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«© Copyright 2007 Forest Tennant, MD, DrPH VERACT INTRACTABLE PAIN CLINIC 340 South Glendora Avenue; West Covina, CA 91790-3043 626-919-7476; E-mail: ...»

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The

Intractable Pain

Patient’s Handbook

for Survival

by

Forest Tennant, MD, DrPH

The

Intractable Pain

Patient’s Handbook

for Survival

by

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: veractinc@msn.com; 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-

sion, provided:

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

Forest Tennant, MD, DrPH, attended the University of Kansas Medical School on a US Army scholarship and later served on active duty as an Army medical officer during the Vietnam War era. Following active military duty, he transferred to the United States Public Health Service assigned to the UCLA School of Public Health as an academic research fellow. In addition to military experience he has served as a medical advisor to many sports organizations to deal with their pain and drug problems. In 1975 he started his pain clinic initially focusing on cancer and post-polio patients. As an inter- nal, preventive medicine specialist, he believes that chronic pain should be medically managed over a lifetime like other chronic medical diseases such as asthma, diabetes, or hypertension. Dr. Tennant has published over 200 scientific articles and pioneered research on the treatment and complications of in- tractable pain. He helped sponsor the California Intractable Pain Act and the Pain Patients Bill of Rights.

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 AUTHOR

This 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 NOTICE

This 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





CARDIAC-ADRENAL-PAIN SYNDROME

BLOOD PRESSURE AND PULSE RATE – CRITICAL MEASUREMENTS

NECESSITY FOR OPIOID DRUGS

BIAS AGAINST OPIOIDS

FIRST STEP OPIOIDS

STEP TWO OPIOIDS

BREAKTHROUGH PAIN

DON'T DEPEND ON ONE FAVORITE OPIOID OR ROUTE OF DELIVERY

ANCILLARY MEDICATIONS

SLEEP

MUSCLE RELAXANT-ANTI-ANXIETY AGENTS

NERVE BLOCKERS

NUTRITIONAL AND HORMONAL AGENTS

TOPICAL MEDICATIONS

CONSTIPATION

NEUROGENESIS: KEY TO CURE

ANABOLIC THERAPY

STRETCHING EXERCISES

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

WEIGHT GAIN

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

ADVOCACY GROUPS

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.. 31

OVERDOSE DEATHS: WHY DOCTORS ARE STOPPING PAIN PRACTICE

MILESTONE: PAIN FREE HOURS

APPENDIX

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 PLIGHT

There 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 SYMPTOM

Always 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.

DEVELOP A SURVIVOR MENTALITY

Now that you have accepted your condition and you begin to consider pain your enemy, you must develop a positive attitude of hope and survivorship. Why? We no longer consider IP entirely hopeless and incurable. Recent medical research advancement is fast and furious. While I make no guarantees, I now see many IP patients who used to have severe, pain 24 - 7, but now have some pain free hours or even days. There are new terms you have to learn along with the word "intractable.” First, you must know about the "cardiac-adrenal-pain syndrome." This is essentially the biologic difference between ordinary chronic pain and IP. The life-shortening, debilitating mechanism by which IP destroys a life is the overstimulation of the cardiac and adrenal hormone systems in the body. A term of hope is "neurogenesis."



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