Making A Catastrophy Out Of Chronic Pain

Today's fascinating post from the excellent pain-topics.org (see link below) includes an article by a guest author, Winnie Dawson. She talks about the 'catastrophising' of pain symptoms by some patients. It sounds drastic but many people exaggerate their symptoms for a variety of reasons. For instance, it can be a sub-conscious act that you may not even be aware of; or it can be as a response to unsympathetic doctors, or even your brain's overreaction to pain itself. The point is that it is both extremely difficult to identify because of patients' varied responses to pain and very difficult to treat because doctors can end up trying to measure pain symptoms which are essentially psychosomatic. It is important to realise that you are not 'faking' symptoms, you may be overreacting to pain signals that are serious enough as they are. The following quote is absolutely true; it's the extent to which the doctor treats the pain that's important.
"Only the patient knows how intense and frequent a pain is - a pain is what the patient says it is." -- Palliative caregiver

The Role of Catastrophizing in Pain Care
By guest author, Winnie Dawson, MA, RN, BSN: Friday, February 8, 2013

Patients who react to pain in a manner that appears to magnify or exaggerate their pain experience may be experiencing the cognitive-affective response called catastrophizing. It is important for practitioners to understand this anxiety-related condition, utilize available screening tools, and refer patients for specialized help when it is appropriate.

Chronic pain management can be more challenging in patients who display a magnified response to pain and some patients may not even be aware of their tendency to over-react or to dwell on the potential of a worst-possible outcome. While the pain experience is real, catastrophizing can add to the patient’s discomfort, reduce the potential for pain control, and challenge the practitioner’s treatment plan. Some patients may also reduce their level of physical activity out of fear or adopt coping strategies that are unhealthy.

Recent studies have explored the influence of catastrophizing on the pain experience and the potential for increased pain intensity, depressive symptoms, and even chronic pain conditions.
Researchers at Maastricht University Medical Center in The Netherlands reviewed 52 years of literature to attempt to learn whether higher levels of preoperative anxiety or pain catastrophizing were associated with a greater risk of chronic postsurgical pain [Theunissen et al. 2012]. The 29 studies of adult surgical patients that met review criteria were evaluated using 14 assessment instruments to rate anxiety or pain catastrophizing.

Results showed that a statistically significant relationship between preoperative catastrophizing and chronic postsurgical pain was identified in 16 studies, including 67% of studies of patients who had musculoskeletal surgery and 36% for other types of surgery. They concluded that pain catastrophizing could play a role in chronic postsurgical pain and suggested that interventions aimed at reducing preoperative anxiety might be helpful.

In another study, investigators in the Psychology Department of Arizona State University evaluated the pain diary records of 230 adult patients with rheumatoid arthritis for a 30-day period [Sturgeon et al. 2012]. The study aimed to identify the existence of a relationship between state pain catastrophizing (ie, temporary emotional reaction to a specific condition like pain or injury) and trait pain catastrophizing (ie, a relatively permanent personal characteristic) and daily pain intensity, its positive or negative influences, and depression.

The investigators concluded that their analysis confirmed that state pain catastrophizing was a significant variable in the patient's daily pain intensity and emotional distress. Furthermore, exacerbations in patients’ pain were often found to be related to changes in the intensity of catastrophizing. Additional analyses showed that people who demonstrated higher levels of trait pain catastrophizing had significantly greater challenges in their ability to adapt to daily pain fluctuations.

COMMENTARY: Because it isn’t always evident whether a patient’s emotional distress actually reflects catastrophizing, healthcare professionals are encouraged to utilize screening tools. When pain catastrophizing is suspected, timely patient assessment is important because experts recommend early intervention.

While there are a variety of instruments available for assessment, two such tools are the Pain-Related Self Statements Scale (PRSS-Catastrophizing) developed by Herta Flor and colleagues [Flor et al. 1993] and the Pain Catastrophizing Scale from Michael Sullivan, PhD at McGill University, Montreal, Canada [available here].

Many cognitive-behavioral interventions are being used to reframe emotional reactions to pain and reduce catastrophizing. Two recent studies have reported such interventions with outcomes that were successful in reducing anxiety-related catastrophizing behavior.
Lead researcher Lara Gallagher and her colleagues at 2 major universities in Australia implemented a study designed to teach patients the basics of pain biology using metaphors and story [Gallagher et al. 2013]. In this controlled study, 79 patients with chronic pain were randomly assigned to receive a booklet of metaphors and stories relating important pain physiology concepts or a booklet containing advice using common cognitive-behavioral principles to manage chronic pain. Study results supported the researcher’s hypothesis that a metaphor booklet would increase a patient's knowledge about the physiology of pain as a way to reconceptualize the pain and decrease catastrophic thought processes.

A study by researchers from Uppsala University in Sweden investigated an experimental internet-based cognitive-behavioral intervention as a technique for reducing pain catastrophizing in patients with chronic back pain [Buhrman et al. 2011]. After an assessment using the catastrophizing subscale of the Coping Strategies Questionnaire, 54 participants were randomized to either 12 weeks of online cognitive skills education and acquisition, or a listing on the program waiting list. While several outcome measures did not show a positive treatment outcome, treated participants showed significant improvement in measures of pain catastrophizing when compared with the control group (58% vs. 18%) as well as improved quality of life scores.

While it is not possible to identify whether the exact mechanisms responsible for the reductions in pain catastrophizing are due to reconceptualization of pain, increased feelings of control, distraction, or other factors, these studies do show that cognitive-behavioral techniques can offer benefits for these patients.

REFERENCES:
> Buhrman M, Nilsson-Ihrfeldt E, Jannert M, et al. Guided internet-based cognitive behavioral treatment for chronic back pain reduces pain catastrophizing: a randomized controlled trial. J Rehabil Med. 2011;43(6):500-505.
> Flor H, Behle DJ, Birbaumer N. Assessment of pain-related cognitions in chronic pain patients. Behav Res Ther. 1993;31(1):63-73.
> Gallagher L, McAuley J, Moseley GL. A randomized-controlled trial of using a book of metaphors to reconceptualize pain and decrease catastrophizing in people with chronic pain. Clin J Pain. 2013;29(1):20-25.
>Sturgeon JA, Zautra AJ. State and trait pain catastrophizing and emotional health in rheumatoid arthritis. Ann Behav Med. 2012(Aug 23); online Epub ahead of print.
> Theunissen M, Peters ML, Bruce J, et al. Preoperative anxiety and catastrophizing: a systematic review and meta-analysis of the association with chronic postsurgical pain. Clin J Pain. 2012;28(9):819-841.

About the Author: Winnie Dawson, MA, RN, BSN is the Research Editor for Pain Treatment Topics and the director of MedSearch Inc., a biomedical literature research service founded in 1993. As a medical information specialist, she researches and provides relevant background literature for presentations on a wide variety of medical topics, including pain management. Ms. Dawson has worked as a hospital staff nurse and a health educator in corporate, community, and hospital environments. She received her Master of Arts in Health Education from the University of Alabama. Visit the MedSearch website at: http://medsearchservices.com

http://updates.pain-topics.org/2013/02/the-role-of-catastrophizing-in-pain-care.html

Coming Out Of The Neuropathy Closet

Today's post from letsfeelbetter.com (see link below) is a general post about coming out to friends and family about any illness you may have. It's full of great advice about how not to overdo it. People with neuropathy often have the urge to explain what's wrong with them in microscopic detail because they either want the listener to fully understand that this is not a normal condition, or they're afraid nobody's going to believe them. It's human, it's natural but it's going to stretch your friends and family's patience to the limit. No one is saying that you don't need to offload, or explain the peculiarities of neuropathy - of course you do but you need to pace yourself and give the information in small doses that the listener can digest, think about and work out how to best support you. It's hard - the natural urge is to sit them down and splurt until you feel you've got the message over but you've got to watch for the 'glassy eyes' and 'uh-huh' repetition, or else you'll lose them for good.
Definitely worth a read.

Five Rules for Revealing Your Chronic Illness: 
As Seen in IG Living Magazine
By Ilana Jacqueline February 5th 2014

IN MY MIND, I have a secret identity. When I meet new people, I try to stay cool and act normal. But, underneath my dress and cardigan, there lies a ridiculously good-looking body — wrapped up in a Holter monitor and a hospital gown.

When getting to know new people in your life, it’s important to remember not to take off your dress and cardigan at the dinner table — even if you do feel antsy about getting your secret identity as a patient off your chest. Breaking the news about chronic illness is a delicate process — one that takes thought, precision and almost no partial nudity. Check out these five rules for the big reveal:

1. Reveal that you deal with an illness on a need-to-know basis. Don’t slap a classified tag on the summary of your medical woes. But, understand, that telling some people in your life about the tumultuous issues related to your chronic illness won’t benefit you.

Before revealing your situation, ask yourself: ”Is the topic of my disease bound to come up between us eventually?” “Do I have any obvious signs of this disease that they might start to build their own (and possibly incorrect) assumptions about?” “Will this person be affected by how this disease affects me?”Last, ask your- self: “Do they care?” You don’t need a pat on the back and someone to call you their personal hero every time you say “I have a chronic illness.” But, if someone in your life has already expressed some kind of prejudice against someone with disabilities or seems to otherwise be incredibly tactless, it might just be better to let that person figure it out (or not) on his or her own.

2. Prepare an elevator speech. Close your eyes, and imagine that nobody wants to sit and listen to you drone on about your aches and pains for an hour. Now, open your eyes. Surprise! That’s the truth! Between surgeries, symptoms, medications and flare-ups, chronic illness can seem like it’s hungrily taking over 98 percent of your life. By going on and on about it, you’re effectively handing over that remaining 2 percent of non- disease-related moments. If you have to talk about the disease, do it in the form of an elevator pitch, or a short summary used to quickly define a situation. By memorizing and reciting this speech, you’ll help minimize the impact of your troubles, while helping to educate new people. Having a speech defining the disease can also help you personally separate your disease from your personality. Once the elevator pitch is over, you can get off on the right floor and start talking about who you really are.

3. Don’t overshare. You don’t need to reveal the details of your sensitive stomach, the current color of your snot or your barely-healed laparoscopy scars. All of these nice stories may have your listener internally screaming “Waaaayyyy too much information!” Save it for your friends in med school who are no longer shocked by any function of the human body.

4. Be the reaction you want to have. People are going to follow your lead when it comes to the state of your disease. If you’re frustrated about it, they’re frustrated about it. You’re sad about it, they’re sad about it. But, if you’re cool about it, they’ll be cool about it. If you haven’t come to terms with your condition yet and are still in a phase of mourning your old life, you may not be ready to reveal your experiences (and open yourself up to the judgment of others) just yet. You’ve got to love yourself — with or without the disease — if you’re going to expect someone new in your life to do the same.

5. Make it common knowledge. Most adult conversations don’t cover the topics of why the sky is blue or the grass is green. It’s just common knowledge (or, we don’t care.) What’s easier than having to explain to everyone you know now, have known or will ever get to know that you have a chronic illness? Having the Internet do it! Don’t be “that guy” who twitters about his medications all day long, but mentioning here and there on your social network how you’re fighting, managing or coping with your disease can help break the ice when you see old friends in person, and it can help lower the shock factor with new acquaintances.

ILANA JACQUELINE is a 23-year-old dysautonomia and primary immune defi- ciency disease patient from South Florida. She’s been writing professionally since 2004 on everything from health and wellness to celebrities and beauty. Her blog www.lets feelbetter.com is both a personal collection of anecdotes about life with chronic illness, as well as a resource for patients of all ages.

40 February-March 2014 www.IGLiving.com

http://letsfeelbetter.com/five-rules-for-revealing-your-chronic-illness-as-seen-in-ig-living-magazine/

Tips For Neuropathic Footware Time To Throw Out The Old And Break In The New!

Today's post from everydayhealth.com (see link below) looks at finding the best solutions for your burning, tingling or numb feet. That requires finding shoes that will provide the best support and the most comfort - no easy task. If you, like me, are still wearing the same sneakers you bought 5 years ago, even though they're falling apart but are so damned comfortable, your conscience will be pricking you that it's really time for a new pair. That's a big step for the neuropathic foot - literally because new shoes can provide all kinds of torture to the healthiest of feet until they're broken in. This article gives some excellent tips - both practical and with the nerve damaged feet in mind. 
 

Shoe Shopping With Diabetes 
By Mary Elizabeth Dallas, HealthDay News
Medically Reviewed by Farrokh Sohrabi, MD
 
If you have diabetes, choosing the right shoes can help protect your feet from injury. Learn which styles could put you at risk for complications.

If you are living with diabetes, shopping for shoes is more than a matter of style. By following some simple guidelines to ensure a good, comfortable fit, you can prevent potentially serious foot problems.

Even minor foot problems, like calluses or blisters, can lead to serious diabetes-related complications. Diabetes can cause poor blood flow to your feet, making it more difficult for wounds to heal, sometimes resulting in infections and possibly amputation. Complicating matters, poorly controlled diabetes can also lead to nerve damage called peripheral neuropathy. This may cause you to lose sensation in your feet, so you may not feel potentially harmful cuts or blisters. To help protect your feet and overall health, it's important to know what to look for in diabetes shoes.

"It's all about prevention," said Katherine Dux, DPM, a podiatrist at Loyola University Medical Center in Maywood, Ill., who treats patients with diabetes. "Any friction in the shoe could lead to irritation and possible blister formation. This could lead to trouble down the road."

Before you shop for diabetes footwear, it's important to have your feet evaluated by a podiatrist to determine your risk for infections or complications, said Dr. Dux. Based on this assessment, the doctor can recommend exactly which types of shoes will be best for your feet.

What to Look For in Diabetes Footwear

Even if your diabetes is under control and your feet are healthy, there are a number of factors you should consider when selecting shoes. By looking for certain characteristics and avoiding others, you can protect against irritation, infections, ulcers, and potentially worse foot problems.

First, look for a shoe that has a large enclosed front, as well as a closed back and top. Shoes that expose your toes or heels increase your risk for injury and infection. You may love slip-on shoes, sandals, clogs, and mules, but they could trip you up when it comes to diabetes foot care.

Other good shoe features for a person with diabetes include:

Adjustable Closure. Look for shoes that have laces or Velcro. The built-in flexibility allows you to tighten or loosen your shoes depending on whether or not your foot is swelling.

Wide Toe. Steer clear of shoes with narrow or pointed toes. "It's best to stay with a shoe that has a wider toe box area as well as something with increased depth to the toe box," advises Christina Sigur, DPM, a podiatrist at Wake Forest Baptist Medical Center in Winston-Salem, N.C. Shoes with a round or wide toe box provide your feet with more room and are less likely to cause irritation.

Low Heel. Flats or shoes with heels less than two inches high are a better option than shoes with higher heels. Lower-heeled shoes reduce the amount of pressure applied to the ball of the foot.

Soft Material. Choose styles made from soft materials, such as leather, mesh or a pliable synthetic fabric. Since feet tend to swell throughout the day, these softer fabrics will give and allow for swelling. Breathable fabrics will also prevent the build up of moisture within the shoe, Dux added.

Cushioned Inner Sole. It’s important to choose footwear with a good amount of cushioning inside the shoe. This added support helps reduce foot pressure and the risk for developing foot ulcers, or sores, and other complications, Dr. Sigur noted.

Hard Outer Sole. Although the inside of your shoe should provide support with cushioning, the outer sole of any shoe you select should be hard. This will help protect your feet from rough or sharp objects and provide shock absorption.

When to Use Therapeutic Diabetes Shoes

For some people with diabetes, a podiatrist may recommend therapeutic shoes. "People with foot deformities, such a hammer toes and bunions, are at greater risk for irritation from ill-fitting shoes," Dux said.

Therapeutic shoes are advisable for anyone with diabetes who also has a history of any one of the following:
An amputation of any part of their foot or toe
Foot ulceration
Calluses that lead to an ulceration
Neuropathy or nerve damage
A foot deformity such hammer toes, bunions, flat feet, or high arches
Poor circulation in their lower extremities

At the Shoe Store

If it’s time for some new kicks, consider shopping later in the day. Since feet tend to swell throughout the day, Dux recommends visiting the shoe store in the afternoon or evening in order to get a more accurate sizing of your foot.

And don’t forget to bring your socks. Experts recommend that people with diabetes wear socks to decrease the friction in shoes and soak up extra moisture to prevent infections. To ensure a proper fit, it's important to always try on shoes with the socks you intend to wear with them.

Finally, ask a trained sales professional to measure both of your feet. One foot is typically larger than the other. You’ll want to determine which one is longer and base your shoe size off of that foot to get the best fit.

Other Ways to Protect Your Feet

Consider Fit, Not Fashion. The type of shoes you wear should have less to do with fashion and have everything to do with proper fit. "Shoes should feel comfortable from the moment you put them on,'" Dux said. "There is no true break-in period for shoes." Dux adds that shoes should never feel tight, rub, or cause irritation.

Inspect Your Feet Daily. It's important to routinely remove your shoes and inspect your feet for problems or signs of irritation, such as redness or marks along the top, sides, or sole. This is particularly true when wearing new shoes. "Any areas of redness or marks that do not resolve in 10 to 15 minutes could be an indication that the shoes need to be addressed or adjusted," Dux noted.

Visit a Podiatrist Regularly. People with diabetes who do not have any foot problems should still be evaluated by a podiatrist annually. Anyone diagnosed with peripheral neuropathy — or those with a history of calluses or foot ulcers — should be reassessed more frequently, according to experts.

Know When to Buy New Shoes. Whether or not to replace a pair of shoes depends on how often you wear them. For everyday shoes, however, Sigur says a good rule of thumb is to change them at least once a year since the interior cushioning of the shoe wears down over time.

http://www.everydayhealth.com/type-2-diabetes/living-with/shoe-shopping-with-diabetes/