Category Archives: Chronic Pain Syndrome

Chronic Pain

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Chronic Pain

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I was half listening to my latest audible book on the way to my first day of orientation at the new job. I say half because it is probably the 3rd time through those last few chapters. It isn’t because the book isn’t holding my attention, it is just it is one of those books I am talking back to as I drive and listen. It is one of the books that I will order in print and highlight and take notes in the margins.  I will review the book in more detail in some future post.

But she said something that had me wanting to scream.  She said that not treating patients in chronic pain amounts to torture.  I may be assuming too much, but it seems she was overly emphasizing opioids as a treatment for chronic pain. Firstly, opioids suck at treating most chronic pain and cause many more problems that they solve most of the time. Secondly, no one has a right to a pain free life. No one.

I was getting all judgy, as I am wont to do. Talking back to the book.  Really? Torture?  How is it my fault that you smoke, don’t exercise, drink like a fish, are 75 pounds over weight and now your knees and back hurt? Really? Sounds like that chronic pain is on your side of the net that divides us in this debate over opioids. I am not going to continue every patient in pain on the unholy trinity of Norco, Soma, and Xanax.

Then, doing my best Tevye impression ( from Fiddler on a Roof), I said, “On the other hand”, What about the obese, sedentary smoker who needs medication to control their blood pressure and blood sugars both of which are out of control because of their lifestyle choices? Do I want to say, No more Metformin for you unless you start exercising? No. Of course not.  But on the other hand, I don’t see Metformin sending the patient down a slippery slope of every escalating medications with all motivation sucked out of them now do I?

I should hold off my opinion of this book until I finish it completely.  I am finding it to be a fascinating if not somewhat biased account of the state of chronic pain diagnosis and treatment.  As loud as I shouted in the car at the author, she did not respond, so I am just venting a bit here.  Torture and not giving opioids to every chronic pain patient are entirely different things. Seriously.

I am not just frustrated with the patient, I am more upset with the system that got us on opposing sides in the opioid wars.  We all know it doesn’t work to just give folks opioids. It is so much more complicated than that.  Pain management is always a trial with an “n” of 1.   Each person is different.  Even that one person is different on a day to day basis.  Not giving out opioids to every patient is NOT torture.  Please review the history of any war of your choice to get a much clearer idea of what torture is and is not.

Alogophobia, Kinesiophobia and Chronic Pain

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Alogophobia,  Kinesiophobia and Chronic Pain

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This morning I fell at work. Hard.  I was in a hurry, putting my purse down in the provider charting area, grabbing my Starbucks red coffee mug and stepped quickly out into the freshly waxed hallway. I didn’t notice that the floor crew had soaked the first two feet of carpet in our little office and my boots were wet.  It was such a strange fall.  I had no sensation of falling at all. I was just suddenly face down on the floor, landing mostly on my left knee, hip and outstretched hand.

My knee is bruised and hand are bruised and my left thigh started cramping up by the end of the day. I put an ice pack on every time I sat down to chart. Here is what I know: I am going to be just fine. I will probably be a little more sore tomorrow but my body is designed to heal. I am not going to sue. I am not going to develop any chronic pain syndrome as a result of this fall. I am not going to believe that I will develop arthritis of my knee or that I did anything to discs in my back that won’t heal on its own.

Sadly, many of the chronic pain patients that I see have had similar minor accidents or falls sometimes as long as twenty years ago that set their lives into a tailspin of chronic pain syndrome. When I talk to them, they tell me that they have degenerative disc/back/knee problems.   There were told by someone they respected that they will develop arthritis in the area of injury. They may have been told that they have a bulging disc, which they may have had before the injury since many times this is asymptomatic. They believe that discs can never improve or heal.

The most interesting thing to me is that they become afraid to move. They are convinced beyond reason that  if they move or exercise they will do damage to their area of injury. This idea remains fixed for what seems to me to be the rest of their life. Physical therapy has never worked for them because they are convinced that the pain means that something is wrong. Really wrong and it not going to heal ever.

Today, I tried to “walk it off” between icing the knee and thigh. I stretched my back gently. I believe that if I sit still, my muscles will spasm. I believe I will be fine. I don’t need Norco or likely even Tylenol for pain. Trust me, the bruises and swelling are pretty impressive. I know I will be just fine because I am not afraid. No one put a soft collar on my neck or took x rays of anything.

I love my vocation. I am happy with my life. But what if I were unhappy? What if I hated my job? What if I believed in lawsuits for slip and fall? What if I didn’t know all the things that I know about pain and the brain? I could be off work for months as many patients that I see are. Some patients are off for more than a year for a very simple slip and fall.

I think one of the most important things we need to do is to teach people that our bodies are designed to heal. There is virtually nothing that is made better by prolonged rest. Teach that the longer you rest, the more the muscles atrophy, weaken and weak muscles hurt when you use them. We need to teach that pain does not always mean disability.