Sunday, May 30, 2010

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,

Thursday, May 20, 2010

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

Saturday, May 8, 2010

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

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.

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.