What Can We Do About Pain?

[Guest guest]

What Can We Do About Pain?

by Lois Berry

(excerpted from her book Cancer Saved My Life)

This breast cancer survivor has some surprising things to say about

managing pain. She also shares the knowledge she gained about things

like stress, forgiveness, and spiritual renewal.

 

 

 

 

 

 

I am a longtime survivor of cancer and what I have learned

about living through that experience has enriched my life in many

ways. In the book, Cancer Saved My Life, I tell my story about breast

cancer which metastasized to the bone. I share my personal journey

through the illness and subsequent recovery from it. I wrote this

book because I wanted to share the knowledge I gained about such

things as dealing with stress, forgiveness, spiritual renewal and the

healing power of prayer. For me, and I believe for others, these

things can add to a happier and more joyful life for everyone, not

just cancer patients.

 

 

 

A discussion of pain is a difficult subject because there are many

degrees of pain. Our ability to tolerate pain is different and our

experiences vary.

 

Acute pain is a signal to the body that it has been damaged in some

way. It is any physical pain with a discernible cause. A simple

example would be hitting your thumb with a hammer. Chronic pain is

persistent and constant. It may be in just one specific area or it

may be the kind of pain that manifests itself in many areas of the

body.

 

Pain that we know is temporary from surgery or an injury can be dealt

with effectively with pain medication. However, long term use of

medications is not advisable nor does it solve the problem. I have

had pain of varying intensity over the years so I can speak from

experience.

 

Years ago I had excruciating pain from a disc that slipped in and out

in the lower part of my back. There would be long periods when I was

pain free. Then, there came a time when it became so bad that I had

trouble functioning. I know what it's like to get up in the morning

wondering how I would get through the day. I did take pain

medications at that time when the pain became unbearable. However,

they were a mixed blessing because although they lessened the pain

they made me feel sluggish and depressed and they did not solve the

problem.

 

X-rays did not reveal what was causing the pain so my doctor tried

everything. I wore a brace, went to an osteopath and even had

traction in the hospital in an attempt to realign my spine. Nothing

worked and I finally had a myelogram. This is a procedure where the

spinal fluid is withdrawn and a dye is injected into the spine. An X-

ray film showed that the disc had ruptured and the pieces were

pressing on the nerves in my lower back. Successful surgery was

performed, my spine was fused to my tailbone with screws and I was

finally pain free. So in this case, medical intervention solved my

problem.

 

Another time I was rear-ended in an automobile accident that resulted

in pain in my head and down my arm. Medical tests showed that I had a

partially herniated disc in my neck and a bone chip. The neurosurgeon

wanted to operate and told me terrible things that could happen if I

did not have surgery. One of the things I remember distinctly is that

he said I could become paralyzed. My decision was not to risk surgery

without trying other things. This was what I call manageable pain

because it didn't incapacitate me, but it was persistent.

 

After going to several physical therapists that were not able to help

me, I found a therapist who practiced myofacial therapy which is a

different kind of procedure. The therapist finds and uses trigger

points in the body to effect healing. It was amazingly effective for

me.

 

I feel very fortunate not to have had much pain with my cancer. I

experienced a brief period of pain and discomfort from the radical

mastectomy after my breast cancer, but had none with the bone cancer.

My oncologist did not believe me at first and said it would be

difficult to treat me if I minimized my pain. I did finally convince

him that except for a sharp twinge once in awhile I was really pain

free. I attribute this to my mental attitude and the fact that

through spiritual intervention I had no fear. Due to the lack of pain

and the fact that my treatment had no side effects, I came through my

cancer experience feeling very well.

 

Other cancer patients are not so fortunate and the ones I have been

privileged to know learned to deal with their pain in many ways. They

were neither passive nor long-suffering patients. They tried many

different things such as, acupuncture, relaxation techniques,

biofeedback, exercise, and, for many, the power of prayer. They also

went to a support group to learn about what worked for other

patients. The camaraderie in that group helped tremendously with the

mental attitude of the patients who attended. It really helps to know

that you are not alone.

 

Chronic pain is a different problem altogether. An experience I had

with pain about a year and a half ago gave me a new respect for

people whose pain is unrelenting and unending. I had been in very

good health for many years when I had a sudden onset of pain all over

my body. It was in my arms, hands, shoulders, hips and legs. I cannot

tolerate most pain medications so I had very little relief. It was

like being healthy one day and an invalid the next. It began in

October and by January I was in a wheelchair because the pain was so

severe I couldn't walk. My doctor was as mystified as I was until a

specialist diagnosed my problem as PMR (Polymyalgia Rheumatica). I

don't know whether that diagnosis was correct, but I reluctantly

agreed to take a low dose of prednisone. I say `reluctantly' because

I do not like to take drugs and I also knew that there were possible

side effects from this one. I believe this helped, but it still

doesn't explain why the pain was completely gone in the next two

months. I used the wheelchair for just three weeks, then a cane and

finally the day came that I could say I was pain free.

 

I prayed a lot for healing and I believe those prayers were answered.

It was a humbling experience and it gave me a new respect for people

who have chronic pain. We need to learn something from every

experience in our lives and I think I did. Why did it happen? I don't

know, but recovering from that episode of pain gave me a renewed

appreciation for my life and filled me with joy.

 

I cannot even imagine the agony of being in pain every day of one's

life. I recently read a book The Chronic Pain Workbook by Ellen Mohr

Catalano, M.A. that explains that this type of pain is seldom cured.

Rather, the patient must learn to control the pain rather then let it

control him. Chronic pain affects every aspect of the patient's life.

Often the person suffering such pain feels that family and friends do

not understand. Family and work relationships suffer and this, in

turn, causes depression. The author believes new strategies involve

working with the whole person and not just the symptoms. Pills are

replaced with skills such as stress management, self-hypnosis,

biofeedback, exercise; anything that brings about relaxation. When

you are in constant pain your whole body is tense and that causes

more pain.

 

The best book I have read on this subject is Chronic Pain: Taking

Command of Our Healing by Wm. R.B. Anderson, PhD with Jesse F.

Taylor, PhD. Anderson says, " Unfortunately, the Medical Establishment

is slow to expand its range of theories in the search for effective

treatments…while many doctors will, informally, admit that emotional

effects are important in healing, they are hesitant to give

professional credence to procedures which treat emotions in order to

heal physical illness. "

 

The authors believe that emotional trauma lies at the base of most

chronic pain. The ideas presented in this book are not offered as an

alternative to successful therapy. Rather, they are offered as an aid

to hasten healing. Our belief systems collected over a lifetime are

not arrived at consciously. In fact, many of them are buried deep in

our subconscious mind. From my own experience, I know that treating

just the disease is not enough. It is a joint effort between patient

and doctor.

 

There have been extensive studies on endorphins and their role in

controlling pain. Endorphins are chemicals secreted by the body that

are natural painkillers. Production is unpredictable and not everyone

produces the same amount of endorphins under each circumstance. It

has been proven that stress and fear reduces the amount of this

chemical that is produced. So, it would seem like common sense to

work toward relieving the stress and fear in your life in an effort

to boost your body's healing capabilities.

 

I talked to a friend who has been suffering with pain for years. His

illness has been diagnosed as fibromyalgia or chronic myofacial pain

syndrome. This is an incurable condition that produces pain in the

fibrous muscle tissue. Over the years that he has been afflicted with

this disease, he has tried almost everything that medical science and

alternative medicine has to offer. The following is what he said in

his search for healing. " My most severe chronic pain began in

January, 1996 with pronounced pain at the end of my rib cage. I do

not know what the trigger (or cause) for this onset of pain can be

attributed to. Trauma, of one sort or another, has been mentioned in

literature as a cause but some pain specialists discount this notion.

I guess my initial painful episodes were the result of emotional

stress.

 

" I was referred to a doctor who specializes in Rheumatology/

Osteoporosis/ and Fibromyalgia diagnosis and treatments. Mainstream

doctors are sympathetic if they have studied or been exposed to the

new evidence and AMA diagnostic procedures.

 

" Through the years my symptoms and pain levels have varied.

Conventional and non-conventional medicine have been used, none with

much success. My treatments have included acupuncture, physical

therapy, biofeedback, and some counseling. I have not gone to a pain

clinic.

 

" I have attempted to resolve a personal problem by moving and living

by myself. Since then, my stress level has been reduced and thus my

pain levels and frequencies of flare periods have diminished greatly.

I have stopped taking long-term medications such as Neurontin and

Vioxx.

 

" I finally realized I had a drinking problem and am now in treatment.

I do feel much better since I stopped drinking. However, as I write

this I am in a flared condition with increased pain and I have no

idea what triggered this episode. These episodes are much like the

onset of the flu, but without the stomach distress, nausea or head

cold symptoms. A lot of generalized pain in the muscles and joints is

typical.

 

" Most of this condition, or a great deal of it, may be induced by

weather changes or emotional stress. At least these two seem to

affect me with regularity and predictable results. "

 

One of my daughters had to have surgery for a suspicious growth on

her ovary. The surgeon would not know until after the operation

whether it was cancer or a benign cyst. She was very fortunate that

it turned out to be the latter. The most remarkable thing, however,

was how she handled the pain. Growing up she was very fearful of any

kind of pain even if it was a minor thing like a shot.

 

She stayed with me after her surgery and I was amazed at how quickly

she recovered with a minimum of pain. I asked her how she

accomplished that and this is what she said: " Several things helped

me deal with the pain of my surgery. I read Dr. Bernie Siegel's book

Love, Medicine and Miracles and it gave me hope. I followed my

oncologist's suggestions on getting in shape before the surgery,

which helped me recover without any problems. I also was pretty good

at following his instructions such as limitations after surgery. I

think trusting my medical team (including nurses) was very important

to me.

 

" Siegel's book suggested that I could ask the doctors to talk to me

during surgery. It would be like hypnotic suggestion. I asked the

anesthesiologist to talk to me about how I did not smoke and had no

fear of pain. I had no compulsion to smoke after surgery and I had

been afraid that would be a problem.

 

" While I was in the hospital, my surgeon lectured me because I was

not taking the pain medication as regularly scheduled. My response to

him was it was because I was in no pain.

 

" I have no doubt that for me a lot of previous pain was caused by

fear. Clearly, when a person is afraid they tense up and, as a

result, have more pain. Relaxing is part of the key. But to me, it

was a miracle that this one suggestion during surgery took away the

fear of pain for me and, as a result, the pain itself. "

 

I asked a nurse friend to give me her observations on how pain is

handled in a hospital setting by both nurses and doctors. She sees

pain on a daily basis and this is what she said: " Almost without

exception, the patients I deal with have pain at one point or

another. Many discovered they were ill because the pain started and

others have pain after they have surgery. As nurses, we assess the

entire patient at the start of each shift, reviewing each system such

as cardiovascular, respiratory, nutrition, etc., including a `system'

of comfort. We view comfort as an important part of the patient's

well-being and over the past few years have focused on improving our

assessment skills and also helping the patient identify and define

their pain.

 

" We evaluate the location, duration, aggravating factors and

intensity (scale of 0-no pain to 10-unbearable pain), so that as

different staff tend to the patient, we have a more consistent

process for evaluating the pain. That being said, the process for

achieving acceptable patient comfort becomes a gray area because pain

is very different to different people. Another system we assess is

psychological and of course one's sense of self, loss of power over

one's own body and one's experiences with pain in the past (his own

or that observed) can all greatly influence one's perception of one's

own pain.

 

" Although it may not be correct, the medical profession's general

first line of offense against pain is medication, There are safe

standards for pain medication doses and doctors generally order a

range for the patient and have the nurse use her judgment on what may

work for the patient, then adjust accordingly. I find that I assess

the patient, taking in his information about his pain, then observe

his non-verbal behavior as well as listen to his other concerns.

 

" Many times solving other concerns can decrease the pain level and

thus require less medication, usually a narcotic. This is where the

psychosocial aspect comes in, watching family interactions, observing

the timing of the pain medication request (when the patient is alone,

frightened) or even comparing or competing with a roommate. Two

patients with similar surgeries and assumed similar pain can have

very different levels of pain based on many of these factors.

Something as simple as repositioning, changing temperature, backrubs,

quiet, helping the patient understand the reason for the pain or

staying a few extra minutes in the room can decrease the patient's

pain. Yet, we as nurses are at times rushed and may find medication

the most available and convenient answer. We are working on that!

 

" I think doctors try to keep their patients comfortable with

medications, but when what they have ordered doesn't work, nurses

often are the ones to suggest alternate medications, dosages, etc.

and become the patient's advocate for comfort. Because we are with

the patient so much more, we have a better sense of what else might

work. Most doctors seem sensitive to the patient's discomfort, but

don't feel the urgency for change since they are not with the patient.

 

" For chronic pain situations, there are Pain Clinics at most major

medical centers to which doctors will refer difficult cases. I would

say that these cases are considered troublesome by doctors (and many

nurses) and we probably do not appreciate all the factors that are

involved in the patient's pain and these types of patients get

labeled as drug-dependent, psychologically weaker and imbalanced.

 

" This is an area we all need to work on. it is hard to empathize with

a patient who says he is having horrible pain, yet is on immense

amounts of drugs, far greater than most patients in similar

circumstances would require, and often his non-verbal behavior does

not demonstrate intense pain. We have to remember, however, that this

type of patient has REAL PAIN within his own perception and he needs

help dealing with it and overpowering it. This actually goes for all

patients and their pain.

 

" Some patients do deal with pain better than others. One interesting

observation that I have discovered is that elderly people seem to

deal with pain in a more accepting manner. Men and women seem to deal

about the same. The difference is mostly based on a person's

personality, their own perception of what pain is all about, their

sense of being part of their healing process and the support they

have within the family circle. "

 

The following comments are the observations of a caregiver. Although

she has never been in pain except during childbirth, she has had to

deal with pain in varying degrees of severity with her husband and

children. She told me that she thinks pain is a very personal thing.

Individuals seem to have different tolerances and handle it

differently.

 

She feels that mind and emotions play a big part. She believes that

control is a major issue. Being able to let go and know you are not

in control of your life helps with getting rid of pain. In

childbirth, learning how to relax is key, in her opinion. When she

was delivering her first child, she remembers how the girl next to

her screamed for hours until she finally asked the nurse if this

person was going to have her baby soon. The nurse replied, " You are a

lot farther along than she is. "

 

Any of you who have children, has probably noticed that they have

different tolerances to pain. I know I did. It seemed that one child

didn't feel pain as acutely as another. This caregiver shares the

reactions of her children. One would be hysterical with a slight

injury while another would hardly react. She felt that in addition to

the pain their emotional makeup was different.

 

When her husband became ill, it was a long time before he received a

diagnosis of cancer, but he was in pain. He had severe headaches and

went to a clinic that specializes in this disorder. They used

biofeedback along with other techniques in an effort to get to the

bottom of his stress level. The patient knew something was terribly

wrong and it manifested itself in headaches and also painful

backaches. What is interesting is that when he knew he had cancer the

headaches and backaches disappeared.

 

This caregiver doesn't give doctors very high marks in dealing with a

patient's pain. Their solution is just to give medicine without

trying to find the cause. From her experience, she says it is

important to take as little medication as possible in the beginning

because long term, as you have to increase the dosage, it might not

work as well. Doctors should be looking carefully for side effects

and allergic reactions.

 

As the nurse stated, when pain is beyond the control of the doctor,

he will often suggest going to a pain clinic. This caregiver feels

that pain clinics, however, are only as good as the patient

attending. If the patient doesn't listen and cooperate, they cannot

be successful.

 

The most helpful role of the caregiver is to do research so she will

be knowledgeable about her patient's illness and to be an advocate

for that person. One of the things this caregiver mentioned was the

need to be aggressive in reaching doctors; not allowing the patient

to go too long without help. Also, it is important to monitor

medicine intake and to encourage consistency. She found that if her

husband skipped taking medications prescribed by his doctor, the

consequences were serious.

 

As an advocate when her husband was in severe pain because she had

done research, she was able to persuade his doctor to perform spinal

nerve blocks. At the time, they were really helpful and necessary,

but had never been suggested by the attending physician. She felt

good about being the one able to get him this help.

 

When a member of the family has a serious illness, it is hard on

everyone and the caregiver tries to keep a balance. In this

particular instance, there were many months when the children could

not have their friends come to their house because their father

needed absolute quiet. The patient becomes the primary concern and

everyone suffers to some degree.

 

Looking back, this particular caregiver said, " I guess what I would

do differently is to be more sensitive and aware of what was going

on. I would watch mood swings and language more. There is a lot of

emotional pain associated with physical pain and if I had dealt more

with the emotional pain, it could have helped the physical pain. "

 

There are many natural remedies suggested for pain. If you are

interested in exploring that possibility I would suggest that you

find books on that subject at your library. Since most natural

products are harmless, there is no reason not to try them.

 

 

 

 

 

Lois Berry, author, has released her personal story of tragedy and

triumph in her first book Cancer Saved My Life.

 

Berry tells the story of dealing with cancer, not once, but twice.

She was diagnosed with breast cancer in 1969, and had a radical

mastectomy. Four years later, the cancer returned, this time in her

pelvic area. The title of the book bares witness to its content which

is bound by a buoyant story of overcoming the odds and gaining

spiritual peace and physical well being. As a " survivor " she speaks

regularly to cancer support groups and counsels with individuals in

the midst of coping with the disease. She has also completed her

second book, The Doctor Who Dared to be Different, a biography of her

oncologist, the late Dr. Glenn Warner. Berry believes he saved her

life by going outside of standard medical practice and dealing with

the mind and soul as well as the body. Her current book reflects much

of what she learned from his work with her as a patient.

 

The book is published by iUniverse.com, and is available through

Amazon, Barnes & Noble and Island Books (Mercer Island, WA, 800-432-

1640). For further information, contact the author at:

berrylw25