Another Post About Pain - I'll Try Not to Hurt You

In some respects, there's almost no end to what can be said about chronic pain - maybe that's why its called chronic (little attempt at humor there, folks.) Seriously, pain management has both upsides and downsides, as well as being something difficult to quantify in any general manner. That is, its mostly a specific "art," rather than a clear, objective science. And when you begin to understand how feeling pain is a critical feedback mechanism for the organism, well, it get's pretty frustrating.

Allow me to illustrate that last point a bit. Let's say you turn the corner and one of your kids just happens to be swinging a bat at that exact moment. And fate, (gotta love fate, eh?) intervenes, and said bat smacks you right in the shin. Now, besides being a possible entry on America's Funniest Videos (you should be so lucky,) the more important result is, well, pain. And this pain causes several things to happen, besides screams, passing out, and threatening to boot the rug rat into next week. First, you are almost certainly going to sit right down and start rubbing that shin, maybe get some ice, or at least an aspirin. And sweatheart, you are gonna limp, trust me.

Now, all these reactions occur because of the pain, caused of course by said injury. And this is at it should be - the pain is telling your body, hey, settle down, and attend to this trauma. And, not being entirely without a clue, most of us do exactly that. I say most of us, because there is a class of people out there who will have substantially different reactions to such a trauma. I am speaking about people with peripheral neuropathy, most such folks being diabetics. Feeling can be lost as high as mid-thigh, in some cases. So, they don't feel pain, or perhaps only vaguely. Now, this doesn't mean diabetics are the only folks like that, but they make up a serious percentage. The results for such folks is, without the pain signal, they do not react in a manner designed to treat or ease the trauma, and thus, can become far more seriously damaged than everyone else suffering the same trauma.

I explain this to illustrate something about the necessity of pain - it is designed to allow the organism time to heal before going out and doing something else that might injure them anew. But chronic pain is quite different than immediate, unique trauma. It has more complex effects and "sequelae," which is just a fancy word for extra surprises. For one thing, there is insufficient time for healing. So the organism, (that's us) has to make a difficult choice - keep doing the things we want and need to do to live our lives, or sit down until the pain stops - not the best set of choices, is it? With some types of chronic pain, management can be accomplished with somewhat simple methods - pain medications. Yet, it can often be difficult to get the right drug and the right dosage, but with the right pain management specialist, its doable.

But when the cause of the pain is not a systemic condition, or is isolated in the upper extremities, as opposed to, in our case, the feet, and its being caused by bone-on-bone or minimal cartilage left to cushion the joints, its a very different ball of wax. Can we use pain management drugs to reduce the pain? Sure. Absolutely. But. There are two potential consequences we have to be aware of. First, we may require substantially higher or more frequent dosages to achieve the desired level of pain reduction. This increases odds for addiction, increases odds we could injure ourselves or others while so impaired, and clearly increase the odds we will be less than desirably functional to do our jobs, maintain our relationships, etc. So, big downside.

Second, by significantly reducing pain - no, let me correct that - we are not "reducing" pain, we are reducing our conscious awareness of pain - a very critical distinction - we become like someone with peripheral neuropathy - we are unable to tell when its time to respond to the on-going trauma. Thus, we end up increasing the very conditions causing the pain in the first place. Which causes a cascade effect - we need more medications, more frequently, or higher dosages, continue to cause the trauma, increasing damage, and so on, and so on. Really BIG downside, because while we may feel like we are somehow controlling the pain, we are really just worsening our situation.

So, What Other Options Do We Have?

None of us like the idea of sitting on our butts. We want to get out there and enjoy our lives, do our jobs, stay fit, etc. But we also have to face a very painful truth - we are not the same as everyone else, no matter what the surgeons told our parents. We are, in fact, more like people with post-polio syndrome who, when they were first afflicted, were told they needed to use their unaffected limbs more, in the mistaken belief about the disease that it only affected what it obviously affected. But twenty, thirty, forty years on, those same folks started to get symptoms of polio, but this time, on their what was assumed to be unaffected side. This was because the disease actually had a systemic affect on the body's myelin sheaths around the nerves, as opposed to only the apparently damaged parts of the body. So now, belatedly, these same folks are told to "just take it easy," don't overdo it, rest, relax. Well, we are somewhat like that.

Many of us have tried to live our lives like we are normal folks - hell, that's what they told us we were, wasn't it? But the long-term effect has been to place ever increasing wear and tear on those poor little joints, and the more we do, the worse it gets. And if we do less, well, there's that weight-gain thing, and further muscle weakness, etc. So, what's a clubby to do? How can we stay healthy, while at the same time learning better how to take it easy, in order to keep our pain manageable?

Well first, we have to come to terms with our very real limitations. This doesn't mean we just lay down and give up, or stop doing the things we love or want to do. We just need to acknowledge the limits are real, and learn to act within them. One example - when I go out walking, I've learned how to pay attention to my "half-way point." If I go one way, I gotta come back, so I need to know my distance limitations, and act consciously to honor that limit. It may be that you need to learn to take more shorter walks, with time to rest between, rather than that long walk to Half-Dome and back, with the resultant five-day vacation from your now painful vacation.

I am not suggesting, by the way, you never employ medications. Just do so with moderation, and only as an adjunct to your pain management regimen rather than a centerpiece. Use it in addition to, rather than a line of first defense.

Here are a few other ideas for your consideration: you may have some of your own you'd like to share, so please leave your comments to share with all the other clubbies out there.

iSqueeze foot massager, or other brands of foot/ca;f massage units - here are a few options.I use mine nearly every evening - it increases my circulation, and relaxes my feet considerably. I would urge you to by the best one you can afford - the higher up the calf it goes, the more effective it will be. Yes, they aren't cheap. But neither is a year's worth of dilaudid, ya dig? By making this a part of my day, I can look forward to some pain relief before going to sleep, and find I sleep considerably better for it. Remember - we are more likely to get a reduction in pain, than a end to pain. And each percentage we lower that pain makes our lives that much better.

Inversion table. This is a device that you lay down on after clamping your feet (with your shoes on, usually) and then lean back and slowly turn your body upside down. Essentially, you are reversing the effects of gravity. It allows gravity to pull you down instead of pushing you down. It actually mildly distracts your joints - that is, it pulls the joints slightly apart so they are not compressed as they are when we stand and walk. And even with your feet in the clamps, it has the same effect on your ankles, and to a lesser degree, on the subtalar joints. Here are some options. Yes, again, they aren't cheap. But you need to see such expenses as essential to your well-being. Compare it to all those latte's you have over the course of a year, which do less to reduce your pain.

Foot soaks. Again, many kinds, even if a bit more labor-intensive (you have to fill and empty them, and clean them once in a while.) But soakin' them sore puppies at the end of the day, well, bliss, right? Here are a few to look at. Be sure to get one slightly bigger than your feet - no reason to feel cramped, eh? And be sure the sides slope sufficiently - you want to be able to sit back and relax - too straight of sides will make you have to sit more erect. personally, I like the basic deep dish type - gets the water up on the calf, ya see?

Paraffin baths. This is a major escalation of foot soaking technology, the big gun, if you will. And while even more labor intensive, it gets the heat much deeper into the foot. When all else fails, this thing will hit the mark, every time.

Finally, at least for this post, there is the ultimate pain reliever. Get your significant other, or even some total stranger, to give you a serious foot massage. Nothing like it. Nothing at all. Unless, that is, you happen to be ticklish.

AAhhhh.

So, what is your technique? Share it with us all.