New Focus on Dealing With Pain, Coping With Stress
Maintaining Your Health
on Mackinac
By Yvan Silva, M.D.

Pain is one of the most common reasons that patients seek medical care. Most often they try remedies and the pain continues and diminishes the quality of life. Pain is an important and serious symptom, and it is most understood and appreciated singularly by the patient. As we grow older, as we succumb to illnesses, pain can become a daily component of our lives.

Chronic pain is difficult to live with. It alters our lives and affects the people around us. It is difficult for the doctor to quantify the pain experienced by a patient because it is so subjective. And therein lays the problem: Doctors for so long have under-treated pain.

It has been too easy to dismiss the complaints as exaggeration, malingering, or even an expression of drug addiction. Physicians have found it easy to hold a high moral ground and avoid promoting an addictive regimen while ignoring the reality of pain and the need for effective treatment. On the other hand, physicians who aggressively prescribe controlled substances to help patients with severe pain have often run afoul of the authorities and faced potential threats to their licenses.

Sudden and severe pain can result from fractures and injuries, while other conditions can cause chronic and disabling pain, ranging from advanced arthritis to advanced cancer. A recent survey found that four in 10 dying patients were in severe pain most of the time. A New York study found that 71 percent of doctors said they had under-medicated pain, for fear of potential problems with the authorities. Our society continues to look upon chronic usage of drugs as addiction, and that is looked down upon as weakness.

The fact that pain can really be controlled is gratifying. Newer, highly effective techniques are now available. It’s good to know that several initiatives are underway to facilitate this area of medical care.

Five years ago, federal legislation promulgated the Pain Relief Promotion Act. This act recognizes that “the dispensing or distribution of certain controlled substances for the purpose of relieving pain and discomfort, is permissible under the Controlled Substances Act.” This measure gave physicians added legal protection and was supported by the American Medical Association. It recognizes the legitimacy of prescribing drugs to patients to relieve pain and suffering. There is the prohibition against using controlled substances in assisted suicides, of course.

The question of treatment with painkillers and drug abuse has been long-standing. A recent article in a leading medical journal reported on the use of opioid-based analgesics (morphine and analogous drugs) to treat severe pain, and its relationship to drug abuse and found that even though the use of these painkillers for medical purposes has increased, the rate of abuse of these prescription drugs remains relatively low.

Common types of pain include a broad spectrum of headaches that can range from mild, such as a tension headache, to severe, incapacitating pain from a migraine. Arthritis pain results from wear and tear on the joints, such as osteo-arthritis, swelling and thickening of the soft tissues around the joints, or rheumatoid arthritis. Low back pain may be related to abnormalities of the spine or muscle strain; poor posture and lack of exercise can contribute to this. Cancer pain can be relentless and result from a number of conditions including pressure caused by a growing tumor or spreading tumor growths.

There are several classes of drugs used in pain control. Acetominophen is a non-aspirin pain reliever. Anti-inflammatory drugs such as aspirin, ibuprofen, and naproxen work to reduce pain and inflammation. Narcotics, such as the opioid-based drugs, are used to treat more severe pain, such as occurs after surgery. Acute attacks of pain are usually well treated with over the counter or, when needed, prescription painkillers. It is long term, chronic pain that remains the scourge of many. Here, the cause of the pain cannot be eradicated, such as in arthritis, and pain management may remain a lifetime pursuit.

Physical therapy, the use of specific exercises and activities to help control pain and improve physical functioning, is one of several therapies for treating pain. Psychological therapy, individual or group counseling with a trained health care professional, can help by offering support and by providing techniques to cope with pain. Relaxation techniques deal with stress and tension that can make pain worse.

If you’re experiencing pain, your doctor will help you determine the underlying pathology and work with you to find safe and effective options for pain management. There has been a shift in attitude and pain management is emerging as an important specialty. Indeed, most medical centers now operate pain clinics for the many patients who need continuing care in this regard. New medications are being discovered rapidly and delivery systems are improving. Recently, dermal patches are becoming popular for slow and around-the-clock delivery for those who need continuous relief. There is a rise in empathy for people in pain and the professions are responding favorably so that people living with pain can find proper relief and a good quality of life.

The objective evaluation of pain is necessary to enable adequate treatment. Termed the new “vital sign,” it is taking its place along with blood pressure, pulse rate, respiratory rate, and temperature in all medical records. Rated on a scale of 10, patients are asked to rate the amount of pain to establish levels and then measure improvement after pain medication is administered.

Stress seems to lurk in the background of our lives, coloring our accomplishments and our failures, influencing our mentalities, anxieties, and dream patterns. Just what is stress?

The term was first coined by the famous scientist Professor Hans Selye, who described it as the "fight or flight" phenomenon. He found that when threatened, animals would survive their predators by one of these two mechanisms, and at the time of attack the output of adrenaline into their bloodstreams would increase more than forty-fold, providing huge amounts of energy for the required physical response.

In the 1980s the term "stress" emerged as a buzzword in our everyday conversations replacing common terms such as, worry, impatience, fear, or anger, leading to “stressed-out,” or “stress-related” bases for poor performance. It was speculated to be a factor in a variety of illnesses.

Stress is now becoming recognized as how people respond to demands. A practical definition: When the problems presented by everyday life exceed your resources for coping with them, you feel stressed. Recent psychological studies of people who respond to demanding situations without losing their sense of well-being are helping to define the "stress-resistant" person.

In a comparison of coping styles of students with the most and the fewest episodes of illness during a given period, one study showed that those who reported little illness tended to maintain reasonable personal control in their lives. If a problem came up, they would look for resources or try potential solutions. People who approached problems passively tended to be ill more frequently. Goal-oriented individuals did better in careers, community activities, hobbies, setting goals in physical fitness, and maintaining a disciplined regimen of exercise.

Choices in lifestyle clearly enhance the ability to cope with stress. Minimum use of substances such as nicotine and caffeine reflects the "take charge" attitude associated with coping. People who are most vulnerable to stress are most likely to complain they don't have time to relax and tend to be more socially isolated. People who deal well with stress tend to seek out other people who are active and have positive attitudes.

In a large group study, 80 percent of a low-illness group engaged in regular aerobic exercise, whereas only 20 percent of the vulnerable group did so. There are several ways that exercise can ease stress. According to the American Council on Exercise, anxiety is diminished following exercise and the electrical impulses measured in muscles decrease; one exercise session generates as much as 90 to 120 minutes of relaxation response, often described as a post-exercise high. Exercise makes you feel better about yourself and self-worth contributes to stress relief.

Surely, certain jobs are associated with higher degrees of stress than others, and certain lifestyles compromise good health. It is now becoming clear that stress-resistance can be pursued successfully by problem-solving approaches to unpleasant situations, healthy social bonding, dedicated time for relaxation, and maintenance of a regular physical exercise regimen.

There has to be a conscious decision that, although one may not be able to change or eradicate the factors causing stress, accepting that there is stress is the first step. Combating stress is the next. Relaxation and the pursuit of simple pleasures is one way– to smell the roses, to take a walk, to see a movie, to get away from it all. The other may be to face it head on –“Get with it, get a life!”

Dr. Silva is a professor of surgery at Wayne State University and a resident of Woodbluff on Mackinac Island.