Dear Mel
Well said.
In this country the medical model is often held up with such awe,
unfortunately I can only see the flaws. We teach our doctors to spot and
cure and when this is not possible they go into denial. Rather than admit
that they do not know they blame the patient; pyschogenic pain.
Unfortunately the physio profession has been to some degree infected with
this arrogance.
Pain often is not something to see, it isn't a tumor to take out or a blood
pressure to regulate. As I have said previously on this site, our
understanding and approach, in musculoskeletal (if not all pain) pain, is
very different to other medical conditions such as an MI.
While our knowledge is incomplete the highly personalised experience must be
managed on an individual level. I feel the patient knows best and as a
therapist it is my job to wrack my brains for possibilities to help tame the
beast. I am sure your wife is lucky to have such a caring and intelligent
therapist on her side.
Good luck and keep the comments coming, they are always thought provoking
and never dull Warm Regards Kevin
-----Original Message-----
From: [log in to unmask] <[log in to unmask]>
To: [log in to unmask] <[log in to unmask]>
Date: 17 May 1999 07:00
Subject: GREATEST MEDICAL PROBLEM?
THE GREATEST MEDICAL PROBLEM?
If I asked you “What would be the greatest medical achievement?”, what would
you reply? Conquering cancer, regrowing damaged parts of the body,
conquering heart disease, conquering degenerative neural disorders,
prolonging life, conquering all hereditary disorders, discovering a
universal
broad-spectrum vaccine against all contagious disease?
I would respond by saying that these objectives are still trivial compared
with another far greater goal. I would even add that resurrecting the dead
is
still far off the mark! Even the Bible say that the last enemy to be
conquered is death, so what could be greater than that? One little
four-lettered word says it all: Pain.
If science can resurrect one to life again and be vulnerable to the horrors
of pain at a later stage, then that great advancement is meaningless, for
life with chronic debilitating pain is not life at all. If one can cure
cancer and the cure takes 5 years while the patient suffers in agony for all
that time, is the most important problem being handled? Is the cart being
put before the horse?
Indeed, is the cart being put before the horse in most medical research?
Medicine is searching for cures for diseases, defeating cancer and heart
disease and a myriad other more high-profile disorders of the human
condition, but far less money seems to be dedicated to solving the one
central problem which makes all disease so dreadful - and that is pain. It
seems as if the management of pain is only of critical concern during
medical
procedures, when anaesthesia is applied to allow the surgeon to carry out
all
those great advances in medicine that fill the medical journals and Press
reports.
What makes any human disorder far worse is the presence of pain. Remove the
pain from any disease and you have done far more for the patient than
healing
the disease, unless, of course, the healing is instantaneous.
There is possibly nothing worse on this planet than severe chronic pain, yet
there are very few interventions which definitely work in all cases, other
than total anaesthesia, which is impractical and potentially unsafe for any
patient who wishes to have any quality of life. Is it not intriguing that
natural or artificially induced sleep is the only definite way of halting
pain, but that is really reducing one to an unproductive state of suspended
animation (isn’t that what we do every night when we retire to bed?).
It has always intrigued me that all the most horrendous tortures, such as
those devised by the Catholic Church for its brutal Inquisition and the
Nazis
for their own sick agenda, would have no effect whatsoever if pain did not
exist. In fact, the threat of or imposition of physical or mental pain has
been and is used by all governments to control its population since time
immemorial.
Part of the problem is that the magnitude of pain is only truly understood
and experienced by the sufferer. Though therapists and family can empathise
to a certain degree, we can never enter into the heart of the pain
afflicting
the person. All too often, those around the patient, including many
doctors,
think that the patient is exaggerating or that most of the pain is
psychosomatic, especially when the patient declares morphine and other
powerful narcotics not to be helping. To the observer, it is often a case
of
“how is it possible that the strongest pain-killers known to humankind are
not working - the patient must be neurotic!”.
This unfortunate perception was driven home to me when I saw a TV program on
Dr Kevorkian. The Oaklands prosecutor involved declared to the jury: “Maybe
the person did not want to commit suicide because of pain, but because she
could not cope with being disabled” This was an extremely ignorant remark!
It is quite obvious that he was totally unaware that one of the major
problems with many paraplegics is severe chronic pain which makes their
lives
an ongoing misery. Many people believe that the number one priority of
disabled folk is to walk again, but for disabled folk who have chronic back
pain, the freedom from pain is by far the greatest priority.
Are we healthy folk just and fair in withholding cannabis, narcotics and
other interventions from our genuinely suffering fellow citizens? Are we
judging in a specific biased way simply because we have never lived for any
prolonged period afflicted by such high levels of chronic pain? Is it noble
to suffer pain? Are we doing anything tangible enough to conquer the
problem
of pain? Are we receiving adequate training to understand and cope with
pain? Is the medical curriculum doing enough in this direction?
Are there others who also feel that far more effort and money needs to be
devoted to the conquering of pain? Is enough being done to manage pain in
patients? Is there too much emphasis being placed on curing the disorder
before managing the pain?
Now for some specifics.
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? Inhalant
anaesthetics or analgesics such as ‘Penthrane’ are about the only
intervention which give almost immediate relief, but nobody can live like
that. I have read through many websites on the subject, but have yet to
come
across anything new or really helpful for the many spinal patients I
encounter through my disabled wife.
Meanwhile, for those of you who are also interested or involved in the
problem of pain management, here is a collection of the websites which I
have
visited. Please let me know if there are other sites which you have found to
be of value.
http://www.nyssa-pg.org/
http://www.pain.com/library.html
http://www.gbso.net/George/linkspag.htm
http://www.healthtouch.com/level1/leaflets/102429/102429.htm
http://www.painonline.com/
http://www.ampainsoc.org/
http://www.pain.com/painpubl.html
http://www.pain.com/DrFiles/doctor.htm
http://www3.sympatico.ca/nacpac/
http://www.pain-clinic.com/news/sum95research.html
http://www.partnersagainstpain.com/pro/newsletter.html
http://www.jr2.ox.ac.uk/Bandolier/painres/MApain.html
http://www.stat.washington.edu/TALARIA/talaria0/
Dr Mel C Siff
Denver, USA
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