|
MEDICATIONS
When I first saw a doctor
about the pain resulting from the fall in 1984, he tried using a
muscle relaxant and mild pain medication. I did not feel the muscle
relaxant was effective, and the pain medication did not come close
to relieving my pain. I tried wearing a neck brace, and that allowed
me to return to work temporarily. Because the medication was not
helpful, I later entered the hospital for tests.
Throughout the course of my
journey with pain, I have tried a multitude of medications.
Analgesics: These
were mostly narcotic medications that have given relief, along with
many, many side effects including drowsiness, confusion, nausea,
vomiting, irritability, and constipation. Morphine made me violently
ill, and I advise hospital staff not to use it after surgery. I have
used the Fentanyl Patch, a strong medication released into the
system over a 3-day period. It was very effective, but I used it
only as a temporary measure. All of these medications can cause
severe dependence, so they are not prescribed until other
conservative avenues fail. I do not have any qualms about taking
narcotics, if they offer relief. I have been in so much pain in the
past, that I thought death would be welcomed if something wasn't
done to relieve the pain. I regret the social stigma attached to
these drugs, because they sometimes are the only means of offering
relief to severe chronic pain. Please don't get impatient with your
doctor. Sometimes conservative treatment works, and you should try
alternative methods, because they can work very well for some
people.
Acetaminophen Analgesics
(Tylenol, etc): I
mention these separately because I want to caution you not to take
more than the recommended dose on a daily basis. The ingredients can
be toxic to the liver, causing life-threatening problems.
Non-steroidal
Anti-Inflammatory (NSAID) Drugs: These
are given for pain and to reduce swelling often occurring in the
joints. People with arthritic conditions often find relief with
them, but I had no success. They often irritate the stomach, and
that happened almost without fail with me. I know there are many
different types produced by many different companies, so again you
must be patient. Even though medications can be in the same class,
they can have markedly different effects on an individual. I
recommend trying as many as possible to see if they might work,
because they are much safer than narcotic analgesics.
Tri-cyclic
Anti-Depressants: Many
wonder if the doctor thinks "it's all in your head" if
this type of drug is prescribed. Actually, anyone suffering from
fibromyalgia and a host of other conditions can develop a sleep
disorder that deprives the patient from the restorative sleep stage.
These medications sometimes allow you to get a good rest, so that
you feel like getting up in the morning. Unfortunately, the
side-effects were too difficult for me to continue taking these
medications. The dose I needed caused me to have that
"hangover" feeling that lasted for several hours upon
awakening, and I could not tolerate that! However, that reaction is
purely individual, so please don't be judgmental until you've tried
for yourself. Also, some of these have been associated with weight
gain, something chronic pain patients often struggle with, including
me.
SSRI's ( Seratonin
Selective ReUptake Inhibitors): These
relatively new drugs often give a sense of well-being by altering
the Seratonin levels in the body. Although they are often associated
with anxiety disorders, they can be helpful to those with pain. I
found them to be helpful, but I eventually stopped taking them,
because of drug interaction problems. Never stop taking them
abruptly and always talk to your doctor before changing the dose. I
have talked with many pain patients who have truly benefited from
using SSRI's, because their moods have stabilized. No longer does
the pain cause depression.
Muscle Relaxants:
For some reason, these medications don't seem to be very popular any
more. However, some can be helpful, short-term. Valium is one of the
best, but has fallen out of favor because of its highly addictive
nature. It is considered a controlled substance for this reason.
Many patients complain of constipation and drowsiness when using
muscle relaxants. I do not use them anymore.
Baclofen:
This medication is relatively new and is used for severe muscle
spasm. It can offer dramatic relief to patients with illnesses that
cause muscle rigidity. When someone has chronic pain, the muscles
often get tight and/or go into spasm. I find the medication very
helpful.
Sleep Medications: I have
been advised not to take these on a regular basis in the past, but
there are newer, safer ones on the market that do not have the
addictive properties of the older drugs. Ambien is quite helpful to
me.
PAIN
MANAGEMENT
Pain
Clinic
Three
years after my failed neck surgery, I was admitted into a four-week,
in-patient, pain clinic. It was one of the first of its kind, but I
believe its multidisciplinary approach remains the same. This clinic
was housed in a wing of my local hospital, but the staff did
everything to prevent us from feeling like patients. Regular
furniture was used, and we wore our street clothes. Each day, we
were visited by our doctors, and our schedules were jam packed with
activities including physical therapy, psychotherapy, vocational
training, and electives. We saw a sociologist who encouraged us to
fit in with our peers, and we could see a pastor to aid with our
spiritual well-being. We had courses on eating well, correct body
movement, and relaxation. We even had time with a game therapist
(someone to help us have fun).
Some of the participants
felt this was just a place to wean us off any narcotics we might be
taking, and that is the direction of many multi-disciplinary pain
clinics. (If you are investigating this avenue, do your homework.
Some clinics are more diagnostic and use medical procedures to try
to alleviate pain.) I felt there was some benefit to be had, but I
did not like attending all of the required activities. I do not have
a problem socializing, nor do I have trouble knowing how to have
fun. My insurance was billed $75/hr. for these, and I have trouble
justifying that!
Still, with a good
attitude, there is much to be learned about living with chronic
pain, and this is a good opportunity for someone new to the
experience. I attended this clinic in the 80's, and I doubt the
existence of any in-patient clinics today. If you don't have one in
your area, it could mean finding a place to stay which can be
cost-prohibitive.
Hypnosis
I
was quite surprised by this experience. I was afraid of allowing
someone else to control my mind, so I entered the doctor's office
with a great deal of resistance. Actually, I had been through the
experience before in seminars at work, except they were dubbed
"relaxation techniques." The hypnotist had me close my
eyes and described a relaxing scene to me. ( You are on a sunny
beach with the waves gently rolling in, etc.) He then asked me to
think about my toes and to completely relax them, then my feet, and
worked his way up until my whole body was to included. Afterward,
all muscles should be very relaxed, and your mind should be at ease.
Hopefully, you can teach yourself the same technique and practice it
whenever you feel a need. If I desired, the doctor would give me a
tape of the session to use. I found this to be very limited; it only
worked on mild pain. I asked my doctor about this, and he said it
had its limitations, and some pain was just too intense for this to
work.
Biofeedback
This
involves being hooked up to a computer with electrodes that can
monitor your breathing, pulse, and muscle tightness. Most likely,
you will sit in a comfortable chair in a darkened room while
listening to relaxation tapes or soft music. The computer is
programmed to make sounds that will indicate your state of
relaxation. The objective is to teach you how to attain a state of
relaxation, so that you will no longer need the aid of the computer
monitoring. Once again, I found the results to be limited; it seemed
to work best on low-pain days.
Acupuncture
When
I first went to the acupuncturist, he told me I would be markedly
better in five visits. The needles were quite interesting to me,
because they were unlike anything I'd ever seen. They resemble
horsehair and are not nearly as thick as the traditional needle. He
inserted them using a twisting motion and applied them to locations
that were believed to trigger the pain. You can view these locations
in a good book on acupuncture or reflexology. He used dozens of
needles, many in my head, neck, shoulders, and arms. I was left in
the room lying down with oriental music playing for about twenty
minutes. On subsequent visits, some of the needles had herbs burning
in them. I did not have marked relief, and the acupuncturist began
blaming it on my outlook. He told me that I must want to be sick,
because we become what we think. Eastern religion plays a big role
in most acupuncturist's healing beliefs. He felt my Christianity was
causing negative thinking, which, in turn, resulted in my pain. I
felt it was time to move on.
I
want to emphasize that I am speaking of my experiences only. I know
that acupuncture can be effective in many situations, and that it is
even being used experimentally during surgery.
Relaxation/Meditation
I
have already discussed this somewhat under "hypnosis," so
I will not repeat myself. However, I want to tell you that I have
found prayer to be very helpful to me. I also read my Bible and
meditate on verses that seem to speak to me at the moment. I have
found this very rewarding and long-lasting. The Psalms are filled
with verses that show me I am not alone and that I am loved. I
highly recommend finding verses that are meaningful to you and
memorizing them for the times when it is too difficult to read. I do
not practice other forms of meditation.
SURGICAL
PROCEDURES
Fusions
This
is an actual surgery in which a neurosurgeon removes a disk in the
spine and replaces it with bone. It is recommended as a last resort,
because of the serious nature of going into the spine. It is
absolutely necessary if the nerve is seriously impinged. I have had
this done four times with only temporary, mild relief. With me, the
recovery time was about four months, most of that time spent in a
brace. I have another disk that needs replacing, but I am trying to
delay surgery as long as possible. If my only symptom is pain, I
will treat the pain by other means. The surgeries were not helpful
for pain relief.
If
you are facing this type of surgery, I want you to know that the
bone is no longer taken from the hip; it is provided by a donor and
readily available without a volunteer. That is a great improvement!
Patients, in the past, sometimes complained more about the pain in
the hip than in the spine.
Epidurals
This
procedure can be done in a number of different ways, and is usually
performed by an anesthesiologist who specializes in pain control. A
needle is placed in the epidural space, a fluid sac surrounding the
spinal cord. Once the needle is in, medication can be administered
and goes directly into the epidural fluid. Often, steroids and/or
pain medications such as morphine are used. The patient is sent home
and waits to see if there is any relief. With me, it took 2-3 days
for the swelling to go down and the medicine to kick in. Some people
get relief for as long as 6-12 months and repeat the procedure
regularly. I did not get the relief I had hoped for.
I
have also had epidurals that were done over a period of three days.
I had the needle inserted with a catheter attached. It was left in,
and I returned to the surgical center each day, for three days to
get steroids injected. Again, the results were not promising.
My
latest attempt was to get an epidural that was different from all
others. In this case, the needle was placed directly into the
space of the faulty disk, C 6/7. Because of the location, the
anesthesiologist used a fluoroscope to direct the needle. After the
needle was placed, steroids were injected. It caused excruciating
pain, because the fluid had no place to go, so it displaced
everything in its path temporarily. I had this done out-of-town, and
when I described this to my regular anesthesiologist, he advised
against having it done again. I did get some short-term relief, but
I cannot drum up the courage to be tortured again for minimal
improvement.
Nerve
Blocks
I
found these to be somewhat helpful. Again, an anesthesiologist or a
neurosurgeon skilled in this technique must do the procedure.
Isolated nerves are injected with numbing agents such as lidocaine
or marcaine. Again, the results vary and are temporary. The
procedure can be quite painful.
Trigger
Point Injections
With
chronic pain and fibromyalgia, usually you have tender points in
your body that seem to radiate pain. I have had these points
injected with a combination of steroids and numbing agents and have
found the results to be quite satisfying. On several occasions I was
able to resume a more active lifestyle, having been reduced to
staying in bed. Usually, the doctor limits the number of injections,
so I have had them done in series if a major part of my body is
flared up. It can be a painful procedure, especially if the doctor
practices "needling." It is the practice of twisting the
needle and sticking the site multiple times in order to produce more
pain in the spasmed muscle. In theory, the muscle is
"stuck" in its spasm; if you can create more pain, the
muscle will respond by relaxing. For me, it seems to work, but the
procedure really hurts!! I think it is worth the effort and tears.
Infusion
Pump
This
truly is a last resort course of action. Before having a pump
implanted, the candidate must be screened and is sent for a
psychological examination. If approved, the anesthesiologist will
implant a catheter into the interthecal space , the inner-most fluid
sac surrounding the spinal cord. The catheter is attached to a
temporary, external pump. The pump is usually filled with morphine
and is programmed to deliver the medication at a predetermined rate.
If this method is of benefit, the temporary pump is removed and a
permanent pump is implanted into the abdomen of the patient. A
computer is able to read the pump and make adjustments. The
pump is refilled with a hypodermic needle that goes into the pump's
"nipple."
I
have been on an infusion pump for almost four years now. I no longer
have a narcotic in it; instead it is filled with marcaine. It does
offer relief and gives me the opportunity to try a new host of
drugs, one of which is ziconotide. I participated in the study
of this drug, derived from the venom of a deadly sea snail. The side
effects were disastrous for me, but other drugs are now in the
developmental stage that show great promise.
|
