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Tuesday, April 2, 2013

Owee Kazowee . . . It's a pain!

Arizona sunset in my front yard
I read a number of blogs and a frequent theme is related to pain and pain management.  Why wouldn't it be?  Pain, whether it is acute or chronic, is always in your face every day no matter how much you try to ignore it.  Many of us use a combination of pain medications throughout the day and night in an attempt to manage our pain, but new findings have demonstrated that using these medications are actually counterproductive.  Long-term narcotic use actually magnifies any pain you may have anywhere in your body.  (Jaret, Peter.  2013, April, AARP Bulletin, Fighting Pain, pg. 10 - 12).  I suspected there was a rebound effect from pain medication use, because I experienced this first hand after using Vicodin for only a short period of time.  Prescription opioid pain medications are now the leading cause of drug overdose deaths in America.  Despite decades of research on how to manage acute and chronic pain there still are no easy answers.  Most pain management clinics are now weaning chronic pain patients off their opioid medications and replacing those medications with a variety of strategies to manage their daily pain.  I use my pain medications judiciously, but I am personally terrified of the thought that I would have no access to pain medication.  I've been there, done that and it didn't really work all that well.  Managing pain every day throughout the day and night is already a full time job.  I can't possibly spend the entire day meditating in an effort to control my pain.  That was the suggestion I received from a pain program I attended 20 years ago.  The reality is that opioid pain medication won't eliminate pain completely and so a number of strategies must be used to get through each day.  For me, balancing pain management strategies with sensible pain medication use currently seems to be the best approach.

A javelina at my bird feeder!
It's a mistake to take larger and larger doses of opioid pain medications so I stick with a regimen that provides enough relief to take the edge off my pain and I resist the temptation to increase my dose in an effort to get additional pain relief.  It just doesn't work and that's the bad news.  The good news is there are other strategies that give me relief throughout the day and using these strategies have become second nature so it doesn't feel as though I'm spending my whole day managing pain.  There are some days that are so bad -- I feel so sick, am plagued with exhaustion, and have so much pain that functioning is difficult.  Those are the days when I lay low and do nothing more than pamper myself and rest.  It's important to listen to our bodies, because they give us clues (some clues are louder than others!) about what they need, and to ignore that gets us into trouble.  I save Vicodin for bedtime, because it's critical to get enough sleep.  Depending on my activity during the day, Vicodin may not be effective, but I have other "tools" in my pain management toolbox.  I have found that distraction is the very best medicine and is far more effective than any pain medication I have used for my chronic and unpredictable pain.  Not moving is the kiss of death.  The hazards of immobility is something nurses learn in their very first class in nursing school, because to keep people moving is critical to everything that ails them.  When people cease to move, their body starts to deteriorate immediately on many levels.  It seems so opposite that we must get up and move when we feel sick, exhausted and in pain, but that's exactly what we must do.  I tend to reject the workout program thing.  Instead I incorporate exercise throughout my day.  The key is to do what you enjoy and brings you joy.  I enjoy going for short walks with my two cats and my dog.  They are all getting older and my dog has two congenital heart defects and taking Enalapril so they all move at my speed!  I also enjoy gardening so I have trimmed down the amount I have to do so it isn't overwhelming, but keeps me moving.  Caring for my cats and dog, and feeding the wild birds also keeps me moving and I have my daily routine to provide them with what they all need to thrive and that brings me joy.  When I stop moving I have a tendency to have more pain and I have to be careful not to overdo.  While I was checking out the bird feeder the other day I was surprised to find a 40 pound javelina grazing on bird seed.  Now that was a distractor from pain!  Ha!  Listening to music while I cook or during other activity distracts me from my pain.  I spend time with my kitties and dog . . . I'm sure that rubbing my hands in a fur ball lowers my blood pressure, diminishes my pain and is very therapeutic in a meditative sort of way!  And they love it too.  I socialize as much as I am able and I love to read; both great pain distractors.  It's all about focusing my senses on environmental stimuli that are able to override the pain I feel.  Night time is the biggest challenge and that's why I save Vicodin for bedtime.  At night everything is dark and when the lights go out there is very little sensory stimulation to override pain, so my complete attention is on painful stimuli.  When I am having difficulty sleeping I go out to the living room and turn on the TV.  I may also do some reading while I'm watching TV, which engages a number of my senses and helps to override the pain.  When I feel sleepy I lay down on the sofa and watch TV and then I am able to fall asleep.  So for those nights I need additional environmental stimuli to override my pain and other discomfort.  Sound machines in the bedroom serve the same type of distraction.
A javelina mug shot . . . Harvey the Javelina!

Another important piece of the pain relief puzzle for me is to maintain my sense of humor and not to give in to this monster that threatens to rob me of my life.  One element in my life that helps me to keep going is trying to keep up with Sid.  When I can't keep up with him I make concessions and alter my level of participation in an activity.  I maintain a mental attitude of wellness rather than sickness.  There's that old saying that when you pick an attitude make sure you pick a good one.  And your attitude determines your altitude. I make a point of getting out of the house every day and interact with the people around me.  I also joined the local garden club to give me some activity that gives some of my time structure.  I may not be able to do the heavier work, but I have skills that will benefit the club in a number of ways.

A javelina mug shot from the other side . . . bristled up and ready for a fight!
All of these strategies may seem so simple, but they do work to provide relief for at least a little while.  Pain relief efforts are just that:  effort.  It requires planning, work and lots of determination.  But that's a small task for a warrior!  All of us would love to be completely pain free, but that just isn't realistic.  The most important component of my pain relief program is being connected to all of you.  Being connected with others that are struggling every day to manage pain gives me a feeling of comraderie and I know I'm not alone.  It also gives me hope too.  Never, never give up hope.

Current research is working on a variety of ways to manage pain.  One approach is to block the pain signals from their source.  The experience of pain is a very personal experience and finding pain relief strategies is personal too.  We can give each other ideas with the strategies that we use, but each of us must define what works for us.  Some people have found pain relief from accupuncture, accupressure, tai chi, meditation and massage.  Whatever works for you, do it.  I'm sure there are some very creative ideas on how to manage pain!  Please share your thoughts with all of us . . .

Meanwhile, I think of you all every day and hope you are finding pain relief for even the briefest of moments and that you have hope and peace and joy in your life.  Blessings to you on this difficult journey!
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