Jody Gardner had joints in her feet removed to reduce the pain andenable her to walk 'more like normal.'
She had a hot tub installed at home to supplement the warm-waterexercise she enjoys and needs.
She watches what she eats, exercises regularly and has developed aclose working relationship with her doctor.
When you have chronic pain, as she does, you keep trying thingsuntil something brings relief.
Gardner was diagnosed with rheumatoid arthritis when she was 22;doctors figure she'd already had it for some time even then. Fortyyears later, chronic pain is just one aspect of the woman's activelife. 'I do so much better now than I ever did when I was young. I doknow how to manage it,' she said.
Others are still learning to live with pain. The American ChronicPain Association says people in the United States are living a'lifestyle of pain.' Headaches, back injuries, arthritis,fibromyalgia, Parkinson's disease, neuropathy and many other medicalproblems or injuries can be associated with chronic pain. There arealso cases of real pain with no clear medical cause.
The Joint Commission on the Accreditation of HealthcareOrganizations says that nearly a third of Americans will experiencechronic pain sometime. It's estimated that about 50 million Americanslive with chronic pain, the No. 1 cause of adult disability in theUnited States, JCAHO says, adding that chronic pain accounts forabout $100 billion in lost productivity and is the major cause ofworker absenteeism. Dr. Lynn Webster, president of the Utah Academyof Pain Medicine (a local chapter of the American Academy), who alsodirects Lifetree Clinical Research and Pain Clinic, said the numbersare probably higher. About half of us will experience chronic pain atsome point, he said. And he warns that the pain itself can become adebilitating disease if it's not controlled or people don't learn tocope with it. 'As it exists over time, it changes the central nervoussystem in ways that contribute to the problem.'
Meanwhile, many of the medications used for chronic pain such asVioxx have either been pulled from the shelves or warnings issuedabout potential complications and side effects, some as serious asincreased risk of heart attack.
Because chronic pain can emanate from or be felt in so manydifferent parts of the body, it's hard to give a simple definition.'Chronic pain persists,' according to a National Institute ofNeurological Disorders and Stroke description. 'Pain signals keepfiring in the nervous system for weeks, months, even years. There mayhave been an initial mishap -- sprained back, serious infection, orthere may be an ongoing cause of pain -- arthritis, cancer or earinfection, but some people suffer chronic pain in the absence of anypast injury or evidence of body damage. Many chronic pain conditionsaffect older adults. Common chronic pain complaints include headache,low back pain, cancer pain, arthritis pain, neurogenic pain (painresulting from damage to the peripheral nerves or to the centralnervous system itself) and psychogenic pain (pain not due to pastdisease or injury or any visible sign of damage).'
The goal of treatment, Webster said, is to 'allow people tofunction at the highest possible level and maximize quality of life.'
Treatment options vary. The National Institutes of Health listsmedications, acupuncture, local electrical stimulation and brainstimulation, as well as surgery, as treatments. It also notes thatsome physicians give a placebo that may, in some cases, lessen oreliminate pain. Psychotherapy, relaxation and medication therapies,biofeedback and behavior modification are used to treat chronic pain.For many patients, it's a try-everything buffet.
The use of placebo as a successful treatment doesn't mean the painis imaginary, the experts say. It simply underscores the fact thatfeelings like hope or despair can have a direct impact on pain.
The key to chronic pain, said Dr. Jason Theodosakis, author of thebestseller 'The Arthritis Cure,' is getting a proper diagnosis. 'Toooften, we treat symptoms and actually treat the wrong disease,' hesaid in a phone interview with the Morning News. 'Say there's amiddle-aged woman with hip pain. We think osteoarthritis when it'sactually bursitis or tendinitis and requires a totally differenttreatment.'
You should also ask how it happened, he said. 'Maybe you can'tfind a reason, but it helps to look, and you might uncover asecondary cause. I might have parathyroid problems that broke downthe cartilage. Don't just treat the symptoms.'
Daren Brooks, founder and president of The Bridge Health RecoveryCenter in Rockville, Utah, adds another twist to the sometimes-complicated search for diagnosis. 'One thing it's sometimes hard toget your arms around is that pain is interpreted in the brain,whether it's a broken back or depression or a failed relationship.The body sometimes will pick and choose spots and yell in thoseparticular spots.'
That may be one reason, he said, that doctors can't always find aclear diagnosis when they look at an X-ray or MRI scan. 'I've seenpeople get rid of lower back pain when they've forgiven theirfather.' But the father doesn't show up on the MRI.
Most experts agree that medications ease symptoms but do not bythemselves offer a cure for most chronic pain. That takes differentsteps and a willingness to try different things, say Webster, Brooksand Theodosakis.
The most common underlying condition for chronic pain is arthritisin some form, while lower back pain accounts for the most pain-related visits to the doctor. (The two overlap; lower back pain maybe caused by degeneration in the spine.) There are more than 100different types of arthritis and related conditions, affecting 70million Americans. And that's just arthritis.
Some patients get immense relief from prescriptions, while othersdon't get much, said Webster.
'Unfortunately, there's a lot of devastating pain problems forwhich we have only minimal ability to provide relief,' said Webster.That's when pain experts look beyond traditional medicine to helppatients.
That's why the Bridge center uses not only western medicine, but abroad mix that includes meditation, yoga, acupuncture, nutrition andmore in an 18-day in-patient pain management treatment course, saidspokesman Jay Snyder.
'The more you do, the more you understand you can do. A greatportion of healing is understanding that the pain may not go away,but you can do everything you have control over in tolerating it andbuilding a life with or without that pain. Most people (with chronicpain) believe they are so limited that their scope of life becomesalmost nonhopeful,' he said.
Openness to new things is the backbone of the self-help classesthat the Arthritis Foundation runs, adapted from a program developedat Stanford University to help patients manage many types of chronicillness. Participants learn to develop their own exercise program,manage fatigue and stress better, know about medications andnutrition and also find ways to deal with the anger, fear,frustration and depression that may come with chronic pain. Sucheducation can reduce arthritis symptoms by as much as 30 percent,said Victoria Saley, health education coordinator for thefoundation's Utah/Idaho chapter.
To the list of what's valuable, arthritis expert Theodosakis addsnutritional supplements, carefully selected for quality, such aschondroitin and glucosamine, to not only ease arthritis inflammationand pain, but to improve the joints themselves. Many of them, hesaid, are safer than the popular anti-inflammatory medicationstypically used. He also likes ASU, a supplement that is made ofavocado or soy oil and is used as a drug in France.
But he warns that 'too often people emphasize treatment that maynot be ready for prime time. We need to focus on what we know works,'including remedies proven in controlled studies in other countries.'Ninety percent of the products, I wouldn't give to my dog. But youdon't want to throw the baby out with the bath water. Supplements canbe made in facilities that manufacture over-the-counter drugs andeach batch tested.' In all cases, proper doses and concentrationsmust be used to be effective, and all instructions followed.
Exercise is immensely helpful with nearly all chronic pain,although many patients resist at first because it may hurt to move.But the more someone does -- as long as it's done correctly to avoidworsening the condition -- the better the body responds and the moreit can do. 'We try to achieve as much as possible,' Webster said,noting that for some patients that's building up to walking threemiles a day and for another 'huge success' might be the ability tosit at the dinner table with the family.
Every movement has a proper form to it, Theodosakis said, andimproper form leads to cartilage damage and pain. Patients may need a'prescription for exercise, a trainer, exercise physiologist,physical therapist, a chiropractor sometimes, training about motionso biomechanics improve.'
Proper diet contributes not only essential vitamins and mineralsto the body but helps control weight, a factor in many painfulconditions. Obese people, for instance, get more finger arthritisthan lean people. They are more prone to diabetes and the risk ofpainful neuropathy. The list goes on.
Nearly anyone with chronic pain can get at least some relief usingmultiple approaches, Webster said. 'We may need to coordinate thephysical, medicinal and mental element in treating the more severeproblems.' Doctors may prescribe physical therapy or an exerciseprogram such as low-impact aquatic therapy, which Gardner loves.'Some patients need help from a behavioral psychologist,' not becausethey have a mental illness but because 'there's a tremendous impacton all aspects of life, and they need to learn how to deal with thatand keep it in perspective so psychological pain doesn't drown us.'
Through it all, patients must recognize that symptoms and diseaseprocess may not match. With arthritis and the popular Cox-2 drugslike Vioxx, for instance, it stops the pain, but the cartilagedegeneration continues, Theodosakis said. And the reverse is true.You can help the cartilage and still have pain. That happenssometimes with glucosamine, where 'you may not have significant painrelief but X-rays show the joint is significantly, statisticallybetter.'
Insurance coverage is another issue for chronic pain, Webster andBrooks said. If an X-ray doesn't show a clear-cut source of pain, itmay be 'placed in a category as more of a behavioral issue anddismissed or at least lessened,' said Webster. Insurance may notcover some of the complementary treatments.
'There is an undertreatment of pain. There are usually treatmentoptions if people are persistent. At the same time, not alltreatments are successful, and there's risk to all procedures. Andover-the-counter remedies can be dangerous or potentially harmful,'Webster said.
The very good news, he adds, is 'there's a lot in the pipelinethat's going to be available in the next few years.'
E-mail: lois@desnews.com
