Everybody hurts

“New technologies to help with pain continue to emerge, including medications and surgical techniques that would have been unthinkable 50 years ago. However, despite these advances, more people than ever are disabled by pain, and the cost, especially in terms of human suffering, continues to escalate.”
—Blake H. Tearnan, Ph.D., 10 Simple Solutions to Chronic Pain: How to Stop Pain from Controlling Your Life

Chronic pain, unrelenting physical discomfort, is a more common affliction than many believe. According to Reno-based Dr. Blake H. Tearnan, director of behavioral medicine for the Functional Restoration Program at Washoe Medical Center Rehabilitation Program, and clinical director for the Southern Nevada Functional Restoration Program in Las Vegas, chronic pain affects 50 million Americans. Nearly 11.7 million individuals are disabled by back pain alone. Dr. Tearnan discusses pain in his new book 10 Simple Solutions to Chronic Pain: How to Stop Pain from Controlling Your Life.

Insight into pain
My mother has suffered with chronic pain for over 30 years. When I heard Dr. Tearnan on the Capital Public Radio show “Insight” discussing an alternative approach to living with chronic pain, I immediately took an interest.

My mother’s case is fairly standard. She suffered a back injury 35 years ago. She was treated with surgery and narcotics and a small amount of physical therapy. That first surgery led to many, many more, each attempting to eradicate, once and for all, the pain she continued to experience. The surgeries only partially relieving, the doses of pain medication increased. Today, after having survived over 15 surgeries related directly or indirectly to that first injury, and on a steady regimen of drug therapy, she continues to suffer to the point of debilitation. This treatment of the physical symptoms alone, with surgeries and narcotics, is the norm. This approach, according to Tearnan, comes out of the disease-injury model that most physicians follow. Part of the problem, though, is that this model was created to treat acute pain, which it often does very effectively. Unfortunately, when such procedures are applied over long periods of time to the treatment of chronic pain, they may help, but they often aren’t effective. Chronic pain and acute pain, as it turns out, are different beasts.

Tearnan takes a different approach. His treatment comes out of the bio-psycho-social model which takes into account the whole person. Working in combination with physicians, Tearnan also addresses emotional, psychological and social factors contributing to a patient’s suffering and disability. This approach factors in not just physical symptoms, but also the way a patient views his or her situation, which, studies show, affects the degree to which the patient suffers.

“The longer someone has pain, the more other factors [like emotions surrounding the pain] begin to be associated as pain,” says Tearnan. “What that person believes about pain, the meaning they attach to that pain—a lot of how debilitating pain is, is dependent with how people think about it.”

“What patients often confound is that all of the problems they’re having are all tied to the pain. What we find, in reality, is that there is a very modest correlation between disability and suffering levels, and the underlying physical problems. Why do we see one patient who has minimal pain suffer more and experience more disability than someone who has more pain?”

Facing the pain
One primary difference between pain treatment approaches is that the traditional model seeks to completely eliminate pain, offering the hope of a “magic bullet” in the form of stronger, more efficient narcotics, or the next surgery, while Tearnan’s approach focuses on living with the pain because, in many cases, it isn’t ever going to go away.

Tearnan’s approach is worth a listen, too, because traditional methods of dealing with chronic pain can actually make the situation worse. For instance, narcotics used over long periods of time in significant quantities don’t eliminate pain and, in fact, can make it worse.

“There is hypoalgesia,” notes Tearnan, “where, when narcotics are taken in sufficient doses for long enough periods of time, the cells actually become more sensitive to pain so that the drugs actually create pain. We found that when we get some of these people off of their high doses of narcotics, oftentimes their pain does improve. There are studies that show that people on significant doses of narcotics, when you get them off of the narcotics, they really don’t show more disability or more problems in overall function.”

Additionally, narcotics have been associated with high levels of depression, as well as other negative side effects such as constipation. On top of that, narcotics just don’t seem effective, with most patients reporting that they usually offer only about 10 to 15 percent relief.

Tearnan’s advice: Face the pain, let it sit by your side. But, he admits, this is very hard for pain sufferers to do.

“It’s a very frightening thing for patients who have been spending months, years, pushing pain away, to accept it,” Tearnan says. “In a sense, I tell people to move toward the pain. If you spend all your life moving away from it, that’s when it gains more significance than it really deserves. That’s when your whole neurobiological system is so oriented on eliminating it because you’ve said it’s the thing that can destroy you.”

The book on pain
In 10 Simple Solutions to Chronic Pain, Tearnan helps remove the mystery of pain and educate chronic pain sufferers on different ways to approach their condition to help make their lives more fulfilling and less about suffering. As he points out in the book, suffering is the emotional side of pain. So, while there may not be a way to eradicate the physical discomfort of pain, there are ways to change one’s way of processing it.

Studies also show that when people are more informed and involved in the managing of their pain, they feel better and are more satisfied. This book provides just the sort of straightforward, hands-on information that can put treatment firmly in the hands of the patients, giving them some control over their situation. The 166 pages of easy-to-read and understand information not only clearly explains the approach, but do-it-yourself exercises interspersed throughout also help patients put the ideas into practice. This is not a magic cure, but rather one that involves active participation. Real world anecdotes of the experiences of several of Tearnan’s patients further personalize the material, making it real.

Though this book is aimed at those suffering from chronic physical pain, I suggest that it is useful for dealing with any kind of pain. Not a chronic pain sufferer myself, I found much of the information applicable to dealing with other types of ongoing painful troubles. This book gives insight into what that person may be going through and how best to help anyone who suffers from chronic pain.

There are no magic bullets here. It’s simply about facing the reality of the situation and making the most of what you do have as opposed to lamenting what you don’t. My mother is looking forward to investigating the information Tearnan presents. The book goes in the mail today.