Many ways to deal with chronic pain
By GARY DeMUTH
The Salina Journal


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Click photo to enlarge

RYAN SODERLIN / The Salina Journal
Massage therapist Danny Zander, Salina, gives Jodi Duncan, Lindsborg, a massage at the YWCA, 651 E. Prescott Road. Duncan suffers from chronic pain in her neck, shoulders and upper back. She manages her pain by receiving weekly, specific massage techniques from Zander.

Entering information into a computer all day was a pain in the neck for Jodi Duncan. Unfortunately, when she stopped for the day, the pain didn't.

Duncan started experiencing upper-back pain in November 2000, which she blamed on prolonged computer use compounded by "a lifetime of bad posture." By November 2001, she was living in a constant cycle of pain from which she could find no relief.

Duncan's pain was diagnosed as myofascial, a fancy term for chronic neuromuscular pain. It was easy to diagnose but not so easy to treat.

Duncan tried everything -- ice and heating pads; stretching; drugs such as Cyclobenzaprine, Skelaxin, codeine, Celebrex and Vioxx; vitamins; trigger point injections; steroids; dry needle therapy; physical therapy; special pillows; acupuncture; and endorphin supplements. But she found even the more effective treatments were only temporary.

"On bad days, my muscles are extremely tight in my mid- and upper back, and it stretches up to my head and neck," said Duncan, Lindsborg, who is in her 30s. "It's not a sharp pain, more like a constant dull pain, like a dull headache in your back.

"It can be very depressing and has all kinds of sidekicks like nausea, depression and anxiety. The best way I can describe it is that it feels like I have a wetsuit on that's several sizes too small."

Duncan is one of the more than 75 million Americans who suffer from symptoms of chronic pain. Chronic pain is defined as pain that lasts longer than three months, whether it be constant or sporadic. It is caused by back, neck and shoulder problems, arthritis, migraine headaches, fibromyalgia (muscle pain), whiplash, diabetes, sickle cell anemia, complications from diseases and accidents, and other causes.

In addition to being in constant pain, victims report feelings of depression, tiredness, stress, tenseness, frustration and insomnia. There are higher rates of suicide, job loss and divorce associated with chronic pain, and, according to retired Salina nurse Myrna Spicer, many physicians have not been properly educated on treating both the physical and psychological effects of chronic pain.

Spicer, 64, is the author of a 50-page booklet on chronic pain, "Making it Better: Living With Pain," published in 2000. She wrote the book because she said she hadn't found an accessible book on pain that she thought was understandable to the layperson.

"I was a cancer nurse, so I knew what a lot of patients in chronic pain were going through," said Spicer, who was an associate professor of nursing at Kansas Wesleyan University before retiring in 2000. "I also took information from books in my library, from conferences and the Internet. My goal was to write something that doctors and pain management centers could give out to their patients."

Spicer also had a personal reason for writing the book: As the result of a back injury, Spicer suffered from chronic pain so intense, she almost killed herself.

Permanent damage

A bad fall in 1998 left permanent damage to Spicer's sciatic nerve, which starts in the lower back and travels through the buttocks and down the leg into the toes. Doctors began to treat Spicer conservatively with pain medication, muscle relaxants and physical therapy, none of which seemed to help.

Spicer's damaged nerves kept her in constant pain, and no matter what treatments she tried -- surgery, injections, acupuncture, chiropractic sessions -- nothing made the pain go away.

"I have a high pain tolerance, but I never hurt like that before in my life," she said. "I finally was put on some long-acting morphine, and that helped quite a bit. That is, until I was taken off the medication and went

into withdrawal."

The combination of returning pain and morphine withdrawal became so bad Spicer contemplated suicide several times.

"I said, 'What's the point?' -- I had my gun out and practiced what angle I could point it to get the job done," she said.

In June, Spicer had a morphine infusion pump implanted in her body in a last-ditch attempt to control her pain. This device, similar to a pacemaker, is placed under the skin and attached to a catheter leading to her lower back. Constant drips of morphine are released from the catheter into her spinal canal.

"It's a computerized system programmed by your doctor," Spicer said. "It's made all the difference in my life. You don't know how it feels to wake up with no pain for days in a row. I call this device 'Mr. Wonderful.' It's something that's not for everyone, but it's been effective for me, and I'll have it for the rest of my life."

As her pain continued to diminish, Spicer began to think about writing a book on pain, something that would be comprehensive yet written simply, with illustrations.

"I was mistreated for so long that I really wanted to write something worthwhile about pain," she said. "I wrote this on a fourth- or fifth-grade level, so everyone could understand it. For someone in pain, they don't think well anyway."

The book, which sells for $2.95, focuses on the different types of pain, pain control medications, complementary therapies such as acupuncture, massage, biofeedback and electrical nerve stimulation, and creating a pain management plan.

The biggest misunderstanding about chronic pain, Spicer said, is that people just don't believe it never goes away.

"I wanted people to know that it isn't all in your head, that there is help available, no matter what kind of pain you have," she said. "There's no one method of pain management, either. It's whatever works for the individual. The expert in pain is the person who is in pain, and there are many ways to manage it."

Massage management

Jodi Duncan finally found a way of managing her pain through once-a-week massage therapy given by Danny Zander, formerly of the YWCA who now is at the Chiropractic Center of Salina, 935 Elmhurst. Duncan said Zander's therapeutic sessions are different than a basic spa massage.

"My first session with her, I felt like I had been run over with a truck," Duncan said. "She found areas I didn't even know hurt and worked them with a vengeance. She's extremely talented in locating areas that cause pain and discomfort and deactivating them."

Zander, who became a certified therapist in Austin, Texas, practices deep massage, a method of locating and massaging trigger points in the body and releasing the tension built up in the muscles. In Duncan's case, it is tension built up in her neck, shoulders and back by the hours spent working on a computer.

"When muscles tighten and contract, it restricts the blood flow," Zander said. "I work the muscles, working the toxins and lactic acids out. I release the blood flow and bring in new blood, oxygen and nutrients."

Duncan found that deep massage therapy, although effective, isn't always pleasurable.

"Sometimes she zones in on a trouble spot, and I grit my teeth and think, 'Wow, that smarts,' " Duncan said. "But I know that any pain now means relief later, so it's worth it. Her treatments don't heal my pain, but they do help significantly in allowing me to lead a normal life."

Zander said each patient is different, with specific problems, so she has to balance the pressure she applies to the affected areas with how much discomfort they can tolerate.

"If they hold their breath or resist my touch, it's usually too much pressure, and that's the gauge I usually go with," Zander said. "But I've had a lot of clients tell me that despite the discomfort, deep massage has helped them when nothing else has."

Chiropractic help

While Zander sees a lot of clients who suffer from upper-back pain, the majority of chiropractor Bret Pennington's patients complain of lower-back problems.

"Lower-back pain is the No. 1 thing people go into hospitals for or lose work over," said Pennington, who works with his father at Pennington Chiropractic Center, 204 W. Walnut. "These people often suffer from chronic sciatica, which affects the big nerve joints in the lower back, and they often benefit from chiropractic help."

Pennington also does acupuncture treatments, which he said may be an effective tool if conventional treatments fail.

"I sometimes get referrals from neurosurgeons specifically for acupuncture," he said. "Acupuncture (which can either be done with needles or by laser) helps take the irritation away from the nerve, increases endorphins and stimulates the spinal cord. We can use it to sedate or to stimulate nerves. A lot of time it yields good results, but in the end, if a person needs surgery, they need surgery."

Pennington is a firm believer that good health care should be a team effort, and he strives to work hand-in-hand with medical doctors to supply the most effective treatment for each patient.

"It's the healing arts, not healing science -- everyone reacts differently to different treatments," he said. "It's important to run the gamut with your chronic pain and don't skip any steps. There has to be no communication barriers between all acting doctors on any given case."

Many chronic pain sufferers feel isolated in their pain. Sharon Thelander heads the Salina Area Fibromyalgia, Chronic Fatigue, Chronic Pain and Post-Polio Support Group, which generally meets once a month in Salina. Thelander said members give each other emotional support, medical information and gain insights from guest speakers.

"We try to give people the most information possible and help them find the right doctors," said Thelander, who has had fibromyalgia for nearly nine years. "They can listen to someone else's story and say, 'Yes, that's me.' Then they feel safe to pour their hearts out."

Water therapy

Salinan George Garrison was involved in a bad car crash 11 years ago that left him partially paralyzed. About six years ago, he began taking water therapy classes at the Salina YWCA, 651 E. Prescott, and he said the improvement in his condition has been profound.

"At first, I had to be put in a lift to get in and out of the water," said Garrison, 74. "Now I can walk into the water by myself, and walk while I'm in the water. In the water, you can use your muscles better because of the buoyancy. You can move easier."

There are several classes offered each week at the YWCA for people suffering from chronic pain as a result of arthritis, strokes or accidents, said Jerri Drummond, aquatics specialist at the YWCA.

"I work one-on-one and in small groups with people to help them gain independence in the water," she said. "It's a safe environment for them. If they are wheelchair-bound or use a cane, they can walk in the water. If they start to fall, they don't have to worry about hurting themselves. Water allows them to move more joints than they might be able to ordinarily."

The pool is constantly maintained at 87 degrees, and the warm water helps soothe and relax arthritic joints, Drummond said.

"The pain's going to be there, but we can find ways to relieve it a bit," she said. "We do a lot of movement and strength-building exercises, which they could never do on land. And the stronger they get, the more support they have in their joints."

Ilene Schaich was told by her doctor to start swimming to help ease her arthritis. Now in her second year of classes at the YWCA, she said it is the only exercise she is able to manage.

"I come over here three times a week, get in the water, and keep my legs moving," said the 77-year-old Abilene resident. "I'm tired when I go home, but I'm able to move better."

Schaich's sister, Lois Hocker, Abilene, has been utilizing water therapy for nearly 10 years for her arthritis and is convinced swimming has made her stronger.

"I'm never without pain, but I feel better after I've been in the water," said Hocker, 74. "My doctor told me I might not have to have any surgery if I do water therapy. Water is good medicine for me."


* "Making It Better: Living With Pain, By Myrna Spicer," is available for $2.95 from Pritchett and Hull Associates. To order a copy, or for further information, call 1-800-241-4925.



* Reporter Gary Demuth can be reached at 823-6464, Ext. 109, or by e-mail at sjgdemuth@saljournal.com.



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"It was once written "To thine own self be true". But how do we know who we really are? Every man must confront the monster within himself, if he is ever to find peace without. .." Outer Limits(Monster)