Shoreline

Hey Catluver, It was interesting at the last PM clinic I went to had all their headache patients Inpatient. This was because of the use of IV meds and hoepfully converting them to oral meds if the IV meds helped and the PM program helped. IF you didn't get better they just move you over too the psych portion of the hopital as PM is usally part of a behavioral medecine program.

With that much time in the clinic they find lots for your to do. A regular day may go something like this, The first hoiur is a group counseling session then you went to PT for 90-120 minutes, after PT a PM psychologist teaches or facilitates a relaxation method. Bio-feedback, self hypnosis, guided imagry. The we usualy had an a short education portionthat may include everything from nutrition and foods that trigger pain, we would see a d DR of pharnacolgy PhD. that would explain how the drugs effect different parts of the brain and would rerview every med the doc was prescribing.

During this period people would be called aside to seee the PM dr in private and discuss medication. WThen lunch for an hour more educational stuff so the docs could get with every patient. Then one on one with a PM psycholgist, Evaluation by psychatrist and always back to PT for a second round 90-120 minutes. If the doc believes n specic methods like trigger point pressure, TP injections, acupuncture, they see patient for treatment during ocupational therapy where you could build a foot step, a trivvit or sand and finish little wooden boxes. OT is basically showing you that you are still capable of acomplishing something even with the constant pain.They teach you to modify things like movement, reach, posture to avaoid muscle strain and fatigue and how to avoid things that trigger pain.

Off to another group meeting about living with CP, you learn how CP is very different from regualr pain in that an increase in pain for me isn't the same as someone who doesn't have CP.For a non A non CP patient, pain is a signal that action should be taken or something is wrong. ie Pull your hand off the hot oven, go to the doc for an Xray. This is normal behavior for a Non CP patient. YOu have to learn that a flair up or the pain we can't abolish with the most potent opiates isn't that same warning to take action. Having a bad day doesn't mean I need a new Xray or MRI and doesn't mean anything has gone terribly wrong.

You learn to cope by understanding that the pain isn't a warning that a tumor is growing or a anurism after having these things ruled out by diagnostic after diagnostic. YOu have likely had your head scanned with every diagnostic and injected with dye to study your vascular system more than once. After doing these test multiple times doesn't provide an answer you have to change your wy of thinking. It behavioral modification, same pain,we just need to repond differently to a headache you may live with every day. What we have been tought prior to PM is I must have a tumor and better get to the ER for a CT or MRI because this headache couldn't possibly be just more of the same you happen to experience all the time.

Same with back pain, if my neighbor woke up with the kind of pain I live with daily, the pain is telling him something is terribly wrong, seek medical attn imediately because they muist have blown a disc. To me it just means I'm still alive. I have to realize every increase in pain doesn't mean I need a new Xray or fresh CT to make sure another disc hasn't blown.

Living with CP has a huge psychological component that can't be fixed with a pill. But the way you respond to the pain can be modified if you understand the next major headache is not likely an anurism and if you hve the tools like knowing how to relax and alter blood flow to the point that you can raise your external skin temp 12-14 degrees during bio feedback. Bio feedback is just a relaxation technique where they can show you that you do have control over what you might think are involentary reponses. Externeal skin temp is just one method of measurement. When you hurt, your muscles get tight and reduce blood flow, often causing more pain from muscle spasm or tightening and not carrying waste away from an injured aea. A spasm to a CP patient is a sucle trying to brace an injured area, not something to go to the ER about. Relaation and excercise has an impact on blood circulation on the capilalrry level and when your stressed your hands will be cold, if your relaxed and have normal blood flow, your hands will be warm. Bio feedback is just learning to control your level of streess and relaxtion to allow your body to ride throguh a paiful experience rather than clenching up and makng it worse.

IF your GP and neurologist haven't found a cure or a preventive or good abortive by seeing you once a month and having you try a new drug at each visit. You may need more than any drug can provide. They pretty much run you from group to class to art therapy to Ocopatuional therapy to PT. Education is a huge component whether it's about pain or the effect they have, the things that trigger your headaches. etc etc etc.

The thing is, not everything you try or do may be something you go home and continue. Take what works and applies to you and put it in your tool bag. The stuff that sems like nonesense, like art therapy, well I don't think painting an hour a day is going to fix my back, but it's not going to hurt it either. You leave with a better understanding of pain and that your not going to die from pain.

Hopefully the excercise from the PT is suited to each persons problems, flexabilty helps pain, strenghthening weak muscle groups can help, stretching, and excercise in general is esential to good health. Headache patients did more neck work and I did more core and leg workfor my back. You may continue on with meds or treatments like botox or occipital blocks or continue to work on your neck if they think they may be cervicle in nature. Once your out of the clinic it's up to you to continue what you found works best.

Some use opiates and some don't, and some clincics are very particlular who they give them too. Using long term opiate treatment is an extreme measure when your talking about being dependnt on opiates the rest of your lufe. With a clinic that covers all those things, At least you know you tried everything else before having to take such an extreme measure. Compared to opiates for the next 30 years, being asked to spend 20 days in patient to learn to manage and cope with your pain is a small sacrifice and not as extreme as giving up on every other method because opiates work so well and offer imediate pain relief.

Everything from posture, mood, understanding of your problem to what you eat and drink effects your ability to mange pain and cope with the pain that can be managed. Again, I think H/A patients were inpatient becuae of the IV meds used, I believe the last clinic was using something like DHE, it had initials, I just can't recall.

That's what they are like, they keep you buisy and it's intensive , educational and very worth while.

Take care, Dave