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December 20, 2013

STAWAR: Holidays of pain

— Last Friday, I got something for Christmas I hadn’t been expecting — a cortisone shot in the knee. I’ve been in denial about my knee problems, but the old high school football injury has finally caught up with me.

I’ve never had much tolerance when it comes to pain. My modest request is simple. All I want is immediate and complete relief.

My doctor seems to sense that I’m not to be trusted with pain medication. I have told him several times about my knee discomfort, but he usually suggests either walking it off or taking a Tylenol. I wonder if he thinks I’m a hypochondriac who is just overanxious.

This time, the knee pain was pretty intense so he tried the cortisone. I could swear he had a smile on his face when he told me that since my knee was swollen the needle didn’t have to go in very far, and then he added with a grin, “ You don’t have any problem with shots, do you?”

It reminded me of the story that Sigmund Freud told about the boy in his village who went around cutting the tails off of dogs and grew up to become a surgeon. The shot itself was not as bad as I imagined, and was certainly no worse than getting a shot in your gums at the dentist.

Some of my fear of pain may actually stem from my childhood dental work. As a youngster I was allergic to the anesthetic that dentists typically use. So instead they just gave me a mild tranquilizer and drilled very slowly. I’m not so sure that slow dental work is very desirable.

When I would go to the dentist for a filling I remember pretending that I’d been captured by the Viet Cong and was being tortured so they could learn the positions of our troops. Our troops were just lucky that I didn’t know where they were.

This time my doctor broke with tradition and prescribed some pain medication. He said I should treat the pills like they were diamonds and only use them if I had trouble sleeping. As I was leaving his office I considered popping a couple of them before I hit the elevator, but I decided I needed to be more sensible. I was less afraid of abusing the medicine than I was of using it up.

I don’t believe that my knee problem had anything to do with the Christmas season, but the stress and strain of the holidays can easily aggravate, or in some cases even bring on, significant pain and discomfort for many Americans. Standing up to bake, cooking large holiday meals, walking for hours in shopping mall, all combined with overindulgence, can be too much for people with recurrent pain conditions.

According to 2011 Gallup-Healthways survey data, 47 percent of Americans report having at some sort of chronic pain. About 30 percent of people experience chronic neck or back pain, about a quarter of Americans report knee or leg pain and 18 percent say they have some other kind of chronic discomfort. An unfortunate 7 percent claim to have all three.

If life were not unfair enough already, Alyssa Brown, from the Gallup Organization, says that low income and overweight Americans are much more likely to experience chronic pain. According to The International Association for the Study of Pain, “Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage ...”

From an evolutionary perspective, pain has an adaptive function since it motivates the individual to withdraw from dangerous situations, teaches us to avoid such situations in the future and encourages us to let the injured body parts to heal without disturbance.

It is estimated that in the United States more than 76 million people suffer from pain. It is the most common reason that Americans consult their physicians. Pain is the presenting problems for more than 30 percent of family practice visits and 50 percent of emergency room visits. It is also the most frequent reason that people use alternative medicine approaches such as acupuncture.

Differences in pain thresholds are related to ethnicity, genetics and gender. Self-reporting is generally the most reliable way to measure pain. According to Allan Basbaum, chair of the anatomy department at the University of California, pain that comes from damaged nerves, rather than damaged tissue, generally produces the most excruciating pain. Since pain, however, is so subjective, it is difficult to compare the different types. The pain from certain cancers, childbirth, kidney stones, dry socket, root canals, cluster and migraine headaches, trigenanal neuralgia, spinal cord injuries, burns, and gall stones are usually at the top of most lists.

Health care professionals often tend to underestimate the severity of a patient’s pain. Research suggests that most doctors are desensitized to such pain.

Back in 2001 the Joint Commission on Accreditation of Healthcare Organization introduced pain management standards for most of their accredited facilities. These standards require hospitals and other health care organizations to recognize patients’ rights to periodic assessments of pain, as well as ongoing pain management and education. It was this initiative that lead to all those posters with smiley and frowny faces in examining rooms and patients being routinely asked to rate their pain on a scale of one to 10.

Karen Lee Richards is a writer and co-founder of the National Fibromyalgia Association. In an article that she wrote for the Fibromyalgia AWARE magazine, she describes how people with chronic pain can best survive the holidays.

First of all she says that people need to eliminate any residual feelings of guilt they might have, saying, “It’s time to stop blaming yourself because you can’t provide the elaborate holiday festivities you once did or because you can’t do everything you think your family expects you to do.” Instead, she suggests focusing on the truly important aspects of the holidays like “expressing your love and thankfulness for family and friends.”

Secondly, she says that priorities should be established so that the most important activities are addressed. Richards also believes that it is essential to communicate clearly and assertively with family members about physical limitations.

Finally people need to think ahead. Careful planning and anticipating various scenarios, can help people prioritize, delegate tasks when possible, and devise more creative ways to accomplish holiday goals.

Personally, I’m hopeful that my bum knee won’t interfere too much with our holiday plans. Last year I opted out when my daredevil wife Diane decided to try out the outdoor ice skating rink in Jeffersonville, but this year she is talking about possibly going sledding or snow tubing.

My knee is throbbing already just thinking about it.

— Terry L. Stawar, Ed.D., lives in Georgetown and is the CEO of LifeSpring the local community mental health center in Jeffersonville. He can be reached at tstawar@lifespr.com. Checkout his Welcome to Planet-Terry blog and podcast at www.planetterry.wordpress.com

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