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«Message to the Reader Since David Corey first published his best-selling self-help book, Pain: Learning to Live Without It, many of the approaches, ...»

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Message to the Reader

Since David Corey first published his best-selling self-help book, Pain: Learning to Live Without It,

many of the approaches, which were then perceived as “alternative”, have been accepted as “best

practice” after being shown to be effective in evidence-based scientific reviews. Although his

message has stood the test of time, the day to day practice of health care practitioners and the

needed resources to facilitate treatment too often remain woefully inadequate. The unfortunate result; patients suffer needlessly.

David Corey completed his doctorate at York University in 1978 in psychology and post-doctoral D training in behavioral medicine at McMaster University. In 1980, he founded Health Recovery Clinic, the first private multidisciplinary pain management facility in Ontario. Since then, his clinics have provided interdisciplinary treatment for pain including cognitive behavioral therapy, biofeedback, manual therapy, active physical therapy and work conditioning for thousands of injured persons.

He has carried out clinical research in pain management and participated in numerous task forces and panels to try and educate policy makers and the public about the appropriate management of chronic non-malignant pain. In an effort get this message out to sufferers of chronic pain as well as to practitioners who would like to learn more about what is taught in his multidisciplinary clinic, David Corey has generously made his book available on this website.

This book is divided into two main parts. The first entitled Why We Hurt discusses some of the reasons why people have chronic pain, a subject widely misunderstood, by laypeople and health care practitioners alike. Part Two, Towards Solutions: Strategies for Overcoming Pain, outlines the main approaches used in the Health Recovery Clinic to help people cope better with chronic pain. The emphasis is on giving patients active, self-management tools and strategies. I believe that adopting this approach from the very beginning would prevent much disability and needless suffering. Part Three contains the glossary, suggested reading and the introduction by Dr.

Hamilton Hall to the first edition of the book.

I would remind all readers that this book is not intended to replace the services of a physician.

While most chronic pain is benign, any pain can be result of disease and should be diagnosed and treated only by a physician. Readers should discuss any recommendations, as set forth in this book, with their physician before acting. Feel free to share this material with others, with attribution.

DAVID ETLIN MD FRCPC

Internal & Behavioural Medicine Medical Consultant, Department of Medicine University Health Network Medical Director, Pain Management Program Health Recovery Clinic, 36 York Mills Rd, Suite 110, Box 400, Toronto, Ont. M2P 2E9 DD November, 2004 Why W Hurte The - ~ u r n a n Body and Pain

Chronic Pain:

The Silent Epidemic 1s constant or recurring pain a part of your life? Or do you know someone who suffers from chronic pain, pain that just won't go away despite the best efforts of his or her doctors?

If so, this book will be of great interest to you.

If you've been putting up with pain for many months, you're probably feeling very fnistrated and uncertain about the future.

Your doctor may have told you that you are healing well but your pain is persisting or worsening. Or you may have a painfhl disease that cannot be cured. Perhaps the doctor has told you, "You are just going to have to leam to live with it."

If your doctor cannot account for al1 your pain, he or she might even have hinted that it is partly in your head. But you know that you are not imagining the pain-it really hurts. It is a fnistrating experience indeed. Many patients have told me, "If only 1 knew and understood why 1 have this pain, 1 could leam how to beat it." As 1 will discuss later, this anxiety only perpetuates the chronic pain, because it causes you to "tense up," and tensed muscles cause more pain.

The strategies discussed in this book can help you with any chronic-pain condition. For example, you may have one of the

following problems:

arthritis (rheumatoid, psoriatic, osteoarthritis) post-shingle pain (post-herpetic neuralgia) chronic back pain (degenerative disc disease, lurnbar strain, mechanical back pain, chronic sciatica, etc.) 4 The Human Body and Pain soft-tissue pain (myofascial pain, ligament strains, muscular spasm, etc.) generalized body pains (fibrositis syndrome, fibromyalgia) chronic neck pain (whiplash, cervical strain) migraine headaches muscle tension headaches facial pains (temporomandibularjoint pain [TMJ] ) neuralgia pains chest wall pain abdominal pain shoulder-hand syndrome knee pain (e.g., chondromalacia patella) Each of these conditions has one thing in common-pain.

And this book is about how you can take control of this pain.

Chronic Pain: An Unacknowledged Malady

"Chronic pain disables more people than cancer or heart disease," according to Dr. J. J. Bonica, who is the father of modem chronic-pain treatment. He was the first to tell doctors that their focus on healing disease was obscuring their ability to alleviate pain symptoms. In Seattle in 1954, he founded the first pain clinic in North America. Since then there has been a proliferation of these clinics around the world. And yet, the magnitude of the chronic-pain problem is still not fidly recognized in Our Society. Why is this?





First of all, chronic pain is not a life-threatening condition like heart disease or cancer or AIDS. With the exception of the occasional drug overdose or drug side effect, no person's life is significantly shortened by this problem.

Secondly, although people have always suffered from chronic pain, it has seldom been considered a problem in its own right.

Instead pain has been viewed only as a by-product of a disease or other medical condition. Because doctors take this view, patients themselves are in the habit of thinking about their problem in terms of diseases. For example, you hear people Chronic Pain: The Silent Epidemic Say, "1 have fibrositis," "He has degenerative d i x disease," and "My uncle has rheurnatoid arthritis." They don't realize that this way of thinking obscures the common denominator, which is chronic pain. Only when experts began studying chronic pain as a field in itself were major strides made in defining, understanding, and treating it.

How many people actually do suffer fiom chronic pain? In 1985, a survey called the Nuprin Pain Study was conducted in the United States. In this telephone survey, 1,254 adults

–  –  –

Only you can fiel the pain.

The Human Body and Pain around the country were asked various questions about pain and pain-related conditions. The most striking finding was that

12.8 percent of the American adult population had a chronicpain complaint of some type. If we assume that the sarne results hold true for the Canadian population, it means that 3.2 million Canadians suffer from some type of chronic-pain problem. This is a huge, but silent, epidemic.

What Is Chronic Pain?

The first thing to understand is the distinction between amte and chronic pain. "Acute" actually has two meanings. lt can mean "sharp" or "severe," or it can be the opposite of "chronic"-te., short-term. In this book, 1 shall use the second meaning.

Acute pain is temporary, although you may not think so at the time; it rarely lasts more than a few days or weeks.

Often it lasts only for seconds, as when you stub your toe or bang your funny bone. It is a signal that something is awry, nature's way of telling you to pause and take heed. Acute pain is usually sharper in intensity than chronic pain and is accompanied by an arousal of the nervous system. Acute pain may require a visit to a doctor, who will examine you and offer treament that, in most cases, will solve the pain problem. Usually the pain disappears for good once the injury or disease has cleared up.

Unfortunately, there are times when that does not happen.

When the medical experts have done their job, but the pain lingers on, what happens then?

If the problem persists past the usual time for healing or recovery, it is usually classified as chronic pain, and it requires a different therapeutic approach and a different way of thinking.

For example, soft-tissue injuries (injuries to muscles, ligaments, and tendons, etc.) heal in about eight weeks, but for about half of those who have soft-tissue injuries pain persists past this time. What this tells us is that there are factors in the Chronic Pain: The Silent Epidemic production of pain other than the actual injury to the tissue.

But those who will go on to read the rest of this book will not be very surprised by this statement. In time, most, but not all, of these pains fade away on their own. In general, three months is usually thè dividing line between acute and chronic pain.

Let me explain acute and chronic pain by way of analogy.

You get into your car and start up the engine. A signal or a computerized voice reminds you to fasten your seat belt.

Acute pain is like that reminder-a warning signal. But what if the signal or voice continues long after you have fastened your belt and it cannot be silenced? Chronic pain is like that signal. For some reason the pain-control mechanism remains activated even when the message is no longer useful, and the message itself becomes the major imtant. If you can imagine what it would be like to drive al1 day with a grating buzzer teminding you to buckle up, you can begin to understand what it is like to suffer fiom chronic pain.

Some chronic-pain sufferers develop their problems after an accident, usually at work or in a car. Sometimes the injuries that initiate the chronic pain are serious and at other times they are relatively minor, as in the case of a soft-tissue injury.

One of the most common problems is chronic low-back pain.

After a low-back injury, most victims are better within three months, but there is an unfortunate group of people whose pain continues for many years. For this group of chronic-pain sufferers, it appears that the longer they have the problem, the less likely it is that it will ever go away by itself. Studies have shown that after the problem has persisted for two years, it decreases by itself in only fifteen percent of the cases. But you rando much better than this by learning pain-control strategies.

What I Chronic-Pain Syndrome?

s Many people function reasonably well with a chronic-pain problem. Others suffer from a more complex and disabling The Human Body and Pain problem known as chronic-pain syndrome. Not all chronicpain sufferers develop chronic-pain syndrome. How do you know which category you fall into?

1put the following questions to al1 my patients in Our first session and their answers help me determine whether or not they fall into the "chronic pain" category and, if they do, whether or not they can benefit from my mode of therapy.

1. Have you been experiencing pain for three months or longer?

2. Has pain recently spread to new areas?

3. Have you nonced any sleeping disturbances and fatigue?

4. Do you find that strenuous activities, such as cutting the lawn or vacuuming, cause severe increases in your pain?

5. Do even gentle activities, such as walking or sitting, cause pain increases after a short period of tirne?

6. Do you notice that you are gradually doing fewer and fewer things and letting others take over?

7. Have you tried unsuccessfully to retum to work?

8. Are you losing interest in sex, perhaps because it increases your pain?

9. Have you been told by specialists that there are no further medical or surgical procedures available for your condition?

10. Has at least one doctor told you, "You are just going to have to learn to live with it"?

11. Are you taking multiple painkillers or tranquilizers, but finding that they are not helping a great deal?

12. Do you find that you are becoming more irritable, are more easily upset, and lash out at others?

13. Do you find yourself often thinking about the accident or disease that is causing your pain and wondering what the future holds for you?

14. Do you sometimes wonder whether others really believe that you have pain?

15. Do you often feel like crying or otherwise feel sad or depressed?

Chronic Pain: The Silent Epidemic If you answered "yes" to question one and to seven or more other questions, your pain problem falls into a category known as Chronic-Pain Syndrome ( a s ) and you ought to seek the type of specialized help for this condition that is discussed in this book. Don't despair; there are solutions to your problem.

If you answered "yes" to question one and to between four and seven other questions, your pain problem could develop into CPS in the future. It would be to your advantage to learn the techniques in this book that will help prevent this from occurring.

If you answered "yes" to question one and to fewer than four of the remaining questions, you seem to be managing your pain problem. When we see patients like you, we advise them that they can benefit by learning some special pain-control techniques, but they are already coping reasonably well.

By the way, if you are wondering whether some of the questions are more significant than others, the answer is no. Let me stress that chronic pain is accompanied by many factors which, when working together, produce chronic-pain syndrome. Certain factors that are vitally important to some people, such as work, sex, or recreational activities, are of little significance to others. So my questions are not meant to be weighted in any manner, except that the presence of pain for more than three months does indicate that it h g become chronic.

You may also be wondering if al1 the issues raised in the questions will be treated in this book. These topics are certainly important and d l be fully explored in subsequent chapters.



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