«© Copyright 2007 Forest Tennant, MD, DrPH VERACT INTRACTABLE PAIN CLINIC 340 South Glendora Avenue; West Covina, CA 91790-3043 626-919-7476; E-mail: ...»
Forest Tennant, MD, DrPH
Forest Tennant, MD, DrPH
© Copyright 2007 Forest Tennant, MD, DrPH
VERACT INTRACTABLE PAIN CLINIC
340 South Glendora Avenue; West Covina, CA 91790-3043
626-919-7476; E-mail: firstname.lastname@example.org; Website: www.intractablepaindisease.com
Published by Pain Treatment Topics
Glenview, IL, USA
http://www.Pain-Topics.org (cover revision June 2007) The mission of Pain Treatment Topics is to serve as a noncommercial resource for healthcare professionals and their patients, providing open access to clinical news, information, research, and education for a better understanding of evidence-based pain-management practices.
This Handbook may be copied and distributed to patients or healthcare providers without prior permis-
all copyright information is retained in the copied document, and the document is distributed free of charge.
If recipients are charged for this Handbook, prior permission for distribution must be obtained.
ABOUT THE AUTHOR
This Handbook was written to provide intractable pain patients and their loved one's a guidebook based on Dr. Tennant's 30 years of experience in dealing with pain problems.
AN INTRODUCTORY WORD FROM THE AUTHORThis Handbook is primarily intended for persons who have intractable pain (hereafter called IP). Others who may read this Handbook will hopefully not be shocked but gain an understanding of a relatively rare medical condition. I started my IP clinic more than 30 years ago in 1975. Since then I have learned and observed a great deal that I believe should be passed on to those afflicted with IP. Some of my current beliefs and recommendations,as time passes and science progresses, may need to be altered. Until such time, this Handbook provides the best information and knowledge I have obtained during the past 30 years in the field of intractable pain.
DEDICATION To the many fine IP patients and their families who I have treated during the past 30 years, and who have taught me the material written in this Handbook.
IMPORTANT NOTICEThis Handbook is based on the author’s years of education, research, and clinical experience, and is made available as a public service by Pain Treatment Topics. It does not take the place of advice from a qualified healthcare provider that addresses a particular patient’s pain disorder and/or medical needs.
Neither the author nor Pain Treatment Topics endorse any medications, products, services, or treatments described in this Handbook. Nor are any representations made concerning efficacy, appropriateness, or suitability of any medications, products, services, or treatments. Product brand names mentioned in this document are registered trademarks of their respective manufacturers and are presented for informational purposed only.
In view of the possibility of human error or advances in medical knowledge, Pain Treatment Topics does not warrant the information contained in this Handbook is in every respect accurate or complete, and is not responsible nor liable for any errors or omissions, or for results obtained from the use of this information. The users of this Handbook assume all risks of use and shall indemnify and hold the author and Pain Treatment Topics harmless from and against any and all damages, liabilities, losses, costs, and expenses, including reasonable attorney's fees, arising out of or related to the use of information, products, or services mentioned in this Handbook.
Tennant - Intractable Pain Patient’s Handbook for Survival ©2007 2 CONTENTS YOU'RE A RARE BIRD
ACCEPT YOUR PLIGHT
A NEW ATTITUDE: PAIN IS YOUR ENEMY – NOT YOUR SYMPTOM
DEVELOP A SURVIVOR MENTALITY
YOUR CLOSE AND LOVED ADVOCATE AND CONFIDANT
MAKE AN INVENTORY OF PAIN TRIGGERS
DON'T BUY THE "MAGIC BULLET" CRAZE
MAKE AN INVENTORY OF PAIN RELIEVERS
ATTACK IP FROM MANY DIRECTIONS AT THE SAME TIME
KNOW YOUR CAUSE OF BY ITS MEDICAL NAME
COMPLICATIONS OF INTRACTABLE PAIN
BLOOD PRESSURE AND PULSE RATE – CRITICAL MEASUREMENTS
NECESSITY FOR OPIOID DRUGS
BIAS AGAINST OPIOIDS
FIRST STEP OPIOIDS
STEP TWO OPIOIDS
DON'T DEPEND ON ONE FAVORITE OPIOID OR ROUTE OF DELIVERY
MUSCLE RELAXANT-ANTI-ANXIETY AGENTS
NUTRITIONAL AND HORMONAL AGENTS
NEUROGENESIS: KEY TO CURE
DEALING WITH YOUR FAMILY AND LOVED ONES
WORK WITH YOUR HEALTH INSURANCE PLAN
FINDING A DOCTOR TO TREAT IP
STRESS CONTROL: MAINTAIN YOUR SPACE
TRAVEL AND WALKING TIPS
PREVENTING DEMENTIA AND MENTAL DETERIORATION
TOOTH DECAY AND OSTEOPOROSIS
POTENTIATORS: WHAT ARE THEY AND HOW TO USE THEM
THE TYLENOL® PROBLEM
DIET: PROTEIN IS YOUR BEST FRIEND
KNOW YOUR CAUSE AND ATTACK IT
PAIN RELIEF FOR SURGERY OR DENTAL PROCEDURES
CUTTING DOWN AND WITHDRAWING FROM OPIOIDS
INTERVENTIONS – A NEW TERM IN PAIN TREATMENT
IMPLANTED OPIOID PUMPS AND ELECTRICAL STIMULATORS
HORMONE REPLACEMENT AND TREATMENTS
Tennant - Intractable Pain Patient’s Handbook for Survival ©2007 3 QUALITY OF LIFE
PLANTS, PETS, AND MUSIC
GETTING YOUR MEDICATIONS IN THE HOSPITAL
YOU NEED A MINISTER AND LAWYER
HUMOR AND MOTIVATION – KEEP SMILING
SELF CHECK FOR OVER-MEDICATION
KEEP A ONE WEEK RESERVE OF MEDICATION
NEVER RUN OUT OF MEDICATION
YOUR MEDICAL RECORDS AND MRI'S
DON'T BE A SOAP OPERA
APPLYING FOR DISABILITY OR WORKER’S COMPENSATION
SELECTING AND TRAINING YOUR PHARMACIST
THE DRUG VICES: ALCOHOL, MARIJUANA, NICOTINE, COCAINE, AND METHAMPHETAMINE.. 31OVERDOSE DEATHS: WHY DOCTORS ARE STOPPING PAIN PRACTICE
MILESTONE: PAIN FREE HOURS
Inventory of Pain Triggers
Inventory of Pain Relievers
DIET FOR WEIGHT CONTROL
Schematic for Neurogenesis
Schematic for Basic Stretch & Hold for IP Due to Spine Degeneration
YOU'RE A RARE BIRD The biggest problem an intractable pain (IP) patient faces for survival is that a bona fide IP patient is a rarity among chronic pain patients. Chronic pain, by standard medical definition, is a pain that is present over 90 days, and which can be continuous or intermittent. Millions of people have chronic pain. Common arthritis, TMJ, carpal tunnel, bunions, and headaches all qualify. However, true IP, as defined here, is constant, severe, disabling pain, which causes changes in pulse rate, blood pressure, and adrenal hormone production. This form of pain is relatively rare. Control of IP requires the daily use of prescription medication. I estimate that one IP case occurs among about every thousand chronic pain patients.
Due to IP's rarity, almost every doctor, insurance plan, hospital, or family member you encounter will initially assume you are just another, average, chronic pain patient who can get by with the standard firstline treatments such as exercise, positive mental attitude, acupuncture, massage, and non-prescription drugs. To survive, you will constantly have to fight this misconception, and you must educate most of the people you encounter.
IP patients all require a custom-made, one-of-a-kind treatment plan. Most physicians and other medical personnel you encounter may be bewildered and even fearful of your treatment, because they may not have encountered another patient with your pain severity.
Tennant - Intractable Pain Patient’s Handbook for Survival ©2007 4
ACCEPT YOUR PLIGHTThere is nothing more demoralizing and depressing than to have severe pain that never stops. It is OK to ask the question. (Why me, Lord?) This is a natural reaction. You can and will repeatedly try to analyze what you could or should have done to prevent it.
No doubt you will try to blame or finger point someone or some event as the culprit for your problem.
You will hope and pray that you are in some nightmare that will be gone when you awake.
Go ahead and cry as often as you need. You probably have every right and reason to feel sorry for yourself. After all, IP is a sorrowful condition.
However, there are two absolute "musts" for IP patients:
1. Do not let pain make you think you are a bad person or some evil spirit. Take it from me:
some of God's very best children have IP.
2. Accept the fact that you have IP. Think of it as a disease that can be controlled and, with a little help from medical science, may even be cured some day.
It sounds so obvious and simple, but the hardest thing an IP patient to do is, down deep in your mind, heart and soul, stop denying that you have a serious, life-shortening, medical condition that will not go away. You have undoubtedly heard, for example, that alcoholics and addicts are often "in denial" that they have a problem. No question about this. It is human nature to deny that one has a serious, incurable disease. There is also no question that an IP patient may have may have a greater degree of denial than the alcoholic or addict, because so many people ignorantly tell you "your pain is all in your mind." You must accept your plight, because denial will keep you from embarking upon a path that will effectively control your pain, give your life meaning, and extend your life. Every single day you delay effective pain control will cause your body to literally age and your organs rust away. Too long of a delay may leave you in a permanent demented, vegetative state. Bottom line. For whatever reason and whatever the cause, you have IP. (Let's accept it so you are not paralyzed and incapable of attacking your problem.) What does this sentence mean? Does it mean – "Accept the fact that you have IP so you will not become paralyzed due to this condition, and incapable of attacking your problem and aggressively treat it.
A NEW ATTITUDE: PAIN IS YOUR ENEMY – NOT YOUR SYMPTOMAlways remember that true IP is relatively rare compared to other forms of pain. This understanding is critical since society bombards you with all kinds of clichés and sayings about pain that not only do not apply to you, but may likely prove to be destructive.
The statements, "No pain, no gain" and "When the going gets tough the tough get going," are truly positive and meaningful to the healthy sportsman, soldier, or weekend gardener with a typical, run-of-themill injury to his or her back, elbow, or knee. Chances are that the injury, once healed, will make the person even stronger and more competitive. After all, many successful champion athletes "tough out" some pain and win. The difference we are talking here concerns pain and nerve damage that is healable, not IP that is caused by some permanent nerve damage and, in most cases, cannot be healed.
Your IP pain is long-standing, constant, keeps you from sleeping, drives up your pulse rate and blood pressure, and alters your adrenal hormone levels. You must remember that your pain is your enemy. To cause it to worsen or flare for any reason may do further damage to nerves and other body tissues that are already permanently damaged.
Tennant - Intractable Pain Patient’s Handbook for Survival ©2007 5 Your attitude about pain must change. Increased pain hurts you. When the pain flares, your pulse rate increases, and hormones stored in your adrenal gland flood your system causing further body deterioration, rusting, and aging.
Therefore, you MUST do whatever it takes to suppress your pain and prevent flare-ups. You simply want to keep pain as far away and as controlled as possible. Never try to "work through it" or "tough it out" or believe that character and will power will solve your problem.