Web Chat on Chronic Pain with Dr. Renate Rosenthal, Department of Psychiatry, UT Medical Group, Inc.
(The following is an edited transcript of questions and answers from a web chat held on Wednesday, April 10, 2002 on News Channel 3)
Moderator: Welcome to this week's chat. Our guest this week is Dr. Renate Rosenthal and our topic is chronic pain.
Hello, my name is Dr. Renate Rosenthal, and I am a psychologist with UT Medical Group, Inc. Today our topic is "Chronic Pain." I have worked with patients with chronic pain at UTMG for a number of years, and I'm very much aware that having chronic pain can take its toll on one's emotional well-being.
Some of you might be wondering what a psychologist is doing talking about chronic pain! I'm not crazy; it's not in my head, I know. That's the first thing people worry about when someone suggests that they should see a psychologist or psychiatrist to get help with their pain problem. When you aren't feeling well, for whatever reason, issues you might normally be able to deal with just fine take a much larger toll. Also, problems and stresses can make pain problems worse. That's where I come in.
Q: I have chronic back pain. My doctor says there is nothing else I can do about it. What do you suggest?
Dr. Rosenthal: There are many situations where surgery or medication will not help. Those are the situations where it is really important to take a deep breath and look at everything else that is going on in your life to see if you can help yourself in other ways. For example, back pain gets worse when you are under a lot of stress. It can get better if you learn ways to relax, if you become more physically fit, and maybe look at your level of depression.
This does not mean that the pain is in your head. I'm sure you have good reasons for your chronic back pain. However, at this point, I would look at other interventions such as massage, nutrition, and other lifestyle issues that might be important. Some people get relief from biofeedback, yoga, or other interventions.
Q: I have had 3 Back surgeries. The last 2 were within 2 weeks of each other. I now have nerve damage in my left leg, from the sciatic nerve being blocked off. I also have chronic leg pains, leg cramps every night, back pain.
Dr. Rosenthal: Unfortunately, you are describing a very typical picture. Often surgeries do not relieve the problem, and for unlucky people, the problem can get worse because their level of physical fitness decreases. Also, depression becomes a big part of the whole picture. Please do not take me wrong, I am not implying that your pain is in your head or that it is not real. You have many reasons for your pain and discomfort.
Sometimes, antidepressant medication can help with chronic pain. It is not the complete answer; a lot of your improvement will depend on how well you can learn to cope with this problem and how much family support you have. You might want to ask your physician to refer you for a psychiatric consultation.
Q: I have MS and the chronic pain from it may be CAUSING depression. Is this possible?
Dr. Rosenthal: Most definitely. Chronic pain can cause depression. It is only human nature to feel down about having a chronic medical condition. There is a feeling of loss, a need to make major adjustments, and a real struggle to find ways to live a full and satisfying life.
Q: I take Neurontin 400mg @ night to help with the siatic nerve pain and leg cramps. I cannot take it during the day, due to it causing sleepiness. I started on Paxil and it has helped me a lot.
Dr. Rosenthal: I'm glad you're getting some relief. It looks like you are on the right track. In addition, once you have had some time to heal from your last operation, take a good look at your entire life and see if there are things you can do to eliminate some unnecessary stress and to find ways to distract yourself from your pain. Pain is worse if you are left alone to focus on it, and it gets better if you are able to find some enjoyment.
Some suggestions for distraction are: learn to visualize peaceful scenes, places where you have been happy, find hobbies or interests that you are physically able to do and give you some enjoyment. Some people in pain cannot focus on reading because their concentration won't allow it, but there are other things such as putting a bird feeder out your window and watching the goings on. Every little bit helps.
Q: I have a severe pain in my jaw. what could it be?
Dr. Rosenthal: We very often see severe pain in the jaw which has to do with a lot of muscle tension and stress. I cannot diagnose your condition; please see your physician to get some help with this. But if you are like many other people, there is reason to believe that stress and muscle tension has something to do with it.
Q: I do try and exercise, but when I start to swim especially if the water is cold, my leg tends to cramp up, and all I can do is walk in the water to help get rid of the cramp. I do enjoy fishing, and being with my kids.
Dr. Rosenthal: Swimming is good exercise, but if any kind of exercise causes you recurrent problems, you might want to think about doing something else or going to a pool that has warmer water. I'm glad you have found ways to get enjoyment from fishing and your kids. Actually, fishing is very good because it is calm and peaceful while being exciting at the same time.
Q: I've gone through a series of 5+ surgeries & more to come, to "fix" a finger that was mulled in a dog fight. After 3 years I found Vioxx that made life bearable. Now insurance won't cover it as it's not necessary to sustain a "healthy" lifestyle. I don't like taking the drugs that make you sleepy. Is there anything else I could take?
Dr. Rosenthal: I am not a physician and cannot tell you about medications. In general, however, it is best to stay away from any medication that is habit-forming. Have you consulted a physical therapist? Muscles, tendons, joints--all those were injured in your accident and you may have to go the physical therapy/rehabilitation route to restore functioning in your hand.
Q: What can you tell me about Piriformis syndrome and some was to deal with the relentless pain it causes. Piriformis syndrome typically causes sciatic pain, tenderness in the buttock.
Dr. Rosenthal: I'm sorry, I'm not familiar with your condition.
Q: I have been going to PT faithfully and so far no progress, but I know the hands take time to heal. Right now I have no use of the whole hand.
Dr. Rosenthal: Hands are very complex systems. In fact, there are specialists who do nothing but hand surgery and hand medicine. That's how complex they are. Please do not get discouraged. Regardless of the cause of your pain, it really helps to learn techniques to distract yourself and to find peaceful imagery. The reason for that is not that your pain isn't "real"; I know it is real. But the pain experience is worse if you focus on it.
Comment: If I didn't have my Celebrex, I wouldn’t be able to get out of bed in the mornings. Tell the caller to try it.
Moderator: It's probably best that the caller ask his primary care physician about that.
Comment: Thanks for the advice on the Celebrex, I will ask my physician. At this point I'm willing to try anything.
Q: Hello, I have chronic headaches and lately I can hear a heartbeat sound in my ears, i'm scared that I have an aneurysm, any input.
Dr. Rosenthal: You definitely need to see your doctor. Don't let your fear keep you from making an appointment. Chances are, it is something less scary than an aneurysm, but whatever the cause for your headache, you need to have the proper diagnosis. If they tell you that you are medically OK, then we need to think about stress and take a look at what you can do to alleviate that.
Q: I had neck surgery some 10 months ago for c3 disk herniation. I still live in a lot of pain, but my doctor wants me to be able to work and has prescribed Oxycontin for chronic pain relief. I'm hoping I don't have to stay on this for a long duration, however it seems that this is the best alternative so far. My Doctor says that more intense investigation may be warranted but it's to early to tell.
Dr. Rosenthal: I suggest you learn to pace your activities in such a way that you do what you can workwise but take frequent breaks so the pain doesn't get to a level that is more intense than it has to be. Often we can catch our pain early, relax a bit, do some deep breathing, do some peaceful imagery, and then return to the task. Chronic pain does not respond well to a "mind over matter" push through it "it's the last thing I do" approach. It is always a challenge to learn how much activity is too little, how much is just right, and how much is too much. If you have a sedentary job, please sure that you change positions and work on your general physical condition.
Q: I have been suffering from a periphial neuropathy in both of my feet since last summer. I have been to a neurologist and no cause for this could be found. I am now taking 1500 mg of Neurontin a day and 50mg of elavil at night. I am still in considerable pain, especially at night. What are my other options.
Dr. Rosenthal: There are some medications for neuropathy; keep working with your doctor and don't get discouraged. In Europe, many chronic pain conditions are referred to places where they have hot mineral springs and well-established medical facilities to help people get back on their feet. Application of hot and cold water, exercise, whirlpool baths, etc. are part of those treatment facilities. I have no idea if this might help your condition, but you might want to mention some of this to your physician.
Comment: I will mention this to my doctor.
Q: I was considering hypnosis to help with my pain. Does that help?
Dr. Rosenthal: Hypnosis can be very helpful. It is one way to get out of that vicious cycle of anxiety and fear which is so hard to break when you are in pain. It helps along the same lines as distracting imagery and peaceful thoughts.
Q: My problem is that my work is somewhat strenuous thus putting me in a position of mentally being defeated feels hopeless.
Dr. Rosenthal: Although you may not be able to change this, sometimes it helps to talk these kinds of issues over with someone who is not involved in the situation, such as a therapist or a counselor. Even if you cannot change it, it may help you to get some of this off your chest in a confidential setting. Depending on your insurance, this may be a benefit for you. You may or may not need a referral from your primary care physician.
Comment: Thank You
Q: How do I make an appointment with you?
Dr. Rosenthal: you can call (901) 448-2400. My office is in the Medical Center area, but occasionally I will see patients at UT Medical Group's Germantown office at 7945 Wolf River Blvd.
Q: I have osteoarthritis, cjd, osteoporosis,,I can manage my pain during the day, but I can't seem to impress my doctors that I need something stronger at night
Dr. Rosenthal: Nighttime tends to be particularly bad for people with chronic pain. During the day, you may have some distractions and things to keep you going. At night, depression, anxiety, and discouragement may come to the fore. If this is true for you, mention it to your doctor. And consider seeing a psychiatrist. Again, I am not saying your pain isn't real, but every little bit helps and if there is medication available to give you better sleep at night without causing you other problems, it's worth a try. As far as getting off to sleep, some people find it helpful to turn on some soft music and to stay away from caffeine.
Q: Thank you so much, I will see any one who can help me get enough sleep, At times I can get to sleep but my neck or hip pain will l wake me up and then I can't get comfortable enough to get back to sleep.
Dr. Rosenthal: Thanks for your comments, Good luck.
Q: All right I guess I need to make it simple, you deal with stress and depression associated with chronic pain right? I have chronic pain. and have noticed a negative result in my concentration and mood. Forget the pain (I'm seeing a doc) what can you tell me about dealing with the stress and the possible depression? What about supplements like St. John's wort and you should get the point.
Dr. Rosenthal: Depression and anxiety most definitely makes any kind of pain worse. Whatever the reason for your pain problems, it is time well spent to look at all aspects of your life and see what you can do to help yourself. St. John's Wort is controversial at this point; in fact, there was a story on the news about it this morning. However, there are many ways to help yourself with depression that have nothing to do with medication. Talking your issues over with a trusted confidential person may be the next step.
Comment: Thanks alot, for letting me listen.
Moderator: Thanks for participating today in our chat. Dr. Renate Rosenthal is a Clinical Psychologist with UT Medical Group. If you would like to make an appointment with her, you can call her at (901) 448-2400. If there are no more questions, we are going to close our chat room now. We hope today's chat was helpful, and that you all seek additional help with your chronic painYou can also visit the UT Medical Group web site at www.utmedicalgroup.com .
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