Learn to manage chronic pain

By JOSH MCLEAN

VIEW ON HEALTH

Pain shoots through the face. It feels like an intense shock or severe burning. Sometimes it may last for a few seconds, other times it attacks for as long as two minutes.

Sufferers can't move, sometimes can't think. The outbreaks attack sporadically for days, weeks or months. Then they subside, maybe even for years. Gone without a trace.

These are the symptoms of trigeminal neuralgia, according to the National Institute of Neurological Disorders and Stroke. The resultant bouts of pain get worse over time, causing patients to live in fear of another outbreak.

Occasionally, a sufferer gets some warning. A cheek might tingle in the days before it strikes, or maybe the jaw goes numb. Then the pain strikes. Doctors say contact with the face or jaw can cause the outbreak. Examples include shaving, brushing teeth or being exposed to intense wind.

This is just one example of a chronic or intractable pain disorder that doctors must deal with. The range of pain people suffer makes it difficult to diagnose causes, and sometimes even treatments. But people have lives to live, and doctors must help them work through these afflictions.

"I look at pain not as a symptom but as a disease process," said Dr. Gerald Hale, D.O., with Integrated Pain Services. "We look at what options we have to help people function better and improve their quality of life. It's not a recipe that's carved in stone."The biggest thing we can do is find the cause, then it makes it easier to find a treatment plan."

A COMMON AFFLICTION

One of the most common causes of chronic pain is arthritis. According to numbers from the not-for-profit American Pain Foundation, about 70 million Americans suffer from this affliction. That's enough sufferers to fill Los Angeles about seven times.

With chronic pain so common, some organizations have united to help patients help their doctors. The American Pain Foundation has joined forces with the American Chronic Pain Association and the National Pain Foundation to launch the Making Sense of Pain Relief campaign. The goal is simple: Help people understand the best way to relieve pain.

Step one is to talk to your physician when something hurts. The campaign's website urges patients to talk to physicians sooner rather than later, because ignoring arthritis or other chronic pain can degenerate one's health and quality of life.

Next, victims of pain must know that while suffering will never be eradicated, it can be reduced. So you should know the methods of reduction. There are over the counter as well as prescription medications.

"We have many options that are non-invasive or minimally invasive," Hale said. "We look at physical therapy, weight loss, over the counter medications, acupuncture, different herbs. We implant medication infusion systems, usually called morphine pumps, with that or different drugs that we use. We implant electrical devices in the spinal canal that alter the pain response before the signal gets to the brain."

Mark Hobbs, L.P.T. and owner of Total Physical Therapy, has worked with numerous arthritis patients and other chronic pain sufferers. He believes pain sufferers can greatly benefit from stretching and low level exercise.

"A lot of peoples' concept of exercise is what they read in a book or see on television, and some people wind up here from over exercising," he said. "When we see chronic pain patients, we attempt to get them to do some form of exercise. It may be so moderate that people say 'that's not exercise,' but it's getting up in the morning, stretching and doing some kind of activity -- because they'll go downhill if they don't."

Modifying a patient's lifestyle with healthier habits is often all that needs to be done, Hale said.

"You make your own endorphins as you exercise," he said. "If the patient knows how to engage those natural pain killers, it's certainly better than using artificial means. A lot of times people give up, and it's a whole syndrome where they get more and more ill. We try to reverse a lot of the behavioral aspects of pain."

Dr. Dan Clauw, director of the University of Michigan's Chronic Pain and Fatigue Research Center, says the most important thing for patients is to recognize that continued suffering is not normal, and it can be treated.

"Patients with chronic pain should not just assume that this is something that they must learn to live with, and that they must tough it out," Clauw said. "There are more and more treatments for different types of chronic pain."

Clauw said patients often try to beat pain alone, or adjust their lifestyles to endure it. Consulting a doctor is a far better way to handle chronic pain. There is help out there.

MORE OPTIONS

There is a treatment for chronic pain that is non-invasive, non-addictive and without a single known side effect. It's called Transcutaneous Electrical Nerve Stimulation, and it involves sending electric currents to specific nerves, free of pain.

Spineuniverse.com, a Web site aimed at helping chronic spinal cord pain sufferers, says the treatment produces heat, which relieves stiffness, makes moving easier and lessens pain. According to the Web site, the treatment is thought to coax the body into producing natural pain killers to ease chronic pain.

The equipment gives users little trouble. It can be worn under clothes around the waist and turned off when not needed. A treatment from a physician is required to purchase the equipment, which costs as low as $100 according to an about.com article on arthritis treatment.

Then there are the steps patients can take to help doctors. Dr. Judith Paice, the president of the American Pain Society, says the patient doctor relationship is crucial for dealing with chronic pain.Unlike other ailments, there is no X-ray or test that will reveal chronic pain. So doctors must get all their information from the patient."I tell my patients and their families that we're a team," Paice said. "I don't know what has worked or what has not worked. We need to communicate."

Patients should come to that first doctor's visit with a detailed medical history. When have things hurt? What medicines have helped? Where is the pain? What activities make it flare or subside?

And after treatment begins the note-taking should continue. Paice says patients must note all these things for an extended period of time. It's the only way the doctor will know what's going on and how to help.

'THE SUICIDE DISEASE'

The pain trigeminal neuralgia shoots through the face is so severe that the condition has become known as the suicide disease. Light contact against a face causes extreme, severe pain to shoot through the cheek, jaw or forehead. Life becomes tough to live. But there may be help soon. Last year, experts at the Oregon Health and Science University School of Medicine received much publicity for studying relief methods for this disease, which is difficult to diagnose because there are so many different causes for facial pain, according to the National Institute of Neurological Disorders and Stroke.

The institute also identifies women at a higher risk than men. People older than 50 are also at a higher risk, though people of all ages can suffer from this affliction that is never life threatening yet almost always disruptive to everyday life.

Last year, doctors at the Oregon Health and Science University School of Medicine told Medical News Today, that they had a developed a method to diagnose and classify the disease. In fact, patients themselves could use this method. The doctors developed software that patients can access with the Internet, Medical News Today reported.

The doctors use an 18-question survey. The program delves into a patient's medical history with mostly yes or no questions to determine whether they suffer from the suicide disease. As always, the doctors urge you to be cognizant of your family medical history and to share it with your family physician.