EXCERPTS
This section contains excerpts from the introduction and several chapters of The Chronic Pain Management Sourcebook.
from the FOREWORD
By Malin Dollinger, MD, FACP
Clinical Professor of Medicine, University of Southern California School of Medicine, Oncology Consultant, John Wayne Cancer Institute, Santa Monica, California
Beginning with Eve, pain has been the universal fear of humankind. Whether it is a toothache (or the experience of having the problem fixed), the milder episodes of headache of backache, or the heroic experience of childbirth, every living person knows about pain. The consolation that it may call our attention to a problem that requires treatment is little solace for the afflicted.
Acute pain at least bears the promise of redemption. When the kidney stone is passed, when the child is born, when the incision heals, you will be well again … and pain-free. Chronic pain is a different and difficult challenge. For weeks, months, and often years, the suffering lingers, as does the sufferer. The pain may seem to outlast the disease, a final reminder of a good life gone awry. Chronic pain has many patterns and causes, but one thing that is always present is suffering. Early in my experience as a cancer doctor, I learned that pain takes precedence over everything else. If the pain cannot be controlled, it does not matter what marvelous deeds I might perform to cure the disease.
Where do you start on your journey to relief from chronic pain? You may spend days and weeks going from one doctor to another, from one pain clinic to another, trying this or that remedy, whether it is pills, shots, skin patches, heat or cold, nerve blocks, TENS units, or acupuncture. And indeed you should not fail to get the best professional help you can.
But first, read this book. The Chronic Pain Management Sourcebook is an ideal place to start. David Drum has become the spokesperson for all of the pain relief professionals, whose wide spectrum of information has been merged into this useful book. He has created for you an easy-to-understand, well-written, comprehensive summary of everything you might wish to know—indeed, need to know – about chronic pain. He discusses the causes and patterns of chronic pain, the choices of treatment and management, the places, people, and clinics to consult, and the wide spectrum of treatment choices that you have. This thoroughly researched book also contains information on diet, physical conditioning, social support, and stress, and a helpful list or organizations and places to seek additional information.
Pain is universal. This book will become the universal companion and friend to sufferers from chronic pain. It brings to everyday understanding the complex and technical aspects of this difficult branch of medicine. This information will be your key to enlightenment, to dealing with the problem, and to your relationship with the most important people in your life: your loved ones, your health care professionals, and yourself…continued in THE CHRONIC PAIN MANAGEMENT SOURCEBOOK
from CHAPTER 1: ABOUT CHRONIC PAIN
When a tall, attractive woman we shall call Leslie escorted her daughter down the aisle to be married on a balmy October day, Leslie considered that short walk a victory. Leslie has suffered from chronic pain for the past several years.
Since a work-related accident, Leslie, who is a single parent with three children, has dealt with the effects of fibromyalgia, carpal tunnel syndrome, and other joint and soft tissue problems as well as a lawsuit which has yet to be resolved. When she was planning her wedding, Leslie’s daughter had asked her to accompany her up the aisle “if you’re able to walk.” Leslie postponed surgery on her knees and it was nip and tuck right up until the time she was able to walk her daughter down the aisle to be married.
Leslie works out at a gym, attends a support group, and cooperates with her medical doctor to manage her pain problems. She has a sense of humor, and a loving family. But Leslie admits, “Sometimes I feel like I’m not a productive member of society, and like I’m not needed. It’s been very depressing for me.”
For any person enduring the debilitating effects of chronic pain and that person’s loved ones, chronic pain is extraordinarily frustrating to experience and to witness, and exquisitely painful to endure. One’s outlook on life is constantly tested. The physical and emotional suffering which accompanies chronic pain tries the body and the mind, and tests the limits of the spirit and the self. More than almost any other type of medical problem, chronic pain chips away at your personal sense of yourself, and at your well-being, on a day-to-day basis. Focusing only on your pain, and fearing that you cannot control its effects, can slowly turn a normal person into a bitter, helpless invalid, unless that person makes a conscious decision to fight back… continued in THE CHRONIC PAIN MANAGEMENT SOURCEBOOK
from CHAPTER 3: PAIN IN THE BODY
The experience of pain itself seems simple, but it is exquisitely complex. A painful stimulus experienced in the nerve cell may be changed as it runs up the nervous system and is finally registered in parts of the brain. Your entire nervous system is affected by many natural pain-reducing substances produced in the body, as well as natural substances which can intensify pain. Significantly, the “gate control” theory provides some new insights into the mechanics of chronic nonmalignant pain. This chapter looks at some of the biological influences which affect the onset, duration and intensity of pain, including where pain originates in the human body.
This chapter is divided into two parts:
I. An explanation of the nervous system, which senses, transmits, transforms, and registers pain
II. A survey of the most common physical causes of chronic pain, such as back pain, headaches, arthritis
I: THE NERVOUS SYSTEM
Although it seems instantaneous to us, the physical perception of pain is at the end of a crackling process of sensation. This process begins when a stimulus electrifies the sensitive nerve endings of a neuron or nerve cell. Impulses or sensations surge from one end of the nerve cell to the other, then up natural pathways of neurons and nerves. Impulses jump up the spinal cord, to the brain, where the incoming message is perceived as pain … continued in THE CHRONIC PAIN MANAGEMENT SOURCEBOOK
from CHAPTER 4: PAIN IN THE MIND
The mind is involved in the experience of chronic pain. Your mental outlook and your emotions can either amplify or inhibit the debilitating pain cycle. The fact that pain has emotional, behavioral, and mental components doesn’t mean that the pain isn’t real. These aspects of pain are addressed in multidisciplinary programs because learning good coping skills makes pain more manageable. Working to understand and apply this to yourself can help you manage chronic pain, since it may be possible to improve your sexual functioning and many other aspects of your life.
Mind and body are so obviously intertwined in the experience of pain that the Greek philosopher Aristotle classified pain as an emotion—that is, a feeling which is the opposite of pleasure. Roman philosopher Marcus Aurelius regarded pain as entirely a phenomenon of the body which could be overridden by the mind. “If it lasts, it can be borne,” wrote the Roman emperor and stoic philosopher. The Roman philosopher, Epictetus, stated, “People are not disturbed by events themselves, but rather by the views they take of them.”
“Pain is always subjective,” wrote the authors of a comprehensive definition of pain by the International Association for the Study of Pain. “Each individual learns the application of the word through experiences related to bodily injury in early life. It is unquestionably a sensation in a part of the body but it is also always unpleasant and therefore is also an emotional experience.” The authors added that pain is “always a psychological state.”
The mental aspects of the pain experience, according to the gate control theory, include motivational tendencies that move or don’t move you toward escape or attack. They include cognitive information also processed in the brain such as on your own thoughts about pain, your past experiences, and the expected outcomes of overt responses that characterize pain, according to Ronald Melzack’s book, The Puzzle of Pain. The placebo effect which colors every scientific experiment is an endlessly-demonstrated expression of the mind’s influence over the body, as is the simple act of blushing.
Mental strategies can be quite helpful in mitigating chronic pain, whether of organic of functional origin. Without question, pain which is not relieved causes physical, emotional and social havoc. Negative reactions and responses feed into a pain cycle where one thing leads to another. This can slowly change you into a passive and dependent invalid unless the pain cycle is broken. Substituting positive coping actions for negative reactions can help you diminish the intensity of pain. … continued in THE CHRONIC PAIN MANAGEMENT SOURCEBOOK
from CHAPTER 6: NUTRITION
Increasing the day-to-day quality of life by maximizing overall physical health makes life more satisfying, and helps in the management of pain. It’s helpful to eat nutritiously, and to develop a strategy to control your weight if that is recommended. Eating well is an aspect of healthy living, and nutrition is one area over which you can exert control to benefit your own health.
The well-established touchstones of good health and good living in general are diet, exercise, and social interactions with other people, which are covered in the next three chapters. Study after study has affirmed the physical and mental health benefits of these aspects of the lifestyle, which all indirectly affect the experience of chronic pain. Many comprehensive pain treatment centers employ registered dietitians or nutritionists, since eating well strengthens your body and mind, and makes you more able to deal with the pain that you have.
Eating good food, in the form of a well-balanced diet, is of vital importance to the maintenance and enjoyment of life. Good food is one of life’s primary sensual pleasures. Diet was even more important in most ancient medical systems than it is today. The Greek physician Hippocrates repeatedly stated, “Your medicine shall be your food and your food shall be your medicine.”
Good nutrition won’t eliminate chronic pain, but it can relieve the extra stress on the body caused by poor nutrition. Eating a balanced diet strengthens the immune system, assists normal body processes, and generally reinforces good mental and physical health. Drinking adequate water every day prevents the dehydration which can negatively affect every body process, and helps all body systems function normally.
It is estimated that one in four elderly Americans have diets which are low in essential fiber, complex carbohydrates, fruits and vegetables. Low income, social isolation, and acute chronic health problems can all contribute to poor nutrition in older people—as can a lack of knowledge about good eating. Poor oral hygiene and poor mental health can also adversely affect one’s eating patterns … continued in THE CHRONIC PAIN MANAGEMENT SOURCEBOOK
from CHAPTER 7: SOCIAL SUPPORT
Other people have a role in your health. Social isolation and depression can inhibit the normal immune system response to infections and other physical threats, but expressing our humanity through conversation and laughter actually makes us stronger and more resilient. Social support can include relationships within a family, workplace, a church or religious group, or even in a group of people in your community with whom you have common interests such as a support group.
Many studies have shown that people who have active social relationships with family or friends live longer, healthier lives. Although your health may have changed your role in the lives of other people, as much as possible, take action to maintain your ties to your family, your friends, and groups of people in the community who know you, and who can provide support. Maintaining supportive, loving, friendly, positive relationships with other people can help you keep a good perspective on things, and buoy your sense of humor. Social support can lower stress levels, and this can lower your perception of physical or emotional pain. Even keeping a pet can be healthy.
One of the normal effects of aging on the human body is a lessened ability to restore damage and insults, which is the job of the immune system. A compromised immune system diminishes our natural ability to fight off illness and disease, including the muscle tension and inflammation which can accompany many types of pain. Proof is accumulating that negative states and emotions such depression and anxiety can weaken the immune system, and inhibit healing. But the immune system is nourished by simple, joyous experiences like love, friendship, affectionate touching, and laughter. By making adjustments which sweeten the quality of your life, you make continuing pain more manageable …continued in THE CHRONIC PAIN MANAGEMENT SOURCEBOOK
How to order, CLICK HERE
(c) Burning Books Press
from the FOREWORD
By Malin Dollinger, MD, FACP
Clinical Professor of Medicine, University of Southern California School of Medicine, Oncology Consultant, John Wayne Cancer Institute, Santa Monica, California
Beginning with Eve, pain has been the universal fear of humankind. Whether it is a toothache (or the experience of having the problem fixed), the milder episodes of headache of backache, or the heroic experience of childbirth, every living person knows about pain. The consolation that it may call our attention to a problem that requires treatment is little solace for the afflicted.
Acute pain at least bears the promise of redemption. When the kidney stone is passed, when the child is born, when the incision heals, you will be well again … and pain-free. Chronic pain is a different and difficult challenge. For weeks, months, and often years, the suffering lingers, as does the sufferer. The pain may seem to outlast the disease, a final reminder of a good life gone awry. Chronic pain has many patterns and causes, but one thing that is always present is suffering. Early in my experience as a cancer doctor, I learned that pain takes precedence over everything else. If the pain cannot be controlled, it does not matter what marvelous deeds I might perform to cure the disease.
Where do you start on your journey to relief from chronic pain? You may spend days and weeks going from one doctor to another, from one pain clinic to another, trying this or that remedy, whether it is pills, shots, skin patches, heat or cold, nerve blocks, TENS units, or acupuncture. And indeed you should not fail to get the best professional help you can.
But first, read this book. The Chronic Pain Management Sourcebook is an ideal place to start. David Drum has become the spokesperson for all of the pain relief professionals, whose wide spectrum of information has been merged into this useful book. He has created for you an easy-to-understand, well-written, comprehensive summary of everything you might wish to know—indeed, need to know – about chronic pain. He discusses the causes and patterns of chronic pain, the choices of treatment and management, the places, people, and clinics to consult, and the wide spectrum of treatment choices that you have. This thoroughly researched book also contains information on diet, physical conditioning, social support, and stress, and a helpful list or organizations and places to seek additional information.
Pain is universal. This book will become the universal companion and friend to sufferers from chronic pain. It brings to everyday understanding the complex and technical aspects of this difficult branch of medicine. This information will be your key to enlightenment, to dealing with the problem, and to your relationship with the most important people in your life: your loved ones, your health care professionals, and yourself…continued in THE CHRONIC PAIN MANAGEMENT SOURCEBOOK
from CHAPTER 1: ABOUT CHRONIC PAIN
When a tall, attractive woman we shall call Leslie escorted her daughter down the aisle to be married on a balmy October day, Leslie considered that short walk a victory. Leslie has suffered from chronic pain for the past several years.
Since a work-related accident, Leslie, who is a single parent with three children, has dealt with the effects of fibromyalgia, carpal tunnel syndrome, and other joint and soft tissue problems as well as a lawsuit which has yet to be resolved. When she was planning her wedding, Leslie’s daughter had asked her to accompany her up the aisle “if you’re able to walk.” Leslie postponed surgery on her knees and it was nip and tuck right up until the time she was able to walk her daughter down the aisle to be married.
Leslie works out at a gym, attends a support group, and cooperates with her medical doctor to manage her pain problems. She has a sense of humor, and a loving family. But Leslie admits, “Sometimes I feel like I’m not a productive member of society, and like I’m not needed. It’s been very depressing for me.”
For any person enduring the debilitating effects of chronic pain and that person’s loved ones, chronic pain is extraordinarily frustrating to experience and to witness, and exquisitely painful to endure. One’s outlook on life is constantly tested. The physical and emotional suffering which accompanies chronic pain tries the body and the mind, and tests the limits of the spirit and the self. More than almost any other type of medical problem, chronic pain chips away at your personal sense of yourself, and at your well-being, on a day-to-day basis. Focusing only on your pain, and fearing that you cannot control its effects, can slowly turn a normal person into a bitter, helpless invalid, unless that person makes a conscious decision to fight back… continued in THE CHRONIC PAIN MANAGEMENT SOURCEBOOK
from CHAPTER 3: PAIN IN THE BODY
The experience of pain itself seems simple, but it is exquisitely complex. A painful stimulus experienced in the nerve cell may be changed as it runs up the nervous system and is finally registered in parts of the brain. Your entire nervous system is affected by many natural pain-reducing substances produced in the body, as well as natural substances which can intensify pain. Significantly, the “gate control” theory provides some new insights into the mechanics of chronic nonmalignant pain. This chapter looks at some of the biological influences which affect the onset, duration and intensity of pain, including where pain originates in the human body.
This chapter is divided into two parts:
I. An explanation of the nervous system, which senses, transmits, transforms, and registers pain
II. A survey of the most common physical causes of chronic pain, such as back pain, headaches, arthritis
I: THE NERVOUS SYSTEM
Although it seems instantaneous to us, the physical perception of pain is at the end of a crackling process of sensation. This process begins when a stimulus electrifies the sensitive nerve endings of a neuron or nerve cell. Impulses or sensations surge from one end of the nerve cell to the other, then up natural pathways of neurons and nerves. Impulses jump up the spinal cord, to the brain, where the incoming message is perceived as pain … continued in THE CHRONIC PAIN MANAGEMENT SOURCEBOOK
from CHAPTER 4: PAIN IN THE MIND
The mind is involved in the experience of chronic pain. Your mental outlook and your emotions can either amplify or inhibit the debilitating pain cycle. The fact that pain has emotional, behavioral, and mental components doesn’t mean that the pain isn’t real. These aspects of pain are addressed in multidisciplinary programs because learning good coping skills makes pain more manageable. Working to understand and apply this to yourself can help you manage chronic pain, since it may be possible to improve your sexual functioning and many other aspects of your life.
Mind and body are so obviously intertwined in the experience of pain that the Greek philosopher Aristotle classified pain as an emotion—that is, a feeling which is the opposite of pleasure. Roman philosopher Marcus Aurelius regarded pain as entirely a phenomenon of the body which could be overridden by the mind. “If it lasts, it can be borne,” wrote the Roman emperor and stoic philosopher. The Roman philosopher, Epictetus, stated, “People are not disturbed by events themselves, but rather by the views they take of them.”
“Pain is always subjective,” wrote the authors of a comprehensive definition of pain by the International Association for the Study of Pain. “Each individual learns the application of the word through experiences related to bodily injury in early life. It is unquestionably a sensation in a part of the body but it is also always unpleasant and therefore is also an emotional experience.” The authors added that pain is “always a psychological state.”
The mental aspects of the pain experience, according to the gate control theory, include motivational tendencies that move or don’t move you toward escape or attack. They include cognitive information also processed in the brain such as on your own thoughts about pain, your past experiences, and the expected outcomes of overt responses that characterize pain, according to Ronald Melzack’s book, The Puzzle of Pain. The placebo effect which colors every scientific experiment is an endlessly-demonstrated expression of the mind’s influence over the body, as is the simple act of blushing.
Mental strategies can be quite helpful in mitigating chronic pain, whether of organic of functional origin. Without question, pain which is not relieved causes physical, emotional and social havoc. Negative reactions and responses feed into a pain cycle where one thing leads to another. This can slowly change you into a passive and dependent invalid unless the pain cycle is broken. Substituting positive coping actions for negative reactions can help you diminish the intensity of pain. … continued in THE CHRONIC PAIN MANAGEMENT SOURCEBOOK
from CHAPTER 6: NUTRITION
Increasing the day-to-day quality of life by maximizing overall physical health makes life more satisfying, and helps in the management of pain. It’s helpful to eat nutritiously, and to develop a strategy to control your weight if that is recommended. Eating well is an aspect of healthy living, and nutrition is one area over which you can exert control to benefit your own health.
The well-established touchstones of good health and good living in general are diet, exercise, and social interactions with other people, which are covered in the next three chapters. Study after study has affirmed the physical and mental health benefits of these aspects of the lifestyle, which all indirectly affect the experience of chronic pain. Many comprehensive pain treatment centers employ registered dietitians or nutritionists, since eating well strengthens your body and mind, and makes you more able to deal with the pain that you have.
Eating good food, in the form of a well-balanced diet, is of vital importance to the maintenance and enjoyment of life. Good food is one of life’s primary sensual pleasures. Diet was even more important in most ancient medical systems than it is today. The Greek physician Hippocrates repeatedly stated, “Your medicine shall be your food and your food shall be your medicine.”
Good nutrition won’t eliminate chronic pain, but it can relieve the extra stress on the body caused by poor nutrition. Eating a balanced diet strengthens the immune system, assists normal body processes, and generally reinforces good mental and physical health. Drinking adequate water every day prevents the dehydration which can negatively affect every body process, and helps all body systems function normally.
It is estimated that one in four elderly Americans have diets which are low in essential fiber, complex carbohydrates, fruits and vegetables. Low income, social isolation, and acute chronic health problems can all contribute to poor nutrition in older people—as can a lack of knowledge about good eating. Poor oral hygiene and poor mental health can also adversely affect one’s eating patterns … continued in THE CHRONIC PAIN MANAGEMENT SOURCEBOOK
from CHAPTER 7: SOCIAL SUPPORT
Other people have a role in your health. Social isolation and depression can inhibit the normal immune system response to infections and other physical threats, but expressing our humanity through conversation and laughter actually makes us stronger and more resilient. Social support can include relationships within a family, workplace, a church or religious group, or even in a group of people in your community with whom you have common interests such as a support group.
Many studies have shown that people who have active social relationships with family or friends live longer, healthier lives. Although your health may have changed your role in the lives of other people, as much as possible, take action to maintain your ties to your family, your friends, and groups of people in the community who know you, and who can provide support. Maintaining supportive, loving, friendly, positive relationships with other people can help you keep a good perspective on things, and buoy your sense of humor. Social support can lower stress levels, and this can lower your perception of physical or emotional pain. Even keeping a pet can be healthy.
One of the normal effects of aging on the human body is a lessened ability to restore damage and insults, which is the job of the immune system. A compromised immune system diminishes our natural ability to fight off illness and disease, including the muscle tension and inflammation which can accompany many types of pain. Proof is accumulating that negative states and emotions such depression and anxiety can weaken the immune system, and inhibit healing. But the immune system is nourished by simple, joyous experiences like love, friendship, affectionate touching, and laughter. By making adjustments which sweeten the quality of your life, you make continuing pain more manageable …continued in THE CHRONIC PAIN MANAGEMENT SOURCEBOOK
How to order, CLICK HERE
(c) Burning Books Press