Participants: Phil Mils, Don Mackintosh
Series Code: HFAL
Program Code: HFAL000036
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00:51 Hello and welcome to Health for a Lifetime.
00:54 I'm Don Mackintosh, your host, and today we're joined with 00:57 Dr. Phillip Mills from Wichita, Kansas. 00:59 Welcome, Dr. Mills. 01:01 Today we're going to be talking about a very important subject, 01:06 a subject that effects millions of lives and that's pain, 01:09 chronic pain. 01:10 Why should we talk to someone like you about pain? 01:13 Because pain, as you said, effects virtually everyone. 01:17 But it's interesting, Don, while everyone knows what pain is 01:23 we don't have a good definition for pain. 01:26 Scientists that study pain argue over what pain exactly is and 01:32 how to describe it. 01:34 I believe one of your specialties is this, 01:39 treating people with pain. 01:41 A "painologist," I don't know what you call that. 01:44 Well, it's a pain specialist. 01:46 There is such a problem with pain and 01:49 people with chronic pain have to be treated differently 01:53 than other kinds of medical problems. 01:57 And so some of us have specialized in the area of 02:00 pain treatment. 02:02 Is there anything good about pain? 02:03 Well, if you look at some very interesting patients that were 02:09 born without any pain fibers you discover some interesting 02:13 facts. 02:15 There was a fellow that was just a few years old and his appendix 02:24 needed to be taken out. 02:25 It was difficult for them to find that he actually had an 02:28 appendix problem because he didn't hurt. 02:30 But after some studies they discovered he needed to have 02:34 his appendix out and they did it without any anesthesia. 02:39 He was able to go through all of the treatment of the surgery, 02:46 without any pain medications, without any anesthesia. 02:50 You would think that was good but as the doctors looked at 02:55 this poor boy that had no pain fibers they saw he had joints 03:00 that were deformed and they also say that he had scars 03:03 all over his body. 03:05 They thought this boy has been abused at home. 03:11 They didn't realize yet that he had no pain fiber. 03:16 So they asked and investigated into the home situation 03:20 and discovered that he hadn't been abused but that he had no 03:25 pain fibers. 03:27 So when he injured his joints, if he burned his hand, there 03:31 there was no pain, no protection, 03:34 no change in behavior, and consequently he was deformed 03:38 and scarred. 03:40 These people without pain fibers their life is short and they 03:44 end up quite scarred, quite deformed, and we should realize 03:50 that pain is actually one of the great gifts of God 03:54 for our protection. 03:56 I know some people are probably saying, "Well, you know that 03:59 may be true but for me this situation that I'm in I don't 04:03 think it's much of a blessing. " 04:04 Let me ask you this question. 04:06 Suppose that you're a physician and I was a patient and came 04:09 into your office and you watch. 04:11 I have a hammer in my right hand and I have this hammer 04:17 smashing the thumb on the left hand. 04:20 I might send you to the guys in the white coats! 04:23 I say to you, "Doctor, my thumb hurts, please do something for 04:28 my thumb. " 04:29 Would you say, "Here, take these pain pills"? 04:32 or would you say, "Stop doing what's causing the pain to your 04:37 thumb"? 04:38 Like I said, I might send you to a different kind of doctor, 04:40 but, yes, I see your point. 04:43 The point is that pain was telling me I shouldn't keep 04:48 doing what I was doing. 04:50 In the majority of cases we should look at pain as a 04:55 protective mechanism, not as an enemy. 04:58 I've always been amazed that if people hurt themselves 05:02 will take God's name in vain. 05:04 When they hurt themselves they should thank God that they have 05:07 those pain centers so they can protect their bodies. 05:10 In fact, if you look at the disease of leprosy, 05:17 what leprosy does is it destroys your pain fibers. 05:21 Some people think that leprosy eats away the fingers and the 05:26 toes, it doesn't. 05:27 It makes it so that you don't feel. 05:30 So if an animal, let's say a rat, comes up and eats on your 05:34 finger, it doesn't awaken you at night. 05:36 If they gnaw on your nose you don't awaken at night. 05:39 So gradually you may loose your toes, fingers, and extremities 05:45 because if it's infected you feel no pain. 05:49 Pain is important. 05:51 One of the problems with sin is it deadens our pain. 05:56 And so we'll sin but it doesn't hurt. 06:00 And so we keep on sinning. 06:02 I'm told by my friends who are specialists in alcohol related 06:06 issues that the people who are apt to be alcoholics are not 06:11 the ones that get hang-overs, although sometimes it involves 06:14 them, but the ones that tolerate the alcohol fairly well, 06:18 they don't get sick, the ones that the first time they drank 06:21 alcohol they got a lot of effect from it, they got a lot 06:25 of sickness, they tend not to drink. 06:29 So pain, again, first of all should be looked at as a 06:33 good thing because it is protective. 06:36 So pain is protective but that is acute pain or 06:41 short-term pain. 06:43 Is that the way to use the word 'acute'? 06:46 Yes, the word 'acute' simply means of short duration. 06:50 So you would consider maybe up to 6 weeks, certainly 3 weeks, 06:56 possibly 6 weeks, to be acute. 06:59 After 6 weeks, about 3 months, you call that sub-acute. 07:04 And then after 3 months you begin to refer to it as 07:08 chronic pain. 07:09 Now chronic pain is different than acute pain. 07:12 Acute pain has a clear cause and it's reasonable in certain 07:19 cases to give medication treatment for the acute pain 07:24 to control it because it's going to go away. 07:26 But chronic pain either is signaling that there is 07:31 something still irritating the body or it is giving signals 07:45 to the brain that you have this danger 07:50 when in fact there is no danger there. 07:56 It is telling you that you need to change your behavior 07:59 when in fact there is nothing you can change. 08:01 And that becomes a problem. 08:02 You would say it's over-protective or confused? 08:07 Yes, both. 08:08 Where the signals to the brain are such that you're getting 08:14 this pain and yet there is no real cause of alarm that pain 08:20 actually is signaling. 08:22 So less than 6 weeks is acute pain. 08:25 From 6 weeks to 3 months is a sub-acute pain. 08:30 And from 3 months and onward is a chronic pain. 08:34 Then the pain itself in a chronic situation, over a 08:40 couple years, the chronic pain itself begins to cause 08:44 changes to the personality, begins to cause changes 08:48 to the person. 08:49 That chronic pain is where the real problems lie in management. 08:56 We want to talk about how to live with some of these pain 09:00 situations because I assume that some of them you just can't 09:04 get rid of them. 09:05 Yes. 09:06 Chronic pain I like to think of this way: 09:09 It's not something you die from but it is something you may 09:14 die with. 09:15 So how do you deal with this chronic pain situation. 09:21 Are there acute pains or short term pains that can turn into 09:24 long turn pains? 09:25 Yes. 09:27 Let me give you a disease for example that is a real problem 09:33 in the area of pain. 09:35 It is an acute, severe pain. 09:38 There is a long name for one of the kinds of pain, 09:42 that would be tic douloureux. 09:43 This is a tremendous pain on the face that can come as 09:48 sudden, sharp, electrical, agonizing sensations 09:55 across the face. 09:56 How do you get that? 09:58 There is a certain nerve that begins to malfunction and send 10:03 those signals to the brain. 10:05 Even a little breath of air across may set this off. 10:12 So a person becomes quite frightened to even get outside. 10:16 It can change their life. 10:20 They will seek for some solution maybe even surgery that 10:24 would cause their face to be disfigured. 10:28 They would rather have that if they could get rid 10:30 of this pain. 10:31 That is how severe it is. 10:33 Other types of severe pain include such problems as 10:36 reflex sympathetic dystrophy. 10:38 It's a long name for a problem that was originally seen in wars 10:44 where you would have a bullet wound that would injure 10:47 two nerves. 10:48 In the healing process these nerves would short circuit. 10:53 They would be wired up in healing wrong and you would 10:58 have this severe pain that would be 11:01 constant and unrelenting. 11:04 And you would say, "Oh the solution would be to cut off 11:07 the hand," but the fact of the matter is even after they 11:11 cut it off the pain would persist right where it was 11:14 just as if the hand was there. 11:16 It has been a real problem in management. 11:22 I want to come back to what kind of things happen to people 11:26 when they're suffering from chronic pain for a long time 11:29 but just a question that is not related to chronic pain but it's 11:34 more acute pain or one of those short-term pains, but what about 11:38 a head ache, what should you do about a head ache? 11:40 Head aches can be a chronic pain. 11:43 That can be a major problem. 11:46 The first thing, obviously, is you have to have a clear, 11:48 work-up to find out if there's some treatable problem, if there 11:53 is some underlying issues such as a tumor or some other 11:59 vasculitis. 12:01 The doctors will work it all up fully and they know just 12:05 exactly to do for that. 12:06 But in many cases all of those studies are normal but severe 12:12 head ache pain persists. 12:15 Before a person should try powerful and potentially 12:19 risky drugs there are some things that take care of in many 12:25 cases people's head aches. 12:26 Some simple things they can do. 12:30 For example: 12:31 If they can stop all caffeine products that can cause 12:37 head aches, theobromine in chocolate, some of the chemicals 12:45 that are in cheese and wine, and then if you have tobacco, 12:51 exercise, and meat have even been found to be a problem with 12:58 head aches. 12:59 I also have patients stop dairy products and it is surprising 13:03 in a certain percentage of patients with making these 13:07 simple changes the head aches will go away. 13:11 In other cases they will not. 13:12 But it is certainly harmless and worth a try for at least 13:15 6 weeks. 13:17 So if you have a head ache and it hasn't gone away 13:20 try going off some of these things. 13:22 You mentioned in that list 'exercise. ' 13:24 Did you mean to say that? 13:25 Yes, if a person can increase their exercise, but sometimes 13:28 that's hard to do with a head ache. 13:30 Sometimes increasing the exercise can be of benefit 13:34 if it's a simple exercise such as walking. 13:37 So there really are some simple things that we can do 13:40 to maybe address the problem of head aches. 13:43 We've been talking with Dr. Phillip Mills from 13:46 Wichita, Kansas about pain. 13:48 He's a specialist in pain management. 13:51 When we come back we're going to be talking about chronic pain, 13:54 what we can do to live with it. 13:56 We hope that you will join us. 14:11 Have you found yourself wishing that you could 14:13 shed a few pounds? 14:14 Have you been on a diet for most of your life, 14:17 but not found anything that will really keep the weight off? 14:20 If you've answered yes to any of these questions, then we 14:23 have a solution for you that works. 14:26 Dr. Hans Diehl and Dr. Aileen Ludington 14:28 have written a marvelous booklet called 14:31 Reversing Obesity Naturally, and we'd like to send it to you 14:34 free of charge. 14:35 Here's a medically sound approach successfully used 14:38 by thousands who are able to eat more 14:41 and loose weight permanently 14:42 without feeling guilty or hungry through lifestyle medicine. 14:46 Dr. Diehl and Dr. Ludington have been featured on 3ABN 14:50 and in this booklet they present a sensible approach to eating, 14:53 nutrition, and lifestyle changes that can help you prevent 14:56 heart disease, diabetes, and even cancer. 14:59 Call or write today for your free copy: 15:23 Welcome back. 15:24 We've been talking with Dr. Phillip Mills 15:27 from Wichita, Kansas 15:28 Dr. Mills is a pain specialist. 15:30 We've been talking about different types of pain, 15:33 Dr. Mills, acute pain, correct me if I'm wrong, 15:36 it's from 0 to 6 weeks, sub-acute being from 15:40 6 weeks to 3 months, and then chronic pain that lasts anything 15:46 longer than 3 months. 15:47 What types of things do you see happening, many thousands 15:51 of patients that you've seen, when they have a pain that lasts 15:54 for longer than 3 months? 15:58 What begins to happen are some interesting changes in the 16:02 psychology of the person, the mental outlook. 16:06 For example: after about 2 years of chronic, 16:11 unremitting pain, virtually everyone will have a 16:14 substantial depression. 16:16 Secondly, they'll be completely consumed and focused on their 16:21 bodily functions and their pain because its part of every waking 16:26 moment. 16:27 There will generally be some financial problems because they 16:30 may or may not be able to work but typically 16:32 they will not be working. 16:34 So you have these pressures. 16:36 All of their friends are tired of hearing about their pain 16:39 and so in some cases, it's bottled up. 16:43 These make changes in the way people deal with other people. 16:50 They may become more solitary and it impacts marriages. 16:58 It impacts parenting skills. 17:01 Are they ever angry at you when they come in? 17:05 Well, I don't look at them as being angry at me, although 17:08 they're just maybe angry. 17:10 They're often quite angry at their employers. 17:13 And if an insurance company has sent them to me to evaluate 17:16 they may look at me as part of the system that's not very 17:20 helpful to them. 17:22 So they may be quite suspicious and quite angry. 17:26 That can be an aspect. 17:29 But generally if they are angry they're really angry at 17:33 themselves but they seem to be angry at other people. 17:36 Do you find that some people... I don't know how to say this 17:41 nicely, but do they need their pain or do they... 17:48 I don't know how to say that... 17:50 Well, you are talking about the psychological issues. 17:52 Are all people with chronic pain do they have 17:54 a real reason for the pain? 17:57 The fact of the matter is in some cases there can be a 18:00 psychological component of pain. 18:03 That pain provides a wonderful escape. 18:06 They are a failure in life and the reason is they could be 18:11 successful but they have this pain. 18:13 They could work, but they have this pain. 18:16 And in fact there are times when we are able to completely 18:19 take away the pain but they're not happy. 18:22 They need the pain and quickly get it back because for 18:26 reasons of their life situation it's the comforting blanket 18:32 that gives them an excuse not to perform, not to help 18:38 somebody else, not to do, and not to reach out. 18:42 It may also be that they get attention from a spouse. 18:47 They have the pain and the spouse will wait on them. 18:51 If they lost the pain then they would loose the attention and 18:54 being waited on by the spouse. 18:56 It is not unheard of to have patients, certainly I have had 19:02 patients where the pain had a psychological basis. 19:07 Let's assume that there are people watching today that 19:12 actually have true chronic pain, they are not malingering, 19:16 they're not trying to fool anybody, they really have 19:19 that chronic pain, what can they do to live 19:22 with chronic pain? 19:23 There are several suggestions that we have found helpful. 19:26 And again we are dealing with chronic pain. 19:29 Now chronic pain can have lots and lots of causes. 19:31 So for the first suggestion, but virtually everyone with chronic 19:36 pain has done this, but they need to have a thorough 19:39 evaluation to make sure that no medically treatable cause 19:44 can be uncovered. 19:45 If they're having chronic pain because a surgical procedure 19:49 needs to be preformed then that can be evaluated. 19:54 Or if they need certain types of medicines to take care of the 19:57 problem, that can be evaluated. 19:59 Because pain is so uncomfortable virtually all my patients 20:06 with chronic pain have had quite thorough work ups. 20:10 Under many physicians probably. 20:11 Yes. 20:13 And they're quite frustrated and so then the next suggestion 20:17 that we find helpful is perhaps the hardest of the group. 20:21 Is this what you start with when you talk to patients? 20:24 Well, I may not start with it but this is one of the most 20:27 important but because we have limited time here 20:30 I want to make sure that I deal with it. 20:33 One of the most important ways of treating people with chronic, 20:40 unremitting pain is to get them off their 20:44 addictive medications. 20:47 Does that mean all medications? 20:49 You're saying get off all pain medications? 20:51 Well, it may mean that. 20:54 It should be done under supervision because some 20:59 medication if you just stop you can have seizures and some 21:01 other problems. 21:02 They may have to be weaned off. 21:04 But the goal here is to get patients off of their 21:09 medication and we find in many cases that the medication was 21:14 providing not much relief, and we're talking strong narcotics, 21:20 the medication was not providing much relief but in fact was 21:25 dulling their mind. 21:26 The reality is that the way to deal with pain requires a 21:34 sharp brain. 21:36 The brain will be able to deal with the pain. 21:40 If you dull that, you dull the very best vehicle that you have 21:45 to handle chronic pain. 21:48 Now even in the acute situation if you recall 21:51 Jesus when He was on the cross they gave Him some vinegar, 21:57 which had been a pain reliever, and His mind was so important 22:02 to Him that as soon as He tasted it He wouldn't take any more. 22:07 That should suggest that the mind is very important in 22:13 dealing with these stressors such as pain. 22:17 So there's some complications with medications and one of 22:21 them is not being able to really think through how to deal or 22:24 cope with pain. 22:27 That is a pretty hard solution, I think, probably for some 22:33 people that are listening. 22:35 What is another suggestion? 22:36 Well, after we work toward decreasing the medications 22:41 or eliminating it, if it's possible, then another, 22:46 and this is also difficult, another important aspect 22:51 is exercise. 22:53 Now a person would say, "Well it hurts if I move this area. " 22:59 But not all pain is indicating that you should stop moving. 23:07 Let me give you an example. 23:08 If you injured your elbow or even if you didn't injure your 23:13 elbow, but you immobilized it in a cast, and that is 23:17 immobilized for 6 weeks, then you take the cast off. 23:22 I don't know if you've ever broken a bone and had a cast? 23:25 Just ribs but we couldn't put a cast on that. 23:27 If you then take the cast off and you start to move the joint, 23:31 oh it hurts! 23:33 But what is the solution to the pain? 23:36 More movement! 23:38 As you move it, it gets better. 23:41 Many times a person has had a back injury and the doctor has 23:45 said, "If it hurts don't move it. " 23:48 So the patient quit moving their back and when you quit moving 23:53 the muscles shorten up and the joint gets stiff. 23:57 With that stiffness, then if you move it, it hurts. 24:04 But we have found in certain types of back pain the solution 24:10 actually was special types of exercises and it even 24:14 involved machines that would help with those isolating 24:19 exercises that actually stretched out those muscles. 24:22 Although at first it hurt, with a bit of movement the pain 24:26 went away. 24:28 Now I found out in my own case that more exercise 24:33 is very important. 24:34 I started exercising about two years ago very religiously 24:40 in the morning. 24:41 But I only went about two miles and I had some underlying 24:46 musculoskeletal pain on a chronic basis but it wasn't 24:49 severe at all, but it is embarrassing so that you don't 24:52 dare let anybody know that you have pain 24:56 because I'm a pain doctor. 24:57 I would try to hide it so nobody knew I had a hurt anywhere. 25:02 However, with the two miles I still had some discomfort. 25:10 After this summer I increased my exercise to 4 miles 25:19 Take your own medicine here! 25:22 A short time ago I did 50 mile hiking up in the Rocky Mountains 25:26 and when I was done I was absolutely pain free. 25:30 If a person can increase their exercise often this is a very 25:38 important aspect of pain relief. 25:42 Many people stop when they begin to get sore. 25:47 They really should keep going. 25:49 It needs to be supervised. 25:50 You don't want to injure yourself but in most chronic 25:52 pain cases you're not in any danger of damaging your body. 26:01 We've talked about stopping medications. 26:03 We've talked about starting to move and that's 26:07 under advisement. 26:08 Medications we don't just stop them abruptly, you check 26:11 with your doctor. 26:12 You don't just exercise unless you really should be. 26:15 You would check with someone like yourself, a physiatrist. 26:17 Anything else that people should do that are dealing 26:21 with chronic pain? 26:22 Yes. 26:23 One of the most important is drinking water. 26:26 Oh, that sounds simple. 26:28 It is simple. 26:29 If you cells are relatively dehydrated they will send 26:33 signals to the brain and the brain may interpret those 26:38 signals as being pain. 26:41 If you make sure they are hydrated, by hydrated I mean 26:45 drink plenty of water, that in itself may make a person 26:50 feel like they're having less pain. 26:54 Some of the pain was just misinterpretations for 26:57 crying out for water. 26:59 Now in that regard, caffeine can dehydrate cells. 27:05 And we also know that caffeine increases the pain 27:11 that a person feels. 27:12 So people should stop all caffeine. 27:15 They should also stop all smoking for similar reasons. 27:19 Wow! so these are really practical things, some of them 27:23 are quite simple, drinking water and getting rid of some 27:27 habits people want to get rid of anyway. 27:29 But there are also some spiritual components to this. 27:33 Study Job and Jacob. 27:36 After Jesus touched Jacob he had chronic pain. 27:40 We need to look for some lessons within pain that maybe are not 27:46 right on the surface, especially those with chronic pain. 27:49 Thanks for joining us today, Dr. Mills. 27:51 I know you have a very busy schedule. 27:53 And thank you for joining us. 27:55 We hope that today you've learned some things that will 27:58 give you health for a lifetime. |
Revised 2014-12-17