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Viewing: Blog Posts Tagged with: pain, Most Recent at Top [Help]
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1. Trains of thought: Sarah

Four people with radically different outlooks on the world meet on a train and start talking about what they believe. Their conversation varies from cool logical reasoning to heated personal confrontation. Each starts off convinced that he or she is right, but then doubts creep in. During February, we will be posting a series of extracts that cover the viewpoints of all four characters in Tetralogue. What follows is an extract exploring Sarah's perspective.

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2. Relax, inhale, and think of Horace Wells

Many students, when asked by a teacher or professor to volunteer in front of the class, shy away, avoid eye contact, and try to seem as plain and unremarkable as possible. The same is true in dental school – unless it comes to laughing gas.

As a fourth year dental student, I’ve had times where I’ve tried to avoid professors’ questions about anatomical variants of nerves, or the correct way to drill a cavity, or what type of tooth infection has symptoms of hot and cold sensitivity. There are other times where you cannot escape having to volunteer. These include being the first “patient” to receive an injection from one of your classmate’s unsteady and tentative hands. Or having an impression taken with too much alginate so that all of your teeth (along with your uvula and tonsils) are poured up in a stone model.

But volunteering in the nitrous oxide lab … that’s a different story. The lab day is about putting ourselves in our patients’ shoes, to be able to empathize with them when they need to be sedated. For me, the nitrous oxide lab might have been the most enjoyable 5 minutes of my entire dental education.

In today’s dental practice, nitrous oxide is a readily available, well-researched, incredibly safe method of reducing patient anxiety with little to no undesired side effects. But this was not always the case.

The Oxford Textbook of Anaesthesia for Oral and Maxillofacial Surgery argues that “with increasingly refined diets [in the mid-nineteenth century] and the use of copious amounts of sugar, tooth decay, and so dentistry, were on the increase.” Prior to the modern day local anesthesia armamentarium, extractions and dental procedures were completed with no anesthesia. Patients self-medicated with alcohol or other drugs, but there was no predictable or controllable way to prevent patients from experiencing excruciating pain.

That is until Horace Wells, a dentist from Hartford, Connecticut started taking an interest in nitrous oxide as a method of numbing patients to pain.

Dr Horace Wells, by Laird W. Nevius. Public domain via Wikimedia Commons.

Wells became convinced of the analgesic properties of nitrous oxide on December 11, 1844 after observing a public display in Hartford of a man inhaling the gas and subsequently hitting his shin on a bench. After the gas wore off, the man miraculously felt no pain. With inspiration from this demonstration and a strong belief in the analgesic (and possibly the amnestic) qualities of nitrous oxide, on December 12, Wells proceeded to inhale a bag of the nitrous oxide and have his associate John Riggs extract one of his own teeth. It was risky—and a huge success. With this realization that dental work could be pain free, Wells proceeded to test his new anesthesia method on over a dozen patients in the following weeks. He was proud of his achievement, but he chose not to patent his method because he felt pain relief should be “as free as the air.”

This discovery brought Wells to the Ether Dome at the Massachusetts General Hospital in Boston. Before an audience of Harvard Medical School faculty and students, Wells convinced a volunteer from the audience to have their tooth extracted after inhaling nitrous oxide. Wells’ success came to an abrupt halt when this volunteer screamed out in pain during the extraction. Looking back on this event, it is very likely that the volunteer did not inhale enough of the gas to achieve the appropriate anesthetic effect. But the reason didn’t matter—Wells was horrified by his volunteer’s reaction, his own apparent failure, and was laughed out of the Ether Dome as a fraud.

The following year, William Morton successfully demonstrated the use of ether as an anesthetic for dental and medical surgery. He patented the discovery of ether as a dental anesthetic and sold the rights to it. To this day, most credit the success of dental anesthesia to Morton, not Wells.

After giving up dentistry, Horace Wells worked unsuccessfully as a salesman and traveled to Paris to see a presentation on updated anesthesia techniques. But his ego had been broken. After returning the U.S, he developed a dangerous addiction to chloroform (perhaps another risky experiment for patient sedation, gone awry) that left him mentally unstable. In 1848, he assaulted a streetwalker under the influence. He was sent to prison and in the end, took his own life.

This is the sad story of a man whose discovery revolutionized dentists’ ability to effectively care for patients while keeping them calm and out of pain. As a student at the University of Connecticut School of Dental Medicine, it is a point of pride knowing that Dr. Wells made this discovery just a few miles from where I have learned about the incredible effects of nitrous oxide. My education has taught me to use it effectively for patients who are nervous about a procedure and to improve the safety of care for patients with high blood pressure. This is a day we can remember a brave man who risked his own livelihood in the name of patient care.

Featured image credit: Laughing gas, by Rumford Davy. Public domain via Wikimedia Commons.

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3. Eight facts on the history of pain management

September is Pain Awareness Month. In order to raise awareness of the issues surrounding pain and pain management in the world today, we’ve taken a look back at pain throughout history and compiled a list of the eight most interesting things we learned about pain from The Story of Pain: From Prayer to Painkillers by Joanna Bourke.

  1. In the past, pain was most often described as an independent entity. In this way, pain was described as something separate from the physical body that might be able to be fought off while keeping the self intact.
  2. In India and Asia some descriptions of varying degrees of pain involved animals. Some examples include “bear headaches,” that resemble the heavy steps of a bear, “musk deer headaches” like the galloping of a running dear, and “woodpecker headaches” as if pounding into the bark of a tree.
  3. In the late twentieth century, children’s sensitivity to pain was debated. There were major differences in the beliefs of how children experienced pain. 91 % of pediatricians believing that by the age of two a child experienced pain similarly to adults, compared with 77% of family practitioners, and only 59% of surgeons.
  4. It had long been observed that, in the heat of battle, even severe wounds may not be felt. In the words of the principal surgeon to the Royal Naval Hospital at Deal, writing in 1816, seamen and soldiers whose limbs he had to amputate because of gunshot wounds “uniformly acknowledged at the time of their being wounded, they were scarcely sensible of the circumstance, till informed of the extent of their misfortune by the inability of moving their limb.”
  5. Prior to 1846, surgeons conducted their work without the help of effective anesthetics such as ether or chloroform. They were required to be “men of iron … and indomitable nerve” who would not be “disturbed by the cries and contortions of the sufferer.”
  6. Concerns about medical cruelty reached almost hysterical levels in the latter decades of the nineteenth century, largely as a consequence of public concern about the practice of vivisection (which was, in itself, a response to shifts in the discourse of pain more widely). It seemed self-evident to many critics of the medical profession that scientists trained in vivisection would develop a callous attitude towards other vulnerable life forms.
  7. In the 19th century it was believed that pain was a necessary process in curing an ailment. In the case of teething infants, lancing their gums or bleeding them with leeches were painful treatments used to reduce inflammation and purge the infant-body of its toxins.
  8. John Bonica, an anesthetist and chronic pain suffer himself established the first international symposium on pain research and therapy in 1973, which resulted in the founding of the International Association for the Study of Pain (IASP).

Featured image credit: The Physiognamy of Pain, from Angelo Mosso, Fear (1896), trans. E. Lough and F. Kiesow (New York: Longmans, Green, and Co., 1896), 202, in the Wellcome Collection, L0072188. Used with permission.

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4. The truth about anaesthesia

What do anaesthetists do? How does anaesthesia work? What are the risks? Anaesthesia is a mysterious and sometimes threatening process. We spoke to anaesthetist and author Aidan O’Donnell, who addresses some of the common myths and thoughts surrounding anaesthesia.

On the science of anaesthesia:

Click here to view the embedded video.

The pros and cons of pain relief in childbirth:

Click here to view the embedded video.

Are anaesthetists heroes?

Click here to view the embedded video.

Aidan O’Donnell is a consultant anaesthetist and medical writer with a special interest in anaesthesia for childbirth. He graduated from Edinburgh in 1996 and trained in Scotland and New Zealand. He now lives and works in New Zealand. He was admitted as a Fellow of the Royal College of Anaesthetists in 2002 and a Fellow of the Australian and New Zealand College of Anaesthetists in 2011. Anaesthesia: A Very Short Introduction is his first book. You can also read his blog post Propofol and the Death of Michael Jackson.

The Very Short Introductions (VSI) series combines a small format with authoritative analysis and big ideas for hundreds of topic areas. Written by our expert authors, these books can change the way you think about the things that interest you and are the perfect introduction to subjects you previously knew nothing about. Grow your knowledge with OUPblog and the VSI series every Friday!

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5. Choosing to stop

Today would have been my father's 90th birthday.

Ten years ago, my family made a decision we have never regretted. Ten years ago we asked that my father be allowed to die.

No one at the hospital suggested we stop aggressively treating my 80-year-old father. Even as test after test came back negative, even as he continued to deteriorate. He asked my brother Joe where Joe was, asked my mom what time the curtain would go up, and thought it was 1902.
Dad in uniform
He had long suffered from Alzheimer’s and Parkinson’s, his life a narrow circle from bed to living room, navigated by his walker. There were times his brown eyes were full of love, and times when they were blacker, lost, blank. Then a sudden illness began to ravage his body. In the hospital, he was put on three antibiotics. Still his skin was so clammy from fever that each new nurse recoiled when she first touched him.

I made a list of questions for his doctor – What was my father’s diagnosis? His prognosis? Why did his white blood count keep climbing? Why did he cry out whenever they moved him? And a few days later I added - What could we stop? - to my list of unanswered questions.

A series of problems
To the hospital staff, my father was no longer a person, but a series of problems. His unrelenting diarrhea indicated a bowel infection.   But when the sigmoidoscopy turned up negative, the specialist only shrugged when I asked what was wrong. “Who knows why?” I wrote down carefully. The doctor who admitted Dad concentrated on getting his fever down. The nurses wanted to see if my father was ‘oriented.’ “Hank?” one cajoled him, prodding his shoulder while he stared at me with sagging, rheumy eyes. “Hank, do you know who this young lady is?”

I wanted to tell her to stop poking him, to leave him alone, to stop us both looking at each other with embarrassed eyes. Finally, my dad mumbled something like “Mary once or twice.” Or was it Merry? Or Marry?

My name is April.
Dad at Mic

He slept more and more, sometimes moaning. When he woke, he might say a few words, and I would think, I have to remember this. These might be his last words. And then he would mumble something else.

Planning for events we knew wouldn't happen
The social worker and discharge planner discussed the options with us, which I dutifully wrote down. If my father got better and seemed capable of rehabilitation, he could go to a skilled nursing facility. This was meant, the discharge planner explained, strictly to be transitional. Dad would have to be able to participate in physical therapy. At this point, my father couldn’t participate in rolling over. Parkinson’s had frozen his legs. When he was first admitted, Joe had tried to push Dad’s legs, hovering a few inches above the bed, down onto the mattress – at least until my father screamed.

If Dad didn’t meet the criteria for a skilled nursing facility, he could go to a nursing home. Or home to my mother, who had already injured her hip and back trying to lift him – from the toilet, the bed, the bath, the chair. And that was when he knew who she was, where he was.

Even as it became clear that he would probably never be coherent again, never walk again, never be anything more than a confused, bed-ridden person waiting for pneumonia to settle into his lungs, no one talked about just – stopping. Not the doctors, not the nurses, not the social worker. My dad talked about it without words. Even when coaxed, he ate nearly nothing. He closed his mouth and turned his head. His body began to forget how to swallow even water.

There was one horrible day when dad began crying out in pain - luckily my mom was at the bank getting into their safe deposit box - and I could not get the nurses to speed along the process for getting morphine. I would go out and beg, and the nurse would chirp that she had paged the doctor. Then I would have to go back to the room, go back to his muffled screams.
Hank Nora wedding day

If you had a cat this sick...
My brother and I started to have conversations that began, “If you had a cat this sick…” and then our words would trail off. What kind of children were we?

We finally steeled ourselves to talk with my mom. She found my dad’s living will. Step by step, it spelled out all possible interventions. And in all cases, my dad had initialed that he did not want them. My father’s final gift was to take the decision out of our hands, or at least make it easier for us to release him.

Now we had to tell the hospital personnel. I found his young nurse and told her we wanted to stop everything, including the IV fluids. With wide eyes, she said, "Then your father’s going to have to drink a lot more!" Feeling like the angel of death, I explained what I meant. We wanted my father to die. The doctor grasped it more quickly. But why hadn’t he brought it up himself? He had a copy of my father’s living will. He knew my father’s wishes.
Dad at Parade

On the fourth day of no IV fluids and no antibiotics, my brother called me. The doctor had been by and said Dad’s heart and lungs sounded good. I felt awful. No matter how
much I reasoned with myself – But he can’t even swallow! But he’s too weak to even sit up! But he has a catheter and keeps having attacks of diarrhea on his bedclothes! – I would
think, maybe we should have tried harder.

A few hours later, my father died. My mother was holding his hand, with classical music playing softly in the background. I realized he died the way he would have wanted, and the way he lived, quietly and with dignity.

About the last thing my father said to me was, “You learn how to do it just by doing it.” And he was right. My father learned how to die, and we learned how to fight, not for his life, but for his right to die.

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6. The Migraine War


Imagine this nut is your head. And this vice . . . is a migraine.

According to Migraine.com, “In the U.S., more than 37 million people suffer from migraines. Some migraine studies estimate that 13 percent of adults in the U.S. population have migraines, and 2-3 million migraine suffers are chronic. Almost 5 million in the U.S. experience at least one migraine attack per month, while more than 11 million people blame migraines for causing moderate to severe disability.”

I have been battling migraines since my early twenties. Unfortunately, as I get older, my migraines have gotten more frequent and more debilitating. In fact, today, I had one while on vacation with my family and had to be left behind in a darkened hotel room with ear plugs in place and a sign on the door, no housekeeping please. It’s not the first time I’ve missed out on something with the kids because, “Mommy has a headache today,” and I’m sure it won’t be the last.

“Take some Excedrin and get back to business.” If only it were that simple. If you get migraines or know someone who does, you understand that over-the-counter pain relievers do not even make a dent in the pain. Sometimes Hydrocodone can knock me out long enough for the migraine to pass, and a couple times a shot of morphine at the ER has done the trick.

Preventive medicine has had mixed results. For a while I was taking Topimax (normally prescribed for folks who suffer from seizures) . It worked at keeping the migraines at bay, but the side effects were miserable: kidney stones and liver cysts, hallucinations, tingling hands and feet, and horrific brain fog. They don’t call it “Dopimax” for nothing. When I first started taking it, I snapped out of one stupor to find I’d been brushing my teeth for twenty minutes. Despite my uber-white smile, I decided to trade out the Topimax for rational thought.

These days I’ve been managing with daily high doses of magnesium and Vitamin D and Imitrex shots and pills. It works. But only if those shots and pills are timed just right. If I don’t catch the migraine when it first starts, I just end up with the dizzy, racing-heart side effects of the medication on top of the migraine pain.

A strategy that has been semi-successful is the headache diary. It’s been helpful to keep a log of the things that I’ve eaten and the things I’ve done on the days preceding and during a migraine. The result? A crazy-long list of headache triggers, which I share with you now in no particular order:

Dehydration, Aspartame, Sucralose, Alcohol (especially wine and beer), Flashing lights, Wearing 3D glasses, Monosodium Glutamate, More than 26 mg of caffeine in 24 hours, Grape juice, Monthly hormone fluctuations, the Summer Solstice, the Winter Solstice, Cigarette smoke, Staying out in the hot sun for 5+ hours at temps greater than 90 degrees Fahrenheit, Sinus infections, Mold, Not eating for 10+ hours, Stress lasting multiple consecutive days, Vigorous workouts, Pinching neck nerves, Lima beans.

OK, lima beans don’t trigger my migraines. I just hate their nastiness and avoid them at all costs.

So, some of these triggers are completely within my control and I successfully avoid them. And others, not so much. As an Earthling, it’s a bit difficult to avoid the solstices.

If you have a migraine sufferer in your life you can help by listening and avoiding insensitive comments such as, “It’s just a headache” or “Get some sunshine and fresh air” or “Reduce the stress in your life” or “have you tried XYZ? It worked for a friend of mine”.  Because a migraine is not just a headache, and going outside can often be a trigger or exacerbate the pain, and even a stress-free, meditation-filled, yoga lover will still suffer from migraines, and chances are, the person has been afflicted with migraines for decades and has tried everything. Every. Thing.

Hypnosis. Been there. Acupuncture. Done that. Biofeedback. Yep. Drugs. Tends to be the first recommendation from the medical professionals, so, yes. And too many other “remedies” to mention.

The best thing I’ve done recently for myself is find a doctor who specializes in migraine treatment. It’s nice to have a physician who speaks the language of migraines. It’s nice to have a physician who doesn’t look at me like I’m a nut when I tell him I can’t drive underneath the canopy of a tree-line road while the sun is shining. “Perfectly understandable,” he says. “I bet you can’t watch the new Transformers movie in IMAX 3D either.”

Photo © Robert Faric

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7. Unravelling the enigma of chronic pain and its treatment

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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8. Does pain have a history?

It’s easy to assume that we know what pain is. We’ve all experienced pain, from scraped knees and toothaches to migraines and heart attacks. When people suffer around us, or we witness a loved one in pain, we can also begin to ‘feel’ with them. But is this the end of the story?

In the three videos below Joanna Bourke, author of The Story of Pain: From Prayer to Painkillers, talks about her fascination with pain from a historical perspective. She argues that the ways in which people respond to what they describe as ‘painful’ have changed drastically since the eighteenth century, moving from a belief that it served a specific (and positive) function to seeing pain as an unremitting evil to be ‘fought’. She also looks at the interesting attitudes towards women and pain relief, and how they still exist today.

On the history of pain

Click here to view the embedded video.

How have our attitudes to pain changed?

Click here to view the embedded video.

On women and pain relief

Click here to view the embedded video.

Joanna Bourke is Professor of History at Birkbeck College, University of London. She is the prize-winning author of nine books, including histories of modern warfare, military medicine, psychology and psychiatry, the emotions, and rape. Her book An Intimate History of Killing (1999) won the Wolfson Prize and the Fraenkel Prize, and ‘Eyewitness’. She is also a frequent contributor to TV and radio shows, and a regular newspaper correspondent. Her latest book is The Story of Pain: From Prayer to Painkillers.

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9. God's Got This

Some are going through a horrible time right now.
Some are feeling lost.

Feeling as if nobody hears them, sees them, knows they are alive.
God sees you, my darling.
He hears you.
He feels you.
Catches every tear that falls from your precious eyes.
I promise.

Focus on something for just a moment.
Something outside of your pain.
Focus on the Glory of God.
Take a deep breath.

If you can't muster the strength to say it aloud-
then say it inside.
You can do this.
I have faith in you.
I believe in you.

"Take me Lord.
Take my junk.
Take my mess.
I am Yours.
Help me.
Lead me beside the still waters.
Restore my soul.
My mess, is Yours.
Use it to be glorified.
Give me peace.
Give me hope.
I find my strength in You, oh Lord.
Bring me to the place of joy.
And bring me into You.
In Jesus' name."

If you need prayer, email me please. I will gladly pray for you. Comments (pleasant conversation or polite debate) welcome. If you feel led, please share. Follow. May you find peace dwelling inside you today and every day. <3

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10. Messages from Angels or Ghosts

Have you ever received messages, which were always delivered to you in a similar way, and which you were certain came from a person once in your family, who was now deceased? I have. In particular, I have received such messages from my brother approximately half a dozen times since he died. How do they begin? Always exactly the same way. I will be listening to a radio, usually in my car, and I hear a specific song twice in a row. When that happens my mind kicks in to high alert. I pay attention to every one and every thing around me. And I clear my mind of whatever I have been thinking, and I allow myself to be as open and receptive to what ever it is I need to discover or learn about. These occasions have always, one hundred percent of the time, proved pivotal in my life. Something always happens which is life changing. And when I say life changing, I mean just that. Old doors close, new doors open, insights sit on my porch, and I find myself on the path of new transformations. Such an event recently happened to me. I was driving through the nearby town of Belen, that song played, then when it finished, I changed the channel, and it played all over again. As in the past, I let the day play out, and I followed my senses. Today I am transforming pain into happiness. And without pain, there would be no happiness. Life is wonderful, but so is the ability to remain in communication with those who have left us. They do speak to us, I believe this with all my spirit and soul. If experience is proof, I do have proof. And when our departed loved ones find it important enough to speak to us, we are wise to pay attention and learn.

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11. Courage Does Not Always Roar

I love this quote. Sometimes courage is a quiet voice that says, "Keep on doing what you are doing, and things will eventually get better." It could be doing a job that you really don't like, but you give it your best, and you're pleasant and positive with all the people that you meet at your job. That takes courage. To fight a serious illness, takes a vast amount of courage. To watch your spouse's hand shake, knowing that the medicine to stop the shaking causes more problems than it's worth, takes courage. We are never "innocent" bystanders to the pain of the ones we love. We see their pain, and we feel their pain, even if we hardly ever verbalize it. That is the nature of true love.

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12. You Might be a writer if...pain is inevitable

It's been a while since I've gotten to reflect on the ins and outs of writerdom, mostly because I've been hanging on by the skin of my teeth in my MFA program. There are just not enough hours in the day.

A few emails ago, however, one of my advisors put me onto a short tome written by a fellow traveler in the writing lane,  Haruki Murakami's  What I Talk About When I Talk About Running.

I am a dedicated runner, which this advisor knows as we've crossed paths in the wee hours of the morn running during residencies. Although the reading tower is approaching critical heights in my office, I got the book (downloaded it to my Kindle, actually, thus not adding to the teetering tower).

Murakami hooked me right away with these words--"Pain is inevitable. Suffering is optional."

It is?

It is.

In this life, if you live it even a little, pain is inevitable. Doesn't matter if you're running, swimming, have kids, are married, or, god forbid, decide to try art for a living. Pain is inevitable.

That's a liberating thought. I'm not alone. Everybody suffers! Don't get me wrong, I'm so not taking joy in somebody else's pain. Far from it. I'm just relieved that, well, the pain thing, it's...dare I say it, normal.

Yippee! I'm normal! (Have I been waiting an eternity to say that).

Suffering however...

Well, I can either fall into it, or accept the pain and move through it.

Which gets back to the running thing. In running, at least, the longer I work through the pain, the greater the reward when I finish. All I need to do is juxtapose my running attitude to my writing. There will be pain. There is pain. What I do with it, that's the true test.

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13. Re-Thinking Your Thinking

thinkAccording to the National Science Foundation, the average person has about 12,000 thoughts per day, or 4.4 million thoughts per year.

I wager that writers are well above the average because we read more and writing causes us to think more than the average.

Who’s In Charge?

I had known for a long time that our thoughts affect our emotions, and that toxic “stinking thinking” could derail our writing dreams and health faster than almost anything. You are the only one who can decide whether to reject or accept a thought, which thoughts to dwell on, and which thoughts will become actions.

But sometimes–a lot of the time–I felt powerless to actually do anything about it on a consistent basis. Sometimes I simply felt unfocused and overwhelmed.

Need a Brain Detox?

I’ve been reading a “scientific brain studies” book for non-science types like me called Who Switched Off My Brain? by Dr. Caroline Leaf Ph.D. which has fascinated me. With scientific studies to back it up, it shows that thoughts are measurable and actually occupy mental “real estate.” Thoughts are active; they grow and change, influencing every decision we make and physical reaction we have.

“Every time you have a thought, it is actively changing your brain and your body–for better or for worse.” The author talks about the “Dirty Dozen”–which can be as harmful as poison in our minds and our bodies.

Killing Our Creativity

brainAmong this dozen deadly areas of toxic thinking are toxic emotions, toxic words, toxic seriousness, toxic health, and toxic schedules.

If you want to delve into the 350+ scientific references and pages of end notes in the back of the book, you can look up the studies. But basically it targets the twelve toxic areas of our lives that produce 80% of the physical, emotional and mental health issues today. And trust me. Those issues have a great deal to do with you achieving your goals and dreams.

There Is Hope!

According to Dr. Leaf, scientists no longer believe that the brain is hardwired from birth with a fixed destiny to wear out with age, a fate predetermined by our genes. Instead there is scientific proof now for what the Bible has always taught: you can renew your minds and heal. Your brain really can change!

Old brain patterns can be altered, and new patterns can be implemented. brain-detoxIn the coming days, I’ll share some more about the author’s ”Brain Sweep” five-step strategy for detoxing your thoughts associated with the “dirty dozen.”

But right now I’m going to read about the symptoms of a toxic schedule. I have a suspicion…

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14. the badnesses of this world

My preference is usually for "uplifting" poetry, that which (along with everything it does for cognition and imagination by sounding good to your ears and feeling good in your mouth) leaves me with a reverberating sense of wonder at the goodnesses of this world, kind of like the ones I posted back in January that suggested some animal spirituality.

I'm having trouble therefore understanding why the poem below keeps me coming back to it. I received it courtesy of The Academy of American Poets' Poem-a-Day service. The pain barely contained in it is enormous and frightening and wonderful.

Prayer for the Man Who Mugged My Father, 72
by Charles Harper Webb

May there be an afterlife.

May you meet him there, the same age as you.
May the meeting take place in a small, locked room.

May the bushes where you hid be there again, leaves tipped with razor-
blades and acid.
May the rifle butt you bashed him with be in his hands.
May the glass in his car window, which you smashed as he sat stopped
at a red light, spike the rifle butt, and the concrete on which you'll

May the needles the doctors used to close his eye, stab your pupils
every time you hit the wall and then the floor, which will be often.
May my father let you cower for a while, whimpering, "Please don't
shoot me. Please."
May he laugh, unload your gun, toss it away;
Then may he take you with bare hands.

May those hands, which taught his son to throw a curve and drive a nail
and hold a frog, feel like cannonballs against your jaw....

Take a deep breath and read the complete poem here. Poetry Friday is hosted today by Breanne at Language, Literacy, Love.

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15. Pain by Morgan Mandel

Monday at work I was taking the copy paper from the box and putting it away on the shelf, when my back decided it didn't like what I was doing. It's been stiff and sore since then. That's happened a few times before, so I'm hoping it's just a strain.

This kind of aggravation reminds me of when a character gets hurt in a book or movie. Sometimes it's almost miraculous how that person can heal so instantly, run around and do all sorts of heroic actions. In real life, it's not usually the case.

Remember, if you include an injury in the plot, give your character time to suffer instead of making everything all right real fast. And if the hero or heroine has to ignore the pain to reach a goal, at least include some references to the fact it's there, like sweat on the brow, bruises, gouges, swellings or some other kind of evidence that all is not perfect.

Rising above difficulties is always a good way to heighten tension in a story, so don't make everything seem too easy. Pain is part of the human condition, unfortunately, so think about including it in when you write.

Morgan Mandel

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16. PAIN Part 5: Resources for Pain Management

This post is Part 5 in a 5-part series on Pain.

Thank you for going with me on this journey to learn more about how we can cope with pain, if and when it does appear in our lives. Here are some resources you might find helpful.

Pain Management Resources on the Web

The American Academy of Pain Management

American Academy of Pain Medicine

American Chronic Pain Association

Various conditions related to pain

American Pain Foundation

Pain: Chatrooms and Discussion Boards

American Pain Society

Guides for Persons with Pain

The Journal of Pain

Chronic Pain Information Page

Counseling / Pain Management Centers by State

International Association for the Study of Pain

Global Year Against Acute Pain: Oct. 2010 - Oct. 2011

Pain (Journal)

National Pain Foundation

National Institutes of Neurological Disorders and Stroke

How is pain treated?

Pain Connection: Helping People with Chronic Pain and Their Families

Pain Recovery Online

Partners against Pain (for Patients and Caregivers)

StopPain.org: Dept. of Pain Medicine and Palliative Care, Beth Israel Medical Center

Physical Medicine and Rehabilitation (Physiatry) is a specialty of medicine concerned with the diagnosis and treatment of aches and pains and other disabling conditions. Board-certified physiatrists complete four years of medical school as well as a four-year residency program, and many physiatrists also do fellowships in specialized areas of rehabilitation medicine. This training develops skills in the areas of orthopedics, neurology, and rheumatology. Physiatrists are therefore skilled in determining the cause of a patient's symptoms—nerve, muscle, joint, bone, ligament, etc.—and treating the patient’s condition. In addition to the conventional use of medications, physiatrists have expertise in the use of modalities (hydrotherapy, ultrasound, transcutaneous electrical nerve stimulation, etc.), exercise programs, manual techniques, equipment (splints, corsets, braces), and coordination of therapy programs. Source: http://www.rehabmed.net/patient_ed/physiatry1.html


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17. Poets Talking About Poetry

Robert Frost (1875-1963) American Poet.
Poetryis finer and more philosophical than history; for poetry expresses theuniversal, and history only the particular.

Aristotle (384 BC-322 BC) Greek philosopher.
Poetryis not a turning loose of emotion, but an escape from emotion; it is not theexpression of personality but an escape from personality. But, of course, onlythose we have personality and emotion know what it means to want to escape fromthese things.

T. S. Eliot (1888-1965) American-English poet andplaywright.
IfI feel physically as if the top of my head were taken off, I know that ispoetry.

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18. Writing: Sitting Fit Anytime

One of my health goals is to stop taking so much aspirin and other painkillers. It causes more problems than it helps. This has been an ongoing goal for years, and recently I found something amazingly simple that is really helping!

The Painful Side of Writing

When I started writing, I don’t recall ever reading anything about health problems associated with writing. But sitting for hours, especially at a computer, takes a toll on your neck, back, wrists, and hands. The associated headaches and back pain keep many writers on painkillers of one sort or another.

Then my daughter suggested that I get some yoga DVDs. My initial reaction was negative. My mental image of yoga was of some spaced-out chanting person twisted into an inhuman pretzel. Not for me!

Yoga for Writers (and other stiff people)

I quickly learned that my ideas were outdated. From my library, I checked out “Healing Yoga for Aches & Pains,” which was as soothing as a massage (and got rid of my headache!) I have yet to try “Yoga for Inflexible People.” My favorite DVD so far is Yoga: Sitting Fit Anytime, which has nine separate 3-5 minute segments addressing individual needs of people who sit at computers for hours.

It’s easy to follow, you do it sitting, and it targets neck and shoulder tension, lower back pain, upper back pain, tight hamstrings, headaches, and carpal tunnel problems. There was even a segment for stiff hands and fingers. There was no chanting. 8-) (FYI: I skip the New Agey intro–not for me! Just want the stretches.)

Preventive and Restorative

If you don’t have aches and pains from writing, thank heaven. But also consider doing some routine stretching to prevent developing such problems. If you already suffer from head, back and/or arm pain, consider yoga as a drug-free solution. Your body–AND creative mind–will thank you.

[P.S. If you long-time faithful readers thought this sounded like a repeat, you're right. Had a ripping headache today that I finally got rid of with the DVD stretches! Thought you all might need the same reminder I did.]

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19. Raise the stakes, please!

I just put down a big YA bestseller with only 100 pages to go. Why? Because I realized I no longer cared.

Oddly enough, the reason I no longer cared is that none of the characters I loved were in danger.

You would think that such a situation would be ideal. After all, I don’t enjoy it when characters are hurt or killed. I actually cried when one of the characters in The Hunger Games died. (Full on tears.)

And this book had plenty of scrapes. The main character is kidnapped. She’s forced to fight in a ring. (And if you lose three times, you are thrown to the crowd which rips you to pieces.) She falls into a river and nearly goes over a waterfall that would mean her certain death. She and her friends fight off giant clawed worms. (Those of you who have read this book will have guessed what it is by now.)

But you know what? Not one important character had died at the point I stopped reading. (Her father dies at the beginning, in the inciting incident, but you haven’t gotten to know him yet.) Not even an important animal. No character is even badly damaged. I started having a hard time paying attention to the latest adventure, because I knew they would find a way out a page or two later.

Life is precious because we know it is short. If we could all live forever, would we care about life as much? I think the very best books are willing to show us that it could all be on the line, and that sometimes the good guys lose (at least one battle, if not the war).

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20. Am I Just Another Broken Glass???

A glassware breaks... you pick up the shards of glass... and glue them together... but it is a broken one and the cracks are so visible... and to hide them, you paint it with beautiful colours and place it somewhere safe and use it for something else that it was not meant to be used for...

There are moments when I wonder, isn't that what I am? Isn't this a short write on my life? Isn't the writer the glassware painted and kept elsewhere and used for something else like... discarding what's not needed...? Or things that we might need one day... Someday...? 

This is a weak moment, I confess. And more often than not, Sana Rose is the person I become when I run away from my life. When love is not very fair... When life seems so... blunt... When it's so blank even when it could be filled with so many precious things that matter... When I am not heard... 
When my heart is a hearth where my very average and sensitive dreams and hopes are burnt... God hears me and keeps me going even when I am denied the lesser things that I need most, unlike other girls of my age...

But it can make me cry, if you offered me some love that's unstained, some tenderness... I would crumble down to nothingness moistened by tears if you gave me a hug - I am so fragile... 
My heart quivers as I write this, for opening myself to the numerous eyes out here is not the coolest thing...
I grew up wanting time and words of love and care, instead of food, clothes and a house from my mother. 
The void is so great that, I constantly tried to fill it, but nothing substituted it, not for a long time. And now, I thought, someone has. But I again and again find, that void is still empty... And every time I try to fill it, it just stays that way. Everyone passes me over that void, no one looks into it. And those who try, can't see into it.
Even after all these years...

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21. blind, feeling a way

It's three months until we move, but in the spirit of making hay while the sun shines, I've begun casually, nostalgically sorting and packing a few things.  In a pile of books in the parlor I came across a collection of Anne Sexton's poems.  Opening randomly, I read--and burst into tears.

Daisy doesn't care for horses, but she is 13, and I see this moment coming.

Pain for a Daughter // Anne Sexton

Blind with love, my daughter
has cried nightly for horses,
those long necked marchers and churners
that she has mastered, any and all,
reining them in like a circus hand -
the excitable muscles and the ripe neck -
tending, this summer, a pony and a foal.

She who is squeamish to pull
a thorn from the dog’s paw
watched the pony blossom with distemper,
the underside of the jaw swelling
like an enormous grape,
Gritting her teeth with love,
she drained the boil and scoured it
with hydrogen peroxide until pus
ran like milk on the barn floor.

Blind with loss all winter,
in dungarees, a ski jacket, and a hard hat,
she visits the neighbors’ stables,
our acreage not zoned for barns,
they who own the flaming horses
and the swan-necked thoroughbred
that she tugs at and cajoles,
thinking it will burn like a furnace
under her small-hipped English seat.

Blind with pain, she limps home;
The thoroughbred has stood on her foot.
He rested there like a building;
He grew into her foot until they were one.
The marks of the horseshoe printed
into her flesh, the tips of her toes
ripped off like pieces of leather,
three toenails swirled like shells
and left to float in blood in her riding boot.

Blind with fear, she sits on the toilet,
her foot balanced over the washbasin,
her father, hydrogen peroxide in hand,
performing the rites of the cleansing.
She bites on a towel, sucked in breath,
sucked in and arched against the pain,
her eyes glancing off me where
I stand at the door, eyes locked
on the ceiling, eyes of a stranger,
And then she cries…
Oh! My god, Help me!

Where a child would have cried “Mama!”
Where a child would have believed “Mama!”
She bit the towel and called on God,
And I saw her life, stretch out…
I saw her torn in childbirth,
And I saw her, at that moment,
in her own death,
And I knew that she knew.

Poetry Friday is hosted today by Tabatha at The Opposite of Indifference, where she's sharing some of the poems exchanged through the Summer Poem Swap she has organized.  I'm participating and will have at least three to share next Friday--thanks, Tabatha!

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22. The truth about quitting your day job

In 2001, my first book, Circles of Confusion, was chosen for the Oregonian’s Book Club. The paper sent a photographer to take a picture of me at my local bookstore, Annie Blooms. The photographer liked the store’s black cat and asked me to pose with it on my lap.

While I’m a cat-person, that cat is not a people-cat, not at all. In the photograph, I’m wearing the strangest expression, a pained smile that’s on its way to just plain pain. It’s because the cat has sunk his claws deep into my thigh.

On Sunday, the Oregonian published an essay I wrote about what it’s really like to quit your day job. They also used that photo from so long ago. Today when I was out for a run, a couple walking a dog stopped me and congratulated me. I kept trying to place them, but couldn’t. Did my kid go to school with theirs? Were they neighbors? It was only after I started running again that I realized they must have recognized me from that photo. Maybe I wear the same pained expression as I stagger up the hill.

You can read the essay here. No photo, though.

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23. Stress and Pain

Dr. John D. Otis is the Director of Medical Psychology at Boston University School of Medicine and the director of the Pain Management Psychology Services at the VA Boston Healthcare System.  He is also Associate Professor of Psychology and Psychiatry at Boston University.  In his newest book, Managing Chronic Pain: A Cognitive-Behavioral Therapy Approach, Workbook, which is part of our Treatments That Work Series, Otis provides a guide to increasing productivity in the face of chronic pain.  Below are some tips, excerpted from the book, which will help you decrease the stress in your life, which in turn decreases your pain.

Stress and pain reinforce each other. You may have noticed that when you are stressed out, your pain gets worse. On the other hand, chronic pain is often a source of stress. This can result in a cycle of pain and stress…

Ways to Decrease Stress:

Given the relationship between stress and pain, it is important to learn how to manage stress. The good news is that there are things you can do to decrease your stress….

Change Lifestyle Habits:
-Decrease caffeine intake (coffee, tea, colas, chocolate)
-Maintain a balanced diet and decrease consumption of junk food
-Eat Slowly and at regular intervals
-Exercise regularly (at least 30 minutes three times per week)
-Get adequate sleep (figure out how much you need)
-Take time-outs and leisure time (do something for yourself every day)
-Do relaxation exercises (e.g., breathing, imagery, PMR)

Change How you Approach Situations:
-Time and money management
-Problem-solving coping skills

Change your Thinking:

-Have realistic expectations (when expectations are more realistic, life seems more manageable)
-Keep a sense of humor (being able to see the humor in the things helps o lighten the situation)
-Have a support system (speak with someone or write down your thoughts)
-Focus on the positive (think half-full versus half-empty)
-Challenge negative thinking using cognitive restructuring skills


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24. The History of Spinal Cord Stimulation

Paul G. Kreis, MD, is the Medical Director, Division of Pain Medicine, Professor of Anesthesiology and Pain Medicine, Department of Anesthesiology and Pain Medicine, University of California, Davis.  Scott M. Fishman, MD, is Chief, Division of Pain Medicine, Professor of Anesthesiology, Department of Anesthesiology and Pain Medicine, University of California, Davis.  Together they wrote, Spinal Cord Stimulation: Percutaneous Implantation Techniques, which looks at the basic multidisciplinary information necessary for understanding SCS and pursing safe and effective implantation.  In the excerpt below we look at the origins of sensory stimulation.

Sensory stimulation has been used to treat pain since antiquity.  It is believed that anciet Egyptians may have used electrogenic fish to treat ailments 4,500 years ago.  One such fish, the black torpedo fish, was used for centuries by the ancient Greeks and Romans.

The live fish was placed over the painful site, and the patient endured the electrical discharge from the fish until the pain was relieved.  The Roman physician Scribonius Largus recorded the medical use of the torpedo fish in 46 CE, and Claudius Galen (131-201 CE) also described shocks from the torpedo fish to treat gout and headache.

An 1871 publication by Beard and Rockwell presented a case of “Faradization” and described the application of faradic current (i.e., discontinuous, asymmetric, alternating current) to stimulate muscles and nerves in a subject using a direct current inductorium device.  Units…were also used by early researchers, including Benjamin Franklin, for pain relief, as well as for treatment of other ailments.

The first modern attempt at electrical stimulation of the brain took place in a conscious patient in 1874.  The patient had ostemyelitis of the scalp, and the brain was exposed during debridgement.  Muscle contractions were apparent when the exposed motor cortex as subjected to electrical stimulation but not when it was mechanically stimulated.  Not until 1948, however, were electrodes successfully implanted in the brain, to treat a patient with psychiatric disorder.

The Electreat, the first electrical stimulator designed specifically for therapeutic use, was patented by Charles Willie Kent in 1919.  It appears to have been remarkably similar to transcutaneous electrical nerve stimulation units that wold appear later in the century.

Advertised to the public as a cure-all therapy, an estimated 250,000 Electreat stimulators were sold over the next 25 years.  Eventualy, Keat would be the first individual prosecuted under the new 1938 Food, Drug, and Cosmetic Act for making unsubstantiated medical claims for the device.  The Electreat Company was subsequently forced to limit its claims to pain relief alone.

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25. Betrayal

Betrayal is the number one deal breaker, it is one of the most devastating experiences a person will ever endure. It is more than a psychologically damaging event, it is a physical insult to the deep limbic system. Betrayal inflicts wounds to our senses which are played out by the body's chemical response network. Neurotransmitters fall out of balance. Brain chemistry churns out feelings so painful, so devastating, it often seems as if we cannot possibly survive into a new moment because the one we are living in is so hurtful, so filled with suffering, we are too stuck to imagine a new door will ever open. I am dealing with this in my life today. I will have to deal with it for many tomorrows that come, because the injury caused by this kind of event requires an entire overhaul of ones personal life, including plans, dreams,hopes, goals, beliefs, trusts, reality. I will ache and I will heal. I will pause to learn, and I will move forward. I've endured similar pain before, yet never this much betrayal. But I will be okay.

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