Page 6                                                                 The Megaphone                                                       December 2000

Jerry McClish, who suffers from a degenerative Intervertebral disk disease,

   Wearing Spandex gloves to bed may ease arthritic pain. Drinking light-colored alcoholic beverages rather than dark ones may relieve headache sufferers. Capsaicin, the ingredient that makes chili peppers hot, may hold a pain relieving property. The way we walk may contribute to back pain.
   We're learning more about pain and pain management every day. That's welcome news for the estimated 90 million chronic pain sufferers in this country more than one third of the total population. The National Institutes of health also reports that 40 million Americans suffer chronic, debilitating pain, defined as pain that usually lasts longer than six months or interferes with day-to-day functions and the ability to work.
   Pain does more than hurt. It can interfere with sleeping and eating (which can lead to depression and anxiety), impair the immune system and delay recuperation. Pain also costs money. Pain-suffering employees miss about 7 million days of work each year; and Americans dish out $90 billion annually in drugs, doctors' fees, compensation and litigation for the problem.
   Large doses of pain killers only reduce certain types of pain, according to Dr. Thomas Chelimsky, director of the Pain Center for University Hospitals of Cleveland (UH) and assistant professor of neurology at Case Western Reserve University.
   That's where pain centers, with their multidisciplinary approaches to pain management, come into play. Patients who are referred to UH's Pain Center usually see an anesthesiologist, psychologist, neurologist and both occupational and physical therapists in an initial day long evaluation to determine the best course of treatment.
   "It's much more effective to block water by putting up three dams in a row rather than one big one," says Chelimsky, explaining the need for other types of pain reducing plans sometimes used in conjunction with medication.
Nationally, arthritis, ulcers and migraine headaches are the most common pain complaints. Chelimsky most often sees patients suffering chronic pain of the back and neck, limbs (following a sprain that doesn't heal properly, for example) and headaches.
   The Pain Care Center of Lakewood, which is affiliated with Lakewood Hospital, treats patients ranging in age from their teens to 90s, although the majority are between 50 and 70. While the center sees all types of pain problems, medical director Dr. Paul C. Shin specializes in cancer pain, which can be "a very horrible experience for patients."
   Shin has seen some dying patients heavily sedated and placed on a morphine drip. "They can't wake up enough to tell you, but they are still in severe pain. As pain centers grow, physicians will realize that there are other methods to relieve pain that allow patients to talk with their families and be in more control."
   Ammunition in the war on pain includes nerve blocks, which interrupt the sensation of pain; spinal cord stimulation; and implanted drug deliver systems, some so small they are worn like wristwatches and allow the patient mobility. Acupuncture, self-hypnosis, massotherapy, biofeedback and relaxation techniques have been successful as part of a total pain-management plan as well.
   Several antidepressant drugs also relieve pain by increasing the amount of noradrenaline in the spinal cord. UH's Chelimsky says tricyclic antidepressants (including amitriptyline and imipraine) are non addictive, reduce deep, burning pain and pain from spasm, and improve sleep cycles.
   North Ridgeville resident Jerry McClish has undergone such a multidisciplinary approach to pain. McClish, 57, suffers from a degenerative intervertebral disc disease and has battled pain for the past 17 years. He has had 17 back surgeries and suffered two broken hips. To manage his pain, a spinal cord stimulator implanted in his body sends low-voltage electric charges to "short-circuit" the pain; for several years he has undergone a number of epidural blocks to lessen muscular pain.
   McClish was a buyer for The Sherwin Williams Co., using a cane as he traveled across the country, until last year, when his condition worsened. He is now Shin's patient, making his way on short trips using a walker and a motorized vehicle. He is considering adding an automated pain-relief pump using low-dose morphine to his pain-management regimen to control his intense discomfort.
   At University Hospitals, patients who are accepted into the Pain Center's Reflex Sympathetic Dystrophy (RSD) management program are seen seven hours every day for four weeks. RSD is a chronic pain syndrome with no known cure, characterized by swelling and often accompanied by a color and temperature change in an area of the body or extremity. More than 70 percent of RSD patients treated at the Pain Center are able to return to work, according to Chelimsky.
   One patient traveled to UH from Louisiana because of the center's national reputation for treating RSD. The woman had been working in an ungrounded airport control tower when a lightning strike sent electricity through her computer and into her arm. As a result, she suffered severe headaches and lost the use of her limb.
   Through a combination of physical therapy, medication and counseling, the patient exceeded the center's expectations and went home fully functional, according to Chelimsky.
"She was so happy that on her last day here she made everyone New Orleans chili and cornbread," he says.
   Mary E. Riley, 76, of Avon Lake also took advantage of UH's Pain Center. Riley injured her back in 1986 while caring for her terminally ill husband and was prescribed megadoses of painkillers before she saw Chelimsky.
   "It was just too many pills. I didn't know where I was," says Riley, who had trouble doing even simple tasks when she was taking her medication, "like picking up change from a table." After her four week program of physical therapy, medication and emotional support, Riley (who now relies only on TyIenol) was able "to walk better and feel less pain."
   Working with pain-suffering children presents another set of challenges. Dr. Howard Hall, a behavioral pediatrician with University Hospitals' Rainbow Babies and Childrens Hospital, values a "self-regulation approach with stress reduction in particular."
   "Headaches are our No. I referral, but we don't want to put young people on medication for the rest of their lives," says Hall. "We often find alternate techniques that are more effective than medication. The key is not how to get rid of pain, but how to prevent it. Pain management is a skill, not a pill."
   Known as "The Ouchless Doctor" ("I was called 'Dr. Pain,' but it scared the kids"), Hall says stress call contribute to pain in youngsters.
   "Kids from the suburbs and from the inner city all have their own kinds of stress they need to deal with," says Hall. "Some adolescent males will tell me, 'I don't want to do this,' when I suggest alternate methods, but their mothers will beg me to help, saying when their son has a headache the whole family is disrupted. I'll tell the kid, 'OK, do what you want. You'll be back, and I'll be here.'"
   When children and teens do seek help, Hall says 90 percent get better. Sometimes the solution is as complex as a pain-management plan to combat the agony of sickle-cell anemia. Other times it's a simpler matter.
   "One kid's headaches didn't go away until I found out he wasn't eating," says Hall. "He'd maybe have a little cereal or a half a piece of lunch meat all day. His mother said, 'I told him he had to eat! 'but I guess it doesn't count if you hear it from your mother."
   For young and old, an important key to pain management is understanding that pain is both a protective system that can help the body function and a symptom.
   As Chelimsky observes, "That insight is useful because once patients understand that, different methods of pain management start to make sense."

Here is the story as of right now, after 6 hours at the Cleveland Clinic today.
   (Tue., 28 Nov 2000)

   I damaged the morphine pump implanted in my right chest cavity. It has two minute leads going into my lumbar area where there is a mass of scar tissue plus the spinal column is missing 5 inches of sheathing. The leads were broken so surgery is the 6th and I will be in two days. The pump has stopped and usually works 24 hours per day, with more during the day.

   The first pain unit, implanted into my left chest cavity, is shot and there are some wires sticking up some in my back. We are going to have surgery some 2 weeks later. We cannot do both at one time. as we have to be very careful as an infection could set in. I will be in another two days. Will not be the first time I got out of the hospital a day or two before Christmas.

   Now, I have to go tomorrow to my hospital, 20 miles closer. I will have an x-ray on my broken hip. If the rod is broken again, a hip replacement is necessary they say. It will be difficult and painful due to my other problems.

   They told me by phone late today, that the degree of the breakage will dictate the date of surgery along with the pain level. I might have to live with it, because of having two operations within two weeks. If bad, they will do the surgery the day after Christmas. I have spent 2 other New Year's Eve and day in a hospital. The surgery would be followed up with two weeks or more in a rehab unit.

That's the scoop my friend.

Ol' Panther
Jerry McClish 

    *Officially from the class of '56