Finding Hope While Suffering From Chronic Pain
“Out of the night that covers me,
Black as the pit from pole to pole,
I thank whatever gods may be
For my unconquerable soul.
In the fell clutch of circumstance
I have not winced nor cried aloud.
Under the bludgeoning of chance
My head is bloody, but unbowed.
Beyond this place of wrath and tears
Looms but the Horror of the shade,
And yet the menace of the years
Finds, and shall find me, unafraid.
It matters not how strait the gate,
How charged with punishments the scroll,
I am the master of my fate:
I am the captain of my soul.”
William Ernest Henley.
What is Chronic Pain ?
Chronic pain is defined as any pain lasting more than 12 weeks.
While acute pain alerts us to possible injury and helps us take quick action to prevent further damage, chronic pain is very different as it persists for weeks or longer.
Some controversy exists over the actual time duration required before pain is considered chronic, with some authors considering ongoing pain lasting longer than 6 months as diagnostic, and others have using 3 months as the minimum criterion.
In chronic pain, the duration parameter is used arbitrarily. Some authors also suggest that any pain that persists longer than the reasonably expected healing time for the involved tissues should be considered chronic pain.
Nearly 50 million American adults have significant chronic pain or severe pain, according to a study by the National Institute of Health’s National Center for Complementary and Integrative Health (NCCIH).
The study estimates that within a previous three-month period, 25 million U.S. adults had daily chronic pain, and 23 million more reported severe pain.
People with serious pain need and use more health care services and suffer greater disability then persons with less severe pain.
Chronic pain syndrome (CPS) is a common problem that presents a major challenge to health-care providers because of its complex natural history, unclear etiology, and poor response to therapy.
Chronic Pain Can Affect People in a Variety of Ways
Major effects are depressed mood, poor quality sleep, fatigue, reduced activity and libido, excessive use of drugs and alcohol, dependent behavior, and disability out of proportion with impairment.
Causes of chronic pain include:
– Lyme disease
– Reiter syndrome
– Disk herniation/facet osteoarthropathy
– Fractures/compression fracture of lumbar vertebrae
– Chronic daily headaches
– Muscle tension headaches
– Migraine headaches
– Chronic urinary tract infection
– Urethral stricture
– Testicular torsion
– Gastroesophageal reflux
– Peptic ulcer disease
– Inflammatory bowel disease
– Irritable bowel syndrome
– Adnexal cysts
– Chronic ectopic pregnancy
Treatment of chronic pain syndrome must be tailored for each individual patient. The treatment should be aimed at interruption of reinforcement of the pain behavior and modulation of the pain response.
The goals of treatment must be realistic and should be focused on restoration of normal function (minimal disability), better quality of life, reduction of use of medication, and prevention of relapse of chronic symptoms.
Psychological interventions, in conjunction with medical intervention, and occupational therapy increase the effectiveness of the treatment program.
Family members should be involved in the evaluation and treatment processes to enhance its effectiveness.
Appropriate caution must be taken during management of chronic pain in patients who exhibit any of the following behaviors:
– Poor response to prior appropriate management
– Unusual, unexpected response to prior specific treatment
– Avoidance of school, work, or other social responsibility
– Severe depression
– Severe anxiety disorder
– Excessive pain behavior
– Physician shopping
– Noncompliance with treatment in the past
– Drug abuse or dependence
– Family, marital, or sexual problems
– History of physical or sexual abuse
– Inpatient and outpatient care
Hospitalization usually is not required for people with chronic pain syndrome, but it depends on how invasive the treatment choice is for pain control and on the severity of the case.
People with chronic pain syndrome generally are treated on an outpatient basis and require a variety of health care professionals to manage their condition optimally.
Celebrities Who Overcame The Challenges of Chronic Pain
Despite the despair that you might feel sometimes when living with chronic pain, it is not a death sentence.
The following well known celebrities have had successful lives and careers despite struggling with chronic pain:
The controversial Irish rocker stepped away from the limelight in 2003, in large part because she suffered from fibromyalgia.
Two years later, she was back, saying, “Fibromyalgia is not curable. But it’s manageable. You
get to know your patterns and limits, so you can work and plan around it.”
O’Connor, who also has bipolar disorder, manages to juggle her career and raising four children—noting that her high pain threshold and ability to lower her expectations that her life be “perfect” help take the pressure off herself to feel good all the time.
Polycystic Ovary Syndrome and Endometriosis
Former trainer for The Biggest Loser and current co-host of The Doctors, Jillian Michaels kept her diagnosis of endometriosis and Polycystic Ovary Syndrome (PCOS) to herself for years, worried that it would damage her “beacon of health” reputation.
The conditions can cause pain—in endometriosis, cells from the uterine lining can grow on other organs and tissue in the body; PCOS indicates a hormonal imbalance that leads to irregular
menstrual cycles and small cysts in the ovaries.
Michaels came forward about the conditions after a reporter’s questions about her plans to adopt prompted her to say she wouldn’t put herself through the physical challenge of pregnancy.
She later clarified that since her condition can cause infertility and pregnancy may require her to have surgical procedures, she felt more comfortable adopting.
She has said that while she used to suffer from debilitating abdominal pain, she found that eating a diet that includes, among other things, organic foods and non-processed soy and exercising regularly have helped alleviate her symptoms.
When she was in college in 1977, the future ABC News/Nightline anchor was diagnosed with Crohns disease.
Her coping mechanisms ranged from humor—she and her friends called it George to avoid having to discuss the specifics of her condition—to growing her fingernails long so she could dig them into the skin on her arm to distract her from intestinal pain that would leave her double over.
McFadden has been in remission since having 15 feet of intestine removed in 1979, but it’s clear she can also credit her own steely determination with managing the disease: “I decided a long time ago, I wasn’t going to live my life around George.”
Her successful career as a news anchor is proof positive of that attitude.
The actress was first diagnosed with rheumatoid arthritis —an autoimmune disorder in which the body attacks the soft tissue and joints— in 1992, though she’d experienced symptoms for about a year before that.
A blood testbconfirmed the diagnosis, which, in turn, gave the actress a healthy dose of perspective. “Suddenly all that stuff about having good looks and being sexy took secondary position to being able to walk without pain,” she has said.
After abusing alcohol to cope with the pain, she got sober and set herself on a path to not only find a cutting-edge medication that placed her disease in remission, but to speak out about the disease.
She went on a crusade to raise funds and awareness for RA (at least 1.3 million Americans suffer from it), earning a Lifetime Achievement Award for her work from the Massachusetts Arthritis Foundation.
“It is important to me that people know they have options so they can get some relief from this debilitating disease,” she has said, noting that early treatments is key to managing the disease.
Millions of Americans remember the suave and successful host of The Montel Williams Show announcing that he had multiple sclerosis in 1999, a year after he received the diagnosis that put an end to 10 years of misdiagnoses for his chronic pain, but for which there had been other symptoms dating back to his late teens. Williams says he chose to view the diagnosis, ultimately, as a “call to Action.”
He went public with his diagnosis, largely to create a sense of urgency to find a cure.
Today, he heads the Montel Williams Foundation, which, for 11 years, has raised funds for research toward a cure.
Williams is also the author of eight books, including Body Change, which outlines the exercise regimen he uses to stay strong and keep additional symptoms at bay.
He has said he exercises for 75 minutes a day.
The actor who is as famous for his anti-genocide activism (and his love life) as his movie roles suffered a debilitating back injury while filming the 2005 thriller Syriana.
Hitting his head on the floor during an intensely violent scene, he tore the dura—the wrap around the spine that holds in spinal fluid—and told reporters that, prior to a number of corrective surgeries, the pain was so bad that he thought “ending it all” seemed like a viable option.
Despite undergoing surgery to reinforce his spine with bolts, Clooney says the injury has never completely healed, forcing the 50-year-old star to drop out of filmmaker Steven Soderbergh’s upcoming version of the 1960s spy series The Man from U.N.C.L.E.
According to Eonline.com, “He said he just can’t do the action and stunt scenes,” revealed an U.N.C.L.E. source who’s familiar with the actor’s health situation. “In fact, I think he’s planning on having another operation during the time he would have been filming.”
The 2010 Dancing With the Stars champ suffered chronic pain for years after a neck injury from a 1987 car accident.
Managing the pain mainly with “Advil and ice packs,” she focused her energy not on her career, but on becoming a wife and mom—eventually marrying actor Clark Gregg and having daughter Stella, now 9.
When she joined Dancing’s 11th season, she did it largely because she wanted to push herself after a surgery to insert a plate in her neck (to ease pain and prevent further damage) led doctors to discover cancerous tumors on her thyroid.
The cancer had not spread, her thyroid was removed, and no chemotherapy or radiation was needed.
“I wondered, what if I took more risks?” She danced
without knowing whether she could complete her final dance—the night before the finale, she ruptured a disc in her lower back. But even her doctor, who supervised her carefully, said, “People are better off moving around than sitting around.” Surgery to repair the disc has left her “pain free.”
Methods of Coping With Chronic Pain
A self-directed or therapist-directed physical therapy program, individualized to the patient’s needs and goals and provided in association with occupational therapy, has an important role in functional restoration for patients with chronic pain syndrome.
The goal of a PT program is to increase strength and flexibility gradually, beginning with gentle gliding exercises. Patients usually are reluctant to participate in physical therapy because of intense pain.
Physical therapy techniques include hot or cold applications, positioning, stretching exercises, traction, massage, ultrasonographic therapy, transcutaneous electrical nerve stimulation (TENS), and manipulations.
According to a double-blind study, exercise groups have significant benefit over TENS. Heat, massage, and stretching can be used to alleviate excess muscle contraction.
Other intervention should be offered to enable greater confidence and comfort when patients do not progress in a reasonable amount of time.
This therapy has significant benefit in the treatment of rheumatoid arthritis and osteoarthritis.
Electrodes should be applied over or near the area of pain with the dipole parallel to major nerve trunks.
TENS application should be avoided near the carotid sinus, during pregnancy, and in patients with demand-type pacemakers. The most common adverse effect of TENS is skin hypersensitivity.
– Application of Heat and Cold
Use of these modalities is encouraged for the treatment of chronic pain, although the use of cold in neuropathic pain is controversial.
– Occupational and Recreational Therapy
Occupational therapy is very important for initiating gentle, active measurements and preliminary desensitization techniques among patients who have chronic pain, especially regional chronic pain syndrome.
Recreational therapy can help the patient with chronic pain to take part in pleasurable activities that help to decrease pain.
The patient finds enjoyment and socialization in previously lost recreational activities or in new ones. Usually, patients with chronic pain are depressed because of intense pain.
Recreational therapists may play an important role in the treatment process as they help enable the patient to become active.
– Vocational Therapy
Vocational therapy should be recommended and initiated early for all appropriate patients.
It can provide work capacities and targeted work hardening so that the patient may return to gainful employment, the ultimate functional restoration.
Each patient is evaluated to determine work history, educational background, vocational skills and abilities, and motivation level to return to work.
The patient should get help from a vocational counselor regarding legal rights and obligations in each state ( e.g. workman’s compensation). Each patient needs to set realistic goals.
– Nerve Blocks, Spinal Cord Stimulation, and Intrathecal Pumps
Nerve blocks are used for diagnostic, prognostic, and therapeutic procedures.
Spinal cord stimulation commonly is used to treat neuropathic pain refractory to other forms of treatment.
Spinal cord stimulation also is used for patients with a failed back syndrome with radicular pain.
Careful evaluation is recommended before patient selection for this treatment, including a preprocedure psychological/psychiatric evaluation, and a successful spinal cord stimulator trial is required prior to implantation of the stimulation device.
– Intrathecal Morphine Pumps
Intrathecal morphine pumps, either fully implantable or external, are used to treat chronic pain. Use of these devices should be considered very carefully for pain of nonmalignant origin, with a preprocedure psychological/psychiatric patient examination being included in the evaluation. A successful intrathecal morphine pump trial is required to implantation of the pump.
This type of therapy consists of reassurance, counseling, relaxation therapy, stress management programs, and biofeedback techniques.
With these treatment modalities, the frequency and severity of chronic pain may be reduced.
Biofeedback may be helpful in some patients when combined with medications, while behavioral techniques have been successfully used to treat myofascial and sympathetically mediated pain syndromes.
Relaxation training, including autogenic training and progressive muscle relaxation, commonly is used.
This approach is as effective as biofeedback.
– Learn deep breathing or meditation to help you relax.
Taking half the amount of normal breaths has been noted to make pain less intense than when we breathe normally.
One theory is that slow breathing reduces pain by having a direct effect on the sympathetic nervous system – fibres in the central nervous system which help to control blood flow and skin temperature. Studies have shown that dampening down the sympathetic nervous system can block pain.
– Reduce stress in your life
Pain and stress have a similar effect on the body: your heart rate and blood pressure rise, breathing becomes fast and shallow, and your muscles tighten.
– Boost chronic pain relief with the natural endorphins from exercise. Going for a walk isn’t a treatment, exactly but regular physical activity has benefits for people with many different painful conditions. Study after study has found that physical activity can help relieve chronic pain, as well as boost energy and mood.
If you have chronic pain, you should check in with a doctor before you start an exercise routine, especially if you have any health conditions. Your doctor might have some guidance on what to avoid, at least as you get started.
– Cut back on alcohol, which can worsen sleep problems.
Serotonin is a naturally occurring neurotransmitter (brain chemical) that is associated with a calming, anxiety- reducing feeling in the body.
When serotonin is depleted from lack of sleep, the result is an increase in sensitivity to pain, as well as increased feelings of anxiety, malaise, and even depression.
– Join a support group.
– Don’t smoke.
Decreasing blood and nutrient flow can cause degeneration, particularly in discs in the spine, which already have more limited blood flow.
The result can be lower back pain and sometimes osteoporosis. Physicians also link smoking with fatigue and slower healing, factors that make painful conditions more prominent.
– Track your pain level and activities every day.
Once seen as bizarre, acupuncture is rapidly becoming a mainstream treatment for pain.
Studies have found that it works for pain caused by many conditions, including fibromyalgia, osteoarthritis, back injuries, and sports injuries.
How does it work? No one’s quite sure. It could release pain-numbing chemicals in the body. Or it might block the pain signals coming from the nerves.”
Setting aside the controversy, marijuana has been shown to have medicinal properties and can help with some types of chronic pain.
“There’s strong evidence that marijuana has a modest effect on certain types of nerve pain — particularly pain caused by MS and HIV”, says Steven P. Cohen, MD, associate professor in the division of pain medicine at Johns Hopkins School of Medicine in Baltimore.
Since it also relieves nausea, marijuana can help people who are suffering side effects from chemotherapy .
However, marijuana does have risks. For some people, Cohen says, those risks can be serious, including addiction and psychosis.
Because of the dangers and the obvious potential for abuse, experts generally only turn to marijuana when all other treatments have failed.
On a practical level, you also need to be aware of the laws regarding the use of medical marijuana in your state.
There are also two prescription drugs, called pharmaceutical cannabinoids, that are derived from the active ingredient of marijuana. They are sometimes used for pain, although they are only FDA-approved for nausea caused by chemotherapy and HIV -related weight loss.
-Chiropractor for back
Although mainstream medicine has traditionally regarded spinal manipulation with suspicion, it’s becoming a more accepted treatment.
– Supplements and vitamins. There is evidence that certain dietary supplements and vitamins can help with certain types of pain.
Fish oil is often used to reduce pain associated with swelling. Topical capsaicin, derived from chili peppers, may help with arthritis, diabetic nerve pain, and other conditions.
There’s evidence that glucosamine can help relieve moderate to severe pain from osteoarthritis in the knee.
But when it comes to supplements, you have to be careful. They can have risks.
Some people with chronic pain balk at the idea of seeing a therapist — they think it implies that their pain isn’t real. But studies show that depression and chronic pain often go together.
Chronic pain can cause or worsen depression; depression can lower a person’s tolerance for pain.
So consider giving therapy a try.
There’s good evidence that yoga can help with chronic pain, specifically fibromyalgia, neck pain, back pain, and arthritis.
– Relaxation therapy
This is actually a category of techniques that help people calm the body and release tension– a process that might also reduce pain.
Some approaches teach people how to focus on their breathing. Research shows that relaxation therapy can help with fibromyalgia, headache, osteoarthritis, and other conditions.
Studies have found this approach helpful with different sorts of pain, like back pain, repetitive strain injuries, and cancer pain.
– Guided imagery
Research shows that guided imagery can help with conditions like headache pain, cancer pain, osteoarthritis, and fibromyalgia.
An expert would teach you ways to direct your thoughts by focusing on specific images.
– Music therapy
This approach gets people to either perform or listen to music.
Studies have found that it can help with many different pain conditions, like osteoarthritis and cancer pain.
This approach teaches you how to control normally unconscious bodily functions, like blood pressure or your heart rate.
Studies have found that it can help with headaches, fibromyalgia, and other conditions.
It’s undeniably relaxing. And there’s some evidence that massage can help ease pain from rheumatoid arthritis, neck and back pain injuries, and fibromyalgia.
In conclusion, given all the treatment modalities outlined above – both conventional and alternative – and the inspiring examples of people who struggled with chronic pain and have gone on to find success in their various works of life, it is safe to say that there’s light at the end of the dark tunnel.
It is possible to let go of the despair that engulf you as a result of chronic pain and find new purpose, pleasure and meaning in life again.
I like to hear from the readers so please leave me a comment below to let me know if this post helped you or if you have any questions.