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BIG DANGEROUS PAINS
Norman Marcus, M.D.
Excerpted from
Bottom Line's Daily Health News, April 12, 2004
The headlines are filled with stories of celebrities and "plain folk" alike who become addicted to pain medications after suffering an injury. While it is tempting to think that the sufferers are emotionally weak or victims of their celebrity, according to Dr. Norman Marcus, founder of the Norman Marcus Pain Institute in New York City, past president of the American Academy of Pain Medicine and author of Freedom from Pain, the problems are real and related to the misunderstanding of chronic pain.
Everybody understands acute pain. When you burn yourself or break a bone, there are obvious physical signs. You experience the pain, and then the injury heals. You forget about it, and life goes on.
Chronic pain, on the other hand, is not necessarily related to any current tissue damage. Your injury may have healed, but you are still in pain. It's much more complicated. People with acute injuries describe their pain with simple adjectives such as "sharp" and "shooting." When those in chronic pain describe how they feel, they are apt to use emotional rather than physical language: "It's torturing me." "It's killing me." "What did I do to deserve this?"
Chronic Pain: Overwhelming and Undertreated
Most people, even physicians, can't identify with chronic pain unless they also have had it, says Dr. Marcus.
People with chronic pain look healthy on the outside but suffer terribly on the inside. Chronic pain goes on and on, without obvious physical manifestations. It affects you emotionally and demoralizes you. You feel as if there's no hope, and you lower your quality of life. You may be depressed and unable to sleep.
Dr. Marcus notes that 50 million to 60 million Americans suffer from chronic pain, and in his view, undertreatment of this condition is a major problem. He believes that the best approach to controlling chronic pain is multidisciplinary -- a combination of therapies, such as medication, physical treatment, stress reduction and psychological support.
Muscle Management
In many cases, all the causes of chronic pain are not properly evaluated. The most common complaints are low back pain, headaches, neck, shoulder and joint pain. All of these conditions may have a muscular component. For Dr. Marcus, the first line of diagnosis for chronic pain involves looking at the physical condition of the patient. Much of the body is made of muscle. In spite of this, most evaluations of pain do not recognize muscles as a major cause. At Dr. Marcus's clinic, an effort is made to diagnose underlying muscle pain and to treat it with exercise, massage, electrical stimulation techniques and his unique muscle-softening injections.
- Exercise. When you're hurting, your first impulse may be to stay still until the pain goes away, but recent research indicates a link between chronic pain and weak, atrophied muscles due to stiffness and deconditioning. An important basic concept in any exercise program is to first relax the muscle, then move it in the range of comfort (limber), then stretch and finally strengthen. Don't strengthen without taking these other steps first, or muscles will stiffen even more.
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Massage. Massage can benefit muscle tension and pain. It relaxes muscles and stimulates blood flow through the muscles, sometimes better than simple exercise.
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Electrical stimulation. This technique is important in the treatment of spasm and as a follow-up to trigger point injections. Neuromuscular stimulation (NMS) can alleviate most spasms in four to five days. This technique works by causing the muscle in spasm to move passively, first in a continuous (tetanizing) contraction followed by a rhythmic contraction. Dr. Marcus also uses NMS following muscular injections to facilitate healing.
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Trigger-point injections. Trigger points are painful, hardened knots that develop in muscles after injury or repetitive strain. These sensitive spots may lie dormant for years until physical or emotional stress sets them off, triggering pain and muscle spasms in the affected muscle or even a distant muscle. There is frequently more than one tender muscle in the painful area, sometimes causing confusion as to which muscle needs to be treated. The Marcus Method can electrically identify the muscle causing the most pain and at the same time avoid unnecessary injections. There are different techniques to treat trigger points -- Dr. Marcus's technique is so different that he calls it a muscle softening injection. After each injection, there is a physical therapy program to restore the maximum length of the injected muscle. With this technique, muscles are rarely ever reinjected.
Stress Reductions and Psychological Support
Stress is one of the primary creators of muscle pain. When you're under stress, muscles tense up and pain gets worse, notes Dr. Marcus. Stress management strategies may include exercise, relaxation techniques, yoga, meditation, aromatherapy, long walks, music and herbal baths. Choose one that works best for you. By reducing stress, you can often alleviate the pain.
Depression Risk
Severe chronic pain can lead to anxiety and depression, which can cause or intensify the perception of pain. In certain cases, treatment for underlying psychological disorders is important and may include both medication (such as antidepressant and antianxiety drugs) and psychotherapeutic approaches. For example, cognitive-behavioral therapy directly addresses pain-related thinking and behavior to promote better coping skills.
Medication for Chronic Pain and the Fear of Addiction
According to Dr. Marcus, if nothing can be done to eliminate the underlying cause of pain, the provision of pain-relieving medication that improves your ability to function is a good and reasonable treatment. He acknowledges that a fear of addiction to prescription drugs is a concern but stresses that addiction is very different from physical dependence. Anyone who takes an opioid, such as codeine, for four days or more shows some signs of physical dependence, he says. Addiction is a psychological state in which the addict compulsively takes the drug for mood alteration and ignores the damaging effects of misuse of the medication. However, reasonable use of a pain medication under a doctor's close supervision -- even for extended periods of time -- does not make a person an addict.Another important fact is that there is no standard dose for a person in pain. The dose is whatever amount relieves the pain without interfering with the ability to function. Addiction is the result of genetic factors and psychological predisposition. The vast majority of patients receiving prescribed painkillers do not get addicted.
The bottom line is you don't have to suffer. There is a treatment out there for you.
