by Sally Matheny
Small, green squares of sandpaper were taped in various places around our house. Three days passed before my husband finally said, “Okay, what's up with all the sandpaper squares?”Reluctantly, I shared how the sandpaper squares were little reminders for me of a dream I had.
Most of the time I don’t sleep well enough to dream at all. However, one night I dreamed I was riding an old, school activity bus. Laughter and chatter ping-ponged through the bus. We were an excited bunch.
Eventually, the bus bumped onto an unpaved route through an open field. The rough terrain jostled us about and I remember mentioning several times about it causing pain to my neck.
After bounding down through the field awhile, we finally arrived at a vast, old barn. The bus windows were down and festive music swirled through the air. The bus pulled alongside the barn and parked.
Through the barn's large open window, I could see a lively party taking place. Smiles, laughter, and music filled the room. Excitement bubbled forth from the bus passengers as they prepared to exit.
The bus driver asked if I would please stay seated until everyone disembarked. I wondered why he would ask such a thing but I obliged, thinking perhaps he had a question or something. After everyone left, the bus driver handed me a piece of brown sandpaper. Fingering its roughness, I said, “I don’t understand. What’s this for?”
He kindly explained that I would have to stay on the bus and watch from the window. “Why?”
“Because every time you say something about your pain, it is slightly abrasive, like this sandpaper.”
I did not ask for further explanation. I knew exactly what he meant.
In reality, I diligently try not to whine about my chronic neck pain. but try to report it in a matter-of-fact way. However, no matter how one says it, if one says it too often, it becomes irritatingly abrasive.
Point taken.
In my dream, I held the sandpaper in my lap. I remember feeling sad and left out. There was no anger, just remorse as I watched the people having fun inside.
Then I woke up.
Sitting on the edge of the bed, I pondered it all for a moment. Immediately, I began a search for sandpaper. All I could find was the green kind. That was okay; perhaps it would hark a little louder. I wanted reminders everywhere!
The pain is more noticeable at night, so one square went beside my bed and another near the bathroom sink. Now, As I brush my teeth, I rub my finger across its scratchy surface.
My family knows nights are worse. I don’t have to tell them that. They see me retrieve ice packs, Tylenol, and such. They are kind and understanding. Continual updates are unnecessary.
The refrigerator was next. After a long day, the neck may be sore but a meal needs to be prepared. A stroke or two over the green sandpaper and soon the food is ready and we’re giving God thanks.
Another sandpaper square is inside my purse. Often, when I reach for my cell phone or keys, my knuckle scrapes across it. Not verbally, but mentally, I say “ouch.” Exactly, I think with a smile.
After telling my sweet husband about my dream, he tried to assure me that I was being too hard on myself. He said I did not complain too much—that it was all my own subconscious worries about complaining.
Nonetheless, the sandpaper dream made an impact and my life has changed.
Don’t get me wrong. Our days do not float smoothly by on cotton candy clouds. Some days are great. Others are chaotic. Life is real at our house. Problems and pain come and go.
However, I have witnessed the effects of ceasing the repetitive pain updates.
I feel better!
Life is a little sweeter.
And next time...I'm getting off the bus!
By Mark Johnson
The prevalence of chronic pain in the general adult population worldwide may be as high as 30%. Yet pain is not seen as a major health care problem by politicians, probably because people do not die of pain, although many people die in pain. Chronic pain challenges our traditional beliefs about the process of diagnosis, treatment, and cure, with over 40% of individuals reporting inadequate management of chronic pain. Chronic pain is an enigma.
We have all experienced pain and we know with certainty when we have it. Yet, we may doubt others who tell us that they are in pain especially if their pain has a vague or uncertain diagnosis and is not responding to conventional treatment. The medical management of pain evolved from the view that pain is a symptom of pathology and diagnosis, and treatment of pathology will relieve pain. This approach usually works well for pains associated with recent tissue damage (acute pain) but starts to fall apart when pain becomes chronic. This is because the link between pain and tissue damage (pathology) is not quite as strong as we are led to believe. For example, soldiers seriously injured in battle often report no pain for some time after the injury occurred. The link between pathology and chronic pain is particularly variable. In fact chronic pain may uncouple from the pathology that caused the pain in the first place. In essence, pain can become a disease entity in its own right.
Life experiences teach us that pain warns of tissue damage and we adapt our behaviours to avoid pain accordingly. Body parts often become “sensitive” in the presence of tissue damage so that non-painful activities become painful. Pain makes us avoid things that may hinder tissue healing so we learn to “fear” walking on a twisted ankle for example, because it provokes pain. Sensitivity associated with pathology results from the nervous system amplifying input from the site of tissue damage increasing the input to the pain producing brain — no brain, no pain. Pain resulting from sensitivity within the nervous system fades over time as tissue heals, although occasionally the nervous system remains in a persistent sensitive state despite tissue having healed. The consequence is chronic pain that has uncoupled from the original tissue damage. Pain of this nature has limited usefulness and is detrimental to well-being and reflects a dysfunctional pain system.
In such circumstances medical tests may fail to detect appreciable pathology, diagnosis may become vague, and treatment uncertain and unsuccessful. Practitioners may start to doubt the legitimacy of the person’s pain and believe that the pain is “psychogenic” (fake). This is entirely irrational because it is impossible to prove or disprove that a person is in pain, because pain is a subjective phenomenon with no objective way of measuring. The only way to gain insight into a person’s personal pain experience is through their self-report — pain is whatever the patients says it is. If a person reports that they are experiencing pain, they should be believed.
Knowledge that pain may persist without appreciable tissue damage has shifted the focus of management strategies for chronic pain that advocate progressive return to and continuation of normal activities despite the presence of pain. The challenge for the practitioner is balancing advice about under-activity, leading to disability, with over-activity leading to further pain and harm. The challenge for the patient is being able to accept and commit to a pain management plan that encourages undertaking activities in the presence of pain, because this is counterintuitive to life experiences that have taught us to avoid pain because it warns of harm. Accepting that total resolution of pain may be unlikely and committing to integrating a painful body into normal life has been shown to have a positive impact on suffering and long-term disability. In fact inactivity is a risk factor for the development of long-term pain, suffering and disability. Easy explanations of the factors contributing to chronic pain to promote a benign view of chronic pain can help individuals to change the way they think and behave about their pain. Pain management plans offering advice about the risk of harm of daily activities and self-management techniques to find solutions for pain flare ups, medication use, sleep disturbances, depression, anger, and relationship problems are becoming available.
Exercise regimes aim to get individuals to return to normal activities through stretching, strengthening, and cardiovascular fitness with the focus on progressive return to activities. Manual therapies such as massage of soft tissue and mobilization and manipulation of joints, and electrophysical agents such as transcutaneous electrical nerve stimulation (TENS), acupuncture, low level laser therapy, and ultrasound, are all part of the multidisciplinary pain management team’s toolkit. Clinical experience suggests that these non-pharmacological interventions are beneficial and popular with patients, although the findings of clinical research have been inconsistent. This is due to the complex nature of administering some of the interventions where optimal technique (dose) is not known.
So the puzzle of chronic pain is being unravelled with the realization that a reliance on diagnosis and treatment of pathology causing pain may not be the most effective way to help patients. We need a multidisciplinary model of care that is flexible enough to shift in emphasis from a biopsychosocial model in the acute phase to a “sociopsychobio” model in the chronic phase.
Mark Johnson is Professor of Pain and Analgesia at Leeds Metropolitan University in the UK. He is author of Transcutaneous Electrical Nerve Stimulation (TENS): Research to support clinical practice.
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Image: Doctor talking with a patient by National Cancer Institute. Public domain via Wikimedia Commons.
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by Sally Matheny  |
| In Search of the Quickest Route? |
Are you a lane-hopper—zigzagging around others in search of the quickest route to your destination? Whether it’s on the highway or in the cashier aisles at Wal-Mart, you’re the man with a plan or a woman on a mission. Punctual and focus-minded are admirable traits but don’t miss the blessings in the slow lane. As nice as it is, this is not a post about stopping and smelling the roses.
However, many of us are like the Mad-Hatter from Alice in Wonderland, scurrying about from one objective to the next. We’re either dangerously overloaded with commitments or we’re borderline OCD with our color-coded organizational charts (which, by the way, have budgeted ample time for travel into the daily schedule).
Life is merrily racing along until—BAM!
An injury, illness, job loss—whatever it is, has suddenly shoved you
all the way
 |
| Slow Lane Got You Down? |
into
the
s-l-o-w
lane.
No one likes to be sidelined. There’s too much to do and too many places to go. We aggressively seek solutions to get back on the fast track. We try to learn how to adapt and overcome. However, as life decelerates, there’s no choice but to scoot along at a reduced speed.
Prior to attending a recent writers’ conference, my concerns were not over agents and editors, but rather mobility issues. Diagnosed with Complex Regional Pain Syndrome (CRPS), I wondered if I’d be able to walk the hilly campus.
After arriving, I met many others gradually and painfully making their way to classes—people in far worse condition than me. Broken bones, rheumatoid arthritis, tumors, diseases, cancer. At last year’s conference, I remember maybe two or three people struggling physically. Why were there so many hurting people there this year?
One morning on my way to class, I did my usual side step down the stairs and made my way across campus. The fast ones already planted themselves in the best seats. Even my new, slow-moving friends weren’t on my usual path. Nonetheless, sharing the warm sunshine with the chirping birds made the stroll pleasant.
Then, I saw the roses. Beautiful reddish pink roses—the shade that looks great on toenails but not on lips kind of red. Why had I not seen them before? I had walked this path at least four times already and had not spotted them stretching over a fence. Most were in full bloom, facing the path, beckoning me to notice what they had to offer.
Bear with me, I told you this was not a “stop and smell the roses” story and it isn’t. In that moment, I realized the roses had always been there, just like the injured people I had met. They were there last year, I just didn’t notice them in my rush to get to class (you know, to learn how to become a better writer for God) or in my hurry to do good things.
My Mary-Martha moment of revelation, by the roses, didn’t bring me to a total halt. Yet, along with my calculated gait, my journey that week grew more focused. Purposeful conversations took place. Radiant beauty burst forth instantly in some and in others it gently unfolded. Promises of prayer and encouraging words were exchanged like birthday gifts. Blessings overflowed.
God is working in all the lanes of life, my friend. Occasionally, when we’re sputtering along, we find encouragement among our fellow slow lane travelers.
And, just like CRPS, not all injuries are visible. Quite likely, the one cutting in front of you, or that irritating tail-gater, is possibly the one enslaved with the most pain.
It’s not so much about stopping to smell the roses for our own benefit. But rather regarding their beautiful presence with the same attention and care as our Creator.
Whatever we think is impeding our progress, God can miraculously transform into delightful delays.
What about you? What blessings have you discovered in the slow lane?
