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In 2006, at age 38, he enlisted in the Army National Guard, a little older, a little used, he says, but he did not let him get in the way of his duties. Afghanistan. He could still follow the 19-year-old man's double timekeeping in the desert with 110-pound sacks, still staying for 12 hours in a row at the back of a Humvee wielding .50 caliber. . Of course, the pain at the end of the day had not won with Advil and a good night's sleep as before, but he could stand it.
At the time of his fourth tour, his works caught up with him. He was 42 years old, and the hours of quad bike training by Afghan police on the eastern border were causing casualties. What began as a strange snap in the neck and a twinge in the back turned into a burning and debilitating sensation, and soon his head no longer felt connected to his spine. His hands began to fail, too, after 18 months of seizing the machine gun. In 2011, when he was medically evacuated from Afghanistan, he could not even button up.
The pain – the oldest of our afflictions, a state that no man escapes – is hell. It's one of our oldest inherited traits, an evolutionary system designed to protect us: burn once and you probably will not get your hands on the fire again. The pain, in a sick way, is good for us. The pain makes sense.
But sometimes, against all evolutionary inclinations, the system runs in circles. When Stephens returned from Afghanistan, his pain did not subside. Fearing further injury, he limited his movements. His doctors had prescribed tramadol, an opioid that relieved the pain of a surgical wound, but it was at best a fleeting escape from the constant companion that his pain had become. He took three to five pills a day, but the headache at the base of his skull made the world blurry, but his hands would not work. Hed lost his shit, he recalls, while anger, stress and anguish consumed him.
We know how to treat chronic pain. We are known since the seventies.
It is a chronic pain: the tissue healed, the wounds healed, but the silent scream radiates. About 50 million Americans suffer, most of them between 45 and 64 years old. The experience is familiar: the dull knee that you knocked out when skiing in your thirties, the back that you can explode just by getting up from bed, no matter what you did 20 years ago to hurt you in the shoulders now. For nearly 20 million people like Stephens, however, the suffering is really debilitating. This pain costs jobs and relationships and lives.
For a patient with a broken leg or an open wound, modern medicine has made extraordinary progress over the years, with whiskey and leather belt giving way to anesthetics and OxyContin. But in America, the treatment of chronic pain is a despicable disaster. The cure often consists of injections, surgeries with a questionable success rate or what Stephens has had after his four rounds in Afghanistan: potentially addictive pills that alleviate pain but ignore the underlying problems.
Here's the thing, though. We know how to treat chronic pain. We have known how since the 70s. But it is not likely that you receive the best treatment. With effort, you can approach it yourself, but to do this you need to know a little more about the inner workings of chronic pain.
Why it hurts
If you hurt your toe, the nerve endings of your foot trigger electrical impulses in your brain: something bad happened here. Your brain works with specialized nerve cells in your spinal cord to determine an answer. Was it a burn? Better to get that leg out of the home. Have we just broken ankle? Lets solve the problem of pain and make it suffer for a few weeks, so stay off. Once the injury has healed, the brain closes the dial and stops sending those amplified pain messages to your body. The wound, fortunately, dissipates. But with chronic pain, the neural circuits remain amplified – your brain has rewired itself – keeping the pain up to 11, even if the damage has been repaired. According to John Loeser, M.D., former director of a legendary pain treatment center at the University of Washington, chronic pain means that nature has failed.
John Bonica, MD, the father of pain medicine, did not know this when he began treating wounded soldiers returning from the Pacific to a military hospital south of Seattle 75 years ago. There, patients apparently cured or with missing limbs confused their doctor with complaints of incessant pain. Dr. Bonica, who was then going to write the first modern text on pain, realized that something complex – something not quite physical – was at work. He found that anxiety, depression and PTSD were bedfellows of chronic pain, suggesting that pain was affected as much by emotions as by tissue damage. Much later, research has shown that areas of your brain badociated with anxiety and depression are also related to your response to fear and pain.
But then, based on his observations, Dr. Bonica decided that chronic pain was such a complex and complex animal that it required all kinds of caregivers. Two decades after the Second World War, he opened the country's first multidisciplinary pain treatment clinic, the latter at the University of Washington. Dr. Loeser, who headed the clinic after Dr. Bonica's retirement, could not be solved by one person. The bottom line was that it was going to be a team approach. The goal of completely eliminating the pain was out of the question and a team was formed to teach patients how to manage their symptoms and improve their quality of life from all angles. A physiotherapist showed you how to move again, a psychologist taught you not to be afraid of your pain, an occupational therapist helped you understand how to manage your stress at work, a dietitian helped you lose weight and eliminate the stress of your joints. , a case nurse made sure everything went smoothly, and a medical advisor oversaw the entire team and your progress. The combined approach was revolutionary in the treatment of chronic pain and she accomplished something that no other treatment did: it worked.
By the late 1990s, there were more than 1,000 interdisciplinary chronic pain management programs across the country. These were expensive places; Treatment by a full expert group could reach $ 30,000. Yet, many studies have shown that this approach had not only succeeded, but that it was profitable. Having healthy people who are able to work costs society much less in the long run.
In 1995, Purdue Pharma introduced OxyContin. It was an immediate hit. Some early studies have suggested in a tempting and false way that OxyContin could be an effective and non-addictive treatment for chronic pain. Insurance companies have recognized a quick and less expensive solution when they have seen one. According to Michael Schatman, Ph.D., director of research and network development at Boston Pain Care, they said they simply give them drugs, opioids.
In 2015, there were 20 million opioid-dependent patients in the United States and 56 interdisciplinary pain-treatment clinics remaining.
Treat pain without pill
Sean Stephens was nervous. The Veterans Health Administration had adopted the same opioid prescription regime as the rest of the US medical system, and a growing number of veterans with opioid-related disorders – 68,000 of them. Among them were in the ranks in 2015. Veterans were twice as likely to die from an accidental overdose caused by other Americans, and a decision from above: opioids were no longer very popular . When Stephens went on show at the San Francisco VA Medical Center in 2010, her doctor, Karen Seal, M.D., told her that they would start working to reduce her tramadol dose. His pharmaceutical crutch, the opioid on which one counted to get through the days, was about to be removed from him. I was scared.
In the two decades since Oxy, almost all interdisciplinary pain clinics have been closed and HAV has become an unexpected leader in maintaining this approach. Other clinics are primarily located in large institutions, such as the Mayo and Cleveland clinics, as these centers can afford to lose money with poorly reimbursed pain care. But the VA does not have to earn money. He is responsible for treating his patients for life and, over time, managing pain is cheaper than pills and endless procedures.
Dr. Seal was at the helm of the VA's Integrated Pain Team and was now in charge of adapting pain treatment regimens without involving an unlimited renewal of medication. His message to Stephens was unequivocal: Pharma tells you that you can take a pill to fix everything. But not here, she said. Here, there would be goals to help manage pain besides relying solely on opioids. Here they would work with him to find his life.
Some of the treatments prescribed by Dr. Seal at Stephens seemed pretty obvious (physical therapy, non-addictive medications, simple goals like doing exercise for 20 minutes at a time), but others were of the kind to make men mad (yoga, deep breathing, meditation, cognitive-behavioral behavior). therapy). Stephens vaguely knew that there were other ways to treat the pain. Hed tried the pot, but he did not like it. He knew that yoga was one thing, but he did not consider himself a type of yoga. I was not interested in finding another solution to the pain, he says. But these people have talked about everything we can do to go beyond this stage. It was this true moment aha. I never understood that stress relief could be pain relief.
Concentrated man practicing yoga in yoga studio
One of the most difficult components of the interdisciplinary care that men are subjected to is probably the consultation of a therapist. Treating physical pain with cognitive-behavioral therapy may seem like a recent BS, but the brain is a strange thing. Show Catholics an image of the Virgin Mary in laboratory-controlled pain control studies and report less pain. Give people a placebo to make them believe that they are about to receive pain relief and that the brain will actually release natural opioids to block the pain. New studies of brain imaging constantly go against our most basic ideas about pain. Tor Wager, Ph.D., neuroscientist at the University of Colorado at Boulder, recently discovered that if the brain anticipated more suffering from injury, it would produce more painful sensations, regardless of physical damage. When you expect more pain, you really feel more pain, he says. And when you live in constant pain, you are afraid to feel it more. You get a feedback loop that actually worsens the pain. Learning to think differently can help break this cycle.
Combined with physical therapy, light exercise, and emotional support, this holistic approach has had dramatic results throughout the VA. So far, the agency has reduced the number of opioid-dependent veterinarians by approximately 40%, and a study by Dr. Seal showed that patients in interdisciplinary clinics were 50% more likely to significantly reduce their doses. I have become almost evangelical about it, she says. When you are rid of opioids, you recover your life.
For Stephens, the approach helped him take control. The pain is still there, he says. My wife has yet to button my shirt for me. But now he is responsible for his pain and not the opposite. Today, he breathes deeply throughout the day. He has a therapy dog that keeps him calm. And he gives himself breaks for ten minutes to defuse each time he feels the pain go up and his fear worsens. It will allow me to overcome the pain, he says.
For the tens of millions of non-veterans who suffer, there is a similar way to find relief, but it takes effort. Stephens adds that it also takes courage. The courage to be the old boy during your first yoga clbad and want to try something that is not related to your pain, such as deep breathing. Because in the end, feeling uncomfortable at the Y or being embarrbaded to go to a therapist is much less painful than a constant suffering life.
How to take care of your pain
The best way to combat chronic pain is to treat it as a team sport, said Sean Mackey, MD, Ph.D., head of the pain treatment department at Stanford University. . You need different actors to handle different positions. If you do not have access to an interdisciplinary pain clinic, here's what to do:
Talk to a social worker or therapist
The pain in the pain lies mainly in the brain, says Dr. Mackey, and a pain psychologist can help you understand this in a relatively short time. This is not mumbo jumbo, either. Your beliefs, your emotions, and your thoughts about your pain play a critical role in your pain experience, he says, and he got the brain scans to prove it. Chronic pain rearms the brain and therapy can help reverse this reorganization. According to Dr. Mackey, this may not eliminate the pain, but it can improve it and keep you in control.
Consider PT
What do you think of the first thing the team doctors do for the 49ers when a guy runs on his knee and he needs surgery? The answer is physical rehabilitation, says Dr. Mackey. While it may hurt, you must strengthen these muscles and support this painful area. Studies have shown that PTs reduce pain over the long term and that insurers often cover it.
Do not worry about it silently
Managing your pain is a long-term effort and many insurers offer support groups. In large cities or nearby, there are often free meetings where you can discover how others treat pain.
Take steps to relax
Reducing stress reduces your pain, says Dr. Mackey. Free apps such as Headspace can guide you through mindfulness lessons, a YMCA can offer meditation clbades and acupuncture provides relief to many people. Your pain may never go away completely, says Dr. Mackey, but that's not the question. By putting all of this together, you can take control and prevent the pain from dominating your life. You win; the pain is not it.
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