As usual, another gem from Mel. Always interesting,
always thought-provoking. He wrote in part:
> All too often, those around the patient,
> including many doctors, think that the patient is
> exaggerating or that most of the pain is
> psychosomatic,
One of my specialties is treating muscular pain
with sEMG biofeedback. It is always helpful to the
patient to show muscular tension and spikes on
the computer display, and to reassure them that
there IS a physiological basis for their experience.
> Does anyone on this group know of pain management
> methods which can alleviate the suffering of paraplegics
> who have tried for years to manage their debilitating back
> pain by the use of powerful narcotics, acupuncture,
> hypnosis, TENS devices, spinal fusions, magnets,
> laminectomies, trigger point therapy, various operations
> to inactivate the sensory nerves, massage, progressive
> relaxation, therapeutic touch, you name it?
My experience is limited to what I call "secondary pain",
the result of muscle cramping that is secondary to
patient attempts to "not notice" primary pain. The
classic example is menstrual cramps, which are
simply spasms caused by attempting to block from
consciousness the primary pain of monthly uterine
lining replacement.
There are many other instances where secondary
pain is a result of avoidance of primary pain. My
favorite patient was a chair-bound paraplegic with
MS, 90% blind, who was always hunched over in
his chair. It turns out he was trying to stretch his
back muscles to prevent them from contracting.
I did a surface scan with sEMG instruments, and
then attached surface electrodes to the most active
region.
I displayed the EMG signal, which contained many
spasms (spikes) on a light-bar portable EMG
device that he held about a foot from his eyes.
(The old Cyborg P-303, with a bright 9 inch long
light bar which even he could see.)
Each time there was a spasm, I asked "did you feel
that one?" and he always said "No!". After about
ten minutes, he began to perceive (cortically) what
his body was always sensing (sub-cortically). He
began to say "Yes" in a tentative manner. After a
few more minutes, he was suddenly "feeling" each
spasm, and understanding what that meant.
After a total of about a half-hour, and with a very
gradual change, he was finally seated completely
upright in his chair, without any instruction from me
to do so. As he focused his attention on the
muscle spasms, they gradually went away. He was
left with minor, manageable discomfort, but not the
debilitating pain.
Unfortunately, I don't know the long term results.
Like many MS patients, he had completely exhausted
his insurance benefits long ago, the state (ME.) wouldn't
cover biofeedback, and he was too proud to
accept free service. I can only pray for him.
I've had many similar experiences in patients with
degenerative disk problems, (unable to walk without
assistance) and elbow problems (three surgeries
made it progressively worse).
In my opinion, all patients with severe, localized pain
should be checked with surface EMG instruments
to see if there is a treatable muscular overlay,
which may account for 90% or more of their pain
experience.
Funny that you didn't mention "biofeedback" in your
list, Mel. How come?
John D. Perry, PhD
Psychologist (ret.),
specializing in biofeedback
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