Philosophical approaches to chronic pain management for medical prepping

Bob - April 25, 2021

https://www.news-medical.net/news/20210423/Researchers-investigate-how-philosophical-approaches-can-change-the-understanding-of-pain.aspx

Good afternoon,

Above article is focused on professional health care providers treating patients.

It is realistic enough for a serious prepper to review the mentioned principles in the article with the view of personally approaching them.

For example, reflect on your personal:

–  “experience, concerns, expectations,..”

–  “socio-cultural priorities”

–  “stigmatization in society”

How one perceives oneself determines much. Working on chronic pain, like much else, takes time. It has been accomplished. I’ve had enough changed expectations that it’s just a routine matter. It’s the same with my changed – and abily to continue changing – socio-cultural priorities.

Philosophical approaches got a “bad rap” for some time. There’s a reason they are returning.  They can work and already have for some to include this scribe here.

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Good afternoon Bob,

There are preppers who must consider chronic pain management as part of their preparedness. Preppers or family members may experience the onset of chronic pain in the future. It is better to understand it now.

My reply begins with acute and palliative pain but that is only to better illustrate the issues of chronic pain management.

In acute care, a patient is brought in with a broken limb due to an accident. Pain management is applied while treating the limb and for the initial phase of healing. The limb heals, the cast comes off, physiotherapy may or may not be necessary and acute injury is resolved.

An injury or illness that can be fixed either through surgery such as appendicitis or medication such as antibiotics in the case of infection is considered acute. Whatever is wrong in the body can be healed and the crisis resolved.

In palliative care training, we learned that there is a distinction in how it is managed versus chronic pain.

Palliative pain usually progresses as the underlying disease progresses to the time of the patient’s death.

There are exceptions. For examples, tumors may render the pain receptors in the brain incapable of function and the patient may no longer register pain. This happened to a young woman I knew who had non-Hodgkins Lymphoma. She was twenty-six years old.

Her death wasn’t easy. Her family allowed her to suffer horribly because of their beliefs. Days before she experienced physical death, something greater than their incompetence finally relieved the young woman of her suffering.

I cannot stress this point enough to everyone. Get your end of life care in order. Accidents and illness can happen in a heartbeat. Regardless of your age and current health, get your wishes legally in order about how you want to be treated and medicated in the event you are debilitated or if require palliative care.

Be very certain of who you allow to act for you. Get a trusted advocate or advocates in place. Don’t assume that family members will “just handle it.” Many family members cannot handle this kind of responsibility and may not act according to your wishes when their emotions cloud their judgement.

Whatever you arrange ensure it is legally bound according to your laws on end of life care.

Watch also for DNR (do not resuscitate) orders if in palliative care. My dad was taken to another hospital for palliative radiation treatment to alleviate his suffering. While in the other hospital’s elevator, he died. My brother was unable to stop them from resuscitating my Dad. They told him that the DNR order was for his hospital and not their hospital. Their actions brought him back for several more weeks of suffering.

The following is another example of pain management and why it is important to have advocates present to speak for you when you can no longer speak for yourself.

My father died in six weeks of an aggressive cancer that we suspect began in his prostrate and then metastasized into his lungs.

My Mom, brother and I and an Aunt from B.C. kept watch over him. He was never alone as he died. Despite that effort, we still encountered numerous problems in the Palliative care ward.

One nurse liked to keep some of her patient’s pain medication for herself. It was easy pickings in the Palliative ward because many patients were unable to speak.

My Dad could no longer speak because the tumors had spread and were visibly exiting at points higher up above his lungs. I caught it because of the pain I saw in my Dad’s eyes.

It was the ward’s bad luck, that I caught this on my watch. The problem was addressed. Think of what the outcome is for someone without supports or an advocate.

Palliative pain is not like chronic pain management.

Palliative pain management is mean to control the pain at all times. The pain medication is titrated up, and topped up as necessary as pain is experienced to keep the patient comfortable and control the pain.

If this is not done, then the patient is put through unnecessary suffering and it is more difficult to get the palliative pain under control again.

Chronic pain is pain caused by an underlying condition for which there is no cure.

Chronic pain management isn’t like acute care where the condition will heal or palliative care where your life ends.

I can speak to the issue of chronic pain from personal experience and as a volunteer who taught in chronic disease management workshops.

I live with chronic pain from widespread arthritis and other things that are known and other components that are as yet not understood by my doctors. It is thought to be genetic in our family with my Mom’s relatives affected in their teens and through to their early 30’s.

My pain management evolved this way. First arthritis, then a post-viral condition that left me with wide spread inflammation and more pain. You can see the swelling yet nothing registers on my ESR (sed rate that measures inflammation in the body). Other conditions came later.

I was unable to take certain medications because of my reactions to them. For example, I was left on a high dose of Naproxen which is an NSAID (non-steroidal anti inflammatory drug) for migraines. That left me with gut bleeds and I can no longer take any ASA products.

Finally I was left with one medication that I could take.

What I take to have quality of life and function is not anywhere near the type of medications in the media. I have been on this medication for around twenty-five years.

I take it only when necessary and always mindfully.

So that is the medication aspect of how I manage chronic pain.

What is the most important part is the non-medication management or philosophical approach.

I use writing, meditation, martial arts visualization, reading, creative visualization, short term distraction, rest, stretching or immobilization, hot or cold packs, comedy, pictures of puppies and anything else I can lay my hands on to distract myself.

On the really bad days, I get through it on pure guts and grit. In the last few weeks the inflammation has been tough, so writing stuff for here has helped.

Several doctors have tried to give me additional pain management and I won’t do it. I’m running a marathon. I don’t want to be sensitized to pain management when I will need it for palliative care.

I used to be afraid in the early days when the pain got really bad. Then I realized “hey, this pain isn’t killing me.” I can do thirty seconds at a time if I have to.

I stopped being afraid of the pain and made peace with it. Pain is a way for our bodies to tell us that something is wrong, but pain also keeps us safe. Pain tells us if we hit our thumb with a hammer or burn ourselves.

There are medical conditions where the patient is unable to register pain and it is a horrible situation for the patient.

If you need chronic pain medication, take it wisely and be accountable for how you use it. I chart my medication usage every day and note any additional factors for why I am taking more or less of it.

If you have chronic pain, don’t expect a pill to fix everything. Non medication management practice has to go hand in glove with medication.

A last point, it’ s okay to be sad or cry on the really bad days. There is an emotional cost to living with chronic disease or pain. It does take it’s toll. If you don’t acknowledge your emotional state, that can also add to your pain.

Be kind to yourself always, especially on the tough days.

Thanks Bob for posting this subject. It is stigmatized and that hurts people more than the chronic pain does.

 

Good evening Ubique,

Real good information for those new to this.

I ran into a situation which now governs much of my approach to any private citizen “good samartan” field first aid. The “Do Not Resuscitate” bractlets are not nation-wide recognized.  

My chronic pain is less a burden than driving a long distance for doubtful care. Chronic pain can be lived with.

 

Good afternoon Bob,

I’m just in for a quick thought regarding the title of your post. How does “Philosophical approaches to chronic pain management for medical prepping” sound to you? (Or something like that?)

I was going to mention a title edit suggestion yesterday when I posted, but I was a bit shy to do it.

People who don’t currently live with chronic pain or have anyone in their family who lives with it may by-pass the current title.

They may not see the relevance to how this is part of medical prepping. And that would be a loss because you have brought up such an important aspect of medical prepping. 

What we prepare for today is based on the way our circumstances exist today, including our health. But our health or a family members health can change in a heartbeat due to accident or illness.

Also, if we encounter a disaster of a long duration or with a very long recovery period, we have to account for more than what’s in our IFAK. 

Medical self-management especially with issues of chronic pain is part of being fully prepared.

Also, how we manage activity is a big part of chronic pain management.

Pacing is so important and that is going to be a huge factor if we have to engage in strenuous or labor intensive tasks due to a disaster and for all the time it may take to fully recover, if we recover to pre-disaster standards.

p.s I’m not super good at titles like Gideon, but hopefully this might help 🙂 

 

Good afternoon Ubique,

I’m all for editorial oversight and corrections.  My view is to get material “out there” and anticipate refinements to arrive.  This is goodness.

Not seeing the relevance requires a couple of medical type courses.

I’ve never lost an arm but did throughly study the event when some guy in Utah (I think it was Utah) went hiking alone and a boulder dropped on his arm pinning him into place for many hours.  He amputated part to get out and then walked to the road area where a couple spotted him and summoned help. This recent story is always in my mind along with others like it.

My preps of today go well beyond today. 

Get the better thread title arranged. It’s a good improvement. I can’t do it from here.

And don’t be shy !

 

Good Afternoon Bob

I found out from Gideon that it is possible to edit our titles/posts/replies.

To the right of the word “Reply” is a “three horizontal dot” icon. If you press the three dot icon, a box will drop down. The box will give you a choice of “edit” or “delete.” Just press “Edit” and the system will bring up your post. Then you type in your new title and press “Edit” or “Submit” (can’t remember which but they are in the same place as “submit”.) Then the system updates your thread. I can’t access your post to edit but you will be able to edit your own title to add those words to it, otherwise I would do if for you. But the edit should work. If it doesn’t we can call “help” to Gideon.

Your guy in Utah story is exactly the type of medical situation we should study as preppers.  I may have a seen a movie based on his case called 127 hours. It was very good. 

https://en.wikipedia.org/wiki/127_Hours

His example is field medicine in a crisis. You’ve got to do what is necessary to live and he did just that. It takes courage and the will not to pass out.

While Mom and I waited for a bus in Kelowna, we had the opportunity to listen the a man’s story about what he survived on Vancouver Island. He was supposed to be writing a book, but I have never found the anything that sounds like his story yet.

He was partying with friends on the Island. He jumped off what he thought was a small outcropping in the dark and dropped many many feet down (I can’t remember how far, but it was bad). He broke a leg and I think ribs and laid in the dark. He was in and out from the pain.

He could hear his friends who were also intoxicated, calling for him, but they couldn’t hear him. The friends left thinking he had gone home. 

Now he was alone, with any resources and badly injured. He kept his head and remembered the things his physician Dad had taught him about first aid. He immobilized his leg with tree branches and used his shirt to bind it to his leg. Then he began to crawl, dragging the broken leg.

Again, I am not certain of some of the details but he was out for about two weeks. He did managed to find some water along the way. He kept crawling toward the sound of traffic. Then he would pass out and go again. Finally he could see a highway. All he had to do is crawl the final stretch through the bush to get to it.

Then suddenly, he was falling. He landed in a pit that for whatever reason was in the ground. He went down a good six feet or better. He said that was his lowest point where he said “okay God come and get me. He said after he said that, he just laid there and waited to die. Suddenly, a big black nose and concerned brown eyes peered into pit and began barking. It was a big brown labrador dog. The dog was walking with his human who soon arrived at the pit to see what her dog was on about.

She saw the man laying there, jumped in and gave him water. She assured him that she was going for help and would leave her dog with him to comfort and protect him.

It was a difficult rescue but they got him out. He spent months in hospital but he survived and didn’t lose his leg or it’s function.

I hope he writes his book. He told a wonderful story at that bus stop. It has so many lessons in it about survival.

 

If it’s the same person I’m thinking about, they made a movie about him called 127 Hours. I haven’t seen this movie, but would like to research more about the man and the story. I might have to start a forum thread talking about people who have survived crazy experiences like this.

Adrenaline is powerful, as shown by that guy and an experience I had. Back before my spinal cord injury, I was watching over a neighbor’s dogs and they had to be kept separated because they would fight. When I was opening the door to get to the other dog, the mean dog ran past me and clipped my knee knocking me to the floor. The dogs got into a heated fight and were attacking each other. I jumped up and went over there and was yelling and kicking them until I got them separated. On my way back home, after the adrenaline dump subsided, I realized that I couldn’t walk anymore. The dog that had ran past and hit me had chipped off a piece of weight bearing bone and I had to get two surgeries to fix it. Crazy how the adrenaline allowed me to run and kick the dogs, but once it wore off pain took over and I couldn’t have done either of those.

And then to comment on the main part of your forum thread, as someone who deals with constant chronic pain, it is something that people need to consider and plan for. My pain comes sitting in the same wheelchair all day every day, our bodies aren’t meant to do that. Massage, acupuncture, chiropractic, stretching, and exercise allow me to get off of medication and be able to function. Chronic pain can lead to brain fog, decrease reaction time, and other things that can be detrimental and deadly in a survival situation. 

 

Hi Gideon,

I found a link for Aaron Ralston, the man behind the story of 127 hours

https://allthatsinteresting.com/aron-ralston-127-hours-true-story

I really think you should start the forum thread on people who have experienced crazy survival stories.  It’s a great idea and we can learn a lot from these stories.

Adrenaline and shock can keep a person going through trauma. That is very intense to get in between two dogs like that.

There would be a lot of discomfort sitting in the same wheelchair all day, every day. It affects everything, muscles, circulation. The adjunct modalities that you are using like massage, acupuncture etc. can make such a difference and your story underscores that.

That’s one thing that scares me, is if TSHTF and I was having a bad day and need to be able to respond and think clearly to defend or escape. I try to think positive and not borrow problems, but I have to work through preparing for a scenario such as that. Hopefull my adrenaline will kick in like yours did.

 

Great suggestion on a title Ubique. I agree with your reasoning behind the change as well. 

Bob, your original title was not bad, but Ubique brings up some good points and changing the title to what she suggested could bring additional people into the chat. Your call though.

 

Gideon, 

I tried to explain how to do it. I think Bob is okay with changing it. I hope my instructions to edit were clear?

 

Great response! Thanks for your help with that.

Bob- if the instructions weren’t clear to you, just let me know what title you want to go with and I can just change it for you. No sweat.

 

Good morning Gideon,

Yes, please do go ahead with a new title with what you believe will work best.

 

There is a movie and tv show that I like called Limitless. It’s about a pill that unlocks 100% of your brain. You are able to remember every thing that you have ever done, seen, or heard. In this one part, the guy gets shot and has to continue doing something heroic so he uses his brain power to shut off the pain receptors of his body and is able to continue.

I don’t know how realistic that is, to have the mind power to be able to shut your mind off to pain, but I think that meditation is powerful and can be used to decrease pain somewhat or at least distract yourself from it. Whenever I go to the dentist I have to listen to my iPod to distract myself from the horrors that await me.

 

limitless was a great movie. It was interesting to see what he did with his power.

Meditation is very powerful for pain control. Music is a good one too. I use ocean wave sounds if I’m having a tough day pain wise.

 

Good afternoon, Bob

Another point about chronic pain and our relationship with it, is that for some people, they may harbor the idea that they have done something to “deserve” it.

They hurt and they feel that they are being punished. It’s important to watch for that and to root it out if you have chronic pain and find yourself feeling that way. You may carry something from childhood that is causing you to think this way.

If anyon reads this who feels like this. You didn’t do anything wrong. Whatever you feel guilty or bad about, remember you are human and capable of mistakes. If you feel chronic pain, feel only that and nothing else that doesn’t exist today.

You are carrying an event that happened many years before. The event must stay in it’s own time. It cannot exist as more than memory in the here and now. Put the burden down and leave it behind you. What you were carrying is the ghost of that event. Walk away free.

 

Good afternoon Ubique,

The personal “self interview” can be more important than physical preps for chronic pain. Who said “As soon as you trust yourself, you will know how to live.” ?

I took a psychiatry class on dream interpretation. The individual has the info. There is work to do prior to self-treatments.

…

 Just saw the “Reply with 3 dots” posts. Thank you. Whatever Gideon posted/posts an improvement to attract more readers.

 

This is so beautiful! I love the idea of doing a self interview and being able to let things go and know that you did nothing wrong. Sometimes things just happen, even to the best and nicest of people.