Vast Numbers Of Americans Live With Daily Chronic Pain

Today's post from drugs.com (see link below) looks at the huge numbers of Americans living with chronic pain on a daily basis. From this, you can also assume that similar proportions apply to many other first world regions and this highlights how ironic it is that nations with the best health services and facilities still have such a high proportion of chronic pain sufferers. A possible cause of this could be put down to lifestyle choices but most neuropathy patients will agree that their pain is a secondary result of another disease or condition. The article talks about the majority of these 25 million having back and joint pain but given that we know that 20 million Americans are living with neuropathy, they will all be experiencing some form of pain, or uncomfortable symptoms. Makes you wonder what the cross-over statistics really mean. Nevertheless, 25 million American chronic pain sufferers means 25 million people receiving medication of one sort or another and over a long period of time. The problem is obvious!

25 Million U.S. Adults Struggle With Daily Pain 
TUESDAY Aug. 18, 2015, 2015

 Pain is widespread in much of America, with more than 25 million adults -- 11 percent -- suffering on a daily basis, a new national survey reveals.

And approximately 14 million adults -- roughly 6.4 percent -- experience severe pain, which can be associated with poorer health and disability, researchers found.

Other national studies of chronic pain have yielded similar results, said study author Richard Nahin, an epidemiologist with the National Center for Complementary and Integrative Health at the U.S. National Institutes of Health (NIH).

"What makes this study unique is that I also looked at how often adults have mild pain," he said.

Nahin found that about 54 million adults -- nearly one-quarter -- reported "mild," but not incapacitating, pain.

Whether pain is increasing nationally is difficult to say, Nahin said. But the good news is that roughly half of those living with severe pain indicated in the survey that they were nevertheless in good or excellent physical health overall.

And even better news: The poll found that 44 percent of American adults say their lives are pain-free.

The estimates are based on the responses of nearly 9,000 adults who took part in the 2012 National Health Interview Survey. The poll is conducted annually by the U.S. Centers for Disease Control and Prevention.

The NIH says more Americans are affected by pain overall than are touched by diabetes, heart disease and cancer combined. Also, chronic pain is the leading cause for long-term disability.

Nahin said joint pain and back pain are the most common sources of discomfort.

"About one-third of all adults have joint pain in a given year, and a bit more than a quarter of all adults have back pain," he said.

For the study, published in the August issue of the Journal of Pain, Nahin asked survey participants about the frequency and intensity of pain experienced in the preceding three months. He coded reported pain into five categories of severity, based on persistence and the degree to which it was "bothersome."

About one in 10 adults experiences "a lot" of pain, researchers found, and nearly 56 percent reported some pain in the preceding three months.

Overall, the researchers found that whites, women, and the elderly were more likely than others to report relatively severe pain.

The survey also found that adults experiencing the most severe levels of pain are likely to be more disabled, in worse overall health, and in need of more health care, compared with people dealing with relatively mild pain.

For those looking to mitigate chronic pain, Nahin said various health approaches can be tried with -- or in place of -- prescription painkillers. Many people turn to yoga, massage and meditation to relieve pain, for example.

"Evidence-based clinical practice guidelines from the American College of Physicians and the American Pain Society found good evidence that cognitive behavioral therapy, exercise, spinal manipulation and interdisciplinary rehabilitation are all moderately effective for chronic or subacute [lasting more than four weeks] low back pain," Nahin noted.

In addition, American College of Rheumatology guidelines advocate tai chi, acupuncture and/or walking aids for knee arthritis, he said.

People in search of a pain plan will often need to mix it up, said Dr. Edward Michna, director of the Pain Trials Center at Brigham and Women's Hospital in Boston, and a board member of the American Pain Society.

"Certainly not all pain requires opioids," Michna said, referring to narcotic medications such as hydrocodone (Vicodin) and oxycodone (OxyContin, Percocet).

"They have a role to play, of course," he added. "But what is needed is an individualization of care and a multidisciplinary approach that might include physical therapy, mind-body therapy, alternative medicines of various kinds, and other types of nonnarcotic medications."

The best treatment "will usually be a combination of these things. There is no one right answer," said Michna, who was not involved in the study.

More information
There's more on pain management at the American Chronic Pain Association.

Posted: August 2015

http://www.drugs.com/news/25-million-u-s-adults-struggle-daily-pain-57937.html

Stop Searching For A Nerve Pain Cure And Begin Learning To Live With It

Today's interesting post from healthskills.wordpress.com (see link below) is an impassioned and intelligently written plea for doctors to start aiming their treatment (at least partially) at learning to live with pain instead of constantly trying to 'cure' it with chemicals. Now nobody knows better than the average neuropathy patient, that chemical treatments almost never take neurological pain away completely. We're well aware that the pills we take are doing nothing to improve our nerve damage and at best provide a sort of security blanket that masks the pain. That security blanket then becomes something we rely on to get us through the day but its side effects can severely affect our well-being and sense of self. Pain is an experience not a disease. Pain is just pain and doesn't mean that the problem is getting worse, so why can't we learn better to accept it for what it is and manage it in such a way that it becomes part of our daily lives. Stop trawling through drug lists in the search for pain reduction and begin learning to manage it. That begins by accepting that the pain is there; every day and maybe for the rest of our lives. It's not a threat; it's just an experience and by using the proper management techniques we can probably put up with more pain than we think we can - now that would be an achievement in itself! Try not to dismiss the idea because pain is so entrenched in your life and try to be open to change. All that said, I too live with daily pain and I too take the drugs to dampen it but I wish I didn't, so if there are effective methods to learn to live with it and reduce its importance, bring them on! For that, we need doctors who are willing to say:' less pills, better management and here's how.'
 

Deciding when to say when: pain cure? or pain managed?
Bronwyn Thompson, PhD, MSc (Psych) 1st Class Hons, DipOT, Registered Occupational Therapist 

I think the subject of this post is the singularly most important yet neglected topic in chronic pain research today. When is it time to say “All this looking at pain cure, or reducing your pain isn’t working, it’s time to accept that pain is going to part of your life.” It’s difficult for so many reasons whether you’re the person experiencing the pain, or the clinician trying to help. It’s also incredibly important for everyone including our community.

Cures for pain that persists are not easily found. One possibility is that the underlying disease or dysfunction has not yet been treated – pain in this case is the experience we have when there’s an unresolved threat to body tissues. Find the source of the problem, treat it, and voila! No pain.

Another possibility is that a new or groovy treatment has been developed – something extraordinary, or something that’s being applied to a different problem or something that’s emerging from the experimental phase to clinical practice. This means clinicians need to have heard about it, maybe will have had to think hard about their clinical reasoning, have developed skills to apply it, and be ready to talk about it with the person they’re treating.

In the case of much chronic pain, pharmacological approaches simply do not work. Machado and colleagues (2009), in a large meta-analysis of placebo-controlled randomised trials, found 76 eligible trials reporting on 34 treatments. Fifty percent of the treatments had statistically significant effects, but for most the effects were small or moderate … the analgesic effects of many treatments for non-specific low back pain are small”, while Machado, Maher and colleagues found that paracetamol was “ineffective” for reducing pain intensity or improving quality of life for people with low back pain, and although there was a statistically significant result for paracetamol on osteoarthritis pain (hip or knee), this was not clinically important (Machado, Maher, Ferreira, Pinheiro, Lin, et al_2015). Clifford Woolf said “most existing analgesics for persistent pain are relatively ineffective… the number of patients who are needed to be treated to achieve 50% reduction in neuropathic pain in one patient is more than four – a high cost for the three unsuccessfully treated patients and their physicians” (Woolf, 2010).

Woolf’s sentence ends with an important statement: A high cost for the three unsuccessfully treated patients and their physicians. I have emphasised the final three words, because this might be the most difficult to process. It’s hard for clinicians to say “I can’t reduce your pain”, and “there isn’t a cure”. It’s incredibly hard. And it’s perhaps because it’s so hard that I’ve found very little published research looking at the way clinicians go about telling people their pain is likely to be ongoing. It’s like a taboo – let’s not talk about it, let’s pretend it doesn’t happen, after all it doesn’t happen often. Really?

Amongst allied health (I can’t bear to use the word “non-medical”), and in particular, physiotherapists, there continues to be a push to address pain intensity and (ultimately) to cure pain. Innovative treatments such as mirror therapy, graded motor imagery, therapeutic pain neuroscience (we used to call it psycho-education in the 1980’s when I first started working in this area), reducing the threat value of the experience have all come into their own over the past 15 years or so. Even long-standing pain problems apparently respond to these approaches – people cured! Who wouldn’t be keen to try them?

Most of these latter treatments are based on the idea that our neurology is plastic; that is, it can change as we change input and thoughts/beliefs about what’s going on. Unfortunately, the systematic reviews of trials, and at least one “real world” trial of graded motor imagery haven’t shown effects as great as promised from the early research (eg Johnson, Hall, Barnett, Draper, Derbyshire et al, 2012). There are sure to be people who can point to amazing outcomes in the people they treat. I’m certain that it’s not just the “treatment” but an awful lot to do with the person delivering the treatment – and the treatment context – that might make a difference to outcomes.

But where this all leads me to is who makes the decision to stop chasing pain reduction and pain cure? When does it happen? What’s the process? And what if we treatment providers are actually prolonging disability out of the goodness of our hearts to find a cure?

Let me unpack this a little.

In my research, several important factors led to people deciding to begin flexibly persisting (and getting on with life as it is, not as it was, or might be).
The first was knowing the diagnosis and that it would not be completely cured but could be managed.
The second, that hurting didn’t mean harm (pain is just pain, not a sign of ongoing damage).
The third, that there was something important the person wanted or needed to do to be themselves.

There were other things as well, like having a clinician who would stand by the person even if the person didn’t “do as the Doctor ordered”, and developing their own personalised model or explanation for their pain as it fluctuated from day-to-day. BUT the single most important factor was knowing that the problem needed to be managed because there was no cure. Knowing this meant that energy used chasing a cure was redirected towards learning to live well and be the person they were, rather than a patient or being dominated by pain.

Unfortunately, I think that many clinicians confuse the idea of managing pain with that of resignation to a lesser life. Even the wonderful Lorimer Moseley and crew wrote recently that “CBT literature seemed to focus on this idea of ‘pain is now unavoidable so it is now time to learn how to cope with it.’ He goes on to argue that because a CBT approach focuses on thoughts and beliefs (much like Explain Pain does), it’s not incompatible with the idea that the plastic brain can learn to reduce the threat value even further to ultimately “helping them live well with less pain, or perhaps without any pain at all.”

Here’s my concern: Right now there are many people living with chronic pain who have lost their sense of hope. They’ve pursued pain cure after pain cure, and in doing so, they’ve lost normal routines and habits, lost their usual occupations (activities), stopped being around people, stopped working, and have suffered in the true sense of the word – they’ve lost their sense of self. While I applaud the efforts of researchers like Moseley and colleagues, and I think we must continue to seek treatments to reverse the neurobiological underpinnings of pain, at the same time I think we need to look at the psychological and social aspects of our attitudes and expectations towards experiencing pain. And we must think of the negative effects of our emotional response to seeing another person who is experiencing pain.

Is it so terrible to experience pain every day? Speaking as one who does – despite my knowledge of neuroplasticity – my pain doesn’t represent a threat. It’s just an experience. It’s there. I notice it, I can feel it. And the participants in my research similarly acknowledged pain as present – but it didn’t have the emotional primacy that pain can represent before it is explained. In fact, some of the participants said they’d learned important things because they’d had pain. A lot like having a mood disorder (that must be managed), or diabetes (that must be managed), or heart disease (that must be managed), or respiratory disease (that must be managed), perhaps it’s OK to have pain – that must be managed. Because until our research has advanced a LOT further than it has, there are an awful lot of people living with chronic pain, and who will continue to live with chronic pain. And even more sadly, there are an awful lot of people who don’t even get the opportunity to know that it’s possible to live well despite experiencing chronic pain because we (as part of society) still don’t accept that pain can be present without it being a threat.

Sometimes I wonder at our (clinicians and researchers) blind spot. We just don’t seem to be ready to accept persisting pain as something that can be lived with. Is it time to look at our own discomfort with allowing pain to be part of life?

Sources

Bowering, K. J., O’Connell, N. E., Tabor, A., Catley, M. J., Leake, H. B., Moseley, G. L., & Stanton, T. R. (2013). The effects of graded motor imagery and its components on chronic pain: a systematic review and meta-analysis. Journal of Pain, 14(1), 3-13.

Cossins, L., Okell, R. W., Cameron, H., Simpson, B., Poole, H. M., & Goebel, A. (2013). Treatment of complex regional pain syndrome in adults: a systematic review of randomized controlled trials published from June 2000 to February 2012. European Journal of Pain, 17(2), 158-173.

Johnson, S., Hall, J., Barnett, S., Draper, M., Derbyshire, G., Haynes, L., . . . Goebel, A. (2012). Using graded motor imagery for complex regional pain syndrome in clinical practice: failure to improve pain. European Journal of Pain, 16(4), 550-561.

Machado, LAC, Kamper, SJ, Herbert, RD, Maher, CG, & McAuley, JH. (2009). Analgesic effects of treatments for non-specific low back pain: a meta-analysis of placebo-controlled randomized trials. Rheumatology, 48(5), 520-527.

Machado, Gustavo C, Maher, Chris G, Ferreira, Paulo H, Pinheiro, Marina B, Lin, Chung-Wei Christine, Day, Richard O, . . . Ferreira, Manuela L. (2015). Efficacy and safety of paracetamol for spinal pain and osteoarthritis: systematic review and meta-analysis of randomised placebo controlled trials (Vol. 350).

Woolf, Clifford J. (2010). Overcoming obstacles to developing new analgesics. Nature Medical, 16(11), 1241-1247. doi: doi:10.1038/nm.2230

https://healthskills.wordpress.com/2015/07/27/deciding-when-to-say-when-pain-cure-or-pain-managed/

Trying To Live With Neuropathy

Today's post from hubpages.com (see link below) is another personal story about life with neuropathy and how you can deal with it. I'm a firm believer that people's own stories often carry more weight with the neuropathy sufferer than the somewhat dry and impersonal scientific explanations. Other people's experiences can be identified with because you know they have been, or are going through the same things as you. Of course, as in this case, you may not agree with everything that's said but you at least know that the writer is talking from experience and may have some helpful tips and hints which you have not thought of yourself.

Living with Neuropathy & Other Chronic Pain Conditions

By MarcyL04

You are not alone

There are so many people that live with debilitating pain each and every day. It seems as if there are more and more of us all the time.
I live with severe Peripheral Neuropathy, I have chronic pain 24/7. It may not be severe all the time but it is most of the time. But one thing is for sure, I cannot remember when the last time was I was not in pain. Anyone living with chronic pain knows how it not only affects us but it affects everyone around us.
There are ways to help cope with the pain. It does not matter what kind of pain, you are in, it is nice to know you are not alone. Chronic pain can be very difficult to cope with on a daily bases. So I hope that this Hub will help you find comfort and help with dealing with your pain.

Managing Pain Can Be Very Difficult

 

It seems as though getting the right pain relief is very difficult. I have been back and forth to different doctors for the past 6+years. Either they want to under medicate or over medicate. There is no happy medium for pain relief.
I don't want to turn into an addict but, cannot seem to get around being medicated. I have started studying natural remedies but to be honest it is hard to find anything that helps with nerve pain. My doctor tells me to stay away from herbal remedies because of the amount of medications I do take.
But to be honest I have gotten much worse since I have been treated with traditional medicine. So, I am looking for alternatives.

Anyway, I have found a few things that have helped me or are suppose to help so I thought I would share. Just wanted to note I am not a medical professional. This article is intended for information only; not to take the place of medical advice or treatment.

Vitamin B with folic acid is suppose to be very good to help repair damaged nerves. I am now on 4 a day, 2 in the a.m and 2 in the p.m (of course talk to your medical professional before using). I have not noticed any change yet but it took me many years to get in this shape so it will probably take a lot of time to get any results.

Very warm baths is also great, I spend a lot of time in the bathtub with Epsom salts and lavender. The Epsom salt helps draw out impurities that are in your body. The lavender helps you relax.

Drinking lots of water helps flush out your system this is good whether you have neuropathy or not. I have read many times that distilled water is good because it grabs onto the bad stuff in your system and helps flushes them out.
If you can handle it, drinking unfiltered vinegar you can get from natural health stores (not the regular white or cider we see at the grocery stores) will help rid your body of impurities and that are in our food, toiletries, smoking, water and in our environment.
The best way (for me anyway) to take it is a tablespoon or so in a glass of apple juice, twice a day.

Also, even if you are not diabetic (I am not) you should cut down or out the sugar in your diet. This is a hard one for me because I use a lot of sugar in my coffee and I have read many times that artificial sweeteners are not good for your nervous system. I did purchase some vegetable glycerin to sweeten my coffee and it is okay but kinda expensive.

Stevia is another great one. It is a natural plant that comes from Africa. It is all natural and of course a bit expensive but it takes less of it to sweeten that it does sugar.

Surround yourself with happy positive people. It will help lighten your mood and take your mind off of your pain. Laughter is a wonderful thing!
Join a support group if you have one in your area or online.

Pace yourself, let your body tell you when it is time to slow down and take a break from the everyday responsibilities. I stop in my tracks sometimes and put my feet up and try and relax. You need to take care of yourself because if you don't you will not be any good to anyone else.

On the days you don't feel well take it as easy as possible.
Read and educate yourself about your condition no matter what it is. As they say: 'Knowledge is power".

http://marcyl04.hubpages.com/hub/NeuropathyandOtherChronicPain

Learning to Live with Pain

Today's very useful article from ezinearticles.com (see link below) gives some realistic advice to people suffering from chronic pain. Remember, chronic pain, is pain that continues longer than two or three months and is a frequent symptom of neuropathic disorders. It's a question of learning to manage your pain so that you can find a place for it in your life. You should still aim for complete removal of pain while at the same time, accepting that it may not go away completely; something that is extremely difficult to do!

Surviving Chronic Pain: What You Must Know Now
By Jo Ann LeQuang: October 2010

More than 50 million Americans suffer from chronic pain, that is, pain that does not go away. Chronic pain can be caused by a disease, like fibromyalgia, or be the result of an old injury. Sometimes there is no obvious reason for chronic pain. Unlike normal aches and pains, chronic pain can seem like it takes over your life.

No matter whether your persistent pain is mild or excruciating, it can change your life--and not in a good way. Chronic pain patients are at risk for depression and other mental health challenges because of their condition.

There are important steps that people with long-term pain can take to help manage their pain.

First, you need to develop realistic expectations. Many people with pain hope that they can take a pill or rub on a cream and the pain will disappear--permanently. While that is a wonderful thought, it may not be the case. You may have to do more than just take a pill to manage your pain. Many times pain control involves lifestyle changes, and those can be difficult to make. Furthermore, your pain may never go away completely. You may be able to reduce your pain by half, or three-quarters, or even 90% but for many people, some degree of pain may still be something they have to live with.

Second, you have to be willing to do what it takes to manage your pain. This means being open minded about pain management therapies, trying things you thought you would never try, and changing the way you live and do things to help defeat your pain.

There are lots of things that we know help some people cope with some types of pains. You should be willing to give these things a fair try. If they help ease your pain, even a little, keep doing them. Even if something only helps a little bit, say by reducing your pain by 10%, keep doing it because lots of little things can add up. Anything that can help improve your pain by that amount is worth doing--and adding to.

Some things that work on pain include ice packs, heating pads, hot baths, hot showers, massage, acupuncture, essential oils, aromatherapy, music therapy, regular sleep schedule (going to bed and getting up at the same time every day), exercise, better diet, eliminating sugar and artificial sweeteners from your diet, losing weight, taking long walks, spending some quiet time alone every day, getting more rest, becoming active in a cause larger than yourself, and taking vitamins.

Looking at this list, you probably think some of these ideas are goofy. That may be. But every one of them has been used by at least some pain patients to get significant relief. You cannot afford to be too critical of things that might turn out to actually help you. The point is to try things and see what works for you. Give things a fair chance, even if they seem a little silly. And do not give up doing something even if it offers only modest relief.

Third, you have to start playing the percentages. Your goal is to get 100% relief (knowing that may or may not be attainable). Instead of looking for that silver bullet that will give you 100% relief, look for lots of things to provide a portion of your pain relief. For instance, losing weight may reduce your pain by 20%. You may also find that eating a more healthful diet improves your pain about 10%. Then you may find that a weekly massage improves your pain 40%. Add to that an occasional ice pack (10%) and exercise (10%) and you have a "recipe" to eliminate 90% of your pain.

That is just an example, but it is an example that is based on what works for many people with pain. Notice that pain relief does not necessarily require drugs. In fact, you should try to do everything you can without drugs for as long as you can, since drugs are powerful chemicals that can cause side effects.

Of course, many people with chronic pain need to take drugs. You should discuss the best type of medication to take with your doctor, even if it is an over-the-counter medication. Learn all you can about drugs since drugs can interact with other drugs (and even some foods) and some common over-the-counter medications can present serious health risks if not taken as directed.

It is not at all unusual to harbor resentment and anger against your family, friends, and even your physician if they do not understand what is happening to you. To be quite fair to them, people who do not live with constant pain find it hard to grasp what it means to live like you do. Instead of arguing with them or getting annoyed with them, realize that they just do not know.

When it comes to your physician, do tell your physician about your pain. If you think your current physician is not doing all he or she can do to help you, ask for a referral to a pain management specialist. To be fair to your doctor, pain is a very complex subject and specialists are more up-to-date with the latest treatments than general practitioners. A pain specialist can be an important player in your battle against pain. Even if you have to drive a long distance to see one, it may be worth the trouble.

If your doctor prescribes drugs or tells you about over-the-counter drugs to take, make sure you understand how to take them and follow your doctor's instructions. If you experience side effects or if you still have pain, call your doctor before you stop taking the drug or double-up on the dose.

For people who suffer from severe chronic pain, there are potent drugs and other remedies that can be considered. There are implantable devices such as neurostimulators or infusion pumps that can help you manage your pain. You should ask a pain specialist about these things if your pain is unbearable using other strategies.

Last but not least, pain management is a war not a battle. You need to fight that war a little bit every day. Be grateful for good days and enjoy them. Take time to be thankful for all the wonderful people and things in your life. Keep doing the things that help you, even if they are inconvenient or boring (such as exercise, eating healthier, getting more rest). Keep learning all you can about your condition and pain. You may never find a magic cure, but you can find at least some degree of improvement.

Click through to www.AssociationofChronicPainPatients.org to learn more about chronic pain and to be part of a community of people raising awareness about chronic pain and its effects. This article was written by Jo Ann LeQuang.

http://ezinearticles.com/?Surviving-Chronic-Pain:-What-You-Must-Know-Now&id=5251785