Monday, December 13, 2010
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
Friday, December 3, 2010
Accidents Victim with Chronic Pain - Simple Ideas to Help Your Credability
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.
Monday, November 29, 2010
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
Monday, November 1, 2010
Even Olympic Gold Medalists Struggle With Long-Term Pain
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
Thursday, October 21, 2010
Fighting Words - Who Are The Doctors Trying To Help?
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
Wednesday, September 15, 2010
Fighting Words Increase Disability & Loss
Thursday, September 2, 2010
Back From Holidays - With A New Focus
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
Monday, July 26, 2010
Fibromyalgia, Chronic Pain, Physical Evidence
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.
Thursday, July 15, 2010
Brain Changes, Chronic Pain, Inspiration, Art
Yours with care
Monday, June 28, 2010
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.
Saturday, June 12, 2010
Chronic Back Pain - Is Deconditioning a Cause??
Sunday, May 30, 2010
Surgery Without Anesthesia - Lessons for Chronic Pain & Fibromyalgia
Thursday, May 20, 2010
Severe Chronic Pain - Life Threatening?
Saturday, May 8, 2010
Sleep Challenge for Women Who Live in Pain
Sunday, May 2, 2010
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.
Saturday, April 24, 2010
Fox Bones Episode an Insult to People with Fibromyalgia
I was disappointed, last night, as I watched one of my favorite TV shows, Bones.
Monday, April 19, 2010
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.
Monday, April 12, 2010
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.
- 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.
- 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.
- 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.
- 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.,
Saturday, April 3, 2010
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.
Saturday, March 27, 2010
Chronic Pain - Largest Investigation Ever
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.
Thursday, March 18, 2010
Chronic Pain - Seven Simple Truths
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.
Saturday, March 13, 2010
Chronic Pain - $100 Billion Validation
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.