The Chronic Pain Letter

New Rights for People in Pain

2011-12-12T13:17:00.000-08:00

The Declaration Montreal: Access to pain management is a fundamental human right is the title of a recent article in the prestigious journal PAIN (2011, 152, p. 2673) by Doctors Cousins and Lynch.

This article includes the Declaration of Montreal, created at the International Pain Summit of the International Society for the Study of Pain (IASP). Eighty-four countries supported this most basic of human rights.

This essence of this declaration is that health care providers, governments and health care organizations are obligated to provide adequate treatment and management of pain, even when it is difficult to diagnose the actual cause of the pain.

The Summit leaders also recognized that chronic pain, with or without diagnosis is highly stigmatized - and that all levels of health care should work to reduce this stigma.

Thank you to the IASP for their continuing dedication to the millions of people who live, all over the world, each day in pain.

Yours with Care - Michael
michael@renfordbooks.com

Be The Voice

2011-12-05T16:29:00.000-08:00

Be the Voice - for those who have no voice. This is the slogan for an ad for the World Wildlife Fund. It is incredible that so few words can say so much.

Many people who live in pain also feel that they have no voice. They feel powerless in the face of constant pain and powerless in their ability to get the help the need.

Health professionals have power. They know the system and have the energy to fight for what their patients need. Let's use this power to do the best work we can. Let's use this power to care. Let's use this power to put our opinions on paper to help validate the true needs of people who live every day in pain.

We can make a difference. I see it every day.

Caring IS good medicine. Thank you to the late Bill Moyers for his wise words.

Yours with care - Michael

Undeniable Scientific Support for Fibromyalgia

2011-09-19T07:18:00.000-07:00

In case you haven't heard, there is a new book on fibromyalgia.

It is by Dr. Kevin White (M.D., Ph.D.), entitled Breaking Through The Fibro Fog. This book is incredible and documents the clear and significant scientific basis of fibromyalgia. Dr. White is a rheumatologist and well-recognized pain researcher. This book is for patients as well as scientists.

Please check it out at www.wortleyroadbooks.com

Take that all you skeptics!

Yours with care - Michael

A Lot of Suffering

2011-09-04T15:51:00.000-07:00

One of my patients made an interesting comment the other day. She said, .." you must see a lot of suffering."

Although this is true, I hadn't really thought about it that way. Probably, because it does not feel like a burden. For some reason, this kind of work is a good fit for me. For over 25 years, I have been working with people who live every day in pain. Each person is different and each person's life has been affected in a different way by physical pain and the loss and suffering it can lead to.

I am lucky to be able to do the work I do.

Yours with care
Michael

Chronic Pain - 25 Years in the Field

2011-05-07T15:01:00.000-07:00

Please check out this new article,

Chronic pain in context: Some observations from 25 years in the field

published in the Journal of Clinical Psychology Practice (2011,2, 22-32). It was written for an invited presentation I did at the Pain Grand Rounds, St. Joseph's Hospital in London Ontario.

This article is written in easy to understand everyday language and includes ideas and methods from my 25 years of work in this field.

I think you will enjoy it.

Here is the link

http://jcpp.scarthmckillop.ca/2011/2011V21P022032.pdf

Yours with care
Michael

Dr. Oz and Time Magazine Talk about Chronic Pain

2011-02-28T13:22:00.000-08:00

Thank you to the American Pain Foundation for alerting me (and now you) to 2 new articles about chronic pain. You can also sign up for Action Alerts from the American Pain Foundation and have new articles and research sent directly to your email inbox. No stress, no hassles. Just solid helpful information.

You can sign up at www.painfoundation.org

These 2 articles were published recently by Time magazine. One is by Dr. Mehmet Oz

"The End of Ouch"

The other one is by Alice Park "Healing the Hurt"

Both these articles add much needed recognition, scientific backing and credibility to the field of chronic pain.

I hope these articles can help make your life even a little better.

Yours with care
Michael

Compassion Can be a Powerful and Practical Tool

2011-02-19T09:13:00.000-08:00

I came across a fascinating talk, recently, at TED.com. This is a great website to watch short videos from leaders in a variety of fields. Most talks are only 6 minutes and get right to the point. Plus they are free.

I was captivated by a talk from Krista Tippett, called Reconnecting with Compassion. It was not a sentimental appeal for more compassion in our lives, although more is definitely needed - everywhere. It was a highly intelligent discussion of what compassion really means, and can mean in our daily lives.

You can find her talk at

http://www.ted.com/talks/krista_tippett_reconnecting_with_compassion.html

She outlined how kindness is at its' core, as well as beauty, empathy and mystery. She described how compassion can be a practical tool for solving problems.

She mentioned how compassion can be thought of as curiosity without assumptions.

This describes, to me, the perfect attitude for health care providers to take when trying to understand others' pain.

Be careful, this talk may change you.

Yours with care
Michael

Two Main Types of Chronic Pain

2011-01-28T07:55:00.000-08:00

My patients suffer from long-term physical pain, mostly to their backs, necks, occipital head area, and knees. These chronic pain symptoms are usually caused by car or work accidents. These are the problems that have made up my rehab practice, for the past 25 years.

It helps patients to learn that their chronic pain often has two main patterns. One is a constant background pain. This is very difficult to endure, but usually over time it gets a little easier. (Most people don't believe this at first.)

The second type is much tougher. This pattern involves escalations of pain or flare-ups. These escalations can be triggered by increases in certain movements, general increases in activity, increases in stress, poor sleep, or sometimes a build-up of all of these causes.

Flare-ups are usually temporary in nature. They can last a few hours, few days or even weeks. They don't feel this way, though. After an injury, your increased pain can be so powerful that you are convinced that it will never settle down. Often the high level of pain is frightening to you and your family.

Over time, people learn about their own flare-ups - how long they last, what might have triggered them, how best to cope during a flare-up, what medications are needed, and how to help your family not be so frightened.

In my book, Unbelievable Pain Control, you will learn about all of the ways that pain can affect you, and how to best manage your pain and your life with pain.

For readers of this blog, I have made a signed copy available to you for only $10.00 (plus shipping). Please just send your request to me at michael@renfordbooks.com

Thank you

Yours with Care

Michael

Chronic Pain is about Pain And Loss

2011-01-24T09:29:00.000-08:00

Most of my patients have been hurt in car or work accidents, so I end up working with a lot of lawyers.

Sometimes, lawyers are confused about my work. I am a rehab psychologist who helps people with physical injuries and disabilities. One lawyer, a few years ago, said to me, rather bluntly, "What do you do". What this lawyer was really asking is, you are a psychologist, my clients have serious physical injuries, what do YOU do?

I told him, "pain and loss". To me that sort of summed it all up.

If a person's injuries and pain go away after a few months, they would never come and see a psychologist like me. Their injuries would heal, their pain would go away, and they could quickly get back on with their regular life. Not much stress involved.

If your injuries, pain and limitations continue, month after month, the stresses in your life start to escalate. Maybe your work is disrupted and you are having trouble getting benefits. Maybe your pain and limitations interfere with your family life and your spouse and children are having difficulties coping with the extra load on them. You may be having trouble sleeping. These problems and losses start to build, day after day, month after month. Many people don't know where to start getting their life back under control.

Most importantly, these stresses and losses can physically aggravate your physical injuries. Stress can aggravate any serious physical health problem - especially chronic health problems.

Pain and injury cause stress and loss. Stress and loss trigger more pain. Higher levels of pain cause even more stress and loss. Who wouldn't need help trying to get this viscious cycle under control.

Please check out my website for some helpful ideas www.UnbelievablePainControl.com.

Yours with care

Michael

Chronic Pain - Many Questions - Simple Answers

2011-01-20T12:30:00.000-08:00

What is chronic pain? What is fibromyalgia?

Are these real physical health problems? Are they recognized by doctors, insurers, and the courts?

Can stress or depression cause chronic pain or fibromyalgia?

Can chronic pain or fibromyalgia interfere with my ability to work?

These are the central questions that my patients ask me every day. They cause injured people, as well as family members, much stress and worry.

I have tried to answer these questions in simple and easy to understand ways. I have even devoted separate chapters to some of these important concerns.

You can find all of this information plus much help for your pain, your stress and the many ways that your life has been disrupted. Please check out my new book

Unbelievable Pain Control: How to Heal and Recover from Chronic Pain and Fibromyalgia

by Michael R. MacDonald, Ph.D.

Please consider a 40% savings. Just send me a quick email.

This book is also available from www.Amazon.com or www.Amazon.ca

My patients seem to like this book. I hope you do too.

Yours with care

Michael

Caring is Good Medicine - New Findings

2011-01-14T08:57:00.000-08:00

This is one of my favourite sayings - "Caring is good medicine" (Bill Moyers).

Some new research findings help support this view. A recent study from the European National Health Service studied hospital treatments, outcomes and costs, and made some strong recommendations. By helping patients have a better experience in hospital, better outcomes resulted and lower costs. Patients suffered from fewer complications after surgeries and were generally healthier.

Common sense approaches seem to help. "Simple things like spending time with patients, talking to them, listening to their concerns..." These are the simple things that are sometimes lacking when patients with chronic pain and fibromyalgia are surveyed about their health care experiences.

This kind of approach is especially helpful for patients with long-term pain. Patience and compassion are necessary to help people learn about their injuries and pain. Encouragement and understanding can help people gain some of the strength they need to move forward in their lives.

Yours with care

Michael

Real and Physical Chronic Pain

2011-01-10T07:31:00.000-08:00

It has been estimated, by numerous research studies, that about 15-20 percent of the population suffer from various forms of chronic pain. For many of these people, doctors have not been able to find any clear results from ultrasound, x-rays, CT scans or MRI scans.

This is actual quite common. But it does not mean that there is no physical injury or illness causing the pain. All it means, is that the high tech tests have not been able to show the physical source of injury.

People with chronic neck or low back pain often struggle to understand their injuries. This is harder when the doctors and their investigations cannot find any clear explanation. This is frustrating for doctors too.

The bottom line is that doctors have to accept what their patients tell them and try to find the best possible treatments. This is the general rule of thumb is all of health care And, generally, the more details that patients can provide, the better.

Another necessary ingredient, of course, is trust. Scientists are devoting their lives to try and come up with better investigation tools. In the meantime, patience and good faith can go a long way.

Yours with care,

Michael

Chronic Pain - A Sense of Entitlement - Of Course!

2011-01-07T08:28:00.000-08:00

When I am preparing to testify in court, the lawyers will send me all of the reports and documentation that have been done on the case. This is important, since I need to know what the particular controversies may be.

Sometimes, when reading reports from insurance doctors, I see that the patient is accused of having a "sense of entitlement". This term is used to attack the person's character and honesty. The implication is that the injured person is exaggerating their symptoms because they feel that others (meaning insurers) owe them a living. This is a transparent attempt to blame the victim.

If you should happen to read such slurs, please remember this. Accusations are cheap and easy to make. It is the facts that count. In fact, attacks may come from both lawyers, not just the insurance lawyers.

If you have been unable to work, your financial losses have been climbing. The longer you are off of work the bigger your losses will be. If you can never return to work, your fears of more and more losses will be high.

Under these circumstances, of course you expect to be fairly compensated for your losses. Just like the insurance doctors have a sense of entitlement about their high fees.

Your job is to be honest and do everything you can to get better. Thats all.

Yours with care

Michael

How to Reduce the Losses Caused by Your Chronic Pain & FM

2011-01-03T07:29:00.000-08:00

Happy New Year everyone. I hope this new year can bring you less pain, less stress (caused by your pain) and fewer losses.

Safety First. This is one of the most important first steps to recovery. You have to protect or restore your benefits. You don't want to incur additional losses and stresses. You need all of your energy and strength to deal with your pain.

From my website, you can download (for Free) a 16 page booklet which will outline how you can keep yourself safe from further losses. Just click this link and it will take you there:

http://unbelievablepaincontrol.com/free_booklet.html

I hope some of this information can help you, even a little.

Yours with care

Michael

Chronic Pain, Depression & Your Credability

2010-12-13T07:43:00.000-08:00

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

2010-12-03T07:31:00.000-08:00

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?

2010-11-29T07:38:00.000-08:00

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

2010-11-01T10:56:00.000-07:00

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?

2010-10-21T11:36:00.000-07:00

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

2010-09-15T12:16:00.000-07:00

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

2010-09-02T11:31:00.000-07:00

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

2010-07-26T06:59:00.000-07:00

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

2010-07-15T15:55:00.000-07:00

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

2010-06-28T13:17:00.000-07:00

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??

2010-06-12T10:11:00.001-07:00

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