Welcome to our month long discussion on Pain and Suffering. We welcome a new Guest DO, Dr. Maureen Sacon. Enjoy her blog, and we will meet back here next Wednesday to hear from a young lady who has had her share of both pain and suffering…
PAIN and SUFFERING : helping patients learn to separate the emotional reaction to pain from the physical sensation of pain
Understanding the difference between pain and suffering can be instrumental towards improving the life of patients with chronic pain. Pain is a physical sensation. Suffering is the emotional response to this pain. Small children will limp around unable to weight bear on a limb without having an emotional response. Adults not so much.
Acute pain serves an important purpose. Touch a hot pan and nerve fibers send an impulse from your hand to your brain. Your brain interprets the signal and sends impulses back to the muscle in your arm to remove your hand. The pain ends. Break your ankle and the nerves in the damaged tissue send a signal to your brain that it hurts more when you try to walk on your leg. The brain tells you to stop what you’re doing and sit down. You have just avoided extending the injury to your tissues. During bone healing your pain decreases when your leg is elevated. Swelling decreases and healing accelerates.
Chronic pain, defined as pain lasted longer than 3 months, is different. The nerves go haywire and continue to send signals to the brain even though they are no longer useful. Not using the leg is no longer helpful. Our medical system has focused on the promise of pain elimination using surgeries and pain clinics focused on procedures and medications. We have corrected the mistake of overprescribing narcotics but instead eliminating medications we have just substituted different medications. A reduction in pain is only a partial success in this scenario and continued pain is perceived as a failure. This can lead to a life trapped on the couch watching TV and counting the minutes until the next medication dose. The focus needs to switch from eliminating pain to increasing function.
Having been taught by my Osteopathic mentors to think of patients as fellow human beings instead of just a condition or diagnosis helps to establish empathy towards my patients. This relationship helps as I guide patients through the stages of grief described by Elizabeth Kubler Ross towards the vital first step: acceptance. Chronic pain is better thought of as a constant companion than as an enemy to be eliminated. It is important to stress that this acceptance is not resignation and I encourage my patients to continue to work towards improvement. Some patients have become so deconditioned that their exercise program starts with just sitting on a yoga ball for 5 minutes once a day.
I typically recommend that I treat patients 3 times using gentle Osteopathic Manipulative Treatment (OMT) and this allows me time to discuss some techniques with them. Sometimes the conversations lead to the triune nature of man and the transformative potential of injuries. My patients frequently rediscover a deep well of strength in their emotional intelligence or spiritual practice which they can tap into. We talk about how functional MRIs demonstrate that the brain works completely differently while meditating. Falling upwards is an excellent book for people who lean towards the spiritual.
Some patients are more interested in the innate healing potential of the body and with these patients I like to talk about the immense potential of harnessing the brain. I highly recommend G. Lorimer Mosley’s TED talk. He tells his own very funny story of walking in the woods, getting scratched by a stick, and thinking nothing of it. He has a lovely swim, gets out of the water, and collapses. Because it wasn’t a stick. It was a bite from one of the world’s most poisonous snakes. When he wakes up from his coma and leaves the hospital he goes for another walk. This time he gets scratched by an actual stick in the same place. He is so surprised by his response of falling over screaming with white hot poker pain that he devotes his life to understanding how the brain perceives pain. His partner, David Butler, developed graded motor imaging and mirror therapy to help patients with phantom limb pain. These techniques can be used to help people learn to use a painful limb in a more normal manner. Check out their youtube videos about mirror therapy, their recognize app, and their books.Especially graded motor imaging and explain pain.
As a neuromusculoskeletal specialist I see a wide variety of conditions in my practice ranging from pregnant moms with malpositioned babies, newborns with trouble nursing, toddlers with developmental delays, adolescents with sports injuries, teens with asthma, and adults with digestive problems but it’s pain that brings most people to my office. I enjoy helping patients get back to socializing with friends, exercising, engaging the mind and ultimately enjoying life. Moving pain into the background and joy into the foreground without the crutch of narcotics. See my website at insightmedicine.com for more information.