Chronic Pain

When I was nine years old my father suffered a "nervous breakdown", whatever that was. The term is no longer in vogue. Too vague. He was sick in every part of his body. When one part healed another part hurt. He thought he was dying.

We moved from the city to a country farm. We didn't have a telephone because he couldn't stand the ringing of a phone. His doctor finally told him he needed to see a psychiatrist. That shocked him into reading everything he could to heal himself. It took him seven years.

During that difficult time my mother suffered chronic back pain.

I suffered chronic shoulder pain relieved by daily use of a Chi machine until I had both shoulders replaced.

I'm sure you know someone who suffers chronic pain. It's no fun.

Here are excerpts from a fascinating lecture presented at the 14th annual meeting of the AmericanAssociation of Orthopaedic Medicine, Tempe Arizona Feb.21, 1997

The title:

Psychological Factors in Chronic Pain: An Introduction to Psychosomatic Pain Management by Dr. Dietrich Klinghardt, M.D., PhD

"Most pain treating physicians have a vague notion, that there may be a psychological component contributing to the severity of chronic pain. The International Association for the Study of Pain defined pain as 'an unpleasant sensory and emotional experience associated with the actual or potential tissue damage'.

"The well respected British neurologist and researcher Barry Wyke demonstrated, that the neurological signal from a painful stimulus travels from the receptors in the periphery to the thalamus, where the message is split: one pathway goes up to the sensory cortex, telling the patient where the pain is and what particular sensation it causes (warm, pulling, pressing etc.). The other pathway goes to the frontal lobe, which is now accepted as being partially part of the limbic system. Stimulation of this area gives the patient the emotional experience that goes along with having pain ("it makes me sick, hopeless …I feel terrible …I am afraid ..etc.).

"Patients, that had their frontal lobes removed, can still tell pain, but there is no suffering whatsoever that goes along with the experience. It is really the "psychological" component, that has earned chronic pain the attention it is given in modern medicine. Why then are we not focusing our attention on the ways in which we can help patients in this area? Why are most of us still trying to "fix" pain with all the invasive procedural approaches available today? Why not develop a psychological intervention, that treats the emotional part of chronic pain and leave the rest alone?

"One of the main reasons I found for this dilemma can be explained quite simply: Medicine is a science, that has clearly come into it's adulthood. Many safe injection procedures and other technical approaches are available today. These are teachable, learnable and reproducible. Psychology however is a young science with many diverting opinions ,each exploring different personality models, being based in often contradictory philosophies.

"In 1992 the San Francisco Spine Institute published a paper in Spine Magazine. 100 adults with MRI proven severe lumbar disc herniations were preoperatively interviewed regarding five possible traumatic situations in their respective childhood:

1. Physical abuse

2. Sexual abuse

3. Emotional neglect/ abandonment

4. Loss of one or both parents (divorce, death etc.)

5. drug abuse at home (alcohol, prescription drugs etc.)

The patients were assigned to 3 different groups:

1. None of these risk factors

2. One or two risk factors

3. Three or more

The long term postoperative success was as follows:

1. 95% excellent improvement

2. 73% improvement

3. 15%improvement

"What does this mean? The result of surgery and postoperative pain have little to do with the surgical procedure itself but largely depend on factors that date back to the childhood of the patient. It can be easily extrapolated from this study, that the same is true for many or all of the other procedures used in pain management, including osteopathic manipulation, prolotherapy and others. A follow-up study demonstrated, that brief targeted psychotherapy that addresses these specific issues, could improve the postsurgical results dramatically in groups B and C. Pelletier showed, that patients, who had a"severe"childhood, but matured through the process of good psychotherapy, ended up having a higher life-expectancy than people, that had a "happy" childhood.

"Another study, conducted by several AAOM affiliated physicians (Klein, Eek, Dorman et al) pointed indirectly in the same direction as the Spine Institute study: Patients were examined regarding the severity of their MRI findings before undergoing prolotherapy treatment. There was no correlation between outcome and the severity of the lesion: patients with severe pathology had the same success rate as the group with no demonstrable pathology, i.e. some patients with no demonstrable pathology did not improve with prolotherapy, others with severe pathology did improve. This study did not look at the probable underlying psychological problems even though I would dare to say, that just as in spinal surgery the outcome of the treatment was determined by the same 5 psychological factors, not by the severity of the lesion."

###

With recognition of psychological factors in chronic pain and illness that travels the body, medical doctors now studying the neurological pathways of chronic pain are recommending treatment rather than prescription drugs. No longer is there shame that the subconscious mind can be the source of pain.

Don't take seven years to get well.

Evelyn Cole