Sunday, March 18, 2012

Full Committee Hearing - Pain in America: Exploring Challenges to Relief

A wonderful thing has happened on Capital Hill. Congress is finally seriously looking into pain and pain research. This video is amazing. Some parts were difficult to watch for me because of my beliefs on pain, but I was amazed by Christin Veasley and her ability to defend pain patients. I am going to speak on the Emotional-Physical connection of pain, which I don't think was very well addressed in the video.

Can emotions cause pain?
Absolutely. That doesn't mean, however, that the pain isn't real. There are studies that show that heartbreak actually causes physical damage to the heart. So the idea of "all in your head" or "you're manifesting this pain" is just silly. Yes, emotions play into and can increase or decrease pain. Yes, you can play with your emotions and influence your level of pain. But I love how in the anecdotal stories, both people admit that their pain isn't 100% gone, but it's better enough that they can function. That's all any pain sufferer really wants---function. And when you find that solution, you'll treat it like a miracle, even if it isn't 100%. I'm the same way about my Occipital Nerve Stimulator. That doesn't, however, mean it works for everyone. Migraine patients, particularly, have the inability to ignore pain like other people. So while biofeedback works wonderfully on some, it just can't work on others. We need multiple ways of treating pain, and everything that comes along with it.

Does this mean doctors can ignore pain and send a patient to see a shrink instead?
Absolutely not. There needs to be a holistic (meaning whole system) approach to pain. One thing we know is that serotonin and dopamine---the neurotransmitters that we tinker with to help people with depression, anxiety and a host of other mood disorders---are the same chemicals used by the body for inflammation control and wound healing. Our bodies use up these chemicals when we are injured, sick, or in chronic pain. That means less of those neurotransmitters for the brain. So it's not surprise then that people who are chronically ill also often come up as patients with mental health needs. Not only is the injury/disease/pain itself difficult to deal with, but we're running at a neurotransmitter deficiency from the word go! Both the pain and the chemicals that support the body-while-in-pain need to be addressed.

But aren't their people out there who exaggerate and are really making things worse for themselves?
If there are, you should feel sorry for them. There are people out there with personality disorders where they will say whatever, including faking illness and pain, for all sorts of reasons. But the truth is, these people are so few and far between that for every one of them there are 40 people who are telling the truth. So really, if you want to err on the side of caution, err on the side that they're telling the truth. Even among children, (according to the book "Nurture Shock") tattlers only tell about one in six of the actual times adult rules were broken, and even then they wait until the most egregious act before they tell on others. Most people won't complain about pain until it starts to interfere with what they're doing. Would you complain about the rain if it ruined your plans? Probably. If it ended up being a tornado that ripped apart the fairgrounds? You'd definitely talk then. Pain is no different.

Well... I mean, are there people out there who can manifest physical pain because of an underlying emotional issue?
This one is a tricky one. As Ms. Veasley points out in the video, once, ulcers were thought to be manifestations of stress, and signs of a weak character. Now we know that it's a bacteria. There are people who spent thousands of dollars on psychiatric care who didn't necessarily need it. They were blamed for their own disease. There are plenty of doctors that think fibromyalgia is a hysterical disease, brought on by stress. However, they also thought Sjogren's Syndrome was rare until they made the second antibody test. Now they know it to be the second most common autoimmune disease. I wonder how many people diagnosed with fibromyalgia are possibly suffering from an unknown or undiagnosed autoimmune disease? It took years before I ended up with the right neurologist who said, "It's small fiber neuropathy causing your pain. You have an autoimmune disease. It's going to happen."

Now, on the same token, I do know that I can cause myself a stabbing pain underneath right my shoulder blade (and only my right shoulder blade) when I am really, really angry with someone and trying to ignore my anger. But in that case, I've usually been sitting in my fury for hours, so it's no surprise what triggered what first. Also, I get migraine headaches from stress, but strangely enough, it's the decrease in stress that triggers me. I learned this one after my father went in for emergency heart surgery. I was fine (which was amazing to me) the whole time that I was sitting there worrying and pacing. When I got the call that he was okay and let out that breath of relief and relaxation, it wasn't five seconds later I was on my knees in blinding pain.

But the point that Ms. Veasley makes that I think is all important, is that we just don't know that much about pain! We may think we can sit in judgement and tell other people that they just need to read this book and they'll be able to fix their problems! No!! The truth is, we are idiots about pain, our doctors don't get enough training in it, and we spend less money in research on it, even though chronic pain affects more people that cancer, heart disease and diabetes combined. We barely have any idea how the skin works, and we now believe the skin has a HUGE role in pain control.

Even if the emotions are manifesting pain, that doesn't mean we should dismiss the pain, or the person for "causing their own problem." On the contrary, if their nervous system is wired such that emotions do cause physical problems, that's a serious issue that needs addressing. We can do much to shore up the person emotionally, so that they don't fall prey to their condition so often, but life is difficult, and break-through moments are going to happen. My experience with migraines is like that. How exactly does one prepare for the stress of their father going into emergency heart surgery? The answer: you don't. Our only option is to fall apart an pick up the pieces on the other side.

All in all, I am very happy to see this video.

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