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Chronic Pain - Managing The Unmanageable - Part I

Chronic muscle pain is an extraordinary problem that demands a comprehensive approach for a successful outcome. Most of this article will be devoted to understanding the complexity of treating chronic pain. At the conclusion is a proposal for helping the victims of chronic pain. Though the proposal only represents the initial baby steps to organize a chronic pain group, it is helpful to remember that all journeys begin with the first step.

Muscle pain can be categorized as transitory and chronic. Transitory pain is produced by recent minor trauma and resolves fairly quickly with treatment. Recent examples in my massage practice include a week-end golfer who strained her muscles by playing 72 holes after a long hiatus from the links. Another client suffered neck and lower back pain after being rear-ended in a slow-speed car collision. Many tourists drive long hours non-stop to hurry up and get their vacations started. They arrive completely locked up in pain, and need relief before they ever get to step foot on the beach. With each of these clients, pain relief was immediate and complete after one session BECAUSE the problem was not compounded, but addressed at the first sign of pain.

When pain is endured on a daily basis over a protracted period of time, it affects people physically, spiritually and psychologically. Treating the entire human paradigm is necessary for success. I call it “tissues and issues”. Common sources of chronic muscle pain include fibromyalgia, osteoporosis, herniated disks and joint problems.

Chronic pain clients report their pain reaching into almost every aspect of their lives, overshadowing their happiness and dominating their concerns. As a therapist, it is heartbreaking to hear their stories. I recently treated a woman that suffered from multiple, debilitating conditions. She was vacationing with her husband and extended family, and called me to come treat her in her villa as quickly as possible. She was miserable. When we started to work, she confided how little sympathy or support she received from her husband and mother-in-law. She was expected to help clean and generally pull her weight, even though she was in severe pain from fybromyalgia and osteoporosis. She was not taken seriously and was given very little support from her family. She was ridiculed and accused of slacking off. It seemed clear that her emotional environment was contributing to her existing pain. During the vacation she ended up in the emergency room with a kidney stone, but even that did not keep her family from demanding that she help clean the house. Clearly, this woman’s pain was exacerbated by the lack of support from her family. It is totally predictable that recovery will be difficult unless she finds a way to help her family understand her needs. I suggested she try to get help from a therapist, group or another, more enlightened family member.

Often, I share my own struggles with chronic pain, as I have a herniated lumbar disk and a knee that was ruined by bad surgery. When if seems appropriate, I try to share my experiences to reassure my clients that they are not alone, and that I understand their suffering. That seems to bring solace.

Chronic Pain - Managing The Unmanageable - Part II

It is not enough to treat the body and neglect the mind and soul. Successful treatment must address all concerns. A pain pill can only address the physical aspect of pain. In fact, people often get into trouble with addiction because they try to manage the psychological and spiritual dimensions of their pain with drugs alone. Pain medication has a strong psychological effect, and patients often get into trouble because they try to medicate the psychic pain that accompanies their physical pain. Good pain management successfully addresses all aspects of suffering.

Chronic pain changes the sufferer spiritually and psychologically for many reasons. The most obvious effect is that it leaves the sufferer feeling isolated. Dr. Jung, the noted psychologist, used the description “feeling orphaned by our pain” to describe the sense of loneliness that can accompany pain. That sense of abandonment can manifest depression and spiritual ennui. While a pill or a potion may help quiet the physical pain, it often takes the intervention of other people who care and understand to help assuage the spiritual and psychological suffering that can accompany chronic pain. Sadly our medical community often relies too heavily on medications alone to treat chronic pain. While medications may be helpful or necessary, often the pills alone don’t heal pain, or help people to manage the untreated pain. Support groups can provide the important missing part of the formula that allows people to cope with chronic pain.

Pain is not a useless inconvenience. It serves a very important purpose. Pain’s function is to call attention to a physical problem. Without pain, we would have no way of telling when there was a problem with our body. It is nature’s way of getting our attention. When people are in pain, they need to become somewhat self-centered and self-absorbed, so they can attend to their problems. It is only by paying attention to the pain that it can be resolved. With chronic pain sufferers, that self-centered focus often creates distance between the sufferer and other people, leading to a sense of isolation. The best way to break the bondage of chronic pain is to destroy the isolation by creating a caring community that can support and help heal the sufferer. I believe that the most important first step to healing is replacing isolation with involvement.

Chronic pain sufferers often have trouble coping with the fears surrounding their debilitation. Pain can create many problems in a person’s life, especially if the pain interferes with the ability to work, or manage the responsibilities of parenting. Often many of the problems do not have an obvious, immediate solution, and must be endured. Harboring concerns about difficult situations and the accompanying fears without the opportunity to emotionally ventilate can create extreme psychological stress, leading to anxiety and depression. Often this stress will exacerbate the pain, creating a downward spiral. Without proper intervention and in the most desperate, extreme cases, people can contemplate self-harm, and sometimes commit suicide.

If isolation is at the core of suffering with chronic pain, then connection with other people is the obvious key to coping. Bill Wilson found that groups were fundamental in helping alcoholics recover from alcoholism and so he founded Alcoholics Anonymous. (In addition, he also introduced a 12 Step Program of recovery, but having a group and helping others was the core concept.) Many other groups have been started to help people coping with similar concerns find the support they need to keep going.

There are many support groups available in communities today that could provide a bridge away from your isolation. Reach out to national organizations that might offer support that relates to your personal areas of concerns. There are national organizations that have groups for people suffering from diabetes, arthritis, fibromyalgia. And the list goes on. If there is no local group, you might want to think about starting one. It does not have to be an elaborate affair. Just a small group of caring people that get together to share. Integrating yourself into the fabric of your community will heal many hurts. I know because the group process saved my life many times, and I will forever be grateful .

Jan Kasmir is a medically trained massage therapist with over 30 years of experience in the field of health. She currently practices massage therapy in Hilton Head, Bluffton and other close-lying cities in South Carolina.

Massage: A Treat or a Treatment by Jan Rose Kasmir
Originally Featured in "The Island Packet"

Bette Davis said, "Growing old ain’t for sissies." Those bodily aches and pains that make aging a misery, respond wonderfully to the healing touch of massage. But that is only the beginning of the story about the health properties of massage.

Massage, a natural therapy, is an effective way to reduce and/or alleviate muscular aches and pain. Muscle tightness, known as spasms, are the primary source of chronic, physical pain not associated with trauma. To better understand the role muscles play in causing bodily pain, it is important to understand why and how we hurt.

Muscles do not hurt.  Nerves are the pain messengers, sending signals to the brain to alert the mind that there is a problem.  When a nerve becomes irritated by tight muscles, the nerve heats up. (the early surgeons felt the heat radiating from the irritated nerve and called the condition inflamed.)
This alerts the brain that there is a problem in a part of the body by producing pain.  

Medical massage works by stretching the muscles to restore them to their original length and width.  This takes the pressure off the nerve, allowing it to cool down.  Consequently, the problem is resolved and the pain messages are discontinued. 

These principals are a simplified explanation of the  anatomy of pain. Understanding these principles will shed light on the role of massage in alleviating physical pain.

Natural healing methods are more time consuming and take a greater commitment then many people are willing to make. Why take the time and bother when a person can just pop a pain pill, and feel relief?  The answer is simple.  Pain is not the problem.  Pain is a SYMPTOM alerting the mind to the fact that THERE IS A PROBLEM.  Removing the pain without addressing the problem only masks the true nature of the problem.  Often when medication alone is used, there comes a time when that problem overcomes the medication’s ability to stop the pain. As time passes, what may have started as an easily treated condition can become a complex, more serious problem, with a much more difficult treatment prognosis.

It is important to clarify that massage works best in conjunction with the diversity of medical and health offerings. Good massage therapists are trained to recognize their limits, and ONLY treat conditions within their range of competency. When client' need help beyond the expertise massage therapy offers, then it is their duty to refer those people to the proper therapist or physician.

Massage is a conservative, and minimally invasive therapy, that can produce wonderful results with people who suffer from chronic muscular pain, and more. Massage has shown beneficial results with a broad range of problems including fibromyalgia, low back pain, arthritis, and bursitis.  Other conditions that have responded positively to massage include fatigue, high blood pressure, diabetes, and immunity suppression. Sickness is not the only realm where massage is gaining popularity.  Infant massage and massage for pregnant women are examples of rapidly growing health therapies.

Massage is gaining respect in the medical community in this country. Many physicians are beginning to understand and prescribe massage for their patients.  Even the US government  has recognized the importance of natural therapies by forming the National Center for Complementary and Alternative Medicine (NCCAM), a component of the National Institutes of

Health.  For example, locally, the use of oxygen in high concentrations, (hyperbarics), is now being offered as therapy for a wide range of ailments, and one cannot find anything more natural than oxygen.

So, is massage a luxury, self-indulgent pampering, or a therapy that treats a wide range of medical problems? The answer is simple. Yes.

Jan Rose Kasmir is a graduate of the New York College of Health professionals, with over 20 years of experience. In addition to her in-home service, Massage Therapy Associates, she practices at Dr. Kenneth Farr’s, The Island Spa, MD.

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