- The Washington Times - Monday, August 9, 2004

Angela Yancey knows all about searing pain. It has been her steady companion for the last quarter century.

The 43-year-old Upper Marlboro resident first felt discomfort in her shoulder at age 17 and it hasn’t let up since.

She recently found some relief through a series of Botox injections, a treatment typically reserved for smoothing aging skin, but her story highlights the ongoing struggle many chronic pain sufferers endure.

The body feels pain when cells release a chemical called prostaglandin after being injured or disrupted. The nerves around the cells detect the chemical and alert the brain that an injury has occurred.

Pain relievers like ibuprofen prevent cells from making and releasing that chemical, thereby preventing the potential pain sensation.

Stronger drugs such as Vicodin work directly with the spinal cord to block the pain receptors at the source. These drugs treat pain that isn’t as responsive to anti-inflammatory agents.

They have their own side effects, including a positive rush that can lead to psychological addiction. The more powerful drugs typically are prescribed after surgery or to treat acute pain.

Ms. Yancey says for years doctors told her the pain she suffered was all in her head. To this day, specialists haven’t pinpointed the exact cause, though she suffers from degenerative arthritis, bulging discs and fibromyalgia, which could contribute to her pain.

Through the years she tried every medication imaginable and even endured trigger point injections, which administer medication directly into the source of the pain.

“At one point my purse was like a pharmacy,” she says.

The pain worsened three years ago, and none of the procedures or medications that previously offered a modicum of relief could help her.

Dr. Lee Ann Rhodes, a pain management expert with the Washington Hospital Center in Northwest, began injecting her shoulders with Botox.

“I feel like I’ve gotten my life back,” says Ms. Yancey, who receives injections in both shoulders every four months and keeps a home traction unit and electrical stimulation kit at home for when the pain is intense. “When you suffer from this kind of pain, it does make you depressed. You’re extremely fatigued all the time.”

Dr. Rhodes says researchers still have plenty to learn about pain and the best ways to treat it.

“Two people with the exact same injury can experience pain differently. It’s an individualized condition. You have some people who stay in bed all day while others go out and go to work.”

A pain specialist’s work isn’t made easier by the array of pain types to deal with, from acute to chronic, whether inspired by cancer, diabetes or conditions such as shingles.

She says another branch of medications, those typically reserved to treat depression, also work on pain by targeting the neurological pathways the pain messages are sent along. These drugs can have side effects and they may take weeks to work.

Some pain has no actual root or cause. Phantom pain can be “felt” by patients who have endured an amputation. In some cases, nerves formerly connected to the limb in question have been pulled free from the spinal cord, which makes them still active despite the fact that no injured tissue is connected to it.

Dr. Christopher Spevak, a clinical associate professor of anesthesiology at Georgetown University, says the treatment of pain has “advanced significantly” over the years as the understanding of the mechanisms and origins of pain has grown.

One of the recent additions to the pain relief repertoire involves surgically implanting devices in the spinal cord.

“They deliver electricity directly to the spinal cord, which blocks the pain by fooling the spinal cord,” Dr. Spevak says. Other surgically implanted devices deliver medication directly into the spinal cord.

These invasive techniques are limited to but a few patients, often those suffering from cancer. Hustler magazine founder Larry Flynt and the late Alabama Gov. George Wallace, both left partially paralyzed by gunshot wounds, tried invasive techniques to deal with their chronic pain with limited results.

Doctors often are reticent to insert any foreign matter into their patients for fear the body might reject the material or begin growing tissue around it, Dr. Spevak says.

A promising and potentially less troublesome way to reduce pain is the development of personalized medications, he says. These elixirs would be developed with a genetic basis tailored to the person’s specific genetic background. Work on these drugs already has begun, he says, and could be ready within about five years.

Dr. Lydia Segal, a chronic pain specialist who runs the Complementary and Alternative Medicine program at Kaiser Permanente, says many doctors are taking an alternative approach to pain management.

“We look at how to take traditional approaches to pain management and add to that mix alternatives such as acupuncture or chiropractic care,” Dr. Segal says. “In the past five to 10 years it’s been used a lot more, hand-to-hand with traditional approaches.”

Kaiser Permanente offers a 10-week pain management workshop for chronic sufferers that involves these practices.

Jerome McAndrews, doctor of chiropractic and national spokesman for the American Chiropractic Association in Arlington, says 50 percent of Americans will suffer from acute low back pain this year alone.

“It can be very debilitating,” says Mr. McAndrews, who says chiropractors perform spinal manipulations to relieve skeletal pressure and restore a joint’s function or movement.

“Sometimes, the relief… is almost instantaneous,” Mr. McAndrews says. The difference, he says, is whether the underlying condition is relatively new or has been around for years.

Some people suffer a trauma-style injury when they’re young and their bodies adjust to the muscular-skeletal injury. Soon, their bodies shift to balance out their new alignment, even though it’s an unhealthy one. Correcting this takes many sessions as the soft tissue is manipulated back into its preferred state, Mr. McAndrews says.

Ms. Yancey says when her chronic pain is at its zenith, it’s tempting simply to give up.

“It would be very easy for me to roll into a ball and never get out of bed. I feel the best when I’m lying down,” says Ms. Yancey, who has resumed working out since the Botox injections began.

“I’m not pain free, but it’s an 85 percent improvement. Before the pain levels on a daily basis were an eight to 10. Now, they’re a two or three.”

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