact mechanisms underlying chronic or long-term pain. But, no one can credibly deny its existence. (Sadly some still try, however).

The Chronic Pain Initiative resulted in 3 final reports. I believe that they are still available from the Workplace Safety & Insurance Board (www.wsib.on.ca). One report summarized the overall findings. A second report reviewed conclusions from the expert scientific panel. A third report emphasized policy recommendations.

As a psychologist, I was especially interested in the expert panels review of potential psychological causes of chronic pain. My personal views were, and still are, that any psychological causes, if they exist at all, are very rare. After reducing the 11,500 studies to only those with credible methodology, the panel was unable to find any clear evidence for psychological causes. It is clear that chronic pain can cause additional psychological injuries, such as depression and anxiety. But, these psychological injuries are caused by the patients long-term pain and widespread losses. Not the other way around. This is not only true for chronic pain, but for any long-term medical problem.

There is a long history of psychological and psychiatric theories, which try to explain the origins of chronic pain. There are theories of long-term migraine pain, back pain, neck pain and even multiple schlerosis. Understandably, these serious medical problems can cause depression and anxiety. There is no evidence that they have any psychological causes, however. The Chronic Pain Initiative has provided evidence to support this view and made an important contribution to this field. Congratulations.

There is a whole chapter, on these studies, in my book, Unbelievable Pain Control: How to Heal and Recover from Chronic Pain & Fibromyalgia (see details at www.UnbelievablePainControl.com ). Go have a look.

Chronic Pain - Seven Simple Truths

Living every day in pain is a battle - a battle with injury, pain and the many ways that pain interferes with your daily life. If you have been hurt in a car or work accident, you may also have to do battle with insurers, employers and lawyers. At the same time, you are trying to keep your head above water and not drown in all of this stress.

Here are some simple ways to cope with these battles and to keep your chronic pains from completely taking over your life.


1. Chronic pain is real, not imagined. It is never “all in your head.”

2. You can’t get better until you stop getting worse. The first step is to recognize this pattern. Even by itself, this step can make a big difference.

3. When you go to war with pain, pain always wins. There are much better ways to gain control over your pain.

4. A simple flare-up formula: pain causes stress, which then causes more pain. If not stopped, the flare-up keeps building to a mountain of pain. The best way to decrease a flare-up is by reducing the aggravations that are feeding the fire.

5. For some people, coping with constant background pain is the easier part. Repeated flare-ups are what bring you down. Reducing flare-ups (and learning to avoid as many as you can) are the best ways to gain pain control and a speedy recovery.

6. If your benefits are cut off, recovery is over. When your losses escalate, it is almost impossible to gain the energy, strength, and pain tolerances necessary to move forward in your life. Make sure you work with your doctors and lawyers to protect your benefits.

7. Helplessness and anger can give pain the power to defeat you. They add fuel to the fire. But not all types of anger are harmful. Anger directed toward simple, achievable goals can give you a powerful boost toward recovery.

These ideas are expanded and detailed in Book Two of Unbelievable Pain Control: How to Heal and Recover from Chronic Pain and Fibromyalgia. You can find out more information and helpful advice from www.UnbelievablePainControl.com.

Chronic Pain - $100 Billion Validation

Recent estimates have put the costs of chronic pain to society at $100 billion in the United States alone. These costs are related to lost work days, as well as disability and health care expenses. That’s huge. And this doesn’t even count the tremendous costs (and suffering) to individuals and their families.

Health, disability, worker’s compensation insurers, as well as personal injury lawyers, complain that these costs are uncalled for. To me, such statistics demonstrate the reality of chronic pain and its costs to individuals and society. It takes big numbers for this serious health problem to be given the recognition it deserves.

In my experience, insurance companies are not in the habit of giving away money unless they have to. Chronic pain is now being recognized (if begrudgingly) by health, disability, and workers compensation insurers, as well as by the courts and government agencies.

It is still very difficult for individuals with long-term pain to get the level of care that they need. They still have to fight for income protection, when they cannot work. I believe that we are making progress, however. Chronic pain is a real, physical and in many cases disabling, health problem that deserves our recognition and attention - just like any other serious health problem.