Is there a cure for
Pain Management
It’s often said that things are easier said than done. Today there’s no better example than physicians who are trying to relieve chronic pain. For instance, a recent newspaper headline read, “Chronic Pain Sufferers Deserve Better Than Opioids.” But the dicey question is what else can doctors prescribe for pain? One story illustrates the problem.
William Shakespeare wrote in the play Richard II, “They breathe truth that breathe their words in pain.” The truth is that people with chronic pain are usually having genuine pain that is soul destroying day after day. They justifiably want relief.
Today many people have become addicted to opioids. North Americans have become soft and have lost their tiger in the tank. They’ve been programed by big pharma’s ads that there’s no need to endure any pain when popping a pill is the answer. It starts a vicious cycle towards addiction.
Popping painkillers is no favour to the liver and kidneys that metabolize and excrete these drugs. The main cause of liver failure in the U.S. is Tylenol overdose. As Sir William Osler once remarked, “The main thing that separates humans from animals is the human desire for pills.”
But what about those who have not abused painkillers and genuinely need pain relief? It’s not easy to do it. The best example is a patient I knew who never rushed even for a baby Aspirin. He sustained a neck injury in his thirties which set the stage years later for arthritis and cervical stenosis. The chronic pain interfered with his work. He quickly discovered that was no free lunch with painkillers. Opioids made him drowsy and unable to work. Equally important, they did practically nothing to relieve the constant pain and caused troublesome constipation. So why take them?
A University Pain Clinic suggested the pain might be relieved by neck injections. This was done without any change in the pain. He was then referred to a well-respected university chiropractor. But several treatments resulted in no improvement. This is when a doctor’s options are starting to run out.
Finally, the patient made an appointment to see a doctor who had specialized in acupuncture. Again this failed to ease the pain. Becoming rather desperate, this man wondered if daily massage would be helpful. It made him feel good during the massage, but the pain immediately returned after treatment. Doctors wondered if an MRI could pinpoint the cause of pain. It did reveal changes in the cervical spine, but was unable zero in on what was triggering the pain.
So what happened? He found that pumping up an inflatable neck support while lying down for 15 minutes and keeping it on while working provided relief for an hour or two. A solid neck support with an ice pack under it also gave temporary relief.
What does this prove? It is much easier to ease acute pain of short duration. Chronic pain takes pain control to a new dimension that leaves much to be desired.
Doctors specializing in chronic pain do relieve some patients of their constant discomfort. But there are cases such as this one where unfortunately patients must learn to live with their pain. Even with the best of care, some pain cannot be cured unless you become totally zonked out with medication. Eventually, patients who reach this point without relief of pain have no pain options left. It’s small wonder that their constant pain becomes soul destroying.
Pain
We’ve become a nation of wimps demanding a painkiller for every minor ache and pain. Unfortunately, it’s one reason why we find ourselves in a major opioid crisis that’s killing many North Americans. This is costing our health care system tens of millions of dollars as addicts return repeatedly for injections. My research in England revealed that patients on huge doses of heroin to ease terminal cancer pain could eased off it in a few weeks if there was remission of the disease. The question is why withdrawal is so prolonged for addicts in Canada. What is more tragic is that addicts are allowed to inject themselves with heroin in addiction clinics. But this same right is denied to terminal cancer patients in hospitals.
How The Horse’s Tail Can Paralyze You
Why call 911 when it’s the same old pain? After all, John X had suffered from occasional bouts of back pain for years and usually the discomfort subsided within a few days. However, two or three times he had been totally disabled from severe bouts of sciatica, requiring bed rest for several weeks. But, with the use of painkillers and anti-inflammatory drugs the severe pain that radiated down his leg gradually went away.
One afternoon, after a sneeze, pain struck with a vengeance. This time the usual medication failed to numb the agony, but he refused to seek help. Three days later when he was unable to urinate, or have a bowel movement, his family finally called 911 and he was admitted to emergency. The diagnosis? “Cauda Equina Syndrome” which required emergency surgery. Why? Because of injury to “the horse’s tail”.
Low back pain affects millions of people every year and there are many causes for this universal problem. A simple sudden twist may stretch a ligament or injure a muscle. In many instances it’s hard to pinpoint the cause, but fortunately tincture of time cures most patients.
On occasion, there’s no doubt about the diagnosis. Years ago, during a trip to Hawaii, a violent sneeze sent a lightning, knife-like pain radiating down my leg. There was little doubt the diagnosis was sciatica due to a ruptured spinal disk.
The only place I could find to lie down was on the pew of an old historic church. As luck would have it, a few moments later a group of tourists entered the church and I knew what they were thinking. Here’s the local drunk lying in a pew at 10:00 in the morning! But I was in so much pain I didn’t give a tinker’s damn what they thought.
Most people are aware of a ruptured spinal disk. But I’d bet that not one in a thousand have heard of the “Mother of all back pains”, the “Cauda Equina Syndrome”, that injures the horse’s tail. And unless treated promptly this injury can have terrifying consequences.
The horse’s tail sounds like a cocktail mixture, but it has to do with the anatomy of the spinal nerves. The spinal cord ends at the upper portion of the lumbar (lower back) spine. But a collection of nerves at the end of the spinal cord continues further down the spine. This bundle of nerves resembles a horse’s tail, and if a massive disk blowout occurs, prolonged pressure on these nerves can cause permanent paralysis of bowel and urinary function.
Several conditions can trigger this emergency. Sometimes an arthritic narrowing of the spinal canal will gradually compress the horse’s tail. At other times it’s an expanding tumour, spinal hemorrhage, birth abnormalities or an automobile accident. But the most common cause is the sudden collapse of the spinal disk.
How can patients know whether they’re suffering from severe backache due to a disk protrusion, or from the Cauda Equina Syndrome? There are several red flags.
Be suspicious if you’ve suffered from previous bouts of back pain, but this one appears to be the granddaddy of them all. Be particularly apprehensive if the pain is associated with numbness in one or, more commonly, both legs, and an inability to move the legs. Another red flag, “saddle anesthesia”. It’s the inability to feel anything in the body areas that sit on a saddle. And, if you’re unable to urinate, or have a bowel movement, the horse’s tail has been badly injured.
One authority adds, that a recent onset of sexual dysfunction is a red flag. But since many people suffer from this problem, the other flags are more reliable. Besides, if you’re suffering from excruciating pain, unless you the world’s greatest lover, sex at this point is not high on the list of priorities.
There are times in medicine when it’s best to let nature do the healing. But when the horse’s tail is injured this is not one of those times. This syndrome requires immediate surgery to remove the pressure on the horse’s tail. The sooner the pressure is relieved the greater the chance that bowel and urinary function will be restored.
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