Pain management: making the unbearable bearable - pain relief

Nation's Business, Sept, 1988 by Carol Dilks

Pain Management: Making The Unbearable Bearable Think about pain. Think about a piercing headache, or a stubbed toe, or a tight lower back that has you wincing with every move. We all experience such pains from time to time--but what kind of person would you be if you had to face that pain every day for the rest of your life?

For people with chronic, incurable pain, the days pass and hours tick away in moments barely endured. "My life was completely focused around pain," says William O'Donnell. After a car accident a year ago, a herniated disc in his back caused severe pain down both legs and frequent back spasms that forced him to lie down for over seven hours daily. It was impossible for O'Donnell, 29, to do his job as district circulation manager for the Providence Journal in Rhode Island, a job that called for long stretches of driving and a fair amount of lifting.

All pain starts as an important warning signal that the body has suffered some damage, but when pain is chronic, it has become a disease itself.

An estimated 80 million Americans suffer bouts of chronic pain. The largest number report recurrent headaches, lower-back pain and arthritis. Thousands more suffer from bursitis and tennis elbow, causalgia (pain resulting from a shock to the nervous system), neuralgia (also a nerve-damage syndrome), phantom limb pain and terminal-cancer pain. The National Institute of Neurological and Communicative Disorders and Stroke has estimated $60 billion as chronic pain's annual cost in lost work time, hospitalization, insurance, legal costs and disability.

Chronic pain often defies treatment. Medical facilities known as pain centers--a number have been set up in recent years--make no attempts to cure pain, since their patients have explored every available treatment before coming to them. These centers try to help patients come to terms with their pain.

After months of disappointment in his search for a pain cure, William O'Donnell contacted the chronic-pain treatment program at Miriam Hospital of Brown University. "They got me to shift my focus from the pain to getting back to work," he says. "They said things would get better, and they have. I am less sensitive to the pain, and I'm back at work."

No single therapeutic approach can accomplish all the goals, so pain centers generally use a mix. "We aim to get the person functioning again even though the pain doesn't go away," says Dr. Edward Aberger, director of clinical services at Miriam. "It is an interdisciplinary approach, where psychiatry, physical therapy, relaxation and family and occupational therapy come together to bring the person out of the incapacitation and isolation pain can create."

Some centers use biofeedback, meditation, ice packs, massages, yoga or hypnosis to decrease stress and so minimize aggravation of the pain. For many pain patients, however, the first step has to be recovering from the damage of previous treatments.

For Grace Watkins, 47, of Royal Oak, Md., this meant being carefully weaned from the staggering number of pain-relief medications she had been taking; she suffered from health problems that were caused by a fall from a horse and an automobile accident. By the time she checked in at the pain-treatment center of Johns Hopkins Hospital in Baltimore, she was taking more than 28,000 pills a year. The drugs that originally blocked her pain eventually caused their own painful symptoms.

Although Watkins' case was extreme, her situation was not unusual. According to Dr. Godfrey Pearlson, director of the in-patient pain-treatment center at Johns Hopkins (which also has an out-patient division), most patients share the problem of overmedication, as well as a lack of exercise.

In Watkins' case, doctors had to clear away all drug-induced pains and problems before her original pain could be handled. She continues to do exercises she learned at the center, and she is also a volunteer in the drug-detoxification unit of another local hospital. Now, she reports, she has "gotten out of the relationship with pain."