• Dr. James H. Gruft

Updated: Dec 15, 2020

Chronic pain affects millions of Americans. According to the new report from the Centers for Disease Control and Prevention “Nearly 20 million Americans are suffering from chronic pain that interferes with their daily activities. In 2016 National Health and CDS Interview Survey found that 1 in 5 Americans, or about 50 million people, suffer from chronic pain. Of those, 8%, or about 19.6 million, suffer from pain that interferes with their daily lives.”

What is pain? Merskey’s classic definition of pain modified by the International Association for Study of Pain (IASP) states that pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage. Note: “Pain is always subjective. Each individual learns the application of the word through experience related to injury in early life.”

Pain may seem a simple event, but we who experience it are complex beings. We have divided our lives into many categories. Consequently, it is difficult to explain a phenomenon that does not honor the artificial barriers we have drawn between one part of our life and the others. A far more simple explanation is that life itself is multidimensional. These distinctions between our body, intellect, emotions, and consciousness are the only made to explain these phenomena to our mind, which likes to divide things up into neat components. In reality, the connection between our body, mind and soul, our physical, mental and conscious aspects are so intimate and dynamically interconnected that it is absurd to think we can experience something as primal as pain without it crossing all the three dimensions in our lives.

How to manage chronic pain?

Pain when chronic is often resistant to simple treatment alternatives. For those reasons chronic pain can lead to depression. Common medical approaches, medication and even surgery are not always a solution and in fact, sometimes can cause worsening with dependences and further loss of function. As James Gruft, MD points out, “To treat chronic pain as an exclusive physical entity is to treat it incompletely.”

According to Dr. Gruft, pain specialist explains, understanding and accepting pain is the most important step. It requires knowledge, courage and persistence. Choosing the correct approach to deal with the pain and moving toward wellness is the second. His approach for treating chronic pain over 20 years has helped many patients to cope with pain and achieve wellness.

How do you measure pain?

Pain is multidimensional, understanding pain and when it needs healing by dissecting it into physical, emotional, mental and consciousness. A comprehensive pain treatment is effective in healing the pain as these four variables are dependent on each other in the process of wellness.

  • Dr. James H. Gruft

Updated: Dec 15, 2020

The other approach is pain management. Entering the road of pain management does not mean that we must forever relinquish the possibility of finding a cure for our pain. However, it does not mean that we are not going to wait for a cure. To manage or cope is to deal with life as it comes, with all the resources we have at our command.

The ability to cope is a well-recognized asset. It has been singled out in recent times as one of the key factors of health. Without the ability to cope, we are easy prey to the stresses of modern civilization. Most people with chronic pain, given the opportunity, learn the basics of coping.

As unscientific as opinion might seem, what people think about their health is very potent. In a study involving 2,812 people evaluating their own health status, it was found that these self-assessments were sensitive predictors of mobility - even when health behaviors like something, alcohol consumption, body mass, and frequency of exercise were factored out. What was particularly striking about the study was that people’s opinions about their health predicted mortality in males more accurately than having diabetes or being a former smoker. This means that people can accurately estimate their health by making self-assessments, or it means that person’s perception of his or her health can have significant influence.

It is a fact that our ability to cope with stress can influence our health. One important study shows that unchecked mental stress in people with the coronary-artery disease can diminish oxygen delivery to the heart. (a condition called myocardial ischemia). What is remarkable about this study is that the magnitude of heart abnormalities induced by mental stress was as significant as those brought on by vigorous exercise. Furthermore, stress caused by asking patients to reveal something unpleasant about themselves induced more myocardial ischemia than tests designed to be stressful. This study demonstrates that we can take stress personally, it can physically harm us.

In a landmark study on pain by Flor and Turk, people with chronic back pain were compared to those with rheumatoid arthritis. The subjects completed two pain questionnaires designed to assess their degree of coping versus non-coping their degree if coping versus non-coping and their level of resourcefulness versus catastrophizing. These as well as the person’s diagnosis, medical history, physical exam, and diagnostic tests - were all analyzed for their ability to predict a person’s level of physical function.

The results of the study were startling. The patient’s history and physical exam is taken by the doctor, the diagnostic tests ordered, and even the diagnosis, couldn’t accurately predict how each person functioned. The only good predictor for each person’s physical function was how he or she perceived his or her ability or inability to cope and solve problems. In other words, how people felt they were handling their pain condition was a more accurate predictor of their own ability to function than their diagnosis or the doctor’s assessment.

To have and maintain a sense of well-being depends, to a great degree on how much control we feel we have over our lives. This feeling of control - that we can cope with life’s conditions has great implications regarding our health.

In an elegantly designed study, healthy people were exposed to different respiratory viruses, all implicate das being causes of the common cold. Prior to exposure, each person in the study completed questionnaires measuring the amount of stressful life events he or she had over the last year, and the degree to which the persons felt that current demands exceeded his or her ability to cope. The rate of clinical colds increased directly with a higher “stress-index score.” The more stress the person perceived he or she has, the more likely he or she was to catch a cold. The implication is that stress is associated with a suppression of the immune system, making a stressful person more susceptible to illness.

By the same token, increased ability to cope results in heightened health. In another remarkable study, nursing home residents were divided into two groups: the control group on one floor received the typical care of an excellent nursing home. The experimental group on another floor was given increased responsibility and choice in their living situation. An announcement was made telling the subject that they should be aware that they could rearrange their rooms however they wanted and could visit whomever they wished. They were encouraged to make their complaints known to staff, and each was offered a living plant of their choice to care for (they all took one). On the control floor, communication to the nursing-home residents stressed the staff’s responsibility for them. On the experimental floor, the emphasis was on the resident’s responsibility for themselves.

The results were dramatic. Those in the experimental group were found to be significantly happier, more active, and more alert. The experimental group spent more time than the control group visiting other patients, meeting with people outside the nursing home, and talking to the staff. All of these activities significantly increased after the study began and were much more frequent than those in the control group.

Our inner sense of ability to cope with life is related to the amount of control that we feel we have over lives. It confers a sense of well-being and this sense of well-being is, as we’ve seen in the above studies, predictive of our future health. Thus, coping is critical to our health.

Psychological stress had been defined as the relationship between person and the environment, which is perceived by the persons as taxing or exceeding his or her resources and threatening his or her wellbeing. That is, stress is perceived as a pressure on the individual. However, stress alone cannot account for the breakdown of health - whether physical, mental, or spiritual. The relationship between stress and illness in an ulcer, headache, or chronic lower back pain, how we cope with the stress completes the equation. In some situations, where many people are exposed to the same problems, stress may be constant, but different individuals respond to stress in dramatically different ways. The variable that can best predict how a person will fare is his or her self- perceived ability to cope with stress.

Coping has been defined as constantly changing efforts to manage external and internal demands and internal demands that are appraised as stressful. In other words, it is only when we are dealing with something that we perceive as taxing or exceeding our resources that we are truly coping. Coping, therefore, is not an automatic process, but one that is required in every situation requires effort. This definition also makes it clear that stress not only exists as a result of an outer occurrence but can be internal as well. Even our interpretations of external events can lead to stress that we need to cope with. How many times have been sleepless with anguish after hearing how a friend wronged us, only to find out later that the rumor of treachery was false? Was the anguish we felt any less real because it was baseless?

Internal stress appears to be most damaging when we are unable to give it expression - when our thoughts, words, or deeds are suppressed or inhibited. As in the case of someone who was traumatized as a child, healing may only begin when the initially absent, repressed reactions to his or her trauma (such as anxiety, rage, anger, despair, dismay, pain, and grief) are felt and articulated. Hence, coping applies to outer and inner stress and is related to the amount of control we perceive we have, whether it be related out attitude, our values, our environments, or ourselves.

  • Dr. James H. Gruft

The road of pain treatment initially seems to be the easier path. For acute pain, which usually resolves over time, it is. The three main features of the path of pain treatment are receiving the proper diagnosis, getting correct treatment, and consequently being cured of the pain. For those of us with chronic pain, in order to receive proper diagnosis and cure, we are willing to spend tremendous amounts of time and money. Unfortunately, no matter how time and expense it costs us, most of us are still left with our pain.

Nevertheless, many of us continue treading this path. We continue our search, spending year after year seeking to get our pain medically exterminated. Each failure may be devastating, but not knowing or not wanting to know any other solution, we get back on our feet and move on to the next pain treatment. Under such circumstances, we can become addicted to the chase, finding it more exciting and less threatening to seek a cure for our pain than to resume living our lives. We may find the excitement of discovering the latest procedure, the last drug, and the newest pain curing device (together with the claims and testimonials) far less complicated than trying to figure out what our life has become. It would be more difficult to consider that we might never be as productive as we once were, for the realization to dawn that we must prepare for a very different future than one we had planned.

The search for a pain cure can be a search with no end. In our world of high tech medicine, there will always be new medications, new techniques, and new machines appearing on the horizon - each claiming to relieve or even eliminate our pain. We can spend our entire lives trying to find the big cure. The sad irony is that this search can distract us from truly mastering our pain. In the excitement of the chase, we don’t look at our pain and what memories it may trigger from our past. We don’t ask whether by pursuing the big cure we’re running away from something. In other words, we do not search for the meaning behind our pain. We only want to take a pill, get treatment, or undergo a surgical procedure - anything to rid of it.

But pain does not occur in vacuum. It always occurs in connection with someone. Pain, in other words, is inseparable from us. Having been inflicted with it, sooner or later we must overcome to the realization that this persistent pain will never be cured by something that lies completely outside us. We need to look inside ourselves in order to understand what our pain is telling us, try to read it cues, and learn what it is we are doing that might have led to its appearance. We might have been cruel to ourselves or to others. If we can change our behaviors, we might finally begin to heal.

If we look closely at ourselves, we might find - behind our present aching - shadowy pains that burn from another time. These pains seldom come to the surface; they remain hidden in the deep recesses of our body and mind, hovering on the edge of our awareness. Rarely exposed, these pains are somehow connected to our life force and smolder inside us, forming a perpetual fire.

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