Posts Tagged ‘chronic pain’

The Language of Pain – a review

August 29th, 2010

I recently finished The Language of Pain, by David Biro, M.D. A practicing physician in Brooklyn, NY, Dr. Biro also has a PhD in literature. This interesting combination of educational disciplines, together with Dr. Biro’s own experience as a patient with a blood disorder, leads to his thoughtful and philosophical writing on the isolating experience of pain. I presume that his earlier book, One Hundred Days: My Unexpected Journey from Doctor to Patient must focus more specifically on his personal (and unexpected) experience in bridging those worlds. The Language of Pain is a more general and outer-focused book, discussing how profoundly isolating the experience of being in pain is (be it physical or emotional pain) and how important it is to find means of expressing the experience.

The Language of Pain is an interesting read, pointing out that an understandable expression of the pain one experiences is necessary both to get proper treatment for the pain (or the underlying condition that causes the pain), and to keep people in pain from being isolated from their families, friends and community. Drawing on many examples from art and literature, Dr. Biro explores how metaphor enables us to take the diffuse experience of pain and put it in terms that others can understand. The book is illustrated with some of Frida Kahlo’s gripping paintings, as well as patient-generated works of art gathered by Deborah Padfield in a pain clinic in the UK, and other art. We read many passages from literature describing pain, disease, and bodily peril, from works by Tolstoy, London, Crane and Joyce, among others.

This is not a long book, but it took me a long time to finish. I found that some of the descriptions of pain were, well, painful for me to read. It may be that for one living with chronic pain, this book hits too close to home. Nor is it an easy read. His points are excellent, but perhaps Dr. Biro couId have expressed them in a more accessible manner. This may sound funny coming from me; an inveterate user of big words. I could have used less literary and philosophical analysis and more practical examples of how finding language for their pain has helped pain patients.

The book is subtitled “Finding words, compassion and relief.” Without doubt the writing is compassionate, and ignites the reader’s compassion. There was inspiration for me personally in the examples of words used to express pain; certainly I remembered them in my own moments of pain, and tried to be more conscious of expressing myself. It is the “relief” that I would like to have heard more of in the book. Maybe because relief from pain is something I long for in my own life, and for other sufferers. It wouldn’t be fair for me to fault Dr. Biro for not providing a magic wand! He pulls it all together very well in his postscript, stating:

More than just communicating one person’s experience, the metaphors of great writers contribute to our collective experience of pain. They add to our ever-growing repository of language, and to our ever-growing understanding of what it means to be human. Indeed, we should think of our great artists no differently than our great scientists. Both have profoundly practical goals; each works to help us understand and talk about what is not fully understood or communicable. But where the scientist shines his searchlight on the objective world, the artist strives to illuminate the subjective one.

One of the things that fascinates me most is the meeting and communication of our left and right brains, our analytical and intuitive sides, the scientist and artist in each of us. I love thinking about what having both an MD and a PhD in literature would bring to a person’s thinking and understanding of the world. Dr. Biro thank you, you have done an elegant job of sharing your thinking with us. I’ll expose my own prejudices as a coach when I ask, next book, would you give us a little more of how to use those two sides of the brain for relief in our own lives?

- Megan Oltman

To keep the FTC happy I will disclose that the publisher asked me if I might like to review the book in my blog, and sent me a free copy so that I might do so. They did not pay me to puff the book, and I won’t receive anything else from doing this review unless some of you decide to link in to Amazon and buy it there, which would net me a few pennies per book. The publisher has no doubt given up on me, as they sent me the book before it’s publication in January of this year.

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Posted in Books, Communicating, Managing, Medicine | Comments (0)

The Miracle of Pharmaceutical Engineering

September 3rd, 2009

Last week Karen Lee Richards of Chronic Pain Connection let us know about a technological advance in medication – the approval of Abuse-Resistant Morphine.  The idea is that extended release opioid-containing drugs like Oxycontin have been prone to abuse because they can be crushed, avoiding the time-release built into the capsule and allowing drug-abusers to take in large amounts of the drug at one time.

King Pharmaceuticals has created an extended release opioid, approved by the FDA and marketed as EMBEDA, which also contains Naltrexone, a drug that blocks opioid receptors.  If you take the drug as prescribed, no problem, the Naltrexone passes through your system without being released.  If, however, the capsule is crushed, the Naltrexone is released and the effect of the opioid is blocked. Very clever!  Read more about it in Karen’s excellent article: Abuse-Resistant Morphine Approved.

This is very good news for chronic pain sufferers who must rely on these types of drugs to get by – societal fears of drug abuse, drug seeking in emergency rooms and similar issues have made it harder to live as a person with a chronic pain condition.  For those of us who must use an opioid occasionally for Migraine rescue, it’s good news as well.

Now, not to take away from the seriousness of this, because it is really is a great advance, it does make me wonder – What other drugs could they engineer to make them abuse resistant?  What about our society’s most prevalent Legal drug – Could we put something in alcohol to make it stop intoxicating people once they approach their legal blood alcohol limit? Just sayin…

- Megan Oltman

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Posted in Current Affairs, Medicine | Comments (0)

Calling all Redheaded Migraineurs

August 9th, 2009

Now I know Migraine occurs in all human cultures, and people of all hair colors as well as all sorts of other characteristics, but I am interested in conducting a very unscientific study here… and certainly interested in knowing if any real studies have been done of this (I don’t know of any).

An article in the New York Times yesterday entitled The Pain of Being a Redhead discussed several studies which indicate that redheads are resistant to anesthesia, take on average 20% more medication to anesthetize (which has been known anecdotally by anesthesiologists for years), and may have a higher sensitivity to pain than the general population.

I shared this link on Facebook and very shortly got comments from 4 redheaded Migraineur friends! Now the comments were all over the place. Most of us agreed that as Migraineurs we deal with so much pain on a regular basis that we think our pain threshhold is higher rather than lower, though several of us have had the experience of being resistant to anesthetic or pain-relieving drugs. But here’s what I’m curious about – is there a high correlation between red hair and Migraine, or was my little flurry of redheaded Migraine buddies just a fluke?

Tara Parker-Pope, the article’s author, states that

a mutation in the MC1R gene results in the production of a substance called pheomelanin that results in red hair and fair skin. The MC1R gene belongs to a family of receptors that include pain receptors in the brain, and as a result, a mutation in the gene appears to influence the body’s sensitivity to pain.

If we redheads have a genetically altered sensitivity to pain, are we more prone to chronic pain conditions? I have no idea – but I do wonder!

- Megan Oltman

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Posted in Medicine, Musings, Science | Comments (10)

February Blog Carnival is Up: Sex and Migraines

February 9th, 2009

Yes, just in time for Valentine’s Day, what you’ve all been waiting for. Hop on over to Somebody Heal Me for the February 2009 Headache and Migraine Disease Blog Carnival.  To quote our host, Diana Lee:

The Headache & Migraine Disease Blog Carnival has been created to provide both headache patients and people who blog about headaches with unique opportunities to share ideas on topics of particular interest and importance to us.

This month’s carnival asks “Can Sex and Migraines Co-exist?,” says, “Tonight, Dear! I have a Headache!” as well as a number of other interesting posts on Migraines, sex, pain, and chronic illness. Please be sure to check it out!

- Megan

Red rose image courtesy of Jesslee Cuizon.

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September Pain Blog Carnival – New Beginnings

October 1st, 2008

Greetings my friends – I know you haven’t heard a lot from me in the past week, and I’ll come tell you all about it soon.  In the meantime, I want to point you towards some good reading over at How to Cope with Pain, a site which is a great resource for many kinds of chronic pain, Migraine included.  The September Pain Blog Carnival is posted today on the theme of “New Beginnings” – in keeping with back to school and our general tendency to get back to work in the Fall.  Check it out at September Pain Blog Carnival.

Talk to you soon!

- Megan Oltman

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Highlights from the American Headache Society Annual Conference

July 1st, 2008

Last week the American Headache Society held its 50th annual conference in Boston.  You may have read other news of the proceedings and the many new discoveries, inventions, understandings, and treatment options that were presented at the conference.  Lead expert Teri Robert of My Migraine Connection and Migraine blogger Eileen of My Life with Migraine attended the conference and will be posting a lot of information in the weeks to come.  If I may relay some tidbits second-hand, I was inspired to hear of their experiences in a collegial atmosphere where a number of dedicated medical professionals and advocates are working and sharing ideas to help bring us relief from this life-stealing disease.   I wish I could have gone along, but first things first.  I need to get my own migraines under better control before attending conferences, which have always tended to trigger me.  Though I suppose there might be no better place to be with a migraine!

The conference will provide material for many posts, both here and all around the Migraine blogosphere.  I’m going to share a couple of highlights that I am particularly interested in, and we’ll touch on more of the new information as I have a chance to digest it.

One new device which looks promising is the transcranial magnetic stimulation, or TMS, device.  Tested for use by those suffering from Migraine with Aura, the TMS device is held at the base of the skull at the first sign of aura (visual and sensory disturbances experienced by about 20% of migraineurs).  You push a button to deliver two short magnetic field pulses to the brain.  Apparently these pulses scramble and abort the abnormal electrical activity which takes place in the brain during a Migraine attack.  The basic black and white model looks good for this raven-haired lady; maybe they’ll come out with some more colors soon!  But seriously, this is a great alternative, since everyone can’t use triptans, and even if you can, triptans knock you out of action for a while.

New research was presented about Why Pain Becomes Chronic.  New understandings of how pain becomes chronic can help headache specialists develop new therapies which can help sufferers with Chronic Daily Headache.  One of the new understandings involves the role of glial cells in the brain, which agitate neurons, increasing pain signals to the brain.  Use of opiates appears to activate glial cells, so can contribute to the development of chronic pain.  Research was also presented indicating that expectation of pain affects its severity, that in the case of chronic pain, the nervous system “over-reacts” but that this overreaction is physiological, not psychological.  A very important distinction – biological changes have been observed in the nerves themselves.  In other words, the pain is “all in our heads,” in physiologic structures in the brain, not “all in our heads” in any psychosomatic sense.  I must say I feel vindicated – read my post It’s All in your Head on the difference between what’s in our heads physiologically and the old psychosomatic accusation we are so often subjected to.

Yet another piece I am particularly interested in deals with Migraine in women and the role of hormones and the menstrual cycle.  More on that when I know more!

Overall, the good news is, there are good people out there looking out for us, working hard to find ways to treat this disease.

- Megan Oltman

Neurons image courtesy of Rebecca Radcliff.

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Posted in Advocacy, Medicine, Science | Comments (4)

Pain on the rebound

January 14th, 2008

Pain is as diverse as man. One suffers as one can. Victor Hugo

The worst pain I have known was not in childbirth. My brother, who is a physical therapist, told me that he sometimes asks women (if they have given birth) how the pain of the physical therapy compares with labor pains. I have had migraines that were worse than any labor pains. I have had injuries worse than any labor

At the end of labor pains comes a blessed event, a birth, the beginning of a life. We finally meet this child who has kicked, wriggled and squirmed inside us all these months. And physical therapy is pain tomake better an injury, to cause healing, improve function. The outcome lacks the drama of birth, but at least we suffer the pain for a good cause.

The worst pain I ever felt was when I broke and dislocated my elbow. The birth theme comes into it – I broke it 8 months pregnant with my second child. I had dropped my daughter at nursery school and was taking an early morning walk, dutifully keeping fit and getting ready for labor. I stepped on a patch of black ice and slipped. My feet flew to the left
and I came down on the heel of my right hand, with my arm extended and elbow locked, taking the entire weight of my pregnant body on that arm. I managed to walk the two blocks back to the nursery school, crying with pain. I walked in and interrupted the teacher and parent who were talking in the doorway, said “Excuse me, I think I broke my arm,” and promptly went into shock.

I have had migraines where I cried with the pain, crying making the pain worse, I moaned with the pain, moaning making the pain worse, I vomited from the pain, vomiting making the pain worse. The best that can be said for a migraine like that is that you know it will pass, in a few hours or many, that this will not
be forever.

I can’t speak to severe chronic pain – I know there is pain that makes people wish to die. I can speak
to moderate chronic pain – the pain of daily headaches, pain that nags, wears you down, beats you, backs
down some, comes back. When I had medication rebound headaches, I learned that I had to endure the pain to get to the point where I would stop rebounding. And since I am sensitive to medications, this has happened more than once.  And so I learn it again.

When I had a dislocated elbow, the worst part was when the doctor “reduced” the dislocation in the ER, popping it back into place. Few things make me scream aloud. That did. That was the worst pain I ever felt. Worse than the break, worse than any migraine, worse than labor pains, or my herniated disk, or my other broken arm. And as soon as it was over, when the elbow was back in place, even still broken, the pain ended.

So yes, this is my (tortured) analogy. This is where I was heading. My heart goes out to everyone in pain. Seek comfort and pampering as best you can. If you are having rebound headaches, just like reducing the dislocation, just like physical therapy, the pain will lead to a good outcome – enduring it, moving through it, will end it.  I’m sorry it’s not a magic pill.  It’s the best I’ve got.  Just hope.

- Megan

Feeling well, wishing you the same

morning breaks courtesy of lida rose

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