A journey into pain and balance

[Guest guest]

I have been reading and taking comfort from the many letters posted to this

group for several years and feel it is time to thank the many contributors

and make my own contribution to the group.

There is no secret to managing pain – managing pain can only come from the

strength within us.

Each one of us has our own strength - the tragedy is that some may never

think to search and develop that strength and resign their independence to

others around them.

It is my hope that the following story with inspire others to find their

individual source of strength and endure the long and frustrating attempts

to restore balance to their lives. My strength was my scientific education,

training and methodology. That training, and a series of, at times bizarre,

personal experiments (with a variety of traditional and non-traditional

treatments) have led me to a balance between pain and living a normal life.

Managing Pain – Managing Life

By Gregg Kervill (gk8@...)

Kervill studied Applied Physics and has worked in the electronics industry

for more than 30 years. He was the victim of a serious car accident in 2004

and has been in chronic pain ever since.

He was used his scientific training to understand and to manage his pain. In

the following paper he describes his personal understanding of pain and the

methodology by which he controls it.

One of the great, memorable quotation from literature (and also the big

screen) comes for Virginia Woolf’s “Cat on a Hot Tin Roof”:

_____

Brick Pollitt: [Offering Big Daddy morphine] It’ll kill the pain, that’s

all.

Harvey ‘Big Daddy’ Pollitt: [Wincing with pain] It’ll kill the senses too!

You… you got pain – at least you know you’re alive.

_____

But what makes it a great quotation?

Woolf’s power of description?

Or, the tragic end to her life?

Or maybe, just what the words mean to us?

But,

Maybe it is because of the tragedy each of us sees in our lives and those

about us?

Within weeks of a serious car accident I was taking Oxycontin – it did

nothing, the pain was excruciating and I just wanted to die.

Things are better now – several surgeries - three wonderful doctors (and a

couple of lousy ones) and I am still in severe (but manageable) pain.

During the last four years I have had time to reflect on pain – about how

our perception of it varies – how it can take control of our lives and

finally - the simple things we can do to recover that control.

Step One:- Find the Cause

Pain does not just happen and it is NOT the norm. Pain is the body’s way of

telling us that something is wrong. Check out the following experiment.

Put your left thumb nail VERY gently against the top joint of your third

finger. Notice the gentle warm, tickling sensation. You are exerting a

pressure of less than 1/10,000 of a pound per square inch.

Now press until your skin just begins to turn white – your feel a sharp

sensation but no pain yet. You are now exerting a pressure of about 20

pounds per square inch (psi).

Finally, press with all your might – there is extreme pain. If you keep

pressing – through the pain barrier you could be exerting more than 2,000

pounds per square inch (psi).

What was the point of this? To show how incredible our nervous system is.

You have just experienced a range of sensation of 20 million to 1. This is

like being able to see a bottle top, one inch in diameter at more than 300

miles!

Our body is marvelous in its ability to feel such a wide range of sensation,

20,000,000 to 1. Compare that to a tire pressure gage that can only measure

over a limited range from 100 psi to 10 psi (10 to 1).

The Tire Pressure gage measures with a linear scale – our nervous system

measures in an exponential scale - just like our eyes.

We have all experienced the temporary blindness when we have been out in the

sun and then go into a dark room. That is how the nerves in our eyes deal

with the huge range of stimulation.

After a few minutes of ‘blindness’ gradually we begin to see the details

around us. After 20 minutes our vision is just as acute as our vision was

outside in the bright sun.

So what has all this to do with pain? Our bodies experience pain just as a

bright light affects our eyes.

When we experience a continuous low level of pain and then take a

pain-killer the pain goes away.

That is how it started for me. My car crash left me with two herniated disks

which began to damage the sheath of my sciatic nerve. At first my back felt

odd and I thought walking would straighten out whatever was wrong. The pain

increased - I was prescribed painkillers (Vicodin) – the pain went away – so

I continued walking – the pain increased – I was given stronger

painkillers……..

During this period I was asked to try some magnet products.

My major was Applied Physics and to say I was a bad subject for

experimentation was an understatement! I looked at the ‘magnet man’ like he

was eating spiders and had just offered me one!

However – despite myself - I did notice some significant relief. But over

the following weeks my pain level rose until not even Oxycontin could take

the edge off it. (But I still wore the magnet, just in case.)

It was after my fourth MRI (this time with dye injected into my spine) that

the cause was clear. Within 2 weeks I had a ‘spinectomy’ and I was pain

free. For about a day!

Now, remember how your eyes reacted when going into a dark room. In the same

way, my extreme pain went to pain free (darkness). Until my body adapts to

reduced pain level and then my sensation of pain continued (Vision).

It is this effect that makes even powerful drugs appear ineffective. In my

case the Oxycontin reduced my sensation of pain – but not to a level that my

body could tolerate.

A few days after spine surgery my sensation of pain increased – not to the

excruciating level before, but enough to prevent clear thought – sleep – or

being able to drive.

The good news – it stopped getting worse!

Moral – pain is a signal from the body – if you don’t find the cause of the

pain (but mask the pain with pain-killers) things will continue to get

worse. Sometimes tragically so.

Step Two:- Find what works

It is tempting to reduce medication when the level of pain becomes

tolerable. This seems logical but it took me nearly a year to understand

that it caused a wide swing between chronic pain and stupefying levels of

pain medication.

Next time you are in the bath, get your sponge (or washcloth) thoroughly

soaked and lift it out of the water.

At first, lots of water will run from it – but after 10 seconds the flow

will be reduced. After 30 seconds it will be much less and after a minute it

will all but cease.

When we take pain medication it is absorbed within our bodies, just like

water in the sponge, Almost immediately it will start to drain from our body

– just like the water flowed from the sponge.

If the level falls too low we experience a high level of pain and usually

react by taking ‘too much’ medication. This masks the pain and we wait until

the level of painkiller drops and again take more medication than we need.

What we are trying to do is like dimming an electric light using only the

ON-OFF switch. We need to maintain a CONSTANT level of medication in our

body but taking it more frequently and by REDUCING its strength.

Think about pushing a child on a swing.

At first we give long strong pushes – after a short time we can push less

hard – eventually we are pushing quite gently. But we keep pushing in a

steady constant rhythm. This is what we need to achieve with our medication.

So, from Oxycontin I dropped to Percocet – and then to Tramadol. But I

didn’t miss a dose if I felt well – because that would result in intense

pain and over medication.

You will probably know what I mean – I am sure many of you will have had the

same experience. Getting through this stage takes time – a great deal of

patience – and you can expect lots of failures. It is frustrating –

depressing – but keep trying. It is worth the time to stabilize your

medication to achieve a constant (but acceptable) level of pain.

Eventually you will find the ‘right’ level and ‘right’ strength of pain

medication.

It is worth noting that this is also why some drugs – and alternative

treatments – don’t appear to work. It’s not that they don’t work – it’s just

that we are swinging our nervous system between extremes that we cannot

notice their effect.

We must first control our pain to a constant level; only then can we

evaluate anything to do with pain management.

My solution was to find a pain medication that I could take every 6 hours

and that did not totally eliminate my pain. That was important because I had

a near constant level of medication in my body and could detect subtle

changes caused by other attempts to reduce my pain.

Be warned; this was NOT easy and it took more than a year.

Now I had achieved a ‘pain plateau’ I could finally experiment with

alternative using scientific methodology and discover what made things

better and what made it worse.

A really hot 10 minute bath gave my back more mobility. After the bath an

ice pack reduced the pain.

Lifting anything more than 20 pounds put me flat on my back and in bed for

5-6 days. Alternatively, I could increase the strength of my ‘maintenance’

drug from Tramadol to Percocet. When I noticed that I had been ‘pain free’

for 2 days I reverted to the Tramadol and life was again ‘normal’.

The next stage was to remove the magnetic plate from the small of my back. I

continued my normal regime of hot baths – ice packs and Tramadol (staying on

the plateau).

On the morning of day three I could not lift myself from the bed. I rolled

onto the floor and crawled into a hot bath of water. The hot bath and ice

gave me some relief – but my pain level continued to rise.

After three hours of this experiment I returned the magnet to my back and

maintained my steady level of pain medication. By the end of the day life

was ‘normal’. The magnetic plate worked!!

This was against all my training and instinct. I had to face up to the fact

that (for me) magnets could greatly reduce my dependence on pain medication.

They are now part of my pain management strategy. (Further research showed

that they have been in use for about 3,000 years; so my discovery was hardly

cutting edge!)

I estimate that using magnets cuts my dependence on pain medication to about

¼ of what I would need without them. For which my liver and kidneys are

grateful!

Step Three:- Live within your limitations

Don’t try to be a hero. Don’t be afraid of what you cannot do. For example,

I have a damaged shoulder, knee, neck and back. Travelling is extremely

unpleasant. So when I travel by air I put my right arm in a sling. (I cannot

lift more than 20 pounds - the armrests on the planes are too low and after

a couple of hours I have shooting pains down to the back of my hand. The

sling supports my arm during the flight and prevents a great deal of pain.

It also prevents me trying to lift my carry-on into the luggage rack or my

suitcase off the baggage reclaim. Better still it makes me feel better able

to ask for help. And don’t forget – most people like to help – so why risk

hurting myself when I can make someone feel good by helping a stranger.

Step Four:- Try not to make Pain your Life

It is easy to become obsessed with pain and we have all met people who think

that a broken toenail equals Chronic Pain.

‘Normal’ people will not understand what we are going through – they will

not understand how vitally important minor victories are to us. So don’t be

surprised if they don’t share your excitement. It is NOT THEIR FAULT – just

be happy that you don’t have to spend the rest of your life listening to

tales of their ingrown toenail!!!

MOST IMPORTANT! There are doctors and there are dOCTORS(sic). Do not put up

with, or be put down by a bad doctor.

We recently moved and I had to replace a wonderful caring doctor who spent

hours doing her best to help me.

My first attempt to find a replacement began with me explaining how my

doctors and surgeons had developed a successful pain management strategy

over many years. The new doctor (from a “family” practice) nodded and showed

sympathy and understanding. All went well until I needed a drug refill. I

was told to go to a pain clinic. I explained that was not my understanding

of out first meeting and that I thought it was dangerous to have more than

one person prescribing drugs. Most (good) doctors will agree with that

philosophy.

I fired the new doctor and sent the practice a strongly worded letter of

complaint. That doctor had no interest in treating me and was afraid of

prescribing pain killers. My present doctor took a lot of searching – but he

is wonderful, caring and understands pain.

Don’t be afraid to fire a bad doctor. It is your body and no-one knows it

better than you do.

My best advice is Keep Positive.

I now work a regular job: but earn only a fraction of my previous income. I

get home – sleep for two hours and then spend 2-3 hours with my wonderful

wife – then I sleep another 9 hours. At weekends I sleep-in (to 1 or 2 pm) -

and then have a few more hours of precious, quality time. This has become

our ‘normal’ life – may not compare to our life before my accident.

We have accepted that things will never be normal – all we can do is make

the best of the hand life deals us – and never giving up trying to make it

better.

Pain may be a life sentence but it is not a death sentence.

KEEP TRYING. It does get better and the alternative is much worse!

GK8@...

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