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Date:         Fri, 28 Aug 1992 12:17:57 EDT
Reply-To:     Bill McGarry <wtm@sheldev.shel.isc-br.com>
From:         Bill McGarry <wtm@sheldev.shel.isc-br.com>
Subject:      Handicap Digest # 2898
X-To:         LHCAP <l-hcap@VM1.NODAK.EDU>

                             THE HANDICAP DIGEST

                                 Issue # 2898

                           Friday, August 28, 1992

Today's Topics:


                                ******


                              General Interest
                                  Lightning
                                    TENS
                                  More pain
                              General Interest
                              General Interest
                                    PAIN
                                  more pain
                              General Interest
                              General Interest


                                ******


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                              Bill McGarry (Moderator)
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Subject: General Interest
From: Kathleen.Mcintosh@f181.n264.z1.fidonet.org (Kathleen Mcintosh)
Organization: FidoNet node 1:264/181 - Les's Corner BBS, Richmond VA


[This is from the Chronic Pain Conference]

Hi Shelby!  I can tell you some things about releiving cancer pain
as I an expert at it.  Narcotics work pretty good and you don't have
to worry about addiction because the brain uses them differently
when taken for pain as for say, recreational use.  I was on a
maximum dose for over a year and was able to stop with no problems.
It's also an interesting fact that non-steriodals like ibuprofen can
be just as effective as narcotics.  The key here is to take the
drugs on a regular schedule.  I used to get up in the middle of the
night to take them so I would'nt wake up in pain.  If you wait to
take your meds until you're hurting, it will take longer for pain
relief, and it won't last as long.
If you are in the hospital and are dependent on the nurses for
giving you pain meds, here is an interesting fact.  Most medical
people have been trained to assess the amount of a patient's pain by
their reaction to it.  Thank goodness this is being recognized as
unreliable as some people like me don't show pain even when it is
excruciating.  If you do find yourself in a situation where they
look for a reaction, my suggestion is give them one! Cry, moan,
scream even, because it's not worth lying there in pain.  Conversly,
you can rate your pain on a scale of one to ten and keep your nurses
advised.  Too many people suffer from pain in the hospital because
they are too intimidated to ask for drugs!  Don't let this happen to
you or anyone you love.  :)
        Hugs and good health,
             Kathleen

--
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Internet: Kathleen.Mcintosh@f181.n264.z1.fidonet.org




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Subject: Lightning
From: Mark.Munson@p0.f14.n279.z1.fidonet.org (Mark Munson)
Organization: FidoNet node 1:279/14.0 - Project Enable, Dunbar WV


[This is from the Chronic Pain Conference]

RK>I am looking for answers, my husband was struck by lightning in the
RK>head, and it exited his right foot. He has been going downhill
RK>ever since. the list complaints are to numberous tolist, but
RK>the most severe ones are pain, fron the neck downward, double
RK>vision, hearing lost and ringing in the ears, vertigo, memory
RK>lost, unable to retain new learn information, and so. When I
RK>ask the doctors that have treated him in the past a question,
RK>the only response they seem to have is 1). Mind over matter 2).
RK>No direct causes due to the lightning and so on. which is now
RK>driving me crazy. If there is anyone out there with some
RK>information on this, or knows someone I could go to for answers,
RK>I would be greatly appreicated......Thanks

Rosemary,
   A lot of times doctors depending who you go to will either go in
   depth to find the problem or brush it off knowing you will go to
   another.  Just some advice I have experinced.

   I am NOT a doctor but do have this to say.. Your husband was struck
   in the head, the head is the main conductor for the rest of the
   body..  If the STRIKE traveled through his spinal cord he would have
   symptons like you say..  If so, there is a cooling off period that he
   would most likely go through..

   This is usually due to the swelling or (Spinal Shock)  This means
   that the Peripheral nerves that are connected to the spinal cord
   could have been affected.  (NOT PERMANENTLY), but it takes a while
   for things to settle down, ie: swelling etc... There are drugs than
   can be given to reduce swelling of the spinal cord (IF THIS IS THE
   CASE, ONLY A DOCTOR CAN TELL YOU),  If not, time will tell, my guess
   is that he will get better, and PLEASE, get a second opinion from a
   Neurologist (spelling)?

Let me know what goes on.

Mark

 * SLMR 2.1a * Never lose hope!

--
Uucp: ..!uunet!bunker!hcap!hnews!279!14.0!Mark.Munson
Internet: Mark.Munson@p0.f14.n279.z1.fidonet.org




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Subject: TENS
From: Wayne.Briggs@p0.f5109.n124.z1.fidonet.org (Wayne Briggs)
Organization: FidoNet node 1:124/5109.0 - National Amputee Co, Dallas TX


[This is from the Chronic Pain Conference]

I've used a TENS on/off since about 1985.I was allergic to all but the
deposite pads with flesh colored tape arrached. LOCATION OF PADS IS
CRITICAL!  Suggest to talk with MD pain management spedialist or PT on
placement. It helped someon thee timw, which was100% better thannone of
the time. Goof luvk!

--
Uucp: ..!uunet!bunker!hcap!hnews!124!5109.0!Wayne.Briggs
Internet: Wayne.Briggs@p0.f5109.n124.z1.fidonet.org




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Subject: More pain
From: Bob.Officer@f408.n208.z1.fidonet.org (Bob Officer)
Organization: FidoNet node 1:208/408 - The Beemer Board, Manteca CA


[This is from the Chronic Pain Conference]

KM > Has anyone used one of those electrical stimulators for managing
KM > chronic pain?  I met a woman who used one, but would like more

I have a "tens"  unit. I thinks it helps somewhat. Sometime more
than other times.

It is no for everyone. Some people get no relief and must go to
other types of relief. I found that there are different type of
pads for the unit and some work better than others. I found the
large silver ones are best for me and may last up to three or four
weeks. and battery lasts 12 to 16 hours depending on how high the
unit is turned up.

I hope that workmans-comp keeps paying for the pads becuase I see
they get expensive after a bit....

Bob Officer
===
 * SLMR 2.1a * Wonder if Lady Godiva had a clothing allowance?

--
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Internet: Bob.Officer@f408.n208.z1.fidonet.org




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Subject: General Interest
From: Shelby.Sherman@f67.n123.z1.fidonet.org (Shelby Sherman)
Organization: FidoNet node 1:123/67 - Shelby's Swamp, Bartlett TN


[This is from the Chronic Pain Conference]

 > Hi Shelby!  I can tell you some things about releiving cancer
 > pain as I an expert at it.  Narcotics work pretty good and you
 > don't have to worry about addiction because the brain uses them
 > differently when taken for pain as for say, recreational use.  I
 > was on a maximum dose for over a year and was able to stop with
 > no problems. It's also an interesting fact that non-steriodals
 > like ibuprofen can be just as effective as narcotics.  The key
 > here is to take the drugs on a regular schedule.  I used to get

I work for a privately owned Drug Company and one of my duties is
educating doctors and other health care professionals in the
management of cancer pain.  You are very correct in your statement
that the narcotics must be taken on a regualarly scheduled basis.
This is one of the big advantages of controlled release morphine,
you only have to take it every eight or twelve hours.

--
Uucp: ..!uunet!bunker!hcap!hnews!123!67!Shelby.Sherman
Internet: Shelby.Sherman@f67.n123.z1.fidonet.org




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Subject: General Interest
From: Shelby.Sherman@f67.n123.z1.fidonet.org (Shelby Sherman)
Organization: FidoNet node 1:123/67 - Shelby's Swamp, Bartlett TN


[This is from the Chronic Pain Conference]

 > with my cancer, I do a lot better if I can sleep.  Well, some
 > doctors
 > just don't pay attention to *basic* needs.  Maybe when he gets
 > released
 > from his surgeon his primary doctor will *listen*.  Time will
 > tell on
 > this one.

Surgeons are as a rule not very good managers of chronic pain.
Maybe you can get a referral to a pain clinic if you have one in
your area. Some primary care physicans are tuned in the management
of chronic pain, but most are not.  Good luck.

--
Uucp: ..!uunet!bunker!hcap!hnews!123!67!Shelby.Sherman
Internet: Shelby.Sherman@f67.n123.z1.fidonet.org




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Subject: PAIN
From: bob.moffatt@f94.n105.z1.fidonet.org (bob moffatt)
Organization: FidoNet node 1:105/94 - Main Street Annex, Portland OR


[This is from the Chronic Pain Conference]

Hi, I am new to this echo, I have had the spinal injury echo before
and I just got it again.  I had a OJI in August of 89, I then had
surgery in January of 1990 to remove a herniated disk at L4-L5, I
had success for about 2 months after this.  Then wham, the pain was
right back.  I then had another surgery in June 1991 to remove more
disk and scar tissue.

This was successful for only about a month.  Now I am in more pain
than before either of the surgeries and they (the doctors) are
telling me that I am gonna have to live with it.  The Pain goes
across the lower part of my back and down the left leg just like
before the surgeries.  I am 32 years old and they tell me I will
have to live with this, I have possibly 40 plus years to go, this
is misreable.  In the last 3 years, I have worked very little, one
thing I would like to do is be able to get back into the swing of
things.  I go to work and sit in their chairs and it feels like
someone is sitting on my shoulders pressing my lower back down onto
my pelvis.  I have been on pain killers for the most part but
really do not like taking them.

I also have a tens unit and when I wear it it works great, however,
when I take it off when I get home it feels like someone hit me
with a baseball bat in the back.  I don't mean to seem like I'm
whining, but lets face it, I AM, hahahah, does anyone have any
suggestions as to what might make my life a little more
comfortable??  Please, any suggestions will do, Thanks.

                                   Bob Moffatt

--
Uucp: ..!uunet!bunker!hcap!hnews!105!94!bob.moffatt
Internet: bob.moffatt@f94.n105.z1.fidonet.org




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Subject: more pain
From: Ruthie.Hoffman@f223.n260.z1.fidonet.org (Ruthie Hoffman)
Organization: FidoNet node 1:260/223 - Interstellar System, Vine Valley NY


[This is from the Chronic Pain Conference]

 > Yes, a TENS is what I mean!  Thanks for the reply.  How long can
 > you use it at a time?  What kind of pain do you use yours for.
 > I have a lot of pain from pelvic adhesions that bothers me all
 > the time.

You can use it for as long as you want.  I started out though,
turning it off after 45 minutes to see how long I could get relief
after it was shut off.  Nowadays when I'm wearing it I usually
leave it on continously for a long period and then shut it off for
awhile and/or change the type of stimulation (there are various
settings).  Changing the settings and/or turning it off for awhile
help because then your body doesn't...  adjust (looking for right
word here) to the stimulation.  I use mine for pain in the lower
lumbar region of my back and pain down my legs, mostly the left
leg.  This is from disk injuries at L4-L5 and L5-S1.  Ask your
doctor if you can try out a TENS unit and see if it helps you any.
If you get one to try, give it time and try the electrodes in
different places.  What works for one person doesn't work for
others.  Lotsa trial and error.

Good luck!!!

CULater, Ruthie

--
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Internet: Ruthie.Hoffman@f223.n260.z1.fidonet.org




------



Subject: General Interest
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 Kathleen!

14 Aug 92, Kathleen Mcintosh writes to Shelby Sherman:

 KM> I can tell you some things about releiving cancer pain as I an
 KM> expert at it.  Narcotics work pretty good and you don't have to worry
 KM> about addiction because the brain uses them differently when taken for
 KM> pain as for say, recreational use.
 KM> It's also an interesting fact
 KM> that non-steriodals like ibuprofen can be just as effective as narcotics.
 KM> The key here is to take the drugs on a regular schedule.  I used to get up
 KM> in the middle of the night to take them so I would'nt wake up in pain.  If
 KM> you wait to take your meds until you're hurting, it will take longer for
 KM> pain relief, and it won't last as long.

I just wanted to add one thing to your comments (which were overall
very good about the management of cancer pain).  The way you
phrased your reply, it would suggest completely substituting a
non-steroidal like ibuprofen for narcotics. While this may work for
some people, for many with severe cancer pain, the non-steroidal
alone will not be sufficient.  The non-steroidal medications work
on pain in a different way and at a different site in the body than
narcotic medications do.  For this reason, the COMBINATION of both
non-steroidal medications and narcotics is an especially good
approach to management of cancer pain.  One medication interferes
with the pain pathway at one point, then the other interferes
further at another point.  An added benefit from this dual approach
is that the pain can be relieved by lower doses of each drug than
would be needed if only one or the other was used alone.  This
lower dosage, in turn, helps minimize any side effect from the
drug.

Arthur

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




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Subject: General Interest
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 Linda!

15 Aug 92, Linda Cummings writes to Kathleen Mcintosh:

 LC> Guilty as charged!  I'm one of those people who just don't like to bother
 LC> anyone, and will writhe in pain before I call them for medication.  Of
 LC> course, by the time they get there, I'm cussing away wondering why it's
 LC> taken them so long.  [grin]  I guess I better change my attitude for the
 LC> next hospital stay (when my batteries run down).

The things you have been talking about are some of the reasons the
PCA device was invented and has become so popular.  There are a
number of reasons that hospital personnel may not seem as
responsive as needed to requests for pain medications.  Although
one of them is that the nurses who are responsible for
administering the pain meds are busy taking care of other patients,
this is not actually the major reason.

The real reasons deal with the pharmacokinetics and
pharmacodynamics of drug administration.  (a couple of big
words...but hang in there and I'll try to explain)  Any drug that
is administered has certain actions (the pharmacodynamics).  Some
of these actions are the desired drug effect such as pain relief,
but some of these actions are undesired drug effects such as
sedation, cardiac depression, dilation of blood vessels,
respiratory depression, hallucinations, euphoria, and even
addiction.

These effects happen over various amounts of time after the drug is
administered.  Now almost any drug is a foreign material to the
body and the body tries to get rid of it after it is given.  This
also takes time, but as soon as it gets there, the body starts to
work to try to get rid of it.  As a result, there is a constantly
varying level of a drug in the body after it is administered.
Initially, the drug concentration increases, but then it reaches a
peak and decreases as the body gets rid of it.  This time-related
changing of drug levels is pharmacokinetics.

Now, for each drug, there is a fairly standard way the body
metabolizes it or "clears it" from the body.  Although to some
extent these routes depend on well defined biochemical pathways to
metabolize the drug, the process is also much more complicated than
that.  Anyway, the net result is that a drug's duration of action
can be expressed in terms of a "half-life" of so many minutes or
hours or days.  The half life is not precise for a given drug,
since this time of its presence in the body depends on how the
person's individual body handles it, so "half-life" is expressed in
a wide range of time (for example: 3 to 6 hours).  It is easy to
measure the exact half life of a drug in a group of genetically
identical lab rats, but not easy at all to measure it precisely for
a given individual person.

Now the reason I've gone into this long discussion is to get to the
following: If a drug is given more frequently than at its
half-life, this leads to drug accumulation in the body.  If
repeated doses are given AT the drug's half-life, it maintains a
steady level, and a steady effect.  If it is given at intervals
that are longer than the half-life, the drug level slowly declines,
and the therapeutic effect will at some time decrease as well or
stop, even though the patient is still taking the drug.  This is
different from drug tolerance, which has an entirely different
explanation.

Going back to the pharmacodynamics, there is a "threshold" level of
drug concentration which is necessary for a drug to have a
noticable effect.  In other words, even though there is a certain
drug present in the body, it may have no effect if its
concentration is below a certain level.

Likewise, there is a ceiling concentration at which toxic effects
occur. Between the concentration that is the threshold and the
concentration that is the ceiling, lies the "therapeutic window".
The goal of drug therapy is to achieve a drug level that remains
between the threshold and ceiling, in this "window".  This is the
reason that compliance with a physician's orders as to the amount
of drug to take and dosing schedule are so important to maintain a
proper therapeutic effect.

Various things interfere with achieving optimal drug
administration, and most of them are very practical considerations,
not theoretical ones such as the biochemistry of how the drug
acts.  Most of us don't like to take medications, and "forget" if
there's not a pressing reason reminding us.  Even in the hospital,
the nurse may be busy with an emergency down the hall or some other
duty and can't get the drug administered at exactly the right
time.  Then because of pharmacokinetic variations, its difficult to
know exactly when the right time is for a given individual.

Even when the patient reminds the nurse that due to pain, another
injection or pill is needed, for narcotics there is a lot of
preparation and paperwork that must be done to keep track of these
carefully controlled narcotics (which have to always be kept locked
up in a locked cabinet which usually has double locks).  In other
words, even though narcotics are excellent pain relievers, they are
very difficult to properly administer.

I think I started out talking about PCA machines.  They bypass much
of the administrative problems because the narcotics are kept
locked in a PCA machine, very small doses are administered at any
one time, and they are administered instantly on demand.  The
patient administer it by pressing a button, and can get drug
administered every few minutes if it is needed that often.  If the
concentration in the body builds to the ceiling level, the effect
is a sedated patient who is too sleepy to remember to push the
button the next time for the next drug administration, so the body
continues to lower the drug level until again the patient is awake
enough to remember to push the button.  In other words, the system
has a built-in safeguard against overdosage, that could be bypassed
only on a Doctor's order (by changing it to a continuous infusion
mode rather than an "on demand" mode) or by some other well-meaning
individual pushing the button for the patient.  As you can see from
this discussion, this is a dangerous practice.

As long as we have to treat acute pain with narcotics, in my
opinion this PCA device is currently the optimal technology for
narcotic administration from both theoretical and practical
reasons.

Arthur

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                                ******

                  End of Issue # 2898 of the Handicap Digest

                                ******
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