Chronic Pain

Well I have decided to go ahead with my neck surgery and pray for the best. I've been dealing with this hell since 2000.



Poll #779258 Chronic Pain
Open to: All, detailed results viewable to: All, participants: 1

Have yo ever considered suicide because of your pain?

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Well I am on the road for divorce now. The disability monster has destroyed my marriage and I am living in a handicab apartment now.
Going next month for an inquiry on a Spinal Cord Stimulator.I hope it helps , I know [url=http://www.medtronic.com/servlet/ContentServer?pagename=Medtronic/Website/Patient&ConditionName=Chronic+Back+and/or+Leg+Pain&Article=bpain_ps_jerry]Jerry Lewis

I love music so much, sometimes I take a song and change it's lyrics to suite my situation. Here is on of those songs.



Spinal Paradise

I walk through the valley of the shadow of death
I take a look at my life and realize there's nuttin left
Cause I've been takin these drugs so long that
Even my Mama thinks my mind is gone
But I ain't never took a drug that I didn't deserve it
May be treated like a druggie, you know that's unheard of
I gotta watch out what my Doctors talking
Or me and my records may be walkin
I really hate the trip but I gotta go
As they smirk I see myself walking out the door,fool
I'm the kinda patient little Doctors don't want to treat light
On my knees in the night
Saying prayers for the drugs, right


I've been spending most my life
Living in a Spinal paradise

I keep spending most my life
Living in a Spinal paradise.


Look at the situation that I've been facing
I can't live a normal life,I can't help how I feel
So I gotta be down with the med team
Too much medical science watching got me chasing dreams
I'm an educated fool with pain in my mind
Got my MRI in my hand and a cure in my eye
I'm a fed up painster,not pointing a finger.
And when my meds is out,don't arouse my anger, fool.
Pain is something that I feel everyday.
I got a screwed up spine,what can I say ?
I'm fourty -three now, but will I live to be fourty-fo
The way things is going I dunno

Tell me why are we---so blind to see
That the drugs I take----are saving me

I've been spending most my life
Living in a Spinal paradise

I keep spending most my life
Living in a Spinal Paradise


Drugs and the doctors,doctors and the drugs
Pill after pill , hour after hour
Everybody's talking but half of them ain't looking
What's going on with my symptoms,but I don't know what's cooking
They say I got a spine,that's no good for surgery
If they can't understand it,how can they treat me?
I guess they can't---I guess they won't
I guess they front ; that's why I know my life is outta luck fool


I've been spending most my life
Living in a Spinal paradise

I keep spending most my life
Living in a Spinal Paradise

Tell me why are we---so blind to see
That the drugs I take----are saving me

I've been up and down the last month. Caught a nasty intestinal virus that had me down for 10 days.My pain Dr. increased my Avinza to 120mg but I hardly noticed any change. He wants to lower the dose back now and is thinking about a Spinal Cord Stimulator for me. Sounds good as long as it works on the whole spine. Would love to get off these drugs and get my head back to normal.
I am going to be starting a Podcast about Chronic Pain and Politics and will talk about the war on drugs and the unjust imprisonment of Doctors and Patients. Also what the average CP has to go through to get pain relief.

We tried to wean off the Cymbalta and when I got down to 60mg I felt so much worse. The pain was increasing and inflammation and could not go any lower. So I gues the Cymbalta was helpful but guess I got worse while I was on it. Started back to 90mg daily and I do feel somewhat better.
Hope everyone has a great holiday.



Anthony

Illustration by Mark Moran

Prisoners of Pain


By Barry Yeoman, September & October 2005


Why are millions of suffering Americans being denied the prescription drug relief they need?





Avoiding Common Pitfalls of Over-the-Counter Pain Relievers

Web Exclusive: 5 Ways to Reduce Your Risk When Seeking Pain Relief (AARP Bulletin)

Vioxx: A Drug’s Day in Court (AARP Bulletin)

Learn About Safe and Effective Prescription Drugs on AARP.org
Deborah Hamalainen was feeling more and more agitated by the minute. Waiting to see her neurologist, she was silently rehearsing a confrontation that had been building for months. She planned to look the doctor directly in the eyes and demand that he treat the chronic pain that had invaded her life.

In the two decades since doctors diagnosed her with multiple sclerosis, Hamalainen learned to tolerate numb extremities, tingling sensations, even the weakness that causes her left foot to drag. And it wasn't like her to be confrontational. "I'm much happier in denial," admits the soft-spoken 52-year-old sculptor.

Some physicians fear that if they deliver humane pain care, they’ll face prosecution by the DEA.
The symptoms she couldn't ignore, though, were the intense shooting pains that raced across her shoulder blades and down her limbs. By the time she arrived for this doctor's appointment, they were a 24-hour presence. Hamalainen barely slept anymore. Rolling over was an ordeal. When the Medford, New Jersey, resident awoke, stiff and exhausted, she braced her shoulders so they wouldn't move as she rose. Sometimes, her husband had to pull her upright from the bed.

Every three months for three years, Hamalainen saw this neurologist. Each time, she mentioned the pain. Each time, the doctor deftly changed the subject. Each time, she left in pain.

But this time would be different.

Hamalainen waited quietly as nurses wandered in and out of the examination room, taking her vital signs. Finally, she lost it. "My pain is real," she said frantically to one of the nurses. "I need relief. Why does he keep refusing to talk to me about it? What do I have to do?"

The nurse turned to her conspiratorially and lowered her voice. "I should not tell you this," she said. "But he doesn't want to treat your pain because the treatment that works is opioids, and he's afraid to prescribe them."

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With that conversation, Hamalainen joined legions of patients who are the victims of a troubling and all-too-common medical practice: the undertreatment of significant and debilitating pain. An estimated 75 million Americans suffer from chronic pain, according to the American Medical Association, and numerous studies have shown that patients often don't receive the medication that could provide relief. Undertreatment runs as high as 50 percent among advanced-stage cancer patients and 85 percent among older Americans living in long-term care facilities.

Much of this suffering is preventable. Experts do know how to reduce pain safely. In particular, physicians now know that opioid analgesics—medicines such as morphine and oxycodone—provide relief for a wide spectrum of pain problems, with relatively few side effects when taken as prescribed. "We can't cure everybody who is in pain, but we can make almost everyone feel better," says Scott Fishman, chief of the division of pain medicine at the University of California, Davis, and president of the American Academy of Pain Medicine. "Becoming a prisoner of pain is not an inevitability."

Additional Resources
For more on pain-management issues, visit the website of the Pain Relief Network.
The problem is that the most effective medications cause skittishness among many physicians. Poor medical-school training has left them unaware of the tools at their disposal and even the importance of treating pain. Many harbor the false impression that opioids frequently lead to addiction or unmanageable side effects, even when used correctly for a legitimate medical need.

'Becoming a prisoner of pain is not an inevitability.'
Worse, some physicians fear that if they deliver humane pain care, they'll face prosecution by the federal Drug Enforcement Administration (DEA) or state medical boards. In recent years, a number of respected doctors have been investigated and even prosecuted after prescribing large amounts of opioids. The result, according to experts, is an environment that scares doctors away from practicing good medicine.

"I've had prominent physicians call me up and say, 'I have patients doing well, taking opioids for otherwise treatable pain, but I'm going to stop writing prescriptions because I don't want the DEA coming into my office and putting handcuffs on me,' " says James Campbell, a neurosurgeon at Johns Hopkins University. "Five years ago, we were actually doing a better job at handling pain patients. Now we've seen a backslide, and patients are definitely the victims. They're suffering."



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On his first day as a licensed physician, Russell Portenoy had a troubling experience that would influence the course of his career. At the New York City hospital where he was interning, a nurse summoned him to a room where a cancer patient was moaning with abdominal pain. Portenoy knew the woman would benefit from opioids, but he was new at doctoring, so he first phoned the resident in charge to clear his decision.

"I have a patient here. She's 60 years old, she's got metastatic ovarian cancer, and she's in bad pain," Portenoy told his supervisor.

"What do you want to do?" the resident asked.

"Well, I thought we should give her some pain medicine."

"What do you want to give her?"

"Morphine."

There was silence on the other end of the line. It was 1980: even physicians who endorsed opioids for terminally ill patients believed that morphine was too potent and too dangerous. Finally, the resident said, "Look, you're the doctor. You want to give her morphine, give her morphine." After further consultation, Portenoy wrote an order for a 3 mg injection, less than one third of what he would likely give her today. He never checked back to see if the medication worked.

The patient was still on Portenoy's mind the following year when he decided to specialize in pain medicine. "I'd given somebody with severe cancer pain a dose that didn't have a prayer of providing any benefit," he says. "My hope is that there was such a profound placebo effect that she didn't scream the rest of the night."

Portenoy joined a coterie of pioneers who encouraged their colleagues to become bolder in treating patients' suffering. They argued that pain is more than a symptom; it's a disease by itself that can trigger a cascade of other health problems—from a weakened immune system to obesity—if left untended.

At Memorial Sloan-Kettering Cancer Center, where he launched his career as a researcher and pain physician, Portenoy initially concentrated on cancer pain. Eventually he discovered that opioid medicines—routinely prescribed in advanced-cancer cases—also worked for patients without terminal illnesses. They relieved the symptoms without fogging patients' brains or turning them into addicts. The only major ongoing side effect, constipation, was manageable with other drugs. But when Portenoy shared the news in a 1986 journal article, he received excoriating criticism from his colleagues.

Slowly, time has proven Portenoy correct. In 1996 two leading professional groups declared opioids "an essential part of a pain-management plan." Five years later, the DEA and 21 health organizations agreed that opioids are often "the most effective way to treat pain and often the only treatment option that provides significant relief."

Across the United States, hospitals are starting to take the issue seriously, creating programs specializing in pain management. Portenoy's own department, at New York City's Beth Israel Medical Center, has 14 physicians, a team of researchers, and training programs for doctors and others. Using opioids and other therapies, these programs have restored normalcy to many lives.

"It's a miracle," says 55-year-old Michele Ferreri, a Staten Island, New York, woman who suffers from a painful nerve condition that appeared in the aftermath of shingles. Once unable to get out of bed because of her burning headaches, she started taking extended-release morphine and other medications after seeing Portenoy at Beth Israel. Now she lives an active life, taking her mother shopping, doing laundry, and attending social functions with her husband, a hospital CEO. "I can smile now," she says. "I can smile and greet people."



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Until recently, there was no legal incentive for doctors to take pain seriously. That's starting to change. In 2001 a California jury awarded $1.5 million to the family of a lung-cancer patient who lay undermedicated and dying in a hospital near San Francisco. (The award was later reduced in keeping with state law.) Two years later, the California Medical Board reprimanded a physician in a similar case involving a nursing home. These decisions "sound a resounding wake-up call to all health care providers that failure to treat pain attentively will result in accountability," says Kathryn Tucker, attorney for Compassion & Choices, which litigated the cases.

But the wake-up call hasn't stirred everyone. Millions of Americans still don't receive the therapy they need. "The odds of your getting good pain management are, at best, 50-50," says UC Davis bioethicist Ben Rich.

Studies bear Rich out. One survey of Oregon families, published in 2004, showed that almost half of terminally ill patients were in significant pain or distress during the last week of their lives. In a study of nursing homes in 11 states, Brown University researchers found that two thirds of the residents initially found to be in daily pain were still suffering two to six months later.

But even when treatment is available, patients often reject it because of widely held misconceptions. Popular media play up addiction—be it on the TV series ER, where Noah Wyle portrayed a young physician addicted to prescription painkillers, or in tabloid newspapers, which devoted voluminous ink to Rush Limbaugh's struggle with pain pills in late 2003. Indeed, Limbaugh's alleged drug of choice, OxyContin (a form of oxycodone), has become popular among rural drug abusers, who chew the pills to destroy their time-release mechanism and get a heroinlike rush.

In reality, for those using opioids as prescribed, the likelihood of addiction is extremely low, according to research. "It's really an unwarranted fear," says Christine Miaskowski, former president of the American Pain Society. Many patients do become physiologically dependent—meaning they'd go through withdrawal syndrome if they quit cold turkey—but this is a normal condition that can be managed by tapering down the dosage. It's not the same as addiction, which requires psychological dependence. Experts say patients with a history of drug abuse can safely use opioids too, as long as they are carefully monitored by their physicians to avoid a recurrence of their abusive behaviors.

These reassurances don't convince everyone. "There is a just-say-no-to-drugs attitude in the United States," says Diane Meier, a geriatric and palliative-care specialist at New York City's Mount Sinai Medical Center. "Even my own family will say, 'I don't want to be doped up on those drugs.' "

Patients aren't alone in their misinformation. Physicians, trained to suspect there's an abuser lurking behind every painkiller request—and, to be fair, there sometimes is—still confuse addiction with physical dependence. The facts don't dissuade them: although Ferreri has become functional on morphine, her family doctor still "talks to my husband all the time about the amount of medication I'm on, how dangerous it is. He really makes me feel that I'm a drug addict."

Worse, some physicians simply don't understand the importance of treating pain at all. Miaskowski, a professor in the physiological nursing department at the University of California, San Francisco, recently completed a study of cancer patients. "We had one patient whose primary care physician told her, 'Don't take your pain medicine. Let the pain kill the cancer.' " Was this advice offered years before recent advances in pain management? No, she says. "This was 2001."



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There's another, more ominous reason some doctors don't treat pain aggressively: they don't want to end up like Arizona physician Jeri Hassman.

Hassman, a physical medicine and rehabilitation specialist licensed in 1986, opened a solo practice in 1999 to focus on nonsurgical treatments for injured patients. Working with physical therapists and chiropractors, she developed a comprehensive program that includes massage, electrical stimulation, muscle injections, and even posture lessons. She also prescribed painkillers. "Medications are important," she says. "If you decrease pain, you get better compliance with exercise and other rehabilitation." Until 2002, she says, "I wasn't afraid of prescribing strong pain medicines alongside the available therapies."

Then, in May of that year, federal agents stormed her Tucson office in full view of her patients. They spent eight hours questioning her staff, seizing patient files and appointment logs, and copying the hard drives off her computers. According to a government brief, the DEA had been contacted by pharmacists "concerned about the large amounts of narcotic drugs that were being prescribed for Dr. Hassman's patients, plus the frequency with which they were returning for refills." The druggists were also concerned that some medicines had fallen into the hands of nonpatients, the brief said. Hassman was arrested and charged with 320 counts of illegally distributing narcotics and 41 counts of health care fraud.

Just before the case was scheduled for trial, federal prosecutors offered Hassman a plea agreement, allowing her to plead guilty to four counts of failing to report prescription abuse. Unwilling to risk a jury trial, Hassman accepted the offer. She was sentenced to two years' probation and agreed to surrender her DEA license to prescribe controlled substances.

Hassman was relatively lucky. This April, Virginia pain specialist William Hurwitz was sentenced to 25 years in prison for drug trafficking after prescribing large doses of painkillers such as OxyContin, morphine, and methadone to his patients. One of his patients died after taking a very high dose of morphine. DEA officials likened Hurwitz to a heroin dealer. Others, though, testified that Hurwitz provided them with the only effective relief they had ever received for debilitating pain.

Though the DEA wouldn't comment for this article, it has previously insisted that it only goes after bad apples. "Our focus is not on pain doctors. Our focus is on people who divert drugs," agency official Patricia Good said during a 2004 teleconference. But physician groups and patient advocates point to a growing list of respected pain doctors who have been prosecuted by the DEA and by state medical boards. They say that while the DEA has a legitimate interest in preventing the diversion of harmful drugs, the agency's adversarial zeal has grown in the past four or five years.

For its part, the DEA notes that it arrests fewer than 100 doctors a year on drug-diversion charges—hardly a full-scale attack on the profession. The numbers hardly matter, though, because the arrests, and the publicity surrounding them, have created a chilling effect. "Every time a physician picks up a newspaper or hears an account of some physician who has been accused of inappropriately prescribing controlled substances, it reinforces the proposition bad things can happen to you when you attempt to manage patients' pain aggressively but appropriately," says bioethicist Ben Rich. "Doctors don't say, 'I'll be more judicious and that won't happen to me.' Their reaction is, 'I don't need this.' "



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It took Deborah Hamalainen another year, plus the encouragement of a friend, to find effective treatment for her pain. Early one morning, the two women took an 80-mile bus trip to New York City, then took a taxi downtown to Beth Israel Medical Center. There, Hamalainen met with pain specialist Russell Portenoy, who found her story credible. Portenoy explained to Hamalainen that he couldn't cure her multiple sclerosis, but he could control her symptoms. "The goal is to focus on the pain itself, to get you comfortable, and to help you function," he told her.

After monitoring several medications for side effects, Portenoy and Hamalainen settled on fentanyl, a synthetic opioid delivered through an adhesive patch worn on her lower back. She uses oxycodone as a "rescue" drug when the fentanyl isn't effective.

As Portenoy predicted, the medicine hasn't eliminated the source of Hamalainen's pain. In fact, the multiple sclerosis has progressed. She's been losing feeling in her hands and feet, dropping objects, and tripping. She relies on a pair of canes to get around. Still, with the pain under control, Hamalainen has been able to return to her art. She recently had a mixed-media exhibition at the gallery where she used to work. In one sculpture, she took old canes—including the ones her father used after he lost a leg to diabetes—and smashed them with an ax, then enclosed them in a clear plastic exhibition box.

When the pain was at its worst, Hamalainen contemplated suicide. Now, with opioids to relieve the symptoms, Hamalainen can envision a productive artistic future. "Being able to be creative again has been thrilling," she says. "It's like having a new life."

Barry Yeoman last wrote for AARP The Magazine about eminent domain ("Whose House Is It Anyway?" (May & June 2005).

Went to a few haunted places and got scared a little and had a decent time. Anybody else out there interested in haunted houses ??? Looking for a group to go to a vacant prison in Ohio that supposed to be real haunted.Hey guys have a great day and if you have time drop me an email.

Cheekwa

My pain today has hit the ceiling. First my lower back was hurting a bunch then it switched to my neck in an even worse way. Going to buy a bag of frozen peas. I heard that was good to set on back or neck for a good Ice bag.
I am planning on taking a small trip to a haunted place this weekend. Waverly Sanitorium in Kentucky, supposed to be real haunted. I go on tours sometimes as a hobby.Hope I can make. it through it.

http://www.prairieghosts.com/waverly_tb.html
http://www.prairieghosts.com/mosthaunted.html

On my 4th day and I have not felt too bad, praise to the Cymbalta. All of you CP with nerve pains need to check this out.
And for the emails telling me to shut-up, you don't have to read my Journal. Even though most the emails I get say this ,I feel this is good for me to write.
Would like to communicate with others like me so if you are out there mail to:cheekwa1@yahoo.com .
Halloween is coming up yeah ! Anybody else out there like Halloween ? I'm going to try to go to this super scary Ghost House this week. I used to be a Ghost Hunter a long while back. It was very interesting.
Have a safe weekend


Anthony

LETTER TO PEOPLE WITHOUT CHRONIC PAIN:

Having chronic pain means many things change, and a lot of them are invisible. Unlike having cancer or being hurt in an accident, most people do not understand even a little about chronic pain and its effects, and of those that think they know, many are actually misinformed.

In the spirit of informing those who wish to understand.
These are the things that I would like you to understand about me before you judge me...

Please understand that being sick doesn't mean I'm not still a human being. I have to spend most of my day in considerable pain and exhaustion, and if you visit, sometimes I probably don't seem like much fun to be with, but I'm still me-- stuck inside this body. I still worry about school, my family, my friends, and most of the time I'd still like to hear you talk about yours, too.

Please understand the difference between "happy" and "healthy". When you've got the flu, you probably feel miserable with it, but I've been sick for years. I can't be miserable all the time. In fact, I work hard at not being miserable. So, if you're talking to me and I sound happy, it means I'm happy. That's all. It doesn't mean that I'm not in a lot of pain, or extremely tired, or that I'm getting better, or any of those things. Please don't say, "Oh, you're sounding better!" or "But you look so healthy!¨ I am merely coping. I am sounding happy and trying to look normal. If you want to comment on that, you're welcome.

Please understand that being able to stand up for ten minutes doesn't necessarily mean that I can stand up for twenty minutes, or an hour. Just because I managed to stand up for thirty minutes yesterday doesn't mean that I can do the same today. With a lot of diseases you're either paralyzed, or you can move. With this one, it gets more confusing everyday. It can be like a yo-yo. I never know from day to day, how I am going to feel when I wake up. In most cases, I never know from minute to minute. That is one of the hardest and most frustrating components of chronic pain.

Please repeat the above paragraph substituting, "sitting", "walking", "thinking", concentrating, "being sociable" and so on ... it applies to everything. That's what chronic pain does to you.

„ Please understand that chronic pain is variable. It's quite possible (for many, it's common) that one day I am able to walk to the park and back, while the next day I'll have trouble getting to the next room. Please don't attack me when I'm ill by saying, "But you did it before!" or Oh, come on, I know you can do this!¡¨ If you want me to do something, then ask if I can.

In a similar vein, I may need to cancel a previous commitment at the last minute. If this happens, please do not take it personally. If you are able, please try to always remember how very lucky you are--to be physically able to do all of the things that you can do.

Please understand that "getting out and doing things" does not make me feel better, and can often make me seriously worse. You don't know what I go through or how I suffer in my own private time. Telling me that I need to exercise, or do some things to get my mind off of it¨ may frustrate me to tears, and is not correct if I was capable of doing some things any or all of the time, don't you know that I would? I am working with my doctor and I am doing what I am supposed to do.

Another statement that hurts is, "You just need to push yourself more, try harder..." Obviously, chronic pain can deal with the whole body, or be localized to specific areas. Sometimes participating in a single activity for a short or a long period of time can cause more damage and physical pain than you could ever imagine.

Not to mention the recovery time, which can be intense. You can't always read it on my face or in my body language. Also, chronic pain may cause secondary depression (wouldn't you get depressed and down if you were hurting constantly for months or years?), but it is not created by depression.


Please understand that if I say I have to sit down/lie down/stay in bed/or take these pills now, that probably means that I do have to do it right now - it can't be put off or forgotten just because I'm somewhere, or am right in the middle of doing something. Chronic pain does not forgive, nor does it wait for anyone.

If you want to suggest a cure to me, please don't. It's not because I don't appreciate the thought, and it's not because I don't want to get well. Lord knows that isn't true. In all likelihood, if you've heard of it or tried it, so have I. In some cases, I have been made sicker, not better. This can involve side effects or allergic reactions. It also includes failure, which in and of itself can make me feel even lower.

If there were something that cured, or even helped people with my form of chronic pain, then we'd know about it. There is worldwide networking (both on and off the Internet) between people with chronic pain. If something worked, we would KNOW. It's definitely not for lack of trying. If, after reading this, you still feel the need to suggest a cure, then so be it. I may take what you said and discuss it with my doctor.

If I seem touchy, it's probably because I am. It's not how I try to be. As a matter of fact, I try very hard to be normal. I hope you will try to understand. I have been, and am still, going through a lot. Chronic pain is hard for you to understand unless you have had it. It wreaks havoc on the body and the mind. It is exhausting and exasperating.

Almost all the time, I know that I am doing my best to cope with this, and live my life to the best of my ability. I ask you to bear with me, and accept me as I am. I know that you cannot literally understand my situation unless you have been in my shoes, but as much as is possible, I am asking you to try to be understanding in general.


In many ways I depend on you - people who are not sick. I need you to visit me when I am too sick to go out... Sometimes I need you help me with the shopping, cooking or cleaning. I may need you to take me to the doctor, or to the store. You are my link to the normalcy of life. You can help me to keep in touch with the parts of life that I miss and fully intend to undertake again, just as soon as I am able.

I know that I asked a lot from you, and I do thank you for listening. It really does mean a lot.

Two days in a row that I have not felt too awful. Pain levels have been in the 3-4 range and tolerable.
The Cymbalta might be starting to kick in. If any of you have been on it and it stopped working, the Dr. should increase your dose. Also it takes about two weeks to notice the change. Also they are giving up to 120mg in the field, 60 mg is the FDA max but many pain patients have been prescribed more. So if it worked before it can work again most likely if you increase the dose.

"quote"
Clinical depression and back pain
Depression is by far the most common emotion associated with chronic back pain. The type of depression that often accompanies chronic pain is referred to as major depression or clinical depression. This type of depression goes beyond what would be considered normal sadness or feeling "down for a few days". The symptoms of a major depression occur daily for at least two weeks and include at least 5 of the following (DSM-IV, 1994):

A predominant mood that is depressed, sad, blue, hopeless, low, or irritable, which may include periodic crying spells

Poor appetite or significant weight loss or increased appetite or weight gain

Sleep problem of either too much (hypersomnia) or too little (hyposomnia) sleep

Feeling agitated (restless) or sluggish (low energy or fatigue)

Loss of interest or pleasure in usual activities

Decreased sex drive

Feeling of worthlessness and/or guilt

Problems with concentration or memory

Thoughts of death, suicide, or wishing to be dead

Chronic pain and depression are two of the most common health problems that health professionals encounter, yet only a handful of studies have investigated the relationship between these conditions in the general population (Currie and Wang, 2004).

Major depression is thought to be four times greater in people with chronic back pain than in the general population (Sullivan, Reesor, Mikail & Fisher, 1992). In research studies on depression in chronic low back pain patients seeking treatment at pain clinics, prevalence rates are even higher. 32 to 82 percent of patients show some type of depression or depressive problem, with an average of 62 percent (Sinel, Deardorff & Goldstein, 1996). In a recent study it was found that the rate of major depression increased in a linear fashion with greater pain severity (Currie and Wang, 2004). It was also found that the combination of chronic back pain and depression was associated with greater disability than either depression or chronic back pain alone.

Depression is common for those with chronic back pain
Depression is more commonly seen in patients with chronic back pain problems than in patients with pain that is of an acute, short-term nature. How does depression develop in these cases? This can be understood by looking at the host of symptoms often experienced by the person with chronic back pain or other spine-related pain.

The pain often makes it difficult to sleep, leading to fatigue and irritability during the day.

Then, during the day, because patients with back pain have difficulty with most movement they often move slowly and carefully, spending most of their time at home away from others. This leads to social isolation and a lack of enjoyable activities.

Due to the inability to work, there may also be financial difficulties that begin to impact the entire family.

Beyond the pain itself, there may be gastrointestinal distress caused by anti-inflammatory medication and a general feeling of mental dullness from the pain medications.

The pain is distracting, leading to memory and concentration difficulties.

Sexual activity is often the last thing on the person’s mind and this causes more stress in the patient’s relationships.

Understandably, these symptoms accompanying chronic back pain or neck pain may lead to feelings of despair, hopelessness and other symptoms of a major depression or clinical depression.

A recent study by Strunin and Boden (2004) investigated the family consequences of chronic back pain. Patients reported a wide range of limitations on family and social roles including: physical limitation that hampered patients’ ability to do household chores, take care of the children, and engage in leisure activities with their spouses. Spouses and children often took over family responsibilities once carried out by the individual with back pain. These changes in the family often led to depression and anger among the back pain patients and to stress and strain in family relationships.

Psychological theories about depression
Several psychological theories about the development of depression in chronic back pain patients focus on the issue of control. As discussed previously, chronic back pain can lead to a diminished ability to engage in a variety of activities such as work, recreational pursuits, and interaction with family members and friends. This situation leads to a downward physical and emotional spiral that has been termed "physical and mental deconditioning" (See Gatchel and Turk, 1999). As the spiral continues, the person with chronic back pain feels more and more loss of control over his or her life. The individual ultimately feels totally controlled by the pain, leading to major depression. Once in this depressed state, the person is generally unable to change the situation even if possible solutions to the situation exist."quote"

Went to a new shrink and he gave me 90mg Cymbalta daily and I hope that does the trick. I was on 60mg and that seemed to wear out,felt almost normal for about 7 weeks. My hope is in this drug that whatever made it work before works this time.I start psycho- therapy this week and that should be interesting.It will be my first time ever.

Oh how I long for the way I was before. Able to do chores On Sunday, go to the flea market,play tennis with my friends and all the other things I used to do when I was well.Still do have some hope left but the well is running dry .

I know we all talk about taking it one day at a time, but any thinking person has to contemplate the future. And barring major new developments in medical science, that future looks bleak for most of us.

Is it ever rational to plan to end your life because it's not worth living? I know that counselling types say that suicide is a permanent solution to a temporary problem, but what if your problem is, in fact, permanent? Does life have value when one is bed-ridden, incontinent, in perpetual pain, can't talk, breath, or feed themselves and is demented. And, furthermore knows full well that it only gets worse from there.

Wouldn't it be better to plan a dignified exit, while one is still able?

I'm not talking about taking rash action in the depths of depression. I am thinking more of a going away party with family and friends, explaining to them that life's been grand, but now you've been dealt a losing hand. Tell them that you'd rather leave in style than wither and shrivel and end up a babbling invalid who can't take himself to the bathroom or wipe his own butt. It's time to say goodbye. You take a few pills and go to sleep

The question is, when is the right time? You wouldn't want to end it all on the day before they find a cure. Wouldn't that be ironic. At the same time you don't want to wait until your physical and mental incapacity prevents you from taking action. And you'd want to make sure that you weren't depressed because that can be treated.

Those with strong religious beliefs about immortal souls, after-life, heaven, hell, and other fairy tales are kindly asked to suppress their urge to respond to this post.

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