Pain – Hope – Resolution; Navigating the chronic pain jungle

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Pain - Hope - Resolution; Navigating the chronic pain jungle It is interesting how people think regarding chronic pain, what they have tried, what they are afraid to try and what they feel comfortable with. Huge systems have been set up by mainstream healthcare to deliver on promises of relief that often in reality are high priced and sometimes life threatening disappointments. An example of this is a recent patient who visited us with a history of chronic pain throughout the body, but most prominently in her neck which began when she was 16 years old The problems were exacerbated with the birth of her child and a neighbor had recommended she visit after having a dozen visits of physical therapy to her neck. As many people have found out, treatment usually is directed at where it hurts, and this was her experience as well. Evaluating and treating her took twice as long as most patients because of her very low pain threshold and her difficulty moving about. Even though she was my height, I found myself looking down at her. When she stood up, after needing pillows behind her back to sit, it was quite noticeable that her hips were distorted and the muscles in her upper back were secondarily very tight. She was unable to turn her neck and was beside herself. "I cannot turn my neck without pain " she said and the physical therapy felt ok" but I feel the same as when I started." After working on the muscles in her mid section and her hips which were extremely tight and sore, she felt dizzy and almost lightheaded upon getting up, likely side effects of the muscle relaxers and other medications she was taking for pain control. She stood up and looked me right in the eyes, not realizing her hips had become straighter and that she actually was standing taller by almost two inches. It has been two visits since she first visited and noticeable improvements include improved mobility, a better ability to move her neck and a marked improvement in her pain level, since she was able to perform some basic hip joint stretching exercises to improve the way she walks. If you know of someone like this ( this of course is an extreme situation ), they too have likely visited numerous health care providers with pain, in search of hop and trying to find a resolution. It is indeed a jungle out there, trying to find the right healthcare provider. Many chronic pain sufferers have asked "why doesn't anyone understand me? There are numerous misunderstandings about chronic pain in the land of healthcare. One of the most disturbing I have heard lately is chronic pain is a disease. I am not sure about you, but when I hear about disease, I think of cancer, blood disorders, and diabetes. By definition, disease is two words dis and ease that were thrown together years ago to explain that the body is feeling not so great. Check Wikipedia for an excellent definition. Perhaps, this is why in 1990, the Board of Rheumatology got together to take a number of conditions they saw in chronic pain and listed them as Fibromyalgia, a chronic pain classification the average physician could now somewhat understand. Many years of labeling later, a number of our chronic pain brethren believe that they have Fibromyalgia and it will be a lifelong struggle. In the book, Cheating Mother Nature, what you need to know to beat chronic pain, the chapter The Fibromyalgia Myth Factory Beginning on page 65, it discusses what this misunderstood problem really is, and give us clues as to why many people are promised relief with a certain treatment discipline and are often disappointed. Maybe the discipline cannot be effective because there is something missing. When most doctors diagnose, they will call it an itis, osis, etc and then send the non performing patient (the one who is not improving) for expensive tests, specialists visits with the end result of an expensive experience that leaves many people on some sort of drug. This type of diagnosis is so non descriptive, that the next practitioner has little to work with other than tests and data such as MRI and other tests which are often negative. As the misery worsens, the drugs get stronger until eventually, out of desperation, and after many years of unintentional neglect, a surgery or some sort of joint replacement is recommended. Would the healthcare world be a different place of the diagnosis was more comprehensive. An example of this would be instead of "you have plantar fasciitis" and you have to wear these appliances in your shoes and stuff just happens to nice people to... You have an issue with the way you are built and walk, with secondary tightening of the legs since your mid section has tightened up and you are now slamming your feet into the ground which is why they hurt. Of course, this is in patient speak, not doctor speak. The good thing about this is the next healthcare provider would understand that this is a functional problem and requires a functional solution. You, as the patient would understand it and when being shown and told that the inserts need to be worn to make you walk better, you are likely to improve your lifestyle to stay out of pain. Armed with the plantar fasciitis diagnosis, you will likely take the inserts out of your shoes once the feet stop hurting, if they ever do. The second diagnosis is more likely to yield more consistent treatment because it describes why you hurt. The idea of "do I see a chiropractor for the back, a physical therapist for the rehab, or perhaps Dr. Sarno because the pain is all in my head" is questionable because most of the good chiropractors do rehabilitation, manipulation and help patients with some stressful problems because it is a people business. There are physiotherapists who do manipulation (although chiropractors do much more of it and have a reputation in the United States for their expertise), however more concentrate on rehabilitation only. The idea of seeing a psychologist may be necessary however, Dr. Sarno's theory of TMS has many holes in it because of the thought process (he worked in the department of rehabilitation). The problem with trying to categorize who does what is that the practitioner who diagnoses the problem correctly will be better and finding the resolution. There needs to be a body mechanic attitude, rather than a behave within your discipline category which is limiting and too dogmatic to help the public. A body mechanic will understand how the body works, look at you, not just your symptoms, understand the mechanism of your pain and work toward resolving that mechanism. There is no brand of treatment in this model, because the mechanic picks and chooses which treatment tools make the most sense to resolve a structural issue. As per Cheating Mother Nature, most chronic pain problems are structural, and the idea of going to this or that person who does this or that is going to be hit or miss. A body mechanic can be any type of therapist, including the chiropractor, although chiropractors are bred to be more wholistic in their level of thinking and diagnosis. The best experience for someone in chronic pain can be to find someone who understands body mechanics and looks at the body as a whole, not just the symptoms and works toward normalizing body mechanics, thereby finding the cause and offering relief or resolution for the chronic pain sufferer. In this model, we can have the different groups of treatment providers however, they must incorporate knowledge that goes beyond the area that hurts and lets test it and treat it. Like the woman in the beginning of the article, the public deserves better expertise of now how to treat but the rationale of why and methods that are available today directed at the right problems. If a neck problem originates in the lower back, you can only see that if you look at the entire body. If a shoulder problem begins in the hips, you cannot see it if you just look at the shoulder. If a knee problem begins in the feet and is affected by body symmetry, you cannot possibly see this if you look at the knee, and wait for bad news or an expensive test. We need a new way of thinking about chronic pain; a body mechanic of sorts which exists today in our chiropractic practice and in some of the more progressive offices within our profession. I often hear people say but I tried this or that treatment already and it did not work or relieve the problem. This would imply all practitioners do the same thing and work the same way and is rather short sighted. The provider who will likely help you the most, labels and professional degrees aside, is the one who truly understands why you hurt. This should never be a mystery and you should never buy into the idea that stuff happens to nice people unless you were accidentally hit be a bus. There are reasons why you hurt and in many cases it should be quite apparent upon your healthcare practitioner taking their history and visually examining you. If the healthcare provider you are visiting cannot understand why you hurt, it is time to move on. They should be able to explain why you hurt in most cases simply and in a way that makes sense. Hint: Often the problem area is not where the pain is. What do you think? As always, I value your opinions.