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    Living With Pain

    Some people with chronic pain are seeking help from pain management specialists.

    Defining Pain continued...

    According to Donald's specialist, Sanford Silverman, MD, of Comprehensive Pain Medicine in Pampano Beach, Fla., pain is the body's way of warning against greater injury (such as a sore thumb when hit by a hammer), or to indicate that something is wrong (such as chest pain for a heart attack). There is a point, though, when the suffering becomes unnecessary, such as when an injury has healed and damaged nerves continue to bombard the brain with messages of pain. At that stage, pain is a medical condition unto itself, a concept little recognized.

    "There are a lot of people out there where pain is a disease, and it significantly affects their life; they have to live with it every single day," says Silverman. "For most other people, pain is a transient thing."

    The result of this unawareness: Many patients and doctors think constant suffering is just something you have to live with, and, thus, little is done to try to relieve it.

    Another common misconception -- many people, including doctors, believe that painkillers are addictive, so they avoid using them. When used responsibly, painkillers are an effective and safe way to tackle chronic pain.

    Diagnosing Pain

    It may be obvious that someone is hurting, but measuring physical distress is far from being an exact science. Despite efforts to quantify pain, or to determine its biological history, the fact remains that it is subjective, and people have different tolerances to it.

    "There isn't a machine that I can hook you up to that absolutely tells me the amount of discomfort you are having," says B. Eliot Cole, MD, director of education at the American Academy of Pain Management. "So we wind up looking at X-rays, at CT scans, at MRI scans for evidence [of disease] that we think correlates with causing pain."

    Newer techniques reportedly include muscle imaging with ultrasound that can locate taut bands and trigger points, and EMG/NCS, a device using electrodes on the skin to identify trouble areas in muscles and nerves.

    For his part, Silverman uses various methods to diagnose pain. He asks patients to give their discomfort a number from zero to 10 (zero representing no pain, and 10 being the worst), and to describe what they're feeling. The words patients use -- such as throbbing, shooting, squeezing, sharp, hot, cold, and itchy -- give him clues to what is wrong. He also uses his own eyes to spot apparent physical damage and X-ray equipment to detect any internal abnormalities. In addition, he tries to find out what else is going on in the patient's life.

    "If [patients] do have a bona fide psychological problem -- not because of the pain, but it's a part of them -- that's going to affect the way ... that the pain is perceived," says Silverman, who notes that some people find it hard to separate physical pain from their emotional conflicts. A patient's problems with work, marriage, and sex, for instance, may affect the ability to cope with bodily distress.

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