The Health Blog

While it is a big step forward, the pain clinic concept does not provide all the answers for all the complex cases seeking help. Despite the many patients who have been helped, doctors are still not miracle workers and the emphasis is on effective pain ‘management’. This does not always mean pain control, and in fact often means simply learning to cope better with ongoing pain.

Those who will not be helped

There are sometimes people who cannot be helped, no matter how much effort is made. These are people who will increasingly become the victims of their beliefs that only narcotics or surgery can help them.

A cry for help

‘Why can’t these doctors help? Surely the problems are due to adhesions in my stomach?’ complained Joanne who had a very long history of abdominal pain commencing after she had her stomach stapled four years previously.

The operation was a total disaster. It should never have been performed because she was not really overweight enough. She subsequently had another ten operations on her abdomen!

Even worse, she had become an opiate addict, even involving her husband who was giving her two to three injections of pethidine a day at the time she was admitted. These had been prescribed by her local doctor who had run out of other options. He had not thought of the dire consequences of allowing this manipulative patient to self-administer potent narcotic pain-killers to herself.

Joanne was referred to the pain clinic because nobody else was able to help her. When she came into the pain clinic, she was told she would have to give up narcotics and look at the alternatives.

This was a firm condition of her admission as part of the unwritten contract she agreed to before admission. It was carefully explained to her that, fundamentally, there was no obvious cause for her pain, and that the pain medicine which her husband was giving her was simply lowering her natural pain defences by preventing her body from producing its own endorphins.

There simply was no physical explanation that could be found for the pain and itsuapparent severity. Certainly, the pain clinic team could not find any adequate explanation for why she should be on narcotics.

She was told that there was no possible way that the dosage of narcotics she was taking was being used just for pain control. Clearly, she had become addicted to them.

Joanne was brought into hospital as an emergency. Sadly, she left three days later because she was not prepared to give up the narcotics. She was re-admitted a week later to the in-patient pain programme where again she was given a lot of support. It was again stressed that she would have to stop using narcotics and that attempts would be made to try to find alternative methods of treatment for her problems.

But, within a week, she and her husband decided that this was not for her and she discharged herself.

There are many ‘Joannes’ who will go on creating problems for surgeons and other doctors, convincing them to operate for pain relief. Most importantly, the Joannes of this world make their own life miserable beyond imagining. Such patients have to be active participants in their own treatment. Being a spectator just is not good enough.

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Simple painkillers In the absence of any locally correctable cause for the pain the simple painkillers such as aspirin and paracetamol should be tried. These should be taken on a regular basis. Drugs such as aspirin (600mg 3-4 times daily), and paracetamol (lg 3 times a day), or any of the non-steroidal anti-inflammatory drugs such as Feldene or Orudis prescribed in doses sufficient to reduce pain.

Aspirin seems to have a greater pain relieving effect than paracetamol in cancer pain due to bone involvement. When these drugs cause vomiting nausea or gastric irritation, alternative forms of medication with protective coating such as Ecotrin tablets or the suppository forms of Indocid, Naprosyn and Orudis will be of value.

Adjuvant or ancillary drugs These drugs are known to assist the pain-killers to act more effectively than when the pain-killer is taken alone.

The antidepressant drugs appear to have a pain-killing effect which is quite separate from their primary role of relieving depression as discussed earlier in this book. The more commonly prescribed antidepressants of which Sinequan, Prothiaden and Anafranil are typical should be prescribed in doses of at least 50-100mg (2-4 tablets) per night. These drugs bring about a decrease in depression, improved sleep and a decreased need for pain-killers.

In those whom there is increased pressure around the brain due to brain tumours or blockage of the fluid surrounding the brain and spinal cord (the cerebro-spinal fluid), the steroid or cortisone drugs may help to decrease the pressure and thus the headache and pain.

The major tranquillisers such as Largactil are effective in reducing nausea and producing sedation where necessary.

The minor tranquillisers such as Valium, Xanax, and Serepax also have a role in the treatment of the anxiety associated with cancer pain and in the treatment of associated non-malignant soft tissue pain and muscle spasm.

Anti-epileptic drugs also have a role in the treatmenf’of cancer pain. The most commonly used drugs for the treatment of pain due to the cancers involvement of nerves are Tegretol and Rivotril. These will also be useful in the treatment of epilepsy caused by brain involvement in the cancer.

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Keep your eyes closed. Now think back to a time when you heard some wonderful vibrant music. You could have heard it anywhere. By thinking back, you can hear it even more exquisitely in your own mind. You make it yourself and you can experience it as intensely as real music. The music can be absolutely powerful — strong, exquisite. It’s vibrating through every pore of your being. It’s going deep into every pore. It’s penetrating through every fibre of your being. It’s the most beautiful, complete, exquisite and overwhelming music you’ve ever heard. Listen to the music now, as you create it in your own mind. Give yourself 15-20 seconds to experience the music. You can stop thinking of the music now.

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How does TENS relieve pain?

Two possible ways to explain the effectiveness of TENS in the relief of pain seem to be the ‘Gate Theory’ and the theory that TENS increases the liberation of endorphin in the blood and spinal fluid.

According to the gate theory, there is a gate between the source of the pain and the area of the brain which perceives the pain, and normal non-painful sensations pass through this gate from the source of pain to the brain. As a result of treatment with TENS the strength of these sensations can be increased enough to squeeze out the pain impulses and permit the gate to block them. According to the other theory, the increase in the liberation of endorphin by TENS acts to block the transmission of pain impulses to the brain.

Can TENS be used for all kinds of pain?

According to world literature there seems little doubt that TENS will block out many forms of pain, such as that caused by childbirth, surgery, trauma, organic lesions and arthritis.

However, it is important to realise that pain may well be a useful and important warning that something is wrong with a person’s body. To block out such pain would be ignoring that warning and could be harmful.

Can TENS become addictive?

When someone has chronic pain, the cause of which cannot be treated directly, he or she may have to take pain pills for a long time. In such a case there is a real hazard of addiction to the medication requiring increasing doses to achieve an effect. As well, there are other possibly undesirable side-effects to some medications. There is no evidence that TENS is addictive.

Can TENS cure a pain or make it worse?

It is very difficult in advance to know what effect TENS will have on pain, because there are many kinds of pain and many causes. Those with a certain kind of pain will not react in the same way. Despite this it is probably safe to say that it is unlikely that TENS will ever make a pain worse. At most clinics where TENS is used the results are that some will achieve partial relief after two to three treatments, others complete relief after 3 or 4 weeks and suffered recurrence of the pain between one or two years later, and still others only felt relief while the machine was being used. This latter group requires continuous stimulation to obtain relief of their pain.

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