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Pondering Pain
by Peggy Lowell
I have seen frequently that it is difficult for
patients to get help fortheir pain from their doctors who sometimes are frightened by it
and don’treally know how severe the pain is. From what I understand, many of themare
afraid if they give medications thatwill truly relieve our kind of pain (opiates), they
will be looked on withsuspicion and may even lose their licenses. There are no doubt many
reasonsfor this reluctance, some valid, some not. There is a public debate goingon about
this currently, and who knows where it will all end up. In themeantime, we are left with
dealing with pain.From a recent article Medical Tribune Neurochemical Mediators Implicated
inFibromyalgia by Andrew Bowser [Medical Tribune 40 (1):23, 1999 C], I offeryou the
following excerpt: “Chemical pain mediators continue to be implicated in the
pathogenesis offibromyalgia suggesting that physicians view thedisease as a syndrome of
chronic widespread allodynia, according to leadingresearchers. “The sense some
physicians have had is that [patients withfibromyalgia are troublesome malingerers,”
said I. John Russell, M.D., Ph.D.an associate professor of medicine at the University of
Texas HealthSciences Center at San Antonio. “I think we must change that viewand use
the new understanding of the condition to start to make a differenceby doing research and
trying to individualize therapies.Dr. Russell, who spoke at the recent annual meeting of
the American PainSociety in San Diego, has along withcolleagues, implicated several
chemical pain mediators in the pathogenesisof fibromyalgia. Those mediators include
nervegrowth factor, serotonin, dynophia A and substance P, the neuropeptide knownto cause
pain sensations in animals and shown to be elevated inhormonally-induced animal models of
allodynia.Investigators have found that substance P content in the spinal fluid
offibromyalgia patients is on average two to three times higher than innormal patients,
according to Dr. Russell. Three other research groupshave reported similar findings in
patientpopulations “very different genetically, hereditarily or racially” from
theTexas group’s population. More recently, Dr. Russell reported thatfibromyalgia
patients with low initial levels of substance P in theircerebrospinal fluid tend to have
increasing levels of substance P anddisease severity over time, while patients with high
levels of substance Ptend to bestable over time.Based on earlier research, Dr. Russell
reported that, compared with normalcontrols, fibromyalgia patients had low levels of serum
serotonin, plateletserotonin and serotonin in the central nervous system. “I
can’t say weunderstand this yet, BUTWE NOW KNOW THERE IS REALLY SOMETHING WRONG
[biochemically],” Dr. Russellsaid. (Emphasis is mine.)So we now know that the pain is
real and that biochemically we are differentfrom “normal” people. While it helps
to know that there are physicalindicators that prove our pain is real, we are still the
ones who need tomanage it and live with it. For a time, I re sisted taking pain
medications, but I have found that when the pain is so great that it begins toaffect my
mental state, I need to take some action. I am currently taking amedication for pain that
it does take the edge off, but there are still somedays of the month that I would give
much for something stronger. On theother hand, using stronger medications may cause
individual reactions makinga bad situation worse. There are some individuals with pain so
great thatthey would not wish to live without strong medication. I feel that inthese cases
doctors should feel free to use their best judgement inprescribing medication rather than
fearing scrutiny from medical oversight.Occasional days of unbearable pain have led me to
develop some strategies toconfront the pain. Here are some of the tools inmy toolbox:1) A
big help to me is to remember that “this too shall pass.”Remembering that
something is temporary and not getting caught up in fear ismy primary tool for surviving
the pain. Sometimes it is a matter ofwaiting until my body adjusts to barometricpressure
fluxuations.2) What’s the first thing you say when you stub your toe? YOUCH! It is
sucha natural reaction to hurting yourself. So forme, finding a way to express the pain is
healing. To have another beingknow, animal or human, seems to help somehow. Usually a
person who hasexperience with the illness will be more receptive than a non-CFS/FMSperson.
A person withoutCFS/FMS may be more likely to want to “Fix it” or even become
frightened ifthey are close to you and won’t be really helpful in simply hearing
yourpain. I have a internet list support group where I can post about what Iam going
through on a day-to- day basis, but if you don’t have a computer,maybe finding a
buddy who will be willing to just listen, not trying tochange anything, when you have a
bad day.3) Prayer is very important in my toolbox for working with pain. I mayeither ask
for prayer from friends or ask in prayer myself. I truly believethat God and his angels
are around us ready and willing to help if we wouldonly ask.4) When my pain is really bad,
I find it impossible to meditate, but whathas really helped me is to call a friend who is
a minister who will lead methrough a guided meditation, focusing on the light within and
sort oftalking me down to a calmer state. Trying to meditate on my own at suchtimes is a
futile battle for me, but the calm voice of a minister or friendreally helps me. You might
tryto find someone who will do this for you in times of need or even a favoritecassette
tape that you like.5) For hurting feet, a great remedy is a hot/cold mini-bath. This
wasgiven to me by an M.D. when I had an injury to my foot. It took downswelling and helped
the pain. Find two basins big enough to get your feetinto. Fill one with water as hot as
you can stand it. Fill the other withwater and ice. Put your feet in the hot water for
three minutes, then intothe ice water for 30 seconds. Do this three times in all. Use
first hot,then cold, ending with the ice water. You may need to replenish the hotwater
with fresh water from the tap as it will likely cool down too much tobe really effective
after the first round. I believe that what this does istoincrease the circulation and
thereby alleviate the pain somewhat. It alsoworks if you have swelling or an injury.
Because it increases circulation,it will speed healing.6) A favorite method given by a
friend is described this way: “I go down tothe riverbank or lake shore and pick up a
small stone.I hold it tight in my hand, visualizing my pain flowing up the arm and intothe
stone. Then I say, "Begone my pain, gofar away, and don't come back for many a
day!" I say this until I feel thatI've transferred as much pain as possible into
thestone. Then, I throw the stone as hard and as far as I can into the water.When it
splashes down and sinks, I say a smallprayer of thanks and go on my way.” She says
that this method really worksfor her even if the relief is for a short time.I am certain
that among the people who live day to day with these illnessthere is a wealth of wisdom
and methods for dealing withpain, but I hope that my article will trigger a new idea or
help in yourday-to-day life with pain in your pocket. I like to keep it in my pocket.That
way it’s not really me. Just something I live with.Comments: lmsoap@pressenter.com
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