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Approved-By:  Bill McGarry <wtm@SHELDEV.SHEL.ISC-BR.COM>
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Date:         Tue, 14 Apr 1992 17:26:27 EDT
Reply-To:     Bill McGarry <wtm@sheldev.shel.isc-br.com>
From:         Bill McGarry <wtm@sheldev.shel.isc-br.com>
Subject:      Handicap Digest # 2581
X-To:         LHCAP <l-hcap@VM1.NODAK.EDU>

                          THE HANDICAP DIGEST

                               Issue # 2581

                           Monday, April 13, 1992

Today's Topics:


                                ******


                          More congratulations.....
                                 Spasticity
                     Re: Birmingham Pain Clinic Visit #4
                       Birmingham Pain Clinic Visit #5
                       Birmingham Pain Clinic Visit #5
                       Birmingham Pain Clinic Visit #5
                     Re: Birmingham Pain Clinic Visit #4
                       Birmingham Pain Clinic Visit #4
                       Birmingham Pain Clinic Visit #4
                                  Migraines


                                ******


To subscribe to the Handicap Digest mailing list or have your
thoughts in the next issue, please send electronic mail to
Bill McGarry at any of the following addresses:


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                              Bill McGarry (Moderator)
                              (203) 337-1518



------



Subject: More congratulations.....
From: Sheila.Fava@f24.n3602.z1.fidonet.org (Sheila Fava)
Organization: FidoNet node 1:3602/24 - ADAnet One (tm) Net, Pinson AL


[This is from the Abled Athlete Conference]

                MORE CONGRATULATIONS!

    Victoria (Tory) Williams,  a  twenty-five  year
    old swimmer  from  Amherst,  Massachusetts,  is
    the United States Cerebral Palsy  Association's
    Female Athlete of the Year.  Tory,  a  longtime
    USCPAA competitor, emerged on the international
    scene with a strong showing in the  1988 Summer
    Paralympic Games in Seoul, Korea.

    Ms. Williams is  one of  the top swimmers  with
    Cerebral Palsy in the  world.  She  is  a Class
    Four swimmer and  swims  distance  events (over
    200 meters) very easily.

    The 1985  graduate  of  Longmeadow High School
    recently  secured  her  degree  in  Elementary
    Education from the American International Col-
    lege.  She spends her spare time in support of
    quality programs like the Speaker's  Symposium
    Network  where she talks to groups in the com-
    munity  about  disABILITY awareness.  She also
    works  with  Valley  Infant Development in the
    Intervention program  for  disABLED youth ages
    to three years old.  She is also a group leader
    in a pilot program to provide  role  models for
    disABLED youth.

    Tory spends her leisure  hours  reading  and im-
    improving her skills with the  COMPUTER.  She is
    a middle and distance  Freestyle  swimmer and is
    busy preparing for  the  1992 Paralympics sched-
    uled for this September in Barcelona, Spain.

    (Posted from an article in UPDATE -- Official News-
       letter of the USCPAA.  Vol.5 No. 4 --Winter '92)

                  ---Sheila.

                  ** HOST(ess) ADA-ATHLETE  Conference **
 * QNet3 * * Pick's Place * Green Village, NJ * 201-765-0164 * HST/v32 *

--
Uucp: ..!{decvax,oliveb}!bunker!hcap!hnews!3602!24!Sheila.Fava
Internet: Sheila.Fava@f24.n3602.z1.fidonet.org




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Subject: Spasticity
From: Linda.Cummings@f34.n375.z1.fidonet.org (Linda Cummings)
Organization: FidoNet node 1:375/34 - Batteries Included , Montgomery AL


[This is from the Chronic Pain Conference]

 > think the important point is that there are multiple proper
 > approaches to a pain or spasticity problem, and much individual
 > variation in the way any particular patient is going to respond to
 > them.  This is part of what makes up the art of medicine that goes
 > beyond our scientific basis of understanding.

I know.  In "group" they explain how some medication works wonders
for one person and won't do diddley for another person.  I guess
that's why there are so many medications.

Linda

--
Uucp: ..!{decvax,oliveb}!bunker!hcap!hnews!375!34!Linda.Cummings
Internet: Linda.Cummings@f34.n375.z1.fidonet.org




------



Subject: Re: Birmingham Pain Clinic Visit #4
From: Arthur.Saus@p160.f72.n376.z1.fidonet.org (Arthur Saus)
Organization: FidoNet node 1:376/72.160 - Windows of the Worl, Columbia SC


[This is from the Chronic Pain Conference]

> At the last group meeting, we were informed that becoming
> addicted to pain medication prescribed by a doctor is one of
> the easiest additions. After all, we're just doing what the
> doctor ordered, aren't we?

> I may become addicted to Flexaril.

As far as I know, there is no risk of "addiction" to Flexaril in
the classic sense of the word (ie physical cravings and drug
seeking behavior).  If you want to take it because it reduces pain
that may be a classical psychological reinforcer, but not truly
addiction.

--
Uucp: ..!{decvax,oliveb}!bunker!hcap!hnews!376!72.160!Arthur.Saus
Internet: Arthur.Saus@p160.f72.n376.z1.fidonet.org




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Subject: Birmingham Pain Clinic Visit #5
From: Linda.Cummings@f34.n375.z1.fidonet.org (Linda Cummings)
Organization: FidoNet node 1:375/34 - Batteries Included , Montgomery AL


[This is from the Chronic Pain Conference]

April 1, 1992

This week was a little more interesting in "group."  More people
felt more at ease and participated much more than last week.
However, it seemed that about half of the people either could not
make the second group session, or dropped out.  We will see next
week.

Dr. Frank Brotherton, Psychologist, explained the difference
between "Hope and expectations."  We all "hope" that someday there
will be someone or some procedure that will help us get rid of or
diminish greatly our chronic pain, but it is wrong to "expect" a
cure.  Most people take a "mechanical" look at the process of
medical attention. We tend to look at ourselves the way we look at
fixing a problem with our car.  We *know* that there's *got* to be
a mechanic out there *somewhere* that can fix our car.  At the same
time, we feel that there has just *got* to be a doctor *somewhere*
that can fix our chronic pain by doing something "mechanical."  Not
so.  In fact, less than 5% get "quick cures," and usually it is
more like 85% to 95% that get "some" pain relief.  Then, there are
some people who receive 0% benefit from any given mechanical
procedure.

Promising a "cure" is pure *quackery!*

Dr. Brotherton also explained how a TENS unit worked:

1.  The electrical pulses help set off a reaction in the body which
     help produce endorphins (just like acupuncture does).  I was unaware
     that acupuncture did this.  He also said that you can run out or
     have diminished endorphins.

2.  The TENS unit acts as a "Gate Control Theory on Pain."  Since all
     sensation, movement, etc., is controlled by the spinal cord, the
     TENS unit sends "signals" to the brain through the "Fast Fibers."
     These are the large nerve tracks.  Since the brain receives signals
     through the spinal cord, it also receives the pain signals through
     the spinal cord.  If the TENS unit can block part or all of those
     signals, then the brain can not perceive the pain.

3.  The TENS unit acts as a distraction to the brain.  Let's give the
     example he gave us.  Say right now, there is a very large explosion
     outside.  The explosion is so large that it breaks your windows.
     At that exact moment, would you feel your pain?  No!  Your attention
     would be distracted away from the pain and all your brain activity
     would be directed at the explosion.  By feeling the electrical
     impulses, the TENS unit is distracting the mind away from the pain.

Now, here is something very interesting he told us about.  There is
something called "Retrograde Amnesia and Anterograde Amnesia."  The
retrograde amnesia is loss of memory usually immediately preceding
a trauma.  Have you ever noticed that later, after an accident, it
may be hard to remember what you were doing? Ever wonder why so
many people can't remember the details if they witness a mass
shooting?  This is retrograde amnesia.  Anterograde amnesia affects
the short-term memory and impairs new memory events.  Everytime a
person is given anesthesia, there are usually some brain cells
destroyed.  In some people, this will affect short-term memory.  We
all lose brain cells everyday (that are not replaced).  We are born
with a certain amount...enough to usually last us a lifetime with
no ill effects by losing some everyday. But, in some people, they
will lose the wrong ones and be affected by short-term memory
loss.

Anyway, the session was mostly devoted to how the brain can control
pain and other bodily functions.  The article given to us explains
it in detail and I will copy it in the next message(s).  The mind
is a powerful organ and we have not yet fully mastered using it.

Bernard Harris, the Physical Therapist, spent most of his hour
continuing the discussion that Dr. Brotherton started.  But, he did
have a few words of advice for us concerning exercise.  He said
that the best time to exercise would be right after a warm shower.
Also, they now have found out that in most cases, "ice" is better
for the relief of pain than heat.

He explained to us that getting muscle spasms/cramps, is usually a
result of muscles that get tight and have trouble getting enough
blood and oxygen. Contrary to popular belief, it is even better to
apply ice to a spasm than it is heat.  Then, before his hour ended,
he told us that he would like for us to exercise about 15 minutes
each day by raising our arms above our head and then dropping them;
to put our arms out at our sides and make circles first forward and
then backwards; and to take our hands and pull up our knees toward
our chests as comfortable as we could...first the left, and then
the right.

Karen Kramer then gave us all our "Biodots."  These are little dots
that were placed on our hand near the intersection of the thumb and
forefinger. According to body temperature, they would change
colors. According to her, the more relaxed you became, the more the
color would change.  She then took us through a relaxation
technique (similar to one of the tapes she had given me prior to
attending "groups").  After the relaxation, we were to observe our
Biodots to see how much they had changed.

Now, Eddie was given one of these dots, too.  His turned deep blue
(which indicated "calm").  Mine was amber when it was placed on my
hand and it was amber when I looked after relaxation.  That meant
"tense." I can see I have a lot of work to do to learn to relax!

For those of you who would like to try this, here is the body
temperatures and what they mean:

    94.6    very relaxed        violet
    93.6    calm                blue
    92.6    relaxing            turquoise
    91.6    involved (normal)   green
    90.6    unsettled           yellow
    89.6    tense               amber
    87.6    very tense          black

Eddie and I discovered that when we went outside (it was a very
windy and cold day in Birmingham), that both of our dots turned
black.  Skin temperature has everything to do with the color of the
dots.  But, she told us that the more relaxed a person is, the
warmer their skin will be.

At home, I layed back on the couch and listened to a relaxation
tape. As soon as I opened my eyes, I got so excited because my dot
was finally "green." Eddie said that probably people with chronic
pain had a harder time relaxing than people with no pain at all.  I
think he's right.  On the way home, with him driving, his dot
turned green to almost turquoise.  Husbands!

I do intend to ask her something next week.  I have a body
temperature lower than the "normal" 98.6.  I'm going to ask her if
that will make a difference in the dot (which I'm sure it will).
Maybe when I get to a blue, it will be like other people's violet.
I think I'll try to find myself a *mood ring!*

Linda

--
Uucp: ..!{decvax,oliveb}!bunker!hcap!hnews!375!34!Linda.Cummings
Internet: Linda.Cummings@f34.n375.z1.fidonet.org




------



Subject: Birmingham Pain Clinic Visit #5
From: Linda.Cummings@f34.n375.z1.fidonet.org (Linda Cummings)
Organization: FidoNet node 1:375/34 - Batteries Included , Montgomery AL


[This is from the Chronic Pain Conference]

Biogenics Program

Place yourself in a comfortable position.  Uncross your arms and
legs.  Close you eyes.

Take a deep breath in and out slowly (*very slowly*).

Repeat the following phrases slowly, five times each with a slow deep breath:

BREATHE IN                  BREATHE OUT
----------                  -----------

A.  I am....................... relaxed.

B.  My arms and legs........... are heavy and warm.

C.  My heartbeat............... is calm and regular.

D.  My breathing............... is free and easy.

E.  My abdomen................. is warm.

F.  My forehead................ is cool.

G.  My mind.................... is quiet and still.

The above was given to us for help in relaxation at the Birmingham Pain Clinic.

Linda

--
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Internet: Linda.Cummings@f34.n375.z1.fidonet.org




------



Subject: Birmingham Pain Clinic Visit #5
From: Linda.Cummings@f34.n375.z1.fidonet.org (Linda Cummings)
Organization: FidoNet node 1:375/34 - Batteries Included , Montgomery AL


[This is from the Chronic Pain Conference]

THE RELATIONSHIP BETWEEN THE MIND AND THE BODY
Handout from the Birmingham Pain Clinic on 4/1/92

Rene Descartes was a great 17th Century French philosopher and
scientist who proposed a view of the relationship between the mind
and body known as *dualism*.  This view basically holds that the
mind and body are separate and distinct.  The body is material,
physical and mechanical and can be understood by applying the
principles of scientific investigation.  The mind, on the other
hand, is spiritual, nonmaterial, and mystical.  If the mind obeys
any laws or principles, they are different from the physical laws
of the body and are not knowable through application of the
scientific method.  While dualism was a view prominent in early
philosophy and should be mainly of historical significance, it is
still the dominant view held by many nonscientists.  This dualistic
view of the mind and body, separate and distinct, has caused a
tremendous amount of confusion in our understanding of ourselves in
general, and chronic pain in particular.  The following statements
or beliefs all reflect this basic misconception that the body is
one thing and the mind is something totally different:

    1.  My pain is real; I'm not imagining it.
    2.  His pain is "all in his mind."
    3.  I can't find anything wrong; you ought to see a psychiatrist.
    4.  If the doctors can't find anything causing my pain, then it
        must be all in my head.
    5.  Just ignore it and don't think about it and it will go away.
    6.  Don't try any of that psychology business on me; my pain is real.

The *modern view* of the relationship between the body and the mind
holds that the mind is the brain.  Of course, the brain is an organ
of the body.  In a sense, it is the master organ for it controls
the rest of the body all the time.  Mental events (thoughts,
feelings, emotions, images, etc.) are the result of biochemical
events in the brain, and bodily changes (heart rate, blood flow,
digestion, etc.) are directly and indirectly influenced by the
brain.  Thus the mind and the body are interacting parts of one and
the same overall system, and each influences the other.  According
to this modern view, the mind and the body are one, and any event
is a product of the interaction of both.  Pain, for example, is an
experience with both mental and physical components and can be
looked at as being both 100% emotional and 100% organic. The
remainder of this handout presents examples of how the mind and
body interact to determine ones experience, especially the
experience of pain.

One interesting example of this interaction comes from research on
*biofeedback*, which is teaching us that the mind can have a
tremendous effect on altering our physiology.  There are physical
processes that no one ever thought could be controlled mentally
that we now know can be controlled, such as heart rate, blood flow
and muscle tension.  As a matter of fact, many of these functions
were thought to be involuntary and under the complete control of
the autonomic nervous system, meaning that they were automatic.
Many painful conditions, as you know, are aggravated by muscle
tension and by abnormal circulation patterns, and it has become
very clear with biofeedback that we can learn to alter our blood
flow and our muscle tension on a partially voluntary basis.
Research in the area of *stress* is teaching us that stress affects
virtually every system of the body, including metabolism, muscle
function, blood pressure, circulation, and even the functioning of
the immune system that protects us against disease.  For example,
recent research has shown that individuals under a high degree of
stress are more likely to become ill.  One recent study looked
at thousands of widowers and found that during the first year of
being widowed, men were much more likely to develop cancer than
were other men of the same age who had not undergone that stressful
experience.  Research on *depression* is showing us that
our emotions, thoughts, and activities have an important effect on
neurotransmitters -- substances in the brain that allow nerve
impulses to be transmitted from one cell to another.  People
suffering with depression often have an associated chemical
imbalance involving these neurotransmitters.

Moreover, we know that physical activity helps to bring these
neurotransmitters into better balance and can thereby serve as an
antidepressant.  On the other hand, we also know that chemicals
introduced into the body can have a profound affect on the way we
think and feel.  There are drugs that relieve depression, drugs
that cause depression, drugs that make us pessimistic, drugs that
make us optimistic, and even drugs that make us see and hear things
that are not there!

Just in the last ten years, there has been some exciting research
regarding the relationship between our mind, our behavior, and our
experience of pain.  It has been discovered that there are
substances that are produced within the brain that are very similar
in their chemical structure to morphine and which have the ability
to directly decrease the experience of pain.  These chemicals are
called *endorphins and enkephalins*.  It has been found that these
endorphins and enkephalins are present in very large concentrations
when an individual is exposed to a painful stimulus, such as a
bodily injury.  It has also been found that there is another
chemical called naloxone that prevents the brain from producing
endorphins and enkephalins, and if naloxone is injected into an
individual, pain can become overwhelming.

What is fascinating is that we have the ability to alter the
concentration of endorphins and enkephalins in our system through
our behavior and our thought patterns.  One study looked at the
concentration of endorphins in response to electric stimulation to
the gums.  It was found that giving a person a placebo drug (a
sugar pill or salt tablet that has no chemical effect) actually
increased the concentration of endorphins in those individuals'
central nervous systems. Because the placebo medication had no
direct effect on pain relief, it had to be *positive thinking* on
the part of the individuals who received the placebo that made the
difference!  In other words, the individuals who *believed* that
they were getting a pill that would relieve their pain actually
produced within their nervous system endorphins which helped them
to tolerate much better the pain from electric stimulation.

This was discovered because naloxone, which prevented endorphins
from being formed, would result in these individuals having much
higher levels of pain after taking this placebo medication.  The
naloxone blocked the placebo effect by blocking the endorphins
produced by the expectation of relief.  So what this experiment
implies is that positive thinking actually has an effect on the
chemicals in the brain that help us to control pain -- another very
interesting example of the interaction of the mind and body.

(to be continued in next message)

--
Uucp: ..!{decvax,oliveb}!bunker!hcap!hnews!375!34!Linda.Cummings
Internet: Linda.Cummings@f34.n375.z1.fidonet.org




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Subject: Re: Birmingham Pain Clinic Visit #4
From: Joel.Lefkowitz@f54.n135.z1.fidonet.org (Joel Lefkowitz)
Organization: FidoNet node 1:135/54 - Ramblin' Roots, Miami FL


[This is from the Chronic Pain Conference]

When I was in the Baptist Hospital in Miami, they had me on Demeral
and a few other medications that they were trying to use to block
the pain. My Doctor walked in my room one evening and calmly says,
I'm taking you off the demeral because you are now addicted. I told
him that I wasn't and we started to argue. My wife and daughters
sitting in the room started crying. He walked out of the room and
my wife and I started discussing what we were going to do.

The doctor came back the next evening and asked how bad the
withdrawal was. I told him that I had no symptoms. He insinuated
that I was lying and called the nurse in. The nurse told him that I
had no symptoms during the day or evening. He muttered something
and left the room. Two hours later I was back on medication until
the bout with the adhesions was over.

When I call him now and ask for pain medication, there is never an
argument.  I am still using the biofeedback and the self-hypnosis
but sometimes when the pain is severe I need the medication.

--
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Internet: Joel.Lefkowitz@f54.n135.z1.fidonet.org




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Subject: Birmingham Pain Clinic Visit #4
From: Linda.Cummings@f34.n375.z1.fidonet.org (Linda Cummings)
Organization: FidoNet node 1:375/34 - Batteries Included, Montgomery AL


[This is from the Chronic Pain Conference]

 > As far as I know, there is no risk of "addiction" to Flexaril in
 > the classic sense of the word (ie physical cravings and drug
 > seeking behavior).  If you want to take it because it reduces pain
 > that may be a classical psychological reinforcer, but not truly
 > addiction.

Arthur, I meant it (maybe becoming addicted to Flexaril) in this
way: You take a drug.  You body gets used to getting that drug.  If
your body doesn't get the drug, it will do things to you to make
you take the drug.  Example.  I didn't take Flexaril one day and
only took it at night.  I suppose my body said, "oh no you don't"
and blessed me with spasms and cramps all day long the next day.
So, now I at least take one in the morning and one before bedtime.
My doctor said 3 is normal for someone like me, but so far, I seem
to be doing alright with 2 per day.

It's like eating.  If you're used to eating 3 meals a day, and you
stop and only eat one or two, your body rebels against you and
produces acid and you get heartburn, etc.  Same principle.

Linda

--
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Internet: Linda.Cummings@f34.n375.z1.fidonet.org




------



Subject: Birmingham Pain Clinic Visit #4
From: Arthur.Saus@p160.f72.n376.z1.fidonet.org (Arthur Saus)
Organization: FidoNet node 1:376/72.160 - Windows of the Worl, Columbia SC


[This is from the Chronic Pain Conference]

Hello Alan!

01 Apr 92, Alan Hess writes to Arthur Saus:

 AH> I am not disputing that narcotics are addictive.  However, several
 AH> physicians with which I have dealt have told me that it is better to be
 AH> addicted to a narcotic and be able to function than to not take narcotics
 AH> and suffer.

I am not exactly disagreeing with this concept.  Certainly it is
better to be able to function without suffering while using the
appropriate medications, administered in an appropriate manner,
than to use no medications and be unable to function.  Properly
used, narcotics can provide this for people who have certain pain
problems.

 AH> The studies they mentioned show that chronic pain patients
 AH> will only take enough medication to allow them to function, since that is
 AH> all they want.

Yes, some studies will show this, and other studies as well as
practical experience will often show exactly the opposite.  This is
why a broad sweeping statement like this is not correct.  There are
some patients who have recurring pain problems that will use only
the appropriate dose of a narcotic to manage their pain, and do not
become addicted to the drug; patients with severe pain from cancer
are a good example of this type of patient.  The biggest part of my
disagreement with this lies in semantics.  There is a significant
difference in the patient who has "chronic pain" and the patient
who had "acute recurring pain" although this is not generally
recognized by patients and medical personnel who have not
specifically trained in pain management.  The true "chronic pain"
patient is very likely to abuse a narcotic and become addicted to
it, while the narcotic does not actually provide the pain relief
the patient is seeking; ie the narcotic is the wrong drug to treat
the problem.

 AH> It is absolute foolishness to deny effective pain-control
 AH> treatment to people just because their condition isn't terminal, due to
 AH> fear of addiction.

True, but the real issue should be prescribing the proper therapy
for that particular problem.  The proper medication selection would
avoid the addiction issue altogether.

 AH> Any drug that the body develops a tolerance to can be
 AH> called addicitve, since the person must be weaned off and can't stop cold
 AH> turkey without withdrawal problems.

Sorry, but this generalization doesn't hold true for "any drug".
Certainly discontinuation of some drugs requires a gradual tapering
of the dose, rather than a sudden stop, but this is not the same as
addiction.  Furthermore, development of tolerance to a medication
is not addiction.  Again I believe we are disagreeing on semantice
here rather than the actual issue.

 AH> Addictions can be handled just as any other tolerance can be.

Oh, if only it could <sigh>.  Sorry, but it doesn't work that way.

Arthur

--
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Internet: Arthur.Saus@p160.f72.n376.z1.fidonet.org




------



Subject: Migraines
From: Dan.Dalby@f712.n250.z1.fidonet.org (Dan Dalby)
Organization: FidoNet node 1:250/712 - Softor Systems, Scarborough ON


[This is from the Chronic Pain Conference]

Imitrex is a fairly new drug on the market, its been out for just a
couple of months.  I was going to a neurologist in TO, who was
doing part of the study on this drug last year, but as my attacks
are so frequent, I was rejected.  I guess I would have screwed up
their stats.

This IS a miracle drug, from what I have heard from other
sufferers.  I am getting limited relief, but that's better than
none.  Others tell me that it eliminates the current attack, and
cuts down on intensity and frequency of others.  From what the
doctors tell me, it is targetted directly at the blood vessels in
the head, and forces them to shrink, thus eliminating the
PULSATING. I know there must be a lot more to it, as I have tried
other drugs that were supposed to that, but this one actually
works!

If you have a drug plan, I would suggest that you go directly to
you family doctor.  He could either prescribe the pills, or the
needles.  As mine are so severe, and frequent, it was suggested
that I try the needles.  If they didn't work, the pills certainly
wouldn't.  I say, "if you have a drug plan" because the pills are
about $16 a tablet, and the needles are about $36 a piece.  As you
are allowed to take 3 pills a day, or 2 needles, this could get
rather expensive.

I am not trying to be a drug pusher here!  Talk with your doctor,
as he is the only one who can get you the stuff.  PS. I dont work
for GALAXO, the manufacturer of this drug.

L8R...

--
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             End of Issue # 2581 of the Handicap Digest

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