This “manual” by Forest Tennant M.D., Dr. P.H. from the renowned Veract Intractable Pain Clinic in Canada describes the therapeutic measures you must take particularly if you want pain free hours rather than a constant state of pain. Intractable pain patients tend to think that simply taking opioid medication will solve their problems. This is not true. So I have been told, and given that I am in excruciating pain again (the debridement gave me only 4 weeks’ “relief”) I am ready to give it a shot, are you?
Without the comprehensive measures given here, you will eventually find that your opioids don’t “work” , says Dr Tennant, and you are right back in constant, severe pain.
Nine steps are given here as a pathway to pain free hours. These steps include your instructions on diet, dietary supplements, exercise, electricity control, and topical medications.
Why these nine steps for intractable pain patients/injured workers?
The nine step guide is for those intractable pain patients/injured workers who are deeply committed to achieving some pain free hours. The material contained in this article is given to Dr Tennant’s private patients, and I wish to share it with other intractable pain patients as almost all of his patients have been able to experience some pain free hours.
However, do not expect your pain to totally stop although the steps given here will greatly reduce your overall pain.
Experience has shown that once you achieve the first pain free hour, more will come.
Be clearly advised that the achievement of pain free hours requires that an intractable pain patient diligently participate in a treatment program with multiple measures.
My best recommendation at this time is to focus and intensely practice the nine steps given in this guide.
The pain research breakthrough
In recent years medical science has learned that an injury or disease with severe pain, which does not immediately heal, may produce excess electrical impulses that travel from the pain site to the spinal cord and brain. Initially the brain tries to cure the pain site by causing the body to produce essential hormones and immune enzymes. If this step doesn’t work the brain rearranges its nerve cells, called neuroplasticity, to shield itself from the excess electricity produced by the injury or disease.
Unfortunately, the rearranging of nerve cells may trap or imbed the memory of the pain in a new, abnormal brain circuitry. This is the mechanism for “phantom pain”, and we now know that this is the mechanism by which one develops intractable pain.
It is the trapping of the memory of pain in the new circuitry that makes the pain constant and produces other intractable pain symptoms including insomnia, depression, nervousness, lack of mental concentration, high blood pressure, elevated heart rate, abnormal hormones, and a feeling of hopelessness.
The nine steps given here are designed to at least partially heal the abnormal nerve cell circuitry in the brain as well as the damaged nerves at the site of pain. This nine-step guide is Dr Tennant’s first attempt, given what he knows today, to help intractable pain patients achieve a “pain free hour”.
You can look forward to improved and more effective measures in the future. Real hope is here, he says.
The meaning of a pain free hour
A single pain free hour has to be the main goal of an intractable pain patient who may have suffered constant -”24/7″- pain for a long time.
Why is this achievement so significant? It means that you have healed some damaged nerve cells that have an abnormal electric circuitry, and it likely means you can achieve more pain free hours.
Thanks to research, Dr Tennant now knows that a patient who is selfdisciplined and closely follows the nine steps written here has an excellent chance of achieving many pain free hours.
NINE STEPS TO A PAIN FREE HOUR
- PAIN MEDICINE : Take whatever medication you must take to be active, functional, and able to leave your house each day.
- SLEEP MEDICATION: With IP you can only sleep about 2 hours unless you take some medication.
- PROTEIN DIET: Pain control and mending your nerve tissue requires amino acids which only come from foods with protein. You must avoid hypoglycemia which comes from too many sugars and starches.
- DIETARY SUPPLEMENTS: Without certain daily supplements your medications may stop working and tissue won’t mend.
- ELECTRICITY ELIMINATION: Your damaged nerves retain electricity in the body (“static”) and you must daily take measures to eliminate it or you will progressively deteriorate rather than achieve pain free hours.
- TREAT YOUR SITE OF NERVE INJURY: You must daily stretch, massage, and apply medication to your pain site. You must learn to make your own opioid topical medication.
- ACTIVITY, MENTAL EXERCISES, MOVEMENT : You must daily be moving, talking with people, and exercising your brain or your tissues will atrophy and you will mentally deteriorate.
- ANXIETY MEDICATION: IP causes the sympathetic nervous system to overstimulate resulting in a high pulse rate, muscle spasm, tremor, twitching, anxiety, blood vessel constriction (cold hands/feet), headache, nausea, fear, and lack of confidence. You will likely need medication to control this complication.
- HORMONES : It is specific hormones whose job is to grow nerve tissue (“neuro-genesis”). Regrowth of damaged nerve tissue is essential to achieve a pain-free hour.
DIET FOR INTRACTABLE PAIN PATIENTS
GOALS:
1. Take in extra proteins since the natural body pain relievers including endorphin, dopamine, serotonin, and gamma-amino-butyric acid are all made from protein.
2. Avoid hypoglycemia since it may cause your pain to flare.
3. Keep your weight down if your pain is caused by spine, hip, knee, ankle or foot problems.
- Diet Key Point: Eat one or more of these protein foods every time you eat: Beef, Fish/Seafood, Poultry, Pork , Eggs, Cottage Cheese
- Drink low sugar (Carbohydrate) drinks. Drink tea or coffee with low calorie sugar. Diet drinks are acceptable.
- Do not drink the following: Milk, regular sodas, Coffee/Tea with regular sugar.
- Eat any food you wish as long as you eat a protein food with it. Especially eat some protein with rolls, donuts, pie, cake, ice cream, candy, bread
Basic supplements
1. EACH DAY – 1 MULTI-VITAMIN/MINERAL TABLET OR CAPSULE – ANY BRAND
2. EACH DAY – 1 0R 2 VITAMIN D – CALCIUM-MAGNESIUM TABLETS (Sold for Osteoporosis)
3. EACH DAY – GLUTAMINE 1,500 TO 2,000mg (Chew a tablet or take a capsule on an empty stomach)
4. TAKE A VITAMIN B-12 TABLET UNDER YOUR TONGUE 3 TO 5 TIMES A WEEK.
Special Notes
All these supplements can be purchased at a Health Food Store. Be clearly advised that your medications may stop working if you don’t take these supplements.
Additional supplements that help some patients: Carnitine, Taurine, Fish Oil, Phenylalanine, Folic Acid, Vitamin C.
Electricity elimination strategies
You must daily eliminate the accumulation of static or trapped electricity in your body which results from damaged nerves. Pain and its complications are fundamentally caused by excess electricity.
Mandatory each day:
1. Rub your pain sites at least 2 times a day with copper and a magnet;
2. Massage one of these topical (skin) medications into your pain site(s) at least 2 times a day: morphine, hydromorphone, carisoprodol, oxycodone: They work best under infrared, vibrator, ultrasound or heating pad
Do some of these each day
1. Take a tablet of magnesium, copper, or zinc;
2. Wear copper and/or magnetic bracelet, anklet, or necklace;
3. Soak in your bath tub or Jacuzzi with 2 tablespoons of Epsom salts placed in it;
4. Walk barefoot for at least 5 minutes
5. Use a TENS, microelectric current (Alph Stim®), or other electromagnetic device over your pain sites;
6. Stretch exercises which put pressure or “tug” on your pain site(s).
7. Frequently grab or touch metal objects.
How to use opioids to control intractable pain
1. You must learn the actual names and not just the trade name of your opioids.
Example: hydromorphone is Dilaudid®
2. You must take your opioids in such a manner that you are not sedated, impaired, sleepy, or have a clouded mind or memory. Your family is the best judge, not you.
3. Most intractable pain patients must control their pain by use of a long-acting opioid plus a short-acting one for flares, surges, or breakthrough pain. Some of the opioids listed here have long-acting, oral formulations which last 6 to 8 hours. You must take a long-acting opioid on a regular schedule which means taking the same dosage at the same time each day. The usual schedule is 7:00am, Noon, 6:00pm, and 10:00pm.
4. Use your short-acting opioids 30 to 60 minutes BEFORE the flare or just breakthrough starts.
STAY AHEAD OF THE PAIN.
Opioids for intractable pain
METHADONE TAPENTADOL MORPHINE
FENTANYL OXYCODONE HYDROCODONE
OXYMORPHONE MEPERIDINE HYDROMORPHONE
How to make pain relief creams
Crush 1-3 tablets of the following and stir in 1 ounce of cold cream.
1. Carisoprodol (Soma®) – 350mg
2. Morphine – 30mg
3. Hydromorphone (Dilaudid) – 8.0mg
4. Oxycodone – 30mg
5. Medroxyprogesterone – 10mg
6. Prednisone – 5mg
Massage one of these topical creams into your pain sites at least twice a day. You will not only get additional pain relief but help eliminate your trapped (static) electricity. You can mix topical medications and pick your own cream or base. These topicals work best under infrared, vibrator, heat, or ultrasound.
Download the Manual here (PFD)
The intractable pain survival handbook
Interested in reading more about intractable pain? Have a peek at this free book by Dr Tennant.
Click to view book (PDF)
Does make sense to me, it is pretty much the same as what my own Melbournian pain specialist prescribes, with the exception of some of the dietary stuff and the topical cream, although he did prescribe voltaren gel and Vit C. He also said that the NSAIDS (such as naproxen, celebrex) are very bad for your health (kidneys, stomach, heart) and that there is nothing wrong with proper, tailored doses of narcotics (opioids). Tomorrow I will ask my pharmacist for some “cold cream” and mix some morphine (endone) in it, see it that helps. I am also going to try a copper bracelet! Anyone else got some other suggestions?
I have severe end stage arthritis in the knee following a work accident (fall) and several operations and am waiting for a knee replacement/ prosthesis.
Hi ‘Pain”, I know exactly what you feel, as I too have end stage osteoarthritis but in the shoulder (as well as end stage rotator cuff failure, gross instability and some CRPS). Pain is pretty debilitating indeed – like a severe, maddening toothache of the worst kind.
Sometimes I find a hot bath with Epsom salts to give a bit of extra relief, especially overnight, when I wake up from the pain. But then again at other times I prefer an ice pack to cool the burning, throbbing heat.
Distraction helps a bit – i.e. listening to great, loud music (ipod) or watching a very scary or suspense movie. The TENS machine does also help, but only whilst its on, eh. I also benefit a lot from psychotherapy, especially visualisation and distraction techniques.
Like you I am going to try the cold cream stuff and the copper bracelet as well as the supplements… see if that helps a bit over time.
Hang in there I’d say and hopefully we will get decent relief with a new joint implant
There are so many problems with this article.
* sham treatments passed off as “workable” (placebo at best)
* static electricity buildup? This is straight out of “use sciency sounding words” sales technique to sell snake oil. One does not need to eliminate “electricity” from their body, it’s just plain and utter rubbish. Laughable, this is the most ridiculous part of the whole article.
* stretching isn’t always good for pain. (eg, I’m already hypermobile, the hypermobility is one of the causes of my pain, stretching increases the mobility)
* Pain medicine — there often isn’t a good drug to make people functional. The drugs I’ve been on (and there’s been a lot) either are so barely affecting the pain at all that it’s difficult to tell, or have huge side effects (such as vomiting constantly, or a mental fog so thick I couldn’t think my way through an open doorway I was standing right in front of) … let alone function daily. If there was something that helped rather than hindered, I’d be on it. But the fact there are no effective pain drugs that doctors are willing to prescribe doesn’t at all evidence a lack of pain. I suspect pain medication mostly dulls peoples brains down to stop them complaining, rather than actually stopping pain. Local anasthetic works great the few times I’ve had it, but it’s not a prescribable treatement. (this also surely counter-indicates the “neurological amplification” theory of pain so often touted)
* hormones — I’ve not been able to find a link between “hormones” and neurotrophins (NGF to be specific) … though exposure to stress and corticosterone (which is a hormone, sure) ..seems to negatively affect it’s production — this would seem to imply that the insurance companies should stop harassing and torturing us as the appropriate treatement, rather than some vague implication that hormones, and nerve regrowth has a chance at “pain free hour” (either the nerve regrowth fixes it, or it doesn’t — nerve regrowth isn’t going to have any “mind over matter” effect over the duration of an hour). Nerves can grow at a rate of up to 1mm/day. So chronic pain (which is defined as long term pain — nothing to do with if the knife is still stuck in you or not) isn’t likely to have particularly large effects on short term pain.
* diet, a good balanced diet is good for everyone, and isn’t specifically of any benefit to people suffering pain. I’ve not seen any study suggesting any link between high protein diets and pain benefit, and rather, it’s typically used to extremes for weight loss and often causes joint pain, liver and or kidney damage.
* sleep medication has many side effects, quite often associated with mild amnesia. Sleep is important, but restful natural sleep is the goal, not a drug induced coma. People with sleep issues first should have as many sources of stress removed (agressive insurance issues, financial issues, work issues, spousal issues, etc) as possible before drugs are even considered.
* Anxiety medication — similar issues to above. There are legitimate things to get anxious about, and as an insurance victim, it’s a huge burden. The obvious solution here isn’t anxiety medication to cover up symptomatically.
* dietary suppliments — another snake oil suggestion as best I can tell. Vitamin D is the only supplement suggested as supported by evidence over placebo that I’m aware of at the moment (and even then, that’s only for people who don’t get 15min of direct sunlight a day). Of course, anyone who’s deficient in something would need to deal with that, but doing it through nutrition should almost always be possible and preferable to supplementation. And if this claim is to be taken seriously, then rather than taken as a prophelactic, there should be a blood panel done to identify the specific deficiency.
* implications of chronic pain being solely a brain or nerve amplification problem. (it’s not). My ankle swelling painfully after a short walk is evidenced to not be pain amplification or brain plasticity by correlation with physically identifiable change. And lack of physically identifiable change isn’t evidence that there ISN’T a physical cause of the pain. Only that it isn’t physically identifiable (the scans aren’t good enough to identify nerves – barely only large bundles of nerves, so proof either way here isn’t and won’t ever likely to be avaialble). But that doesn’t mean chronic pain is always neurologically based. Basic logic failure, and it’s a common misconception that suits insurance companies to proliferate. But it’s just plain bad logic, and scientific process. Misleading at best.
* Implications that if victims subject themselves to these things “for some relief” that it’s their responsibility and liability to do so. Freedom to choose shouldn’t just be for the uninjured, and forcing people to meditate who otherwise would not do so is a cost of individual freedom that should be borne by the insurance, not one borne by the individual.
* that by victims subjecting themselves to treatements such as these, they “get some improvement” by some measures — of course one does, but by calming people down, getting them less stressed, one does many things — include erode their legal rights. Unjust, unethical.
* that long term pain medication is “safe” — there are a lot of consequences, shortened lifespan for the individual, reduced immune system function, greater risk of disease, decreased brain function, nausea. You name it. The consequences of forcing people in pain into treatements wtih side effects is resulting in an externalisation of costs — the victim and their social group bears these costs, not the insurance that’s tasked with the job.
* That anxiety and stress medication, and mediation is appropriate treatement for the ADDITIONAL stress that insurance companies burden victims with. Injured at work, disabled by insurance is a common phrase, and it’s common for a reason. If the stress of a legal case, medical expenses, living expenses are such that it’s causing medical providers to drug people for some symptomatic relief — then the solution isn’t symptomatic relief, the solution is for doctors to grow cahonies, and make very strong, clear statements to the court to prevent insurance companies from being allowed to profit through deny, delay and destituion tactics, that force people into an increasingly deseperate position such that when the “low” offer eventually comes through (that they’ve earned interest on the money the whole time they’ve been delaying — average of 13.5 years for the TAC for example) people are so at the end of their humanity that they accept. And often wind up in mental hospitals subsequently anyway. It’s outright torture, it’s against any sense of morals or ethics one could call reasonable.
Not to be a total negative nancy, I do agree with the general principals of get better sleep, reduce anxiety, eat well, exercise mind & body (not to excess, and only under doctors instructions). The other principal I assert needs much more airtime in articles on pain, is the impact of stress reduction — people shouldn’t be fighting to survive, paperwork, legal case, doctors, lawyers, on top of trying to earn a living, or live off the insanely low ‘loss of earnings’ payments that get made which are a fraction of pre-injury earnings, while expenses go up (due to insurance companies offloading liability onto the victim to pay, as well as everything getting more expensive. Can’t drive? Can’t survive the jolts and pain of public transport – then Taxi’s at much much higher $$$ than a private car can be had for are the only choice. Or even if you can still drive, but you can’t walk far or fast, you wind up getting a lot more parking tickets, or being forced to park in expensive car parks (often up to $80 for a couple of hours)! (previously, I’d have parked out of city free, walked, or ridden, or public transport – but it’s yet an additional cost unfunded by the insurance that adds to victims stresses). The stress of worrying constantly if you’re being video taped…. if you go out for a meal, try and ignore it as best as possible, and they get a clip of you smiling and trying to ignore the pain so as not to upset your date, then it’s used to hang you. So victims either get to take their pain with them everywhere, never try and ignore it, or they get hung. It’s an absurd burden. And it tangibly increases people stress, and that makes pain and consequences worse.
One thing that this article didn’t mention, that helps me a little is warmth on one of my areas of pain, and (unluckily) cooling, to the point of freezing/icing/numbness my other areas. Only thing other than a cortisone injection that’s had any real net effect.
Anyone else spot any other problems with the article?
Any studies for or against my assertions?
Ben.
@Ben. This doctor is a renowned pain specialist and I would think he knows what he is doing, however some of the the way he writes things to make it ” readable” to “all” (incl. the average Joe) can be debated.
His methods are however very much in-line with what my own, reputable and internationally renowned pain specialist prescribes and advises!
Also,the article is about INTRACTABLE pain which is really CRPS (chronic regional pain syndrome) aka as reflex sympathetic dystrophy (RSD).
http://www.rsds.org/index2.html
If you would like me to not cut down their arguments so you can believe in a placebo effect, just say so, and I won’t waste my time commenting. And you should stop reading now.
That’s a fallacy in logic — appeal to authority. The fact there’s more than one pain specialist agreeing doesn’t prove they’re good scientists, it might for example prove they’re colluding. (in-bred areas of research often have this problem, poorly reasoned, but self referential and self reinforcing beliefs and insufficient critical review)
The evidenciary requirements are so much higher, and these people should know it. It’s a travesty to even represent articles like this as “common joe” intended articles as they’re even misleading when read in that context in implying that these treatments are reasonable or effective.
These same pain doctors almost universally fail to openly debate pain treatements, treating them more like closed secrets, never quoting sources, or research. There’s also some really good reasearch that’s been done, that shows that the vast majority of doctors do not even have the basic mathematic, or logic training to be able to even interpret the statics on their own lab reports correctly, let alone critically analyse pain treatments. So one should absolutely be cautious about accepting these peoples word. Regardless how “expert” they are in their field. It’s rare for them to be actually trained in evaluating treatments, even as supposed experts. I’m more than happy to dig up the study that was done on this if you’d like me to quote my sources.
But seriously, does anyone actually believe the rot about static electricity? Copper bracelets? That shit is straight out of some cult handbook. They may as well tell you about the healing power of pyramids, known for thousands of years, since the space aliens built them as signs of their greatness.
It’s utter bolony. I challenge you to find any real well controlled independant study on the effect that doesn’t conclude placebo at best.
Ben.
I’d also argue it’s unreasonable to impose “forced behaviours” to control pain on victims without paying them for their time.
I wanted to be a goal driven person, who works hard, plays hard, and spends every waking moment doing something active. Now I’m required to try and mediate, rub copper on me, exercise, eat less, take drugs that stop my brain working, so I get to be in pain, or not achieve anything in life… And if I choose pain, then the things I get to achieve amount to little more than subsistence. Hardly valuable, hardly worth the much much greater effort to achive not much, than the effort I used to put in to achieve many broad and interesting things.
Basically, they’ve stolen my dreams, and there’s nothing to replace it with but some absolute rubbish about rubbing copper on my crotch to distract me from being robbed of everything I ever cared about, or ever might care about in the future, in broad daylight, by the biggest bullies on the block — the state government through their hired goons, the TAC.
There’s a civil war coming. People will die. We can stop it now, but nobody will.
Such is life.
Ben.
@Ben. What you think of trained and renowned pain specialists is your own opinion, not necessarily that of others, including myself – who have -thankfully- gotten a hell of a lot of pain relief from them.
Talking about ‘electricity’, why do you think TENS machines (trans-cuteaneous-electric-nerve-stimulators) are so effective in relieving neuropathic pain? They deliver electric current! There’s nothing more to it. The type of pain therapy does depend on the type of pain you have, whether it is neuropathic, nociceptive (radicular/somatic)…
Vit C for example has been proven to prevent the onset and the spread of reflex sympathetic dystrophy and is also a powerful anti-inflammatory.
From what I know about your reported pain and relief you most likely suffer from nociceptive pain, and a “electricity” won’t help that. Cortisone injections and NSAIDS may help though.
Good pain sites
Good painlinks
I’m bringing my data to the table, and claiming it as fact, not opinion.
I’ve offered to provide supporting evidence in support of my presented stance as fact, and am still happy to do so.
Writing off a viewpoint as “opinion” like you have is a disengaging strategy designed to protect your own viewpoint, rather than engaging in discussion to discover the actual truth.
Regarding your TENS machine example, that’s got nothing at all to do with static electricity – it’s providing a very localised current at sufficient voltage to get over the activation threshold of nerves. The studies I’ve read suggest that there’s no pain relieving effect directly from the electric stimulation, but rather, the shock and cell damage is sufficient to trigger an opioid response from the body. There’s caution against the long term use of TENS due to localised cell death at the point of application.
I wasn’t criticising TENS the same way I was criticising the “touching metal” sillyness, and that TENS has an effect isn’t sufficient evidence to suggest the “touch metal” theory is even remotely reasonable.
Ben.
No comments?
Either I’m wrong, or I’m not. There is a truth, and trying to imply my claims are “opinion” and then ignoring it isn’t a mechanism for discovering the truth.
These lies about pain are part of the mechanism by which insurance companies deny people their rights to claim compensation under the law, as “juries” have seen rubish like this list and think that pain is something that can be cured.
The reality is, a huge amount of pain can’t be cured, and the management is at best “tradeoff ville” — take NSAIDs and you are almost certainly shortening your lifespan. What’s the value of a year of life? 2? 10? Yet somehow this “pain solutions” rubish implies that, it becomes a common belief for people across society, most of whom have never experienced pain. And the people who are in pain grab on to the false hope, with the placebo effect actually making some of them think it’s helping, and the end result is even more rights being undermined of victims
Ben.
I suffer from CRPS and happily shorten my life span for QUALITY of life. My pain specialist has helped me tremendously over the years, and made my pain more”live-able”, and yes this means that I am taking huge amounts of narcotics, some NSAIDS, I use a TENS machine, I have mirror therapy (tricking the brain in believing my injured limb is the non-injured one), topical gels, ketamine infusions, stellate ganglion blocks, I also had a sympathectomy (T2), I take magnesiun (also in infusions),VitD, Vit C and have methadone breaks. I can assure you that the therapy helps, Without it I would be dead, a life not worth or not capable of living. When you suffer from CRPS (which can be SEEN and MEASURED ie. your skin gets blue, puffy, the temperature of your affected injury area is at least 3 to 5 degrees cooler than the other, you have increased hair growth, nail growth etc), believe me you would do just about anything to get rid of some of the pain, even if you “benefit” of a placebo effect (i’e’ mirror therapy, perhaps copper bracelets).
With no offense to you personally, perhaps your pain is not nearly as bad as what CRPS sufferers feel.
Hello “Profit”
Thank you for your insightful comment. I must say that I totally sympathise and agree with what you write here, suffering myself from CRPS, in addition to nociceptive and neuropathic pain.
When the pain is truly intractable, any help is extremely welcome, and I also couldn’t care less whether I get some pain relief through tricking of my brain or through potent analagesia, as long as I get some relief.
@Ben. You recently also wrote for example that working with voice recognition was virtually “impossible” for you. Well, I have been using it for a couple of years and my entire blog for example is solely create with Dragon naturally speaking vs 10. The thing is if the pain is truly debilitating and you have really no other option you make it work, no excuse. I know Dragon is frustrating, especially at the beginning, but if you persist you will soon make magic with it (and I have a rare accent as well). The point made, if you really suffer you do something about it, otherwise you just can’t cope. I am not saying you don’t suffer, I am sure you suffer a hell of a lot and that you pain is very real, put perhaps not painful enough to male you use Dragon, to use narcotics (and put up with side-effects which GO AWAY), to explore some alternative pain therapies (i.e. mirror therapy, which I have done as well with some good outcomes), psych visualization pain strategies etc etc.
I think it is rather inappropriate to just trash all and every pain specialist and pain therapy module, given that many of us benefit from it and also, re intractable pain (which is not the same as chronic pain), there is a lot of scientific evidence about the use of certain medications, vitamins, etc etc.
I’ve seen studies on mirror therapy that impressed me. People with phantom-limb style pain (ie, absence of signal causing the brain to freak out) seem to respond well to “secondary path stimulation” of those understimulated areas of brain.
It’s not a solution for all types of pain, but there’s some pretty clear benefits to those with that type of pain, and it’s an increasingly well studied phenomena — not placebo.
Unlike the insane “copper bracelet” static electricity theories. <shaking head> … Has anyone actually heard of anyone finding metal-touching to be at all beneficial?
Ben.
It’s “okay” for conversational english.
I gave narcotics a damn good go — I wound up in hospital vomiting every few minutes several times, and have been told I’m sensitive to them, and some people cop the side effects worse than others. I tried a bunch of different ones, and the side effects were all totally unacceptable. Lying in a pool of your own sweat and vomit on the bathroom floor until someone drags you to hospital is worse than pain. My doctors have told me I’m unlikely to be able to make the side effects go away by continuing to try to take them, and if they do go away, then likely so will the pain relieving effects. (which only had a relatively small effect on the pain anyway, certainly in relation to the side effects). They are just not an option for some people, and you telling me that I’m “not in that much pain” because I don’t take them is kinda missing the point, isn’t it?
I found voice recognition okay for conversation english, but I live/work in a shared space where people are on the phone to clients, and using voice recognition would be a major problem for other peoples productivity. Also, it is absoultely unusable for doing the job I’m trained to do (linux system admin & programming) … where the difference between one mistyped character is deleting someone’s entire server.
I challenge you to type this command in dragon, and time how long it takes. If you can’t do it as fast as it can be typed, you can no longer compete, and will not win any contracts (or if you do, you’ll only be paid for getting the job done, and you won’t win many because you’ll be that much slower)…
ls -1 *old* | awk '{print "mv "$1" "$1}' | sed s/old/new/2 | shRemember, getting one letter or quote wrong can be fatal, an enter pressed at the wrong second can change an innocent command into a command that ruins things and makes it complex and difficult to recover from.
It’s kinda like telling you that you can do your job of nurse admin with your feet – people born without arms manage, so stop complaining, you don’t need help from workcover, get back to work. It’s just as ridiculous as telling me I’m not in pain if I don’t use dragon or take opiates. http://www.youtube.com/watch?v=YSyaHCzJYwY (btw, I’m not attacking you here, I’m on your side, I’m using it as an example of poor logic leading to incorrect conclusions)
Also, don’t get me wrong I’m not trashing all and every pain specialist. I’m sure at least some of them are professionals who understand the scientific method. But anyone passing off that touching metal therapy is a giant sham, poor scientist, and shouldn’t be representing themselves as a doctor. Shouldn’t have passed first year stats or science at uni with that level of incompetence.
We need doctors who understand evidence based science, and can not only get results, but communicate very clearly about the well understood facts about pain, not only to patients, but also to the general public and the courts. And the fact we have shamsters passing off 19th century rubbish as truth really hurts everyone in pain, in so many ways, and I have a huge objection to it.
Ben.
Point valid about using Dragon in your field of work – impossible! (but you could use it to post comments and alleviate some of the pain you have typing comments).
Re touching “metal objects”, I must say that I had not heard of it before, saying that the article was written in 2000 and since research as well advanced again around Pain. There is however a link between electricity and nerves, that I know for a fact, but I would need to research the matter to come up with the “evidence’ (on my list to do’s).
Copper bracelets, again he article was written in 2000. I know that there is recent research stating that this does not work (apart from placebo) although the researchers could not really distinguish between placebo effect and the possibility of “natural cycle of arthritis pain” which comes and goes (flare ups). I know for a fact that some people swear by it (including a very good friend of mine who’s a specialist nurse and has severe hip arthritis). Whether it is just “the natural cycle of the arthritis which tends to subside after about 4 weeks and then flares up again) is of course THE question. But if it gives the “perception” or “belief” that it helps… well why the heck not, they only cost $5.
Touching metal objects is FREE so nobody can rip you off here, not even the “doc”… nothing to loose, or? But yeah, maybe it’ is bullshit. I will research it.
Did you get sick on Norspan? This drug makes me violently ill –> I also ended up in hospital. I am OK, though on Oxycontin (initially low dose) and Endone. Also Mersyndol Forte is great for my pain.
Haven’t tried norspan. Mersyndol fort did nothing for my pain as far as I could tell (sometimes it’s hard to tell though, less pain = I push myself more until I wind up back in more pain than I can tolerate, which isn’t really any way to live – need to be able to slow down, but how does one do that when under financial constraints?) … oral steroids didn’t seem to make much difference when I was on them, but when I came off them the pain got significantly worse, so they probably did more than I thought at the time. Tramadol may have helped a little, but after they changed me over to the slow release version, which put me in hospital, I’ve not tolerated any other opiate since. Fenantyl was more mild on the vomiting, it was a skin patch, took 24 hours to hit vomit stage whereas it’s usually only a few hours. It did seem to help the pain, I got one good night sleep on it, but it’s hard to tell having not made it through a day with it. There’s been 25 different drugs I’ve tried, and the only one that’s made any significant difference has been the latest cortisone injection — the other times they injected it into the wrong spot, I’ve been telling them where the pain is, and it’s only the most recent one that they put where I told them. Surpise suprise it actually made a difference. But it’s still bad. Agressive burning sensation, not massively dissimiilar to someone putting the biggest bulldog clip officeworks has on it. Like a hot screwdriver between the bones of the 4th/5th metacarpal twisting.
As far as I can tell, mersyndol forte is a drug-company excuse to charge 10x the price for two drugs which are quite cheap seperately (panadol and a muscle relaxant)… If you’re happy to take 2 tablets you could probably get them both a lot cheaper.
If you have “burning pain” it may be neuropathic pain, have you ever tried an anti-epileptic such a garbapentin, topamax, amytriptilin?
I have a “burner” in my leg (severed nerve from the harvested tendons) and was put on Topamax 1 year ago, with the best results ever, beats any narcotic by far… Maybe worth a try?
I know about Mesyndol Forte (aka Panadeine Forte) but I couldn’t care less as WorkCover has to pay for my medication, I am lucky. Given that they have stuffed me around enough denying me physio and other vital things such as home help (hey my shoulder ball is about to shatter) I am NOT going to make a specific effort to research and demand the cheapest option of paracetamol + codeine+ muscle relaxant.
Funny, I can’t tolerate Fentanyl, Norspan nor Tramadol (get very sick as in vomiting). I only tolerate Endone (Morphine), Oxycontin and Mersyndol Forte, Topamax…. so you see it’s a matter of trial and error and finding the right one and the right dosage for you. I also can’t tolerate patches, they’re often way to “heavy” and make me sick after a few days. I go with slow release tablets through and take short acting ones for break through pain.
Pain is indeed a very complicated issue to get on top of, they’re so many different source and types of pain.
My doctor refuses to let me try morphine, apparantly it has a huge paperwork load, and it’s difficult to justify for me, I don’t fit the typical mould apparantly. I’ve not pushed massively hard, because I’m hesitant to hunt for more opiods (though it would be nice to try one of the ones that haven’t be specially modified to make people sick before they get high — modern pharmacology money spent in the war on drugs — make people sicker than high, and the junkie problem is solved. Regulate the hell out of the ones that don’t make people sick. Great strategy, thanks guys.)
I’m scared of taking drugs that mess with my head. Pain is easier to deal with than not being able to think straight, because then I can’t even will-power my way through it. I’m not sure I’ve tried an anticonvulsant though – I’ll ask.
It’d be so nice to have something that was at all effective, so I could even just have a few days off every now and again to catch up on sleep.
Ben.
@Ben, that’s the most outrageous thing I have ever heard re morphine (Endone) – my own local GP prescribes it for me and if it’s just 1 box no paperwork is needed at all. But given that I take at least 4 tablets of 5 mg per day (on top of the rest) he prescribes me 80 tablets at a time (4 boxes of 20 tablets) for which you need a “special permission/authorisation”, which takes him less than 30 seconds as it is done over the phone in my presence (no paper work needed). Sounds more like your doctor does NOT want you to have it /try it! Re potential for addiction etc, the main issue with narcotics is not so much the addiction but the tolerance, meaning that you need a higher dosage to achieve the same effect. That’s why it’s so important you are under the care of a pain specialist/anesthetist who can manage that aspect as well by alternating medication on a monthly basis or so to avoid tolerance and possible addiction. I suggest you go and see a good pain specialist so a tailored pain plan can be made for you, where you can try some medications in small dosages and see what works and what doesn’t. Given that you know that you get sick on some of them will also help the pain specialist in selecting the best, most suitable meds for you. They are moreover allowed to prescribe meds in larger quantities without ‘special authorisation”.
Re brain fog etc, I vividly remember the first time I took 2 Mersyndol Forte (panedeine forte), they virtually knocked me out! Currently I take 4 endone tablets/day, 2 tablets of oxycontin slow release 20 mg/day, Topamax 50 mg twice a day, 6 to 8 Mersyndol Forte/day and a sleeping tablet or two!!!! I have no brain fog whatsoever (pretty alert as you can see from my blogging). The point being, the brain fog goes away after a week or so, your body adapts, you get used to it. Saying that you always need to start off with a very small dose and increase slowly and only as necessary. Then also give your body regular breaks of one of the drugs (and replace them with a variant). If I don’t take those pain killers I go insane from the pain. Even with this amount of pain killers I spend many nights awake from extreme pain, last night was again such a night (despite 2 sleeping tablets – temazepam).
Interesting, so this doctor is telling me fibs too?
Where does one find an honest person -anywhere- thesedays?
Ben.
Also, I have been referred to pain specialists, who have declined to see me. I’m unsure how one goes about talking to a pain specialist without getting over their hurdles.
Seems that people don’t get offered pain help routinely unless they “voluntarily” give up their legal rights. If that’s not duress, I don’t know what is.
If I wasn’t so stubborn about “the right thing to do” I’d have given up and thrown myself on their mercy already. But it’s not the right thing to do, pain or not, torture or not, one shouldn’t ever accept decisions under duress, and refusing decisions under duress shouldn’t be seen as evidence of “therefore no pain” — it’s not correct and makes me sick that the public has been manipulated into believing it. The insurance industries brand advertising really should be seen as “tampering with the jury”
Ben.
You gotta make sure the pain specialist your GP refers you to is a) reputable and b) takes on WorkCover/TAC cases. I have given you the name of such pain specialist in the past (Dr Malcolm Hogg, Elisabeth St. Melbourne).
Your thoughts are interesting and well intended. There seems to be a lack of General Practitioner referral to pain clinics. Too many Workcover and TAC injured workers rely simply on their GP’s and stay in that cycle of medication, rest and exercise. When I was at my wits end (literally)I googled pain and ended up at a very reputable pain clinic and having Radio frequency neurotomy for intractable neck pain radiating down one arm.It has been remarkably beneficial. My point is an injured worker must break away from the GP reliance. You have to be mercilessly proactive with your own pain.You must seek every possible reducing of your pain. Take no prisoners in this process. Depression and axiety will be your reward for inaction.