"The pain it is,
"The most dangerous diseases are
The philosophy of chronic pain at the Eumedica Swiss Center:
Treat the patient, not just the pain
Decrease pain intensity and increase health
Protection from tissue damage
"FIRST DO NOT HARM"
What is Pain? The International Association for the Study of Pain (I.A.S.P.) defines pain as:
“An unpleasant sensory and emotional experience associated with actual and potential tissue damage or described in terms of such damage”.
The scientific definition of the I.A.S.P. admits that pain is not necessarily associated with tissue damage and that it can also arise from unpleasant emotional experiences. In addition, the definition of the I.A.S.P. does not sufficiently stress the difference between acute and chronic pain, as well as its extreme subjectivity, which render much more difficult the evaluation and the treatment. As mentioned elsewhere, in treating chronic pain, the recent scientific guidelines order that the physicians should follow the advices, which appear in the best available scientific international literature. But, most of the available scientific literature is supported by the Pharmaceutical Industry and has shown to be ambiguous, confusing and not free from conflicts of interests. It often reflects: Finally, the international scientific literature, because of the individuality and the subjectivity of people in pain, cannot be standardized and applied to every country and to every patient. . Therefore, at the present time, in treating chronic pain, it would be unwise, if we physicians, exclusively relay on the consultation of the available scientific literature. In absence of satisfactory scientific explanation and treatment, validation of chronic pain management can be best done by the specialist's own clinical experience.
In accordance with the "credo" of the International Association for the Study of Pain, it is my duty to provide the patients and the readers with the most useful information , which are the result of our clinical experience and reflections in the treatment of chronic pain, and which can be summarized as following:
- The pain cannot be permanently and totally eliminated. Pains appear, disappear and change intensity and place in relation to the individual emotional status, the place, the climate and the seasonal and circadian (daily) variations.
- The pain is always accompanied by regional and/or systemic dysfunction of the autonomous nervous system (A.N.S.), most of the time, by sympathetic hyperactivity.
- Emotional factors, such as anxiety and depression, which may coexist and aggravate pain intensity, are the most frequent sources of A.N.S. dysfunction and can also render difficult the evaluation and the treatment of chronic pain.
- The pain, more frequently, is worse at rest and better by physical activity.
- The pain is often accompanied by neuro-vegetative disturbances, such as sleep problems, dizziness, discomfort in abdomen, chest and throat, high blood pressure, bladder hyperirritability, etc…, which may seriously complicate evaluation and treatment, if not simultaneously evaluated and treated.
- No evident relationship exists between chronic pain, tissue damage, diagnostic investigations, and disability. Chronic pain may be felt in absence of structural pathology or be absent in the presence of severe tissue damage. In addition, the pain may persist even after complete recovery of the actual tissue damage or after specific surgical interventions.
- Tissue damage, if present, include evident degenerative changes, often preceded or accompanied by evident signs of microcirculatory arterial, venous and neuro-dystrophic disturbances.
- Tissue damages are not necessarily signalled in the places where the pain is felt. For example, pain felt in the right shoulder and upper eyelid may reflect disturbances in the liver and gall-bladder or in the tonsils and in other internal organs. In the same way pain along the spine may signal gastro-intestinal or/and pelvic genitor-urinary problems.
- Despite the contrary current scientific attitude, no analgesics work for chronic pain! Their use, over time, may aggravate the pain and the tissue pathology, and may even induce additional structural changes, dependency and serious organic complication. The steroidal and the non-steroidal anti-inflammatory analgesics (NSAID), which are often erroneously prescribed without any evident signs of inflammation, are potent vasoconstrictor drugs causing the block of enzymes necessary for the regulation of the immune system and of blood microcirculation, further aggravating the existing pathology and even creating new possible tissue damages in any part of the organism. Paradoxically, the management of chronic pain by such drugs may turn people into feeling painless spectator of their own decay and may even cause additional "Analgesic syndromes" with new pains and new tissue damage.
- Surgical interventions, useful in traumatology, should be considered with very much prudence for chronic pain, because they, inevitably, include the damage of healthy tissues and scar formation, further complicating the painful chronic syndrome through the development of new sympathetically maintained pains and neuro-dystrophic disturbances, such as the well known post-operative algo-dystrophies, which can be produced even by very small traumatic lesions.
- The regional and systemic therapeutic manipulation of the A.N.A and the cognitive/behavioural rehabilitation have shown to represent the most useful parts of the comprehensive chronic pain management program.
- The pain and the tissue damage can positively be influenced by reduction of dietary caloric intake and proper individual nutritional education.
In absence of a satisfactory and safe scientific chronic pain management, validation of treatments can be best made on the specialist's own experience.
According to our over 30-years clinical experience, the management of chronic pain must be multi-factorial, individually tailored and must include the simultaneous evaluation and treatment of important factors, such as:
- The pain and its individual characteristics.
- The accompanying emotional and neuro-vegetative disturbances.
- The evaluation and treatment of the individual status of the A.N.S.
- The personal and parents's physical constitution, and the cognitive family, social and ethical attitudes.
- The individual reaction to climate and biorhythmic variations.
- The nature and severity of the structural changes (Tissue pathology)
- The nutritional and life stile habits.
MORAL AND SPIRITUAL CONSIDERATIONS IN CHRONIC PAIN MANAGEMENT
“Oh Lord make me aware, through the pain that I did not feel in my soul, because, Lord, the greatest sickness is insensibility..... Let me feel pain sharply so that I can wash the offences I have committed”.
Considering that, at the present time, despite the advanced scientific progress in chronic pain management, there are no satisfactory explanations and treatments, it may be useful for the readers to take account of other non scientific, but logic, considerations which, in my opinion and experience, can further help people in pain. I cannot, therefore, close this section on "Philosophy of Chronic Pain" without mentioning my personal view on the therapeutic influence of certain moral and spiritual consideration.
Medical science today states that man possesses complex inborn neural and biochemical control mechanisms, which allow self-defence, self repair and the modulation of pain intensity. However, man does not always possess such performance abilities and needs the activation and mobilization of superior performance mechanisms which, in turn, depend on the degree of the individual consciousness quality. This concept has been scientifically stressed by Roger Sperry, professor of psychobiology at the California Institute of Technology, in his book "Science and Moral Priority", as well as by the Nobel priced professor of neurophysiology J. J. Eccles and other eminent scientists. The research studies of Eccles, superbly resumed in his well know book "How the Self controls the Brain", supports the hypothesis that Self, through the intervention of our free will at attention, can induce mind-brain functions and interactions capable to influence the quality of our consciousness and thus our performance abilities in relation to the quality of our individual morality, thoughts, judgements and goals. The self is the philosophical word used instead of the religious word Soul and represents the focal point our Psyche in which God's image show itself. The Self is the "Kingdom of God within us".
Consciousness, volition and attention are mental events necessary for the activation and regulation of overall physiologic activities by causing the simultaneous firing of photons or quantum of light during neuronal activation. Neurons can fire or not, can emit photons or not, according to our moral will and attention, which implies that we must have the will and the discipline to follow the stable moral and spiritual divine rules (God or God-like guidelines) rather than the unstable and dangerous scientific guidelines. This concept was already clearly stressed in the New Testament in which Jesus, the greatest teacher ever existed, at the end of the cure, "prescribed" to "Sin no more", which implies a disciplined change in moral habits and personality, rather than the ingestion of a drug or any other similar cure. In other words, for Jesus the cure of pain and suffering is possible only through sinning no more, which, implies the following of the God's guidelines or Commandments. This ethical concept has also been marvellously expressed by Michelangelo in his famous painting "The Creation", in which he, intuitively, represented the "Kingdom of God within us" as located in the Thalamus, the most blood supplied and illuminated area of the brain, where the permanent contact between God and man was to be maintained in order to get superior performance of healing mechanisms, which include the wisdom to control our chronic pain intensity, as well as the ability for the performance of Self-defence and Self-repair mechanisms of tissue pathology. The New Testament, although non scientific, is still practiced by the multitude of Christian people.
Of course, following the scientific guidelines is much easier, because it does not require any particular effort and discipline, from both sides, the patient and the physician: just prescribe or take a pill and do everything you like. In contrast, the following of God or God-like guidelines requires a continuous effort for strong moral and disciplined will power. This concept may sound strange in our super-materialistic epoch and society, but it's worthy here to quote a recent statement made by the Canadian physician Kirkaldy-Willis, professor of orthopaedic surgery at the University of Saskatchewan, who in his famous book on "Low Back Pain", wrote:
“The wise physician knows that in practice it is not always possible to be scientific as one wishes..... we come to a point in our story of the patients at which we are compelled to go beyond the realm of science into that of metaphysics.....”
At the end of his book, professor Kirkaldy-Willis made to his chronic pain patients the following recommendations:
“You, your-self have to make a big effort”
which, of course, requires the involvement of the will power to follow certain ethical rules similar to those described in the New Testament.
In absence of satisfactory effective and safe cures for chronic pain, it may be wise to consider that the regulation of pain intensity and health may also depend from your strength to discipline your mind and your life to pay attention only on God or God-like guidelines.
In conclusion, in managing chronic pain, there are cases in which we both, physicians and patients, may need additional guidelines, having not only scientific, but also God-like qualities in order to achieve those superior conscious mind-brain functions and interactions necessary for superior interpretative and curative abilities. We both, patients and physicians, have to make a big effort to cooperate together in order to achieve a better and even permanent cure of chronic pain.