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Buddhist Teachings for Pain Management

This is the sixth and final post in a series exploring the topics covered in the book You Are Not Your Pain*. See You Are Not Your Pain: An Introduction to learn more.

Mindfulness-based stress reduction is a secular approach that applies the Buddhist principle of mindfulness to pain, illness, and stress. The more I learned about mindfulness, the more curious I became about Buddhism. Many Buddhist practices can help with managing pain and illness. Vidyamala talks about the ones that she employs regularly. (If you want even more, How to Be Sick* by Toni Bernhard is a treasure trove.)

Kerrie Smyres: What other Buddhist teachings do you find helpful in managing chronic pain?

Vidyamala Burch: Along with mindfulness, loving kindness and compassion are other qualities that come from Buddhist teachings. Both mindfulness and loving kindness are integral to how I manage my pain and to all of Breathworks’ pain management programmes in “You Are Not Your Pain.”

Through Breathworks’ pain management programmes, we guide people very, very gently and with loving kindness – metaphorically holding someone’s hand – to help them move closer to what is actually happening in their bodies.

Loving kindness is about having a response to yourself that you would naturally have to a loved one who is hurting, so for example if your child fell over it’s completely instinctive to scoop that child up to comfort with love and tenderness. So, try and turn that instinctive emotional response back on to yourself; it is basically gentleness and tenderness and acknowledgement of the feeling of sorrow of what it’s like to live in a body that hurts. It’s not an easy thing. I often think one of the most heroic things that you can do in life is to inhabit a body that hurts.

In Buddhism mindfulness and loving kindness are articulated in some key Buddhist texts. The main one on mindfulness is the Satipatthana Sutta and this provides a theoretical basis for what we teach. The Brahma Viharas is a key teaching on loving kindness. The Salattha Sutta describes primary and secondary suffering very well. So all these are implicit in my approach to living with pain and illness.

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Web MD’s Pain Management & Migraine Relief Blog

Indie Cooper-Guzman, WebMD‘s pain management and migraine expert, has recently started a blog on exactly that. Using her knowledge gained as an RN and a chronic pain sufferer, Indie is devoted to educating health care providers about chronic pain and managing it successfully. Through her work with WebMD, she teaches patients a lot too. In addition to a blog, she also moderates the migraine/headache and pain management forums and the back pain support group.

Some of this week’s poignant posts include:

Grieving the Loss of a “Normal” Life is on a topic that many of you know intimately. It’s a comforting post in that it’s a reminder that we’re not alone, but far more comforting are the lessons learned that Indie shares. Yes, you grieve the loss of your life as you know or expect it to be, but you also learn how to live a better life.

“I remember what it was like when I realized my life would never be “normal” again…

“I went through a period where I didn’t want people I knew to see me like I was. I worked extremely hard to perfect my new walk and conceal the slight limp and the fact I would sometimes have to walk by swinging my leg from the hip when it failed to respond like it should. It is something I know I will have to deal with for the rest of my life but I am ok with it now.

“Being an independent female much of my life, I think the hardest thing I had to accept was the fact I would need to rely on others to help with certain things I had ordinarily done by and for myself. I still struggle with that one and probably always will.”

Mandatory Pain Management Education takes a constructive approach to fixing the problems associated with treating pain with opioids — in contrast to my recent preachy posts. She even links to some educational resources.

“Pain and pain syndromes are not going to go away. Mandatory education for all health care professionals, political and health care business/insurance workers, and anyone else who is involved with health care should be considered. It is necessary. Although we all have busy lives, it is time to demand some accountability for the standards of practice in pain management.”

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Chronic Pain is Real; Take Us Seriously!

An article in the current New England Journal of Medicine examines how the DEA‘s influence on medical practices for pain control ultimately harm patients. Although the article focuses on end-of-life pain control, the issues affect people with chronic pain as well. The authors assert,

“Uncontrolled pain and other distressing symptoms are the primary concerns and greatest fears of patients facing serious illness. More than 90 percent of the pain associated with severe illness can be relieved if physicians adhere to well-established guidelines and seek help, when necessary, from experts in pain management…. Despite the efficacy of opioids and a commitment by the medical profession to treat pain, abundant evidence suggests that patients’ fears of undertreatment of distressing symptoms are justified. Although a lack of proper training and overblown fears of addiction contribute to such undertreatment, physicians’ fears of regulatory oversight and disciplinary action remain a central stumbling block.”

Again, this is in the context of palliative care, so the practices are a different; the implications are much the same.

Using the NEJM article as a springboard, today’s New York Times addresses the core problem: Currently policy places fear of prescription drug addiction above the lives of people with pain. There’s little regard for those who wonder if a life with excruciating pain is better than no life at all.

The author describes how doctors’ hands are tied to some extent, and that how they work within these restrictions to treat patients or simply turn away from the dilemma all together.

“…[T]he D.E.A. has recently increased raids on doctors’ offices, confiscating files and arresting doctors on charges of overprescribing narcotics to patients who are addicts or drug dealers.

“Most of these physicians are compassionate people trying to help suffering patients but  are sometimes fooled by clever addicts, drug dealers or undercover agents who fake their pain.

“Yes, there are bad apples among members of the medical profession. There are some doctors who charge for medical exams that they never do and provide phony patients with prescriptions for narcotics to feed their habits or sell on the street.

“But should all physicians be subject to intense scrutiny by the D.E.A. and risk arrest and prosecution, leaving legitimate patients to suffer intensely or scramble to find other doctors willing to risk taking them on?

“The growing number of arrests of pain management specialists is exacting high costs for patients, physicians and medical insurers. Some doctors order costly but unnecessary diagnostic tests so they can show the D.E.A. a reason for prescribing strong pain medication.

“Many doctors are simply unwilling to prescribe narcotics, no matter how much a patient suffers. Ignorance, as well as a fear of the D.E.A., plays a role.”

Want to help get this mess sorted? Visit the American Pain Foundation‘s advocacy page for ways you can help. One quick way to contribute is to send a pre-written e-mail to your congressional representatives.

I can’t create a blog-safe link for the Times article. You’ll have to register with the newspaper to read it; even then, the link will expire in about a week.

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Pain Management Certification for Nurses

Pain management certification is a new option available to licensed, registered nurses beginning next month. According to the American Nurses Credentialing Center, pain management nurses must have “…a thorough understanding of the science of pain. [They] are also experts in pain assessment, treatment, side effects and the important aspects of educating the patient and family.” The credentialing center says that more nurses are interested in this certification than any other in recent history.

This is a huge step! It means that some of the efforts of the Decade of Pain Control and Research campaign are paying off.

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Studies on Living with Chronic Pain

It’s important to have clinical studies to describe and quantify what it’s like to live with chronic pain, but sometimes I read the news and think, “Well, of course.” Two studies presented at the International Association for the Study of Pain’s 11th World Congress of Pain that elicited this response were Study Suggests it is Unsafe to Drive when Suffering from Chronic Pain and An Evaluation of the Impact of Chronic Pain on Quality of Life. Again, they are valuable studies, but people with chronic pain have known these things for years.

An interesting aspect of the second study is that headache is described as localized pain that doesn’t affect the whole body, thus doesn’t reduce quality of life as much as full body pain, like fibromyalgia. While I can’t compare the pain to fibromyalgia, I don’t think of headache as confined to the head. Or am I confusing headache with migraine?

Two other studies presented at the World Congress of Pain reviews the impact of prevalence of pain worldwide and the social, economic and governmental barriers to pain management in Europe. They are both summarized in 20% Around the World Suffer from Chronic Pain yet there are Still Barriers to Adequate Pain Relief. The worldwide and European trends addressed in these studies are fascinating.