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Alzheimer's Disease & Dementia board

For the purpose of this I am going to discuss chronic pain as this is what we are more likely to see.

For many years, people who suffered with chronic pain had basically very few options to deal with the discomfort. Scientists and Researchers have made great strides in understanding pain and how it affects a person’s physiological and psychological make up. Using these findings, they can formulate better pain methods. Everyone has different pain thresholds. What causes a great deal of pain and discomfort for one individual is nothing but a minor annoyance for someone else. Having to deal with pain on an ongoing basis also increases your tolerance for pain.

A person with pain is ruled by their pain. They no longer live their lives in terms of their hopes and dreams and aspirations. Instead, they are so overwhelmed by the wanting their pain to improve, that they are swept away by depression, anxiety, anger, fear, hopelessness, frustration and most importantly, grief. Their sense of loss is justified as they have usually lost a lot of what makes up a life. They may no longer feel they can work to support their family and their family may no longer give them the emotional support they need. At their centre, they may have lost a sense of moving forward in their lives. They also become afraid to move physically or to actively use the part of their body that has caused the pain. It’s as though they were frozen in fear.

What can you do to help?

True pain management involves a multidisciplinary approach of physical therapy, massage, medication management, counselling, occupational therapy, exercise physiology, a case manager and a doctor. It may also involve some type of movement therapy such as Tai Chi, classes on spiritual wellness, yoga or meditation.

It is also important to recognise that just as pain is personal, so is each treatment. What strategy works for one person may not suit another.

• Suggest keeping a record of different pain strategies that your resident has tried and their response to these. This is helpful for future reference for that person. Documentation is our only proof that the strategy works for that person.

Some alternatives and supplements to medication
1. Exercise.
Exercise can:

• Improve circulation. This is important for people with diabetes and atherosclerosis.
• Relax tense muscles and assists in eliminating stress
• Improves mood and helps to overcome mild to moderate clinical depression.
• Keeps joints strong and flexible.
• Reduces risk of osteoporosis

Exercise prompts your body to release special chemicals, called endorphins that actually block pain signals from reaching your brain. These chemicals also help alleviate anxiety and depression, conditions that can make your pain more difficult to control. Athletes often can run on a sprained ankle due to these endorphins. You basically “feel the rush”. They are a truly natural pain relief.

Readers Digest: Conquer Pain: 2001 (page 61)

‘Exercise naturally causes a certain amount of pain as it exerts extra pressure on the muscles, tendons, ligaments and other body structures. This prompts the brain to step up production of endorphins, body chemicals that block any messages in much the same manner as morphine. In fact endorphins attach themselves to the same brain receptors as morphine. Not only do endorphin’s block out the pain messages that are being sent to the brain from peripheral nerves, but they also elevate mood.’

Endorphin’s can also help alleviate anxiety and depression, which are conditions that make controlling pain more difficult. Exercise also increases the body’s serotonin levels. Serotonin inhibits the
• Production of the type of prostaglandin that causes inflammation
• Cures insomnia by facilitating falling asleep at night
• Reduces pain signals by launching a counter attack inside your brain
• Makes you feel happier by lifting your mood which in itself reduces pain
• Reduces the leakage of fluid from blood vessels. Leakage is a problem associated with some types of pain eg. Migraine and irritable bowel syndrome.

Inactivity can cause chronic pain to become worse. Muscles become weaker and joints stiffer. People also stop moving, fearing more pain or damage occurring. However the way to reduce your pain and increase function is to start moving again under the guidance of a skilled therapist. They can teach the best ways to gradually rebuild your flexibility, strength, endurance and coordination.

Flexibility exercises could include simple range of motion and stretching movements. Such exercises help reduce joint stiffness and allow the client to move more comfortably. They also prevent muscles from shortening and tightening.

Strengthening exercises assist in lean muscle mass and can assist in weight loss if this is needed, as extra weight that is carried by the person will out strain on their body and cause more pain. Aerobic exercises will challenge your heart and lungs and muscles. It will increase your heart rate. These exercises help your body work more effectively and reduce your risk of heart disease, high blood pressure, high cholesterol and diabetes.

2. Socialisation and emotions. Emotions can make a painful situation worse. Anger, depression, frustration or anxiety commonly accompanies pain. It is also common to feel a loss of control or helplessness with chronic pain.

Wellbeing magazine (2002) states that:

Pain is personal. We all feel and respond to it differently and our tolerance levels vary. Long-term pain, or chronic pain, can be a lonely experience and sufferers can feel isolated and powerless. Perhaps the most destructive aspect of chronic pain is the way in which it steadily erodes and fragments the consciousness and life force of the person in pain. It leeches not only physical energy, but also psychic energy. Those suffering often live in a labyrinth of dead ends. They lose a sense of being in charge of their life, becoming demoralised. They become imprisoned in a pain trap. By its very nature it will affect all aspects of the sufferers life – their relationship with themselves and with others, their finances, and if they are able to work their work performance.

Family attitudes to pain are vital to cultural influence as in some Middle Eastern or European cultures; the whole family becomes involved with the person who is suffering the pain. This may reinforce the patient’s belief that pain is acceptable and increase their pain behaviours negatively and disempower them. Social and environmental factors also determine how a person can cope with pain. Lack of a support network of family or friends, previous bad pain experiences and/or the environment the person may be in such as a stressful one of a hospital setting, can all contribute to negative pain influences. IN some cultures the ability to endure severe pain is a rite of passage or a badge of honour. Youths may make cuts on the body as the scars testify that they can endure enough pain to become warriors. Religion also can teach people that pain is something to be endured as a consequence of original sin or transgressions in an earlier life.