Day In The Life...

I live in Florida and we just had a hurricane go through, Irma. Luckily I am in the panhandle so all we got was a tropical storm in our area. Some wind, some rain, and a dent in the van where a branch fell on it from the tree. Weather definitely effects chronic pain conditions and I am no exception to that. For the last couple days I have had lots of muscle spams, sciatica, tingling/numbness, shooting pain, and a higher pain level over all. A bad few days so far.

Since this is Chronic Pain Awareness Month (September) I thought this would be a good day to do one of those "Day in the life..." type posts. I think it will be a good idea to give people information on what it is truly like to have a bad day with a chronic pain condition. This is how it effects me, but I figure it will at least give people a rough idea of how it might be effecting someone in their lives and hopefully it will promote understanding.

So lets start with over night, sleeping. (Sleep? What's that?!? LOL) Due to the increased pain and severe muscle spasms I was not able to try to sleep until 2AM. I had a hard time getting comfortable enough to try and fall asleep because when I shifted position the muscles in my back (just under my shoulder blades all the way down to mid thigh on both legs) tightened up and started to spasm. This causes extremely sharp and intense bolts and waves of pain to shoot through the entire area. When it first starts it is extremely intense and takes my breath away. I then have to mentally remind myself to breathe, slowly and calmly. Somewhere around 3AM or so I dozed off. I woke up a few times due to pain and spasms but managed to go back to sleep until 4:30AM. I've been awake since then (it is now 9AM). I have been alternating between applying heat and ice to the affected areas (alternating; 20 minutes on/20 minutes off/switch to the other/repeat). Neither helps tremendously but when it is like this I'll take what I can get. I am having to shift position every 3 to 5 minutes (instead of my normal 8 to 10 minutes) to try and stave off another episode of spasming. This is not very effective since I still get the spasms and sciatica, it just isn't as intense. I am currently sitting at an 8 on the pain scale of 0 to 10. I took my morning medications at 7AM. Right now I am watching vlogs on youtube.

To get breakfast I had to think of something to eat that would require minimal movement and preparation as standing and walking are very painful for me. With the sciatica going on it is also dangerous as my legs can give out without warning and falling to the floor is not a good thing. I decided to make toast because it required the least amount of standing, bending, and reaching for things.

It is now 11AM and I am still in bed shifting position and alternating heat and ice every 20 minutes. I've also done some very gentle stretching to ease muscle stiffness. I am having to shift between sitting and laying down every 5 to 10 minutes. I can go 10 minutes laying on my right side, but only 5 minutes sitting up. Every 5 minutes sitting up I have to shift around and change which way I am leaning (left, right, forward, back against pillows). My left side is the worst and I can't lay on it at all. This is very annoying shifting around all the time. I'm still at a level 8 on the pain scale but am grateful that it is not getting stronger and am hoping it stays this way (I don't think it will as I have to pick my husband up from work this afternoon). I keep thinking of my mother telling me, as a child, when I was restless "Do you have ants in your pants?" and it makes me giggle.

It is now 6PM. I slept from 11:30AM or so until 2:15PM. Was a restless sleep and I woke up a few times with the muscle spasms. Back to alternating heat and ice. At 4:30 or so I went and picked my husband up from work, which hurt a lot, but it felt nice to get out of the house and into the sunshine. Came home and ate dinner which my daughter had cooked. Now, while alternating heat and ice I am going to do a stitching hangout to chat with friends and stitch for distraction. Sometimes it helps distract from the pain but even if that doesn't happen, it always lifts my mood to be chatting with friends.

It is now 9:47PM and just got off the stitching hangout. Made good progress on my project which can be seen on my stitching blog. I continued to alternate heat and ice during the hangout, shifting positions as needed as well as getting up to walk around and stretch my muscles out. My pain has been pretty steady at an 8 all day, but I am grateful that it didn't go higher or hit a pain crisis (level 10). I really didn't want to be curled up in bed and crying from the pain.

Now I will continue with the heat and ice while I watch some stuff on Youtube or Netflix/Hulu until I am sleepy, then I will try to sleep. I don't know how much sleep I will get but am hoping I get more than a couple hours. Lack of adequate sleep does not do good things for my pain, it also makes it harder to mentally deal with the pain.

That's pretty much my day today. My hope in sharing this is to help people understand what it is like during a bad day. As well as to show that being home a lot due to pain is not the fun, relaxing day off that people think it is.

Taking Proper Care of Prescription Medication(s)

Many chronic pain patients are on different medications. Some are for the pain and others are for the condition(s) that is/are causing the pain and or depression. Many of these medications can be controlled substances, or have a street value as addicts have found they can give the “high” that they seek. Surverys asking teenagers if they have taken medications out of a family member’s medicine cabinet have shown that many teenagers have done just that. Also there are “parties” out there called “pharma parties” (aka “candy dish” or “trail mix” ) where people dump different pills that they get out of those medicine cabinets then just take a handful in an attempt to get high. These parties have resulted in overdose deaths from heart or blood pressure medications or even narcotic pain medications, psychiatric drugs, etc. all being mixed without any knowledge of what they are doing.

It is a chronic pain patient’s responsibility to keep their medications safe from theft. The best way to do this is to keep the medications in a locked box or safe of some sort, not in the medicine cabinet in the bathroom or a cabinet in the kitchen. All medications should be stored in a locked box or safe. If more people took their responsibility seriously less thefts of their medications would occur. As a chronic pain patient here are some tips to keep your medications safe.

1. when picking meds up at the pharmacy, be careful to not advertise that you are picking up pain medications. Always check to be sure the medications are correct before leaving the pharmacy.
2. put the bottles in a locked box or safe and make sure that you do not share the location of the key or the combination with others. Do not leave the lock box in plain sight either.
3. remove labels from all empty prescription bottles before throwing the old containers out (or reuse them to store small items such as screw, nails, beads for crafts etc.) or recycling them
4. shred the labels to ensure that someone going through your trash can not read the label and know you are on pain medication
5. shred pharmacy receipts that list the names of your medications for the same reason as number 4
6. Do this for all medication, both prescription and over the counter

By protecting your medications in this manner, you greatly reduce your chances of having your medications stolen by a family member  or friend. You also decrease the chances of drug addicts finding out what medications you are on by going through your trash.

You are responsible for how you handle your medicine and being careless is not an excuse, especially in today’s political climate of removing pain meds from people. The more often you have to call for lost or stolen medication, the more likely you will be labeled as an addict or diverter of your drugs. Now, just a single instance will be enough to be labeled and having your pain control revoked. So take your responsibility seriously.

Anyway, these are the things I do to protect my medicines, both prescription and over the counter. If I am missing anything, or anyone has ideas on better protections, please feel free to comment, or email to let me know!

More Reading and Thoughts

I am continuing to read the book The Chronic Pain Care Workbook" by Michael J. Lewandowski, PH.D. It looks like there is going to be a lot of record taking. Tracking pain levels through the day, as well as graphs for activities and pain level on the same graph (to show correlation between the two), tracking flare ups daily, and weekly, as well as individual write-up for each flare. The idea behind all of this tracking is a good one and I am sure it will help because I agree with the statement that the more I know about my pain and how it affects me, the easier I will recognize areas that I can change to gain better control and less pain. But wow does it look rather overwhelming to just keep all those charts every day, almost a job in and of itself LOL 

I've gotten to the part about setting goals, I am thinking I will set 2 to start with. The first is to help me feel like I'm actually achieving something every day, so I will try to do at least 1 to 2 loads of laundry per day. The second will be to fill out all these charts LOL 

Because my depression and apathy are so deep, and my ability to move around is so low, I am taking the advice from one of the other books regarding pacing from a place a being bedridden. It basically said that I may have to start out with something very small, that someone else may not see as a big deal, but since I've been doing almost nothing for 18 months or so now, it is a big thing. It is important to help re-build the desire to fight again, to get better, especially for those like me who are coming at this from a place of having given up and letting the pain run my mind and my life for so long. This will take a while, one small thing at a time because if I try to change lots of things at once I will set myself up to fail.

Interesting statement I just read. I did some of the exercises that are on the book, on the website for the book. I did one about activities and avoidance of those activities due to pain. There were a couple that have not changed due to my pain. The comment was that even though I am thinking I do nothing, those couple things prove that this is not true, that I am still doing something. When I read that it kind of gave me a little jolt, one of those "duh! Missy!" jolts. I've been so focused on what I haven't done every day, that I ignore what I have done.  

Gosh I feel like I'm having to learn how to live all over again. hmmmm...I guess in some ways that is exactly what I am doing. 

My pain wasn't too good today. We have bad weather this week and stronger weather moving in today, which is what woke me at 4AM. All the muscles in my back and pelvis were tight so I took muscle relaxers and applied the heating pad, which has helped. I also took my meds, which has helped as well. I did some mild stretching that the physical therapists taught me to help release the tension in my back and pelvis muscles, this also helped. I did some breathing and am refusing to let myself think the catastrophic thoughts I usually have running in my head. I'm sitting at a 7, but it is not rising like it normally would be. Instead of just letting it run rampant, I tried doing things to help control it and it is helping. Usually when I wake up this way, by this point (2 hours later) the pain has gone up. But so far, I am controlling it and who knows, if I continue to do that I might actually make it go down and not hit a 10 (pain crisis) when the thunderstorms go through today. Does this mean that I am doing it? I think so!

Today will have to be a rest day with the exception of filling those forms.

My brain is still working over the fear. I will probably do some stream of consciousness writing in my written journal to see what comes out, then hopefully I will be able to post something here in a couple days that talks about more reasonably than stream of consciousness writing allows.

Edited to add at 6:47AM: I just took the test about how my husband's response to my pain issues affects me and possibly our relationship. Finally, a really GOOD score! It asked me to rate by frequency on 0-10 how often he does or says things like "Your pain interferes with my life", "you can't be in as much pain as you say" and similar negative things. It then asked me to rank whether I liked or disliked when he says those things. For the entire list I got to say 0, because he doesn't say those things to me. This doesn't mean that he never talks about being frustrated or concerned, but he never throws it in my face, tries to make me feel guilty, or anything like that. He has been so immensely supportive, understanding, and helpful. We've talked about this many times, and he does express that he occasionally feels a twinge or frustration or similar emotional reactions, but it doesn't go beyond that twinge because he knows this is not my fault and he loves me the way I am.

It felt good to get a good score on something! LOL

Taking Stock In Attempt To Change

For the last 18 months, and probably longer, my pain has been in control of my life not the other way around. When my pain got worse a few years ago I adapted and still managed to function. When it got worse in April 2011, I could not figure out ways to adapt as nothing seemed to work. As time went on, depression increased, mobility decreased and pain took control. My old methods for dealing with and living despite my pain are no longer effective with this new level of pain and symptoms (no standing/walking more than 5 minutes). So I decided to try and get some help. I can't locate a behavioral therapist who deals with chronic pain in my area, so I ordered some books.

I am currently working through "The Chronic Pain Care Workbook" by Michael J. Lewandowski, PH.D. I already knew that my coping mechanisms are not good and in the case that I've been using dissociation to deal with my pain, they have degenerated into very unhealthy mechanisms. I bought the books back in early February I believe. Since then I've read a few pages in each one (I bought 4), then did what has always worked for me. I allowed my mind to analyze and think about the ideas these books represented.

It is very hard for me to admit that my actions and thoughts are contributing to my pain. It is difficult to admit that I lost some of my ability to manage my pain effectively a while ago, and lost the rest of it in the last 18 months or so. It is hard to admit that I gave up. I wanted so much to believe that I was doing everything I could. That I was trying to function with the pain, but the truth is I gave up. The pain got so much worse, with new symptoms and the inability to stand for more than 5 minutes, no real help from my doctor, and I gave up. Now I am sitting here crying because this is the first time that I have faced head on and admitted clearly that I gave up. Instead of saying something like "yeah I've given in BUT <insert any but here>", the truth is I was kidding myself, there has been no actual "but" for a long time. I do occasionally fight back and try to do things like some laundry or housework or cooking, which increase my pain and when that happens, I give up again for a while before trying again. But those attempts are few and far between.

Why am I sharing something that to me is emotionally painful, humiliating, terrifying, and so intensely personal? I'm not really sure what all my reasons are, but the one that comes to mind immediately upon asking myself that question is that I want others who may be in my position to see they are not alone. In addition I am hoping that by sharing the truth about my own mental, emotional, and physical ability to fight/live with my pain, that those who are in the same boat as me, can see that there is still hope. I have reached a point where I am sick of this. I want my life back. The only way to achieve that is to work at it and learn new ways of coping, since obviously my old ways aren't working. Sitting around waiting for something outside of myself to give me back my life obviously doesn't work. So I guess it's time to get off my ass again.

In the book I mentioned above there are lots of exercises. These are designed to help you see where you are now in dealing with your pain. What is working well, what is not working at all, and what could use some improvement to work better. The beginning of the book, like any other self-help book or even therapy with a therapist, starts out with taking stock of where you are right now. Identifying what works, what doesn't etc. Also identifying your readiness to change, your motivations. I understand all of this having gone through it before with and without a therapist when I was dealing with healing after abuse. I've done these things in conjunction with a therapist in order to help my daughter heal from abuse. Many of these first steps are the same.

What surprised me was the fear reaction. Having the fear of facing old abuses in your past, acknowledging the damage it has done and the negative effects it has on your present all made sense to me. Who wants to face such painful memories, accept them, work through them and all that. The fear made sense.

But now, accepting this fear of dealing with my own pain means accepting that I have failed. For some reason I am finding it much harder to accept that I am afraid of trying anything. My biggest fear is increased pain and decreased mobility, followed by fear of failure. For some reason this isn't making sense to me. I keep asking myself "Why am I afraid of my own pain?, heck I've lived with it for 30 years (varying over that time from mild, to bad to worse to now [horrible]). I know I will live with pain the rest of my life. Why am I afraid? Is it really that simple as fear of change?". It isn't making sense to me why I am so scared.

And with so very little for me to look at as things I can do well (in the sense of a job or productive activities), the idea of having failed in dealing with my chronic pain in my daily life is terrifying and painful. I am feeling very vulnerable and very sacred to look at all these things, to see exactly where I have failed. What if admitting all this makes people around me decide I'm no good? What if it makes me decide I'm no good (seeing myself as no good is worse to me than others having that opinion)? What if I fail at trying to change? Heck since I've already failed, what are the chances I can succeed now? I've tried to fight over the past 18 months, but failed time and time again.

But I don't have a choice, I have to try. So I will take my anger and fear and try to harness it as a motivation to get the changes I want. To get my life back.

One of the exercises was to draw a pie chart that represents how I view the way my pain problems affect my life. Included are the pain issues themselves, then social issues and psychological issues. Here is a picture of the pie chart I drew. It clearly shows that the pain issues have overtaken everything else in my own mind; I have allowed the pain issues to overshadow everything, to take over. This ticked me off and scared me and I want to change it. So here's hoping I can do that. I will try simply because I want a life, my life, back.

The book then goes over the Stages Of Change and I am in the "Open to thinking about change, but...". I know Doc's can't fix me. I know that I will have pain for the rest of my life. I know that what I've been doing isn't working. I know my fear of trying to change and failing, isn't going to help. I want to change this pie chart, I want my life back. So now comes working through the fear and getting rid of it so I can take the steps necessary to manage my pain better.

Knowing how I tend to work, when it comes to having to fix things mentally/emotionally/behaviorally, I will probably revisit these topics a few times. Hopefully on this blog so my journey can help others, but it is possible that not all of it will show up here, depending on how personal it is or if the thoughts etc affect someone else, not just me. So most likely I will have to revisit this topic of my fears until I understand them well enough that I can counteract them with more reality based thinking.

Here's hoping that I can get my life back.

Cartesian Model and Gate Control Model of Pain

Living with chronic pain is extremely difficult. With new research have come new ideas and understanding about how pain works. Sadly physicians, people in general, medical personnel etc. are still being taught an outdated model for pain. That model is the Cartesian Model of Pain. This basically says that all pain is a direct result of tissue damage/injury and every person will respond in the exact same manner to the same injury. In other words a broken bone gives a certain amount of pain and every person will have the same amount of pain as a result of that injury.

Research has proven this to not be true. PET scans and fMRI's have shown that the parts of the brain responsible for pain sensations light up even when no specific injury/illness can be found for that patient. The Gate Control Model Of Pain (by Ronald Melzack and Patrick Wall) says there is a gate, the spinal cord, which allows pain signals to travel to the brain. When that gate is closed, no pain signals get through. When it is open, pain signals get through. Further they have shown that the gate can be opened by injury, emotions, mood, thoughts and memories.

The Gate Control Model makes sense to me simply based on my own experiences with my pain. Most CP (Chronic Pain) patients know that stress, levels of high emotions, focusing mentally on their pain and more directly affect their pain levels. We often tell each other about how high stress levels, anxiety, depression and more will increase our pain. We say this because we have experienced it. I know that when I get angry, my pain rises. I recognize that when I am angry my body tenses resulting in my muscles tightening which leads to spasms, pressure on the injured areas and results in an increase in my pain.

Despite the research showing that psychological and social factors contribute to a patient's experience with pain, most physicians and other medical professionals, still work under the Cartesian Model because that is what they are taught in school. Most physicians do not receive training in chronic pain, or pain management. Instead they are taught the scientific method and as a result see pain as a cause and effect only so far as physical disease/injury (cause) results in pain (effect). Many do not realize that other issues also effect pain. This is not good as the result is that people who live in chronic pain are not receiving the optimal therapy for their pain. They are not being taught things that will help them manage their pain.

It doesn't help that most people also have outdated ideas of how to deal with chronic pain. We are not taught that chronic pain exists. Most people's experience with pain is acute pain. You sprain your ankle, rest it and allow it to heal. This works for acute injury, but does not work for chronic pain. In fact this method of dealing with chronic pain will make the pain worse. Included in the area of what works for acute pain but not chronic pain are "no pain no gain" and "push through it". These beliefs actually cause more mental anguish and suffering for chronic pain patients.

Chronic pain is affected by the original injury or disease (and progression of same), the people around you, your own thoughts/beliefs about pain, and more. So far the most effective treatments for chronic pain have included methods which include all these areas, rather than choosing one or two and ignoring the rest. Many do not believe that mood (for example) affects pain but consider this: You have had a bad day at work, your mood is not good, and by the time you get home you have a headache. Most people have experienced this. Part of the reason is that the area of our brains which control our emotions, is one of the areas that lights up in response to pain signals. In a person with chronic pain those stressful emotions can trigger pain signals and vice versa.

Ok, this entry has focused on factual information. Now I am going to write a more personal entry.

Yesterday's Doctor's Visit

Yesterday was my pain management doctor's appointment and since Ron (my husband) was home he went with me. When the doctor finally came into the room it started out as usual, him not really looking at me but focusing on signing the prescriptions the nurse had filled out. Though he was a bit surprised when he entered the room to see my actually laying on my side on the examining table.I usually do not do that, instead I tough it out sitting in the chairs and do my best to hide my pain level. I choose to hide showing it physically because  I am afraid of being accused of lying or acting it up to make it appear worse than it is. Both are things I have been accused of by doctors in my past and 2 different nurses in my current doctor's office. I was hurting a great deal, finally gave in and laid down to get the weight/pressure off my left hip. I couldn't stay laying down for long cuz the right side started to hurt even more, so I had to sit up for a bit and when that started to hurt too much (after a minute or two) I would walk around the room; rinse and repeat. This prompted some questions, which I answered honestly, but he didn't comment on my replies.

I asked about the results of the cat scan that was done in January and was told there was nothing he did not expect regarding my sacrum and SI joints. He then said there was nothing exciting about my lower back either. Since I didn't get to read the report I don't know if that means everything is pretty much the same since the last cat scan (which showed the herniation at L5-S1 and bone fragments within the broken left SI joint) or  if it means that what new stuff did show up is what the doctor had been expecting to see. I like it much better when the doctor actually goes over the written results with me so I can ask questions.

Then the mobility evaluation was brought up. The doctor started to say that he didn't want me to have a power chair and that's when Ron started speaking up. The doctor had been getting ready to leave the room when Ron spoke up, instead he sat back down, crossed his legs and actually *looked* at Ron. He told the doctor that I've been in bed for months, that my pain has been real high, that I fall frequently and that I can't walk from my bedroom to the kitchen without having to sit down in the kitchen doorway or possibly falling. I said that I had been telling the doctor all of this for months, all about the new symptoms and how I can't stand or walk for more than 3 to 5 minutes. I went through it again, describing exactly what happens when I stand for 5 minutes. At minute 2 or 3, I get the sharp stabbing pain at the top of both SI joints and my lower back starts to scream and the sciatica symptoms start. By minute 4 my legs are shaking, shooting pains are going through entire pelvis, down both legs, and up my back. If I continue to stand after that starts, at minute 5 my leg gives out (usually the left, but sometimes both) and I fall. I've tested this many times, timing it as well, and that is the progression. I told him that I have been telling him this for months, which I had. But since I haven't been able to read my medical record, I can't say for sure if he put it in there. I'm pretty sure Ron, the PA, did though because I heard him speak into his tape recorder after a visit with him. (This was a few months ago, before the office stopped using physician's assistants)

The doctor looked down at my chart and started flipping through the pages and he had a slightly sheepish look on his face. Ron then asked me to tell the doctor how many times I fall in a week, so I did (the answer is 2 to 3 on average). The doctor asked if the injection they did helped, and I told him no, which it didn't help and I wasn't expecting it to. They haven't helped ever since I did that fundraising stuff for Kyle's friend, and suffered that fall on Christmas Eve 2010, when I landed on the edge of the arm of that heavy solid wood chair that Ron's dad built. The corner hit the scar over my left SI joint and my right SI joint hit the edge of the desk as I went down.

The doctor checked my reflexes by tapping on my knees and my ankles. My left leg jumped just a little, which surprised me. But when he tapped my right knee, it became obvious that my left leg did not respond the way it should have. It moved just a little, whereas my right leg jerked very noticeably. The same reaction occurred with my ankles, though my left foot barely moved at all. My right foot strongly jerked in response. I could feel the difference too. He didn't say whether he noticed it or not, just but the little reflex thingy back on the counter (it wasn't a hammer, it was a circle on the end of a handle).

The doctor ordered that I undergo the mobility evaluation for the power chair. This is GOOD!

 He then decided it was time to get the prep work done for radio frequency in June or July (when my year is up). He says my record shows I had radio frequency this passed summer, but I don't remember having it. I remember getting injections, but not RF due to insurance issues. I had been told my insurance would only pay for 1 RF procedure per year, not the 4 that I need (2 in lower back, 2 in pelvis). The doctor explained that the insurance company will not pay for more than 1 RF procedure to the same area in one year, but they will pay for more than one procedure to different spots and as long as they don't repeat any of the spinal levels, I can get all 4 sections done. He then said he wanted to go ahead and set up the diagnostics and filled out the order sheet for those. So I am all set for the diagnostic part of radio frequency in April. This way we can just order the RF in June without having to do the diagnostics and making me wait any longer than I already have. This is GOOD!

I mentioned to the doctor that I had purchased some books that are designed to help people suffering with chronic pain to learn techniques to help them cope with it. Some of these things I already do, such as meditating, deep breathing, visualization, and pacing myself but I figured it can't hurt to read them and see if there was anything new I could try. I told him that the book had a paper that lets the patient keep a pain journal and I would start doing that. A pain journal is a daily record of my pain levels. I will fill it out 3 or 4 times a day, writing down pain level by number, what activities I did that increased the pain, and what treatment methods/coping mechanisms I used to help me deal with the pain. This will give him a record of how I experience my pain on a daily basis. He seemed very pleased by both of these things. These are GOOD!

Ron then mentioned this blog and the doctor wrote down the URL. I don't know if he'll actually read it or not. If he does, I hope he isn't expecting daily postings with multiple reports of pain numbers throughout the day etc., like a pain journal. This blog is more for me to get out my thoughts, feelings, and experiences as it pertains to my constant pain (I still think that is a better descriptor than chronic pain). Even though it doesn't give the same day by day accounting as a pain journal does, it can provide the doctor with a better idea of how my pain has been affecting me and how I've been stuck in bed for months and how I am coping with it. So this is GOOD also!


I was saddened by the fact that everything that was said yesterday has been said by me alone for the past 9 months, yet it wasn't taken seriously until Ron was there and said the same things.

I understand that doctors, specially pain management doctors, have to be very very careful now thanks to the DEA's war on doctors and chronic pain patients. I understand that they have to be watchful and careful so they don't give a prescription to someone who turns out to be an addict. I understand that they are working under the threat of not only going to jail and losing their license to practice medicine, but also under the additional threat of losing everything they own. I understand where the doctor is coming from, I really do. But I can't help but feeling upset that (it seems) I was not believed until my husband talked to the doctor.

I think it is very wrong that doctors now have to assume their patients are exhibiting drug seeking behavior when all they are doing is what they should be doing, describing their symptoms to their physician, especially if those symptoms have changed. I think it is wrong that a patient has to bring in a witness to be believed. I am sure that this must frustrate the doctors as well because it interferes with their ability to develop a respectful and trusting relationship with their patients. All these new regulations and rules interfere with the doctor's ability to help people, which is usually why a person becomes a doctor in the first place.

Don't get me wrong, I like my doctor a great deal. He is understanding and genuinely wants to help me control my pain. If I didn't like my doctor I wouldn't have remained a patient of his office for the past 9 years. It is just frustrating to see how pain management has changed over those 9 years, to what it has become, as a result of the war on doctors. I can only imagine how much this must upset my doctors as well as it upsets me.

Re-enactment of First Appointmet with Pain Management

I made a little video of what often occurs when a chronic pain patient goes to their first appointment with pain management. This video is based on both my personal experience, and my recent research/reading into chronic pain.

Chronic pain patients are required to sign contracts with their pain management physician. Many of the stipulations in these contracts remove the patient's rights to privacy of their medical information as well as removing the constitutional rights that require law enforcement to obtain a warrant (meaning need to show probable cause to get such a warrant) in order to get the medical record. These contracts also often contain false information regarding what is drug seeking behavior, physical dependence, and tolerance to pain medication. Also they rely upon presumptive testing that is widely known to be inaccurate in order to deny treatment. Basically these contracts are set up in such a way that every chronic pain patient will eventually violate some part of the contract and lose treatment. Depression is NOT drug seeking behavior, it is a common occurrence with ANY chronic illness, not just chronic pain.

To learn more, including information about the so-called studies that the DEA rely upon to call prescription drug abuse an "epidemic" when the numbers don't support it. To learn more about chronic pain, contracts, and more:
http://www.dailykos.com/story/2011/04/06/963719/-Chronic-Pain-Patients-Lose-Their-Rights
http://pain-topics.org/ for updates on studies http://updates.pain-topics.org/

To learn more about Richard Paey, an example of the unfair investigation procedures and prosecution on chronic pain patients see here:
http://www.november.org/thewall/cases/paey-r/paey-r.html

Negative Effects Of The "War On Drugs" In Florida

I understand the need to fight drug dealers. I understand that they engage in many illegal activities in order to sell their illegal drugs. They steal from others. They are violent and will commit assaults and murders. I understand they tend to be dangerous people, often associated with particular gangs or other organized crime groups. I understand that Southern Florida apparently has many pain clinics, staffed by doctors, who are willing to write prescriptions for narcotic pain medications for people who do not really need them, instead they sell the drugs on the street. I understand that some of these people are allegedly well aware of what they are doing when they supply people with prescriptions for these drugs. I understand that they allegedly will write prescriptions for whatever the person asks for, in whatever quantity they ask for it, in exchange for a cash payment for their services.

I agree that these practices are wrong and are contributing, in part, to illegal narcotic drug trafficking.

However I do NOT agree with how the state is choosing to fight these so-called doctors and drug mills. Their chosen methods of dealing with this is making it impossible for uninsured people to receive the medical care they need!

In order to gain public support for their actions, they present all pain management doctors and clinics as nothing more than "legal drug mills". They present all chronic pain patients as "drug addicts". They engage in mass mis-information in order to gain public approval for their actions. As a result honest chronic pain patients are discriminated against on the grounds that "all chronic pain patients are drug addicts".

What they are doing is harassing any doctor who treats chronic pain patients, and causing chronic pain patients to be treated like drug addicts. We are required to undergo drug testing every month. Our prescriptions are closely monitored and dated exactly 30 days apart. We used to get a bit of overlap so that the patient didn't run out of medication should their appointment need to be rescheduled. Now, when the office sets my appointment on a day that is after I run out of medications, I have to suffer with the withdrawal symptoms and rebound pain because if the doctor writes a script without the urinalysis they can go to jail. Also he is not allowed to write a small script to cover the days between the end of my 30 day supply and my appointment. The doctors are no longer allowed to decide what is the appropriate dose for a particular patient, instead they are cautioned against writing a prescription over a specific dosage amount in order to keep their practice from being "investigated". This leaves patients who need a change in dose unable to get it, meaning they end up suffering with higher levels of pain than they should have to.

As if this isn't bad enough Florida is now making it even worse. Their rules have now made it impossible for my daughter to receive the medical care she needs because she pays cash.

The state has decided to investigate every chronic pain doctor, whether they have reason to believe the doctor is engaging in illegal activities or not. As a result my doctor has hired a lawyer, to provide guidance on reducing his risk of being accused, just in case. On the recommendation of the lawyer, the doctor has to stop accepting Medicaid patients and any cash paying patient who wishes to see him for pain management. The reason for this advice is that the majority of drug addicts who doctor shop (see more than 1 doctor to get meds) are usually cash paying patients or on medicaid and the doctors who are willing to provide prescriptions to addicts (the ones who actually run drug mills in southern Florida) and dealers will only accept cash payments for the office visit. This means my daughter, who has been a patient in this office for 5+ years, can no longer see this doctor as she has no insurance and pays cash for the visits. So as a result of this "War on Drugs" (which we have already lost) patients who need treatment can not receive it if they are on medicaid or pay cash! Exceptions can NOT be made for patients who can show very obvious conditions or injuries that would require pain management, nor can they be made for patients who have already been with this same doctor for many years and have never shown any signs of illegal activity or addiction, if they're on medicaid or pay cash. It is a case of "too bad, so sorry, go somewhere else"!

My daughter has some major damage to her lower back from a car accident. Her vertebrae no longer sit correctly one on top of the other, one of hers has slid off of the vertebrae beneath it by 50% (this is called  Spondylolisthesis ), she also has spondylosis (aka degenerative osteoarthritis), degenerated disks, a large herniated disk (that literally surrounds the sciatic nerve root at L3-4), nerve damage to sciatic nerve roots (L3-4, L4-5 and L5-S1) causing permanent sciatica, and suspected sacroiliitis. As a result they had to fuse her spine in this out of alignment position because the first attempted repair failed when the vertebrae slid off again despite the screws that should have held it in place. She now has rods, screws, plates, and posts in her lower back holding her spine together. As a result of these injuries she lives with constant pain and constant sciatica. She has been seeing the same doctor for pain management for over 5 years. She has never failed the drug screening. She has never shown any behaviors that are considered signs of an addict (such as losing scripts, constantly demanding an increase in dose or frequency, losing the medication itself etc.). Despite all of that, she has been discharged as a patient from her doctor just because she pays cash.

Not all pain clinics and pain management doctors engage in writing prescriptions for people they know are going to sell the drugs. My experiences with these clinics has been the exact opposite. It is very difficult to obtain prescriptions for pain control.

Every month I have to undergo urinalysis drug testing to ensure that I am not taking drugs I wasn't prescribed, doing illegal drugs (such as cocaine or pot) and that the level of prescribed medication in my urine is the correct level for the dosage I was prescribed. When or if my needs change (due to further injury or tolerance to current dose) it is extremely difficult to get my dosage changed as well. In fact, I was told a few months ago that no matter what they will not increase my dose any further and that I will just have to "live with" any increase in pain or new symptoms. Which I have been doing for the last 8+ months due to further injury caused by the yard sale I ran back in April 2011. This means I am now pretty much bed-ridden and will stay that way for the foreseeable future and my daily pain level stays around a 6 to an 8.

So the results of the war on drugs in Florida are that patients who need treatment can't get it if they are on medicaid or pay cash and patients who are receiving treatment can't receive proper treatment because the doctor can be arrested for doing their job.

This is WRONG!

Law enforcement agencies and lawyers (be they prosecution type lawyers or other types of  lawyers) should NOT be the ones making medical decisions for patients, the doctors should be.

I am terrified of how much worse this is going to get when Obamacare goes into effect. My understanding is that with Obamacare pain management doctors will be given a limit of how many controlled substance prescriptions they can write in a month. If they go over that number they can be arrested and charged with drug trafficking. As a result of this, how many more patients will end up without treatment? Example: doctor has 31 pain management patients. Gov't tells him he can only write 25 controlled substance prescriptions per month. This means 6 patients will go without pain management.

Further, it is my understanding that under Obamacare a government panel will decide what injuries deserve pain management and what dose is appropriate for said injuries regardless of the medical history of the patient. My worst injury does not have a diagnosis code (permanent compound fracture of left SI joint) because it is extremely rare to have a permanent fracture, so it won't be considered when this government panel decides what the appropriate pain management is for me. If my doctor prescribes something different from what they government tells him to give me, he will go to jail and pay very high fines.

Medical decisions should be made by DOCTORS, not government officials and not law enforcement officials.

Radio Frequency Procedure

Warning: Graphic Image and Specific Language about a medical procedure. If you are upset or bothered by reading about or seeing a picture of said medical procedures being done! then please do not view this post.


For those who may not understand what radio frequency procedures are, I asked for a picture from the flouroscopy (almost like an x-ray) view so that I could scan it in and explain about how it is done and why it sends me to bed for a couple days after it is done, as well as why it helps so much making me willing to keep repeating such a hellaciously painful procedure. As well as to discuss it and other topics with my son.

I will be referring to this picture:

You may need to click the picture to view it full size and read the labels.

You can easily see the main part of the 6 inch screw that lays horizontally through my left sacroiliac joint. It starts near the hip (I can actually feel the screw head under my skin if I press the right area) and goes through the entire illeum, across the broken joint and ends about halfway through my sacrum. This screw was supposed to hold both sides of the SI joint together while it fused to solid bone. It did not fuse so the screw now acts to stabilizing my sacrum so it can't move as far as it is capable of. The area underneath the ridges of this screw is my sacrum itself.

In the lower left area of the picture it gets pretty dark. This is because the surgical steel plate and screws cast a shadow on flouroscopy (they do the same on x-ray and cat-scan). The plate can be seen though, along with the screws that go back to front holding the plate in place.

For background knowledge, the plate and all the screws are loose. (so not only am I permanently screwed, all my screws are loose too! ROFLMAO) There are visible spaces around the threads and length of all the screws on cat-scan review. It is these spaces that have allowed the affected bones to be mobile again. When I walk they grind together and you can sometimes hear them pop, crack, or snap very loudly. Also, the second attempted fusion resulted in pseudoarthrosis which is a thin bone covering over an attempted fusion. An uncommon side effect that results instead of a complete solid fusion that would have removed the SI joint and left the illeum and sacrum connected as one solid bone. This thin covering makes it appear the fusion is solid on an x-ray, but the spaces of the original joint are still visible on cat scan {as cat-scan takes slices, that can see behind the bone covering}. When this covering broke, and a subsequent fall was endured (which caused further fracturing of the bones), the end results is a permanent compound fracture of the left SI joint and bone fragments are floating around. It is the plate and screws that make it possible for me to continue to walk, but since they are loose the bare bones do grind together and new bone fragments can be chipped off if I were to further injure the area through falling or a car accident or something.

Ok..radio frequency step by step.
I am brought into the flouroscopy room at my local outpatient surgical center. I am laid face down on the table and prepped. A grounding pad is placed on my right thigh when they do the left side. (everything is the opposite when they do the right side) Iodine is wiped over the area to be treated and sterile drapes are placed over my body with the opening in the cloth showing the lower back and pelic area on the left.

I had an IV for the first time this was done, with mild sedation using versed. In some people versed makes them very emotional. That is the reaction I had. When I started crying from the pain, I could not control it or stop even when the procedure was over, and instead of just crying for a moment or two I was sobbing (I hate crying from pain btw). This caused a nurse (who was later let go) to insult me and call me names. As a result the next 3 times I went through this procedure I did it without an IV or even mild drugs as that nurse (who was still there for the next 2 out of 3) told me only Versed could be used (Which was wrong by the way). However the last time I had this done (Aug. 2009) the nurse assigned to me asked me why I did not want an IV and medication. I told her how versed affected me and that I was told it was the only medication they could use, so I chose to suffer through it rather than be humiliated. She was the one who told me that versed can do that to people and that they can use a different drug instead. She told me to give it a try with the different drug and see if that helped at all. It did. The procedure still hurt like hell but it was not as bad as it is when I am not medicated. So this time I was again given an IV and a low dose of medication right before the procedure started.

For the first part of the procedure only my skin can be lightly numbed. The doctor then proceeds to place each needle with the assistance of the flouroscopy. This is to help ensure proper placement of the needles, and to ensure they are not going into areas known to carry nerve roots for a mobility nerve (sciatic nerve and its roots which are present at all lower lumbar disc levels).

The needles for L4-5 and L5-S1 hurt the most because it is those areas that have a degenerated disc and a herniated one (in that order). There are areas of scar tissue and bone fragments which make it difficult to just slip the needle in. This is further complicated by the presence of the surgical steel screw. One needle goes above the screw, but the other one has to go underneath the screw. This takes some maneuvering on the Dr's part. While these needles were being placed all I can do is cry and try to breathe through the very sharp pains that are shooting across my entire lower back and pelvis. It hurts a great deal.

Once all the needles are placed, they must test each one. This means they send the waves through the needles, one at a time. This stimulates the areas and thus exacerbating my pain. This is the part that gives the reason for not numbing the entire area first and the reason I must be awake for these procedures. As each needle is tested, it is my job to feel the waves and where they cause pain. If I can't feel the waves, they adjust them until I can. In addition to that I must be able to tell them if I get any sciatica type symptoms. This means any numbness, tingling, sharp pulling sensations, or sharp pains going down my leg. If those symptoms are there, the needle must be withdrawn and replaced because those symptoms mean the waves are hitting the sciatic nerves.

Once all the needles are in the correct places and tested, they numb me. But it is not completely numb. I can still feel the waves as each needle is activated, run for a little while, then move on to the next one. The only difference is it is nowhere as intense and sharp a pain as I feel during the testing section. Part of the reason is that I am numb, but because the waves are now at the correct frequency (thus stronger) I can still feel it. Again, L4-5 and L5-S1 are the worst. Once the proper time has passed for each level, the needles are removed and a dressing is placed. I am moved back onto a gourney and into the recovery area. This is where I am watched for about 20 to 30 minutes, then sent home.

Radio frequency procedures damage the nerves around a painful area, thus preventing them from sending pain signals to the brain and lowering how much pain the patient feels. I call them middle nerves because I can never remember their proper names LOL. These are not the surface nerves that allow you to feel sensation through your skin. Nor are they the nerves that lay near your bones and handle movement, bladder and bowel control etc. (Sciatic nerve in lower back and pelvis). The nerves being deliberately damaged lay in between those two areas (surface/skin and mobility nerves near bones) hence I call them the middle nerves and usually explain them to people as the filling inside a sandwich. This scarring interrupts the pain signals that, in a chronic pain patient like me, are constantly being sent to the brain.

The longer a person is in pain, the better their nerves and brain get at feeling that pain. (I guess practice makes perfect is just as apt for the human body) The nerves become overly sensitive and send pain signals to the brain constantly. The brain gets better at reacting to the pain signals received from those areas because the more often it works, the better the brain gets at noticing it. In a chronic pain person what this means is that they will feel pain constantly, and even minor fluctuations in that pain are perceived as more intense by the brain. This can also distract the brain from noticing minor pain relayed from different areas. This is part of the reason I do not always feel the muscle aches that accompany doing too much right away. Instead I only feel those after I have stopped doing whatever it was, sit down and relax for a while. It is while I relax that my brain starts noticing the signals from other areas, as well as from the injured ones. This is why I clean house in 10 to 15 minute bursts, alternating with sitting down for 10 to 15 minutes. It is those resting minutes that allow me to guage my pain level and realize that I am reaching my limit and must stop even if I am not done.

The scarring/burning of the nerves lasts for quite some time. I get about 9 to 10 months of lower pain levels out of it. Some patients can get up to 2 years from this procedure and apparently a few lucky people get permanent results. But for the majority of patients these nerves do regenerate and when they do the original levels of pain return. For some it happens quickly, for others it happens over a period of time. I am one of the latter people.

Side effects vary but for about 2 weeks after the procedure I experience odd sensations, which are signals the damaged nerves are sending out. I get pins and needles sensation throughout the affected area, these little zinging shoothing pains that shoot every which way a few times an hour, a burning or heated sensation in the treated area, or a sensation of tingling as if I had a tens unit on. These sensations start out frequent for me and lessen over time, usually stopping within 2 weeks. They can be greatly alleviated through the use of medications such as Lyrica or Neurontin during those two weeks.

This is what was done to me on Monday the 11th. It will be repeated on the right side on the 25th. In addition I will be scheduled to have the procedure repeated two more times, this time to the sacroiliac joints themselves, which I erroneously thought was already being done and it wasn't. I'm not looking forward to the procedure on the left SI joint, which is the broken one, because I am expecting it to hurt even more than the left side of my lower back does. I am expecting that because it is the part of my body that causes the most severe pain. But I will get it done because I know how much relief these procedures do give me, and by adding the SI joints it is possible that I will be able to lower my pain medication for the first time in the many years I've been stuck having to take such medication on a daily basis. Ohhhhh I am really hoping and praying that this will be possible!! It is also possible that with the pain of my lower back and pelvis under much better control, that I will be able to do a lot more physically and thus rebuild some of the muscle tone I have lost due to immobility. (and maybe lose a few pounds too!)

I originally had the picture printed out to show to my son and give him a little science lesson on nerve conduction, bone structure, and the issues facing a chronic pain patient such as dependency, tolerance and the differences between those two things and addiction. There is a lot of emphasis being placed on prescription drug abuse. As I have stated in older posts, these political views even showed up in his science text book for the 6th grade. The book flat out stated that anyone who takes pain medication on a daily basis is an addict, that there are no medical conditions that cause chronic pain. With those messages coming from so many different sources (friends, family members of his friends, teachers, school books, television, newspapers and radio) I was expecting him to eventually have doubts and start wondering if I was an addict or not. So I took the opportunity of homeschooling and the time to explain these things in detail to him.

So we spent some time discussing tolerance, dependency and addiction and the differences between them. We spent some time going over the behaviors that are present with an addict and how they differ from a non-addicted chronic pain patient. The biggest one being: no addict would put themselves through the hell of such painful procedures as radio frequency, steroid injections or more because their goal is not pain control, it is to get high. Whereas a chronic pain patient will attempt those procedures (and repeat them if they work) because their goal is pain control, not to get high. I didn't even have to point that out to him, he got it on his own. He understood that I continue to suffer through these procedures because they help me and they make it possible for me to deal with my pain without having to increase my medication every year or so. (I took the same dose for 6 years before the pain got so bad that I had no choice to but to increase my medication, even with the injections and RF.

So that is how radio frequency is done on me. For more information about this procedure here are some links:

http://www.spine-health.com/treatment/injections/radiofrequency-neurotomy-facet-and-sacroiliac-joint-pain

http://www.medscape.com/viewarticle/718292

http://www.neurotherm.com/

http://www.webmd.com/cancer/tc/radiofrequency-lesioning-for-chronic-pain-

I do feel lower pain in the treated area, but since it is only 1 area out of 4 it isn't enough to affect my ability to move around or to be out of bed for more than a couple hours at a time. Still it is nice to have a lower pain level in that area and I am looking forward to how it will feel when all 4 sections have been done.

For now I am still stuck mostly in bed because it is the most comfortable place for me to sit, and still stuck with pain levels at a 7 or 8 on a daily basis. This high level makes it a lot easier for me to hit a pain crisis simply by doing normal every day things. So for now I am still having to take it extremely easy with small windows of freedom (freedom meaning I can sit at the dinner table for an hour or half an hour, or sit in my recliner and watch tv for an hour or so, or take a shower without my shower buddy [read hubby] and more.

I hope this long rambling disjointed explanation of radio frequency helps you understand things a bit better. If you hung in and read it all, thank you!

Distraction is a cure?

I have read many articles online and in print about chronic pain. Some were written by doctors, some by social workers or therapists, some by journalists. I have also read blogs written by people who live with chronic pain. Sooner or later the topic of distraction shows up.

What amazed me was this one article was posted with a title that misrepresented the contents of the article.The title is "The Most Powerful Pain Reliever Revealed". It made it sound like someone had found a cure for chronic pain, yet when you read the article it simply states that distracting yourself cures pain. The example it gave was not one of distraction, it was one of a person in full fight or flight mode, full survival mode complete with a major adrenalin rush. The example was of a woman going back into her burning house to save her cat from death and not noticing that she sustained 2nd and 3rd degree burns while doing so. It used this example as proof that by being distracted one doesn't feel pain. It was a doctor who posted this article. You can find the article and the comments generated here.

The responses to this article ran the gamut from agreeing that distraction works in controlling pain, to anger that anyone could think that such a life and death situation counts as mere distraction.

There were a few things that bothered me when I read this article. First, the title. I agree with the opinions stated that the title was in fact misleading. It is misleading. When I read the title, had I not known better, I may have felt hope that finally something to truly help me had been discovered. I may have felt that finally I might have a chance at leading a more normal and active life with little or no pain. Luckily, I knew that there is no miracle cure for pain so I did not feel those things. What I felt was curiosity and wondered what wonderful so called powerful thing the author would espouse as such a great treatment for pain.

Second, the example provided in the article really bothered me. I agree that the example provided is not one of distraction. It is, in fact, one of a person in full survival mode. Science has shown that when a person is put into a position by a life threatening emergency that their body goes into fight or flight, survival mode. To do this, non-necessary bodily functions shut down such as digestion. The brain sends commands to increase adrenalin and endorphins and these chemicals are released into the blood stream in large quantities. These chemicals cause many different physical responses, but one of them is the inability to feel pain or the dulling of pain so it is easily ignored while the brain is focused on surviving the situation. You can find many examples of people ignoring serious painful injuries while in a situation that could have easily taken their lives. There is a difference between being distracted and being mind-locked into truly surviving when your life is threatened.

Distracting yourself through hobbies or other activities does not cause the body to dump massive amounts of adrenalin and endorphins into the blood stream. It can cause some release of these chemicals, such as during sex, but it rarely happens with fairly sedentary activities such as reading, or other hobbies. Hobbies such as running (marathoners often experience "runner's high", which is a result of such adrenalin and endorphin release into the bloodstream) may cause these chemicals to be released but not many severe chronic pain patients can run or do marathons. They simply hurt too much and the cost of such activities in increased pain is just too high.

Thirdly, the response of the doctor who posted the article to the comments really bothered me as well. The people who posted positive things about how distracting themselves with hobbies can provide some relief of pain were praised as survivors, having heart, being beautiful and other positive things. Whereas the ones responding with anger or disbelief were judged as having "negative thought viruses" and worse. The doctor who posted the article states she has lived with chronic pain for 10 years, at the time the article was posted. I understand that this person has obviously chosen to try to stay as upbeat and positive as she possibly can and that is fine. But to be so derogatory towards those who took offense with the way the article was presented was exclusionary and wrong. To hold those people who commented only with positive things up as "survivors" and beautiful people, to lord them over the ones who were angry at being mislead and then belittled is very wrong in my opinion. Especially from a doctor. Chronic pain patients get mistreated and misunderstood by doctors far too often as it is. We are judged as drug addicts, drug seekers, attention seekers, as having mental illnesses and worse, far more often than we are believed when we describe our pain. For most of us it takes years to get a doctor to listen to us and start exploring possible reasons for our pain. For those who are harder to diagnosis, they often have to see many different doctors over periods of years to finally get one who will seek an answer and then treat them even a little bit. Even after having a diagnosis (or more than one) of a condition that causes severe pain, we are still seen as weak, drug seeking addicts who just want attention and dismissed by many doctors because we can't be easily "cured". To have another doctor, publishing articles that just add another reason to dismiss chronic pain patients as weak minded is, in my opinion, counter productive and wrong.

Many chronic pain patients try very hard to stay on the positive side. To see the little things in their lives that are still good, the things that make it worth getting out of bed every day. But they also have every right to be upset, offended, and angry when an article such as this one is presented as the cure to chronic pain.

Distraction is not a cure, nor does it give the same physical response as a life and death situation. Distraction merely takes the conscious mind and focuses it on something other than the pain your body is feeling. It does not make the pain go away, nor does it really lessen the pain. It just shifts your focus so the pain becomes secondary to whatever you are focusing on, but you still feel the pain. And when the pain gets bad enough, it distracts you from whatever you are doing, it takes over your mind.

I agree that the mind is a wonderful tool that can be utilized to help one control their pain in different ways. Meditation, relaxation techniques, distraction, visualization techniques and more can all be used to help manage pain, but they can not get rid of the pain completely, they are not a cure. To present it as a cure is, in my opinion, wrong and belittling of those of us who live every day with severe pain by making us out to be weak minded, psychologically inferior or somehow less than other people. To teach other doctors (as this article purported to do) that distraction will cure pain or cause a patient not to feel it, is to make being properly treated for pain even more difficult than it already is.

Think about it, you are in severe pain and have been for months. You finally break down and go to the doctor, hoping for some kind of relief, any kind of relief. The doctor then tells you that you merely have to distract yourself with other activities and the pain will go away. How would you feel hearing that? Yet, this is the exact scenario that this article and the presentation (to doctors no less) that it describes is teaching doctors; to cure pain all a patient has to do is distract themselves.