toe pain medication

>> it can spike to the point towhere it will knock you on your knees and put you in bed. >> pain -- we all feel it. but for millions with chronicpain, it lingers for months, even years. >> it is like ten times worsethan a toothache. >> from the ymca volunteer, tothe marine wounded in iraq, and a mother struggling to continueher mission to save abused animals.

follow three stories of peoplein pain. >> it just eats away at you. it devours you, and eventuallyit can take your soul. >> explore different treatments. and weigh the risks and benefitsof prescription drugs. >> the use of painkillers in theunited states has become an epidemic. >> we will have a panel ofexperts and portraits of patients as we discover whathappens to the body in pain.

>> funding for "body in pain"comes from the dr. donald j. goodman & ruth weber goodmanphilanthropic fund of the cleveland foundation. the margaret clark morganfoundation. the mcgregor foundation. the woodruff foundation. and the community foundation oflorain county. ♪>> my name is lisa novak, i am 38 years old.

i run a nonprofit animalshelter. no animal is to be left behind. that is our motto. we deal with a lot of animalsthat are abused by people. a lot of cruelty that occurs. ♪this year so far, the rescue organization, the volunteershave saved 263 animals. i know chronic pain. i know the suffering that occursand i know the pain that comes

with it. i was working at an animalhospital, i was lifting a 120-pound dog. the dog fell and i ended upripping my abdomen and getting multiple hernias. no matter how much i rubbed myside or my leg or tried to apply heat, you couldn't -- it was adeep penetrating pain. almost like being stabbed. chronic pain, it takes awayeverything.

i think it makes you feelinadequate. it causes depression. i think your children areimpacted more because they do not understand. at one time you were doingsomething and now you are broken. i ended up having to sell myhome because i was not making the income that i was. i gave up almost everything justto try to survive.

>> raise your hand up to you. >> my name is yvonne wood, i am62, and i know the whole nightmare of chronic pain. in 2002, i was diagnosed withserious arthritis in both knees. at one point it was so bad thati was in a wheelchair. i was immobile. it affected my work in the factthat i was an office manager. i was not able to move around. i was not mobile.

because of the fact that i couldnot do the job that i was responsible for doing, i retiredin 2002 on disability. it is like a throbbing, nagging,gnawing pain. it is there while you aresleeping. there is no comfort level. you sit up, you have pain. you lay down, you have pain. have you ever had a toothachewhere the pain is just throbbing like a pulsating pain?

it was just that painful. chronic pain affects your wholelifestyle. it affects the way you live andit affects the choices that you make. as to how you do things on adaily basis. it affects you mentally, also. it is so painful that you do notwant to be bothered with people. it isolates you. ♪>> i am derick young from

warren, ohio. in iraq in 2005 i was wounded inan explosion and since that time i have lived with chronic backpain. i enlisted in the marine corpsafter high school in 1998. in 2005, i was part of operationiraqi freedom. i was deployed with the thirditalian -- the third battalion 25th marines weapons company. headquarters is over in burkepark, ohio. the public will remember us asbeing the unit with heavy losses

in early august 2005. our mission was to patrol theroadways and support any of the foot movements. and to disrupt any type ofinsurgent activity within the anbar province of iraq. on may 7, 2005, at approximately3:30 in the morning, we were returning from the patrol. i was the vehicle commander andi sat on the right front seat. there were five of us total inthat vehicle.

that is when my vehicle ran overantitank mines. you hear ringing, things areslow. some things you remember, somethings you do not remember. it is kind of hard exactly tosay how i was feeling at that time. it was somewhat of a state ofconfusion. and you just go into react mode. you rely on your training. the other guys were wounded alot worse than me.

and so i wanted to make surethey were the priority. i had some lacerations, someback injuries. from nerve damage in my legs,concussion. ♪it just -- like with any veteran, everybody has differentsymptoms and a different diagnosis, whether it is ptsd,traumatic brain injury, chronic back pain like myself. there is a combination ofemotional and physical pain. ♪>> so, chronic pain really

derails people. it really changes people'slives. dr. tabah, you are ahead of painmanagement at metro health. you have seen everything underthe sun when it comes to this. >> kay, that is absolutely true. i have seen a lot and treated alot of patients. what comes to my mind first isthe case, after i did my cardiac surgery at the cleveland clinicand i switched to anesthesiology and critical care.

there was a case at southwesthospital, i got a patient in a coma after committing suicide,the patient expired. the police brought with him hismemoir. principally, his diary aboutwhat has happened to him. when i read his writing, it wasbecause of chronic back problems that he had. and he became isolated from hisfamily and his community. and he lost his job. this sad story by itself, for meas a surgeon -- when i

considered pain as principally atemporary thing, you give them a couple percocet after surgery, acouple pain medications, everything is gone. i had never seen the impact onthe patient, society, or the family like this case iexperienced 20 years ago. >> it can be riveting topatients and families. dr. jeffrey janata, you are apsychologist and you have studied pain for 20 years, youhave treated a lot of patients. tell us how this kind of chronicpain we are talking about is

different than the kind of painyou have when you cut your finger. >> we all experience pain. pain in an acute sense is thebody's warning sign that has been injured. in that sense, pain can be veryhelpful. it is helpful, otherwise wewould not known that we have hurt ourselves. chronic pain, by contrast, isthat system now gone into a

sustained mode. chronic pain is defined as anunpleasant and emotional sensory experience that persists overmonths and months. typically, we classify it asbeing six months or more. that now has taken on a life ofits own. where the body stays in a cycleof experiencing pain. even independent of andoriginating injury. >> there are many differentcauses of chronic pain. that is very much the case inour three profile patients.

♪>> here. >> whether it is feeding orgrooming, working with animals is a 24/7 job. something lisa novak was able tofully embrace until she encountered debilitating legpain. >> it was literally going to bethe end of the shelter, the end of what i have been doing myentire life, and the end of saving animals. >> lisa was in pretty bad shapeas far as her pain.

it was interfering with herdaily living activities. she had a little boy at home andshe could not care for her family. she could not care for heranimals. novak's current doctor, a painspecialist, suspects novak's leg pain might have resulted fromnerve damage suffered during hernia surgery. >> the medical treatment ireceived actually cause more pain.

i was hoping for a cure andinstead i got a problem. >> doctors say the nerve damagecan occur in up to 10% of operations for hernias or othersurgeries involving the ribs or chest. >> an operation can sometimesaccidentally damage small nerves that are hard to see duringsurgery. that may be cut. sometimes it could be from theretractor, it could be from positioning during surgery.

>> nerve damage pain is calledneuropathic. it is different from other typesof pain. normal pain, also called acutepain, is protective. and results from intact nervesdoing their job to let the body know something is wrong. let's say you cut your finger. sensing trouble, the body'sdefense system issues a red alert, an inflammatory responsethat causes nerve endings at the injured site to send a painsignal to the brain.

>> so the pain signal travelsfrom the skin along special nerve fibers, all the way upthrough the spinal cord. from there, it is conducted intothe brain. >> the pain subsides as thefinger heals. but in neuropathic pain, damagednerves malfunction. they are basically nerves gonewild. they continued firing painsignals to the brain without any connection to an outside injury. >> you may be feeling pain inyour chest or in your arm even

though there is no injury to thechest or the arm. >> lisa novak has neuropathicpain. the first dr. she saw prescribedstrong narcotics. novak opted not to take them. instead of drugs, novak wouldtry several different treatments over the next six years. for novak, the only relief hascome from a new freezing treatment. in a procedure known ascryoablation, doctors guide

treatment probes to the problemarea. >> as you can see, here is aball at the tip of the pro-, that ice ball is laced veryclose to the nerve. by freezing and thawing, wedenature small proteins inside the nerve. by denaturing the proteins, weessentially kill the function of or kill the pain for a while. ♪>> i have life again. it is like giving me back mylife.

>> doctors cautioned thatcryoablation does not work for everyone. and novak will likely requirerepeat procedures. >> hey! >> hey. >> for now, novak is once againfunctioning and able to keep the animal shelter open. >> i only have a bad day everyonce in a while. versus a bad day all the time.

nice throw, bud. ♪>> nine years ago, at age 53, yvonne wood was losing herindependence due to debilitating pain in her knees. >> i could not walk without acane or a crutch. otherwise, i was in awheelchair. even though i was at home, icould very well have been in a nursing home. i was not capable of doinganything for myself.

>> close to 50 million americanshave some kind of arthritis. wood has a severe form known asrheumatoid arthritis. the lubricating fluid in thenknee produces excess chemicals that wreak havoc on thecartilage, the cushion for the joint. >> the excess of fluid haschemicals in it that start eating away at the cartilage. it kind of creates a cascadeeffect. enlargement of the joint,destruction of cartilage, loss

of cartilage, painful motion ofthe joint, limitation of the and then the patient getsprogressive destruction of that >> eventually, both of wood'sknees had to be replaced. but joint replacement surgeryonly offers a partial solution. patients also need to takemedications to try and manage both the pain and progression ofrheumatoid arthritis. lifestyle changes also areusually necessary, which in wood's case includes losingweight. >> it is a struggle because i dohave a problem with my portion

control. pain will cause you to eat, yesit will. it does. and if you are not able to getout of the house, whatever is in the house, you are going to eatit. if you are in pain, you go tothe refrigerator and say oh i will eat this and maybe i willfeel better. >> weight does play a role. what we see in arthritic jointsis for every one pound of weight

that a patient loses, about fourpounds to five pounds of weight are taken off the joint. if you have a patient who loses10 pounds of weight, they essentially are taking off 40pounds of weight from their knee >> 5, 6 -->> one of the most useful exercises for arthritissufferers is water aerobics. it helps reduce weight, and theresistance of water helps strengthen muscles withoutstressing joints. and there is an added benefitfor almost any exercise.

>> it helps the body producevarious chemicals that are actually self generatingpainkillers that our body can produce. it can only be produced by doingexercise. we cannot artificially give allthose chemicals to our patients. >> unfortunately, studies showthat people with arthritis, those most likely to benefitfrom exercise, are the least likely to do it. ♪yvonne wood wants other chronic

pain sufferers to know, workingthrough the pain of exercise is worth it. >> even though some days areworse than others and i might have pain, i pushed my waythrough and do the pain. generally afterwards, i feel alot better. and had i given into the painand not done anything, i would have felt a lot worse. >> one knee up, one knee back. ♪>> the third battalion 25th

marines touched home to a hero'swelcome. during the ohio regiment's sevenmonth deployment to iraq, it lost 48 members. another 241 were wounded. derick young was one of them. with his humvee flattens in anexplosion, young was left with wounds. despite his injury, he completedhis tour. >> just because you are hurtdoes not mean the war stops.

your back hurts, you're tired,so what? deal with it and move on. >> being on the battlefield orindividual or civilian life, most back pain stems from acombination of factors. the discs, the cushions betweenour vertebrate, naturally start to degenerate around age 30. the joins in the spine may alsobecome inflamed due to arthritis. such changes can be compoundedby military training and or

traumatic injuries. like the explosion derick youngexperienced. ♪young suffers from a combination of spinal problems, includingseveral herniated discs. the jellylike center of the discmoves out of place and presses on nerves in the spinal area. >> the yellow parts of thenerves? >> yes, these are the nerveroots coming out. and then the more they areirritated, the more often and

comment the shooting pain downthe lake. >> depending on the type of day,it could be an aching pain, just an annoying type pain. some days you are bedridden. it is like riding a rollercoaster, you have your highs and lows, but you never stop. >> young's injuries caused himto be medically retired as a staff sergeant at age 29. once a marine, always a marine.

it took a while for young'sstrong warrior attitude to surrender to the fact that heneeded help learning to cope with chronic pain. >> it was limiting to me towhere i was feeling so worthless, so to speak, i wasnot able to do the things that i like to do. i was not able to move aroundthe way i wanted to. something needed to be done. >> on your worst day, how bad isyour pain?

>> on my worst day, probablyright around a seven. >> young eventually sought helpfrom the louis stokes cleveland va. >> i am mixing steroids withlocal anesthetic and saline. >> using radioactive dye andadvanced scanning technology, the doctor injects a steroid anda numbing agent into the area of young's spine. >> you will feel a littlepressure here. >> the goal of the epiduralinjections, what people refer to

as nerve blocks, is to addressthe neuropathic pain that is coming from the nerve. the nerve sometimes is firingconstantly. and what the steroids can do isreduce the repeated and sometimes spontaneous firing ofthese nerve fibers. >> nerve block injections onlywork temporarily. but they got young functioningenough so he could work out again. exercise helps build strong cordmuscles to support the spine.

♪as you can see from these stories, managing chronic painis a multifaceted proposition. freezing nerves, spinalinjections, physical therapy, surgery, as well ascomplementary and alternative therapies like acupuncture, area few of the many strategies specialists are using. there is also nutrition therapy. >> we know that low magnesium inour bodies can cause an increased perception of pain.

>> and the use of painpsychologists. >> the definition of pain isthat it is a physical and emotional experience. that shows the importance of themind-body connection and that those hats are making acontribution to what the person is experiencing on a dailybasis. >> but probably none of theseapproaches is as common or as controversial as the use ofprescription painkillers. narcotics known as opioids.

lisa novak chose not to takethem. >> i have a 10 year old son, ido not want to be doped up. i want to be able to belevelheaded and not put on narcotics. >> retail sales of opioids likesoxycontin and vicodin nearly doubled in a recent 10 yearperiod. yet their use to treat chronicpain remains clouded. >> while effective for a subsetof patients, they can be detrimental for another largeproportion of those patients.

and therefore, their use has tobe judged very, very carefully. >> is that happening? >> unfortunately, no. there is not enough educationfor the practitioners in medical schools and nursing schools. practitioners are not taught whoare the patients that should not be receiving these medications. and when to be careful withthese medications. >> dr. mchaourab generallysteers clear of prescribing

opioids, especially forveterans. >> the veterans coming from iraqand afghanistan -- they are young, they have significantmusculoskeletal injuries, and they have all of these chronicpain complaints. but it is complicated by thepresence of ptsd in a large number of them. there is a great set up for themto obtain these medications and end up staying on them. while the right thing, and theright treatment is not being

offered. >> many pain specialists areopen to using opioids. at least as temporary tools formanaging chronic pain. there is widespread agreement onone thing -- patients need to lower their expectations. most will not see their chronicpain go away completely. in fact, many will only get asmall amount of long-term relief, no matter what treatmentis used. that is true for drugs or any ofthe other therapies we have

mentioned. as one analyst put it, chronicpain relief is an oxymoron. >> pain is always going to bethere. if i let it limit me in thethings that i like to do, it is going to affect my quality oflife. i will not let that happen. ♪>> so, medicine is the most common way to treat chronicpain. and there is a whole gamut ofmedicines.

we are going to focus thisdiscussion on the use of opioids. vicodin, oxycontin, narcoticslike that. even though none of our profilepatients use them, they are an important part of treatment. we're not going to be talkingabout their illegal use when they are diverted and sold onthe street. we want to discuss theirlegitimate use for chronic pain patients.

let's start with the benefits. dr. tabbaa, what do you see assome of the benefits of using these drugs? >> there is no doubt about itthat opioids therapy was one of the most oldest therapies thathas been used by humanity since 3500 years b.c. until now, it is the samemedication derived from opium. these medications are veryeffective in controlling pain. we know it is very effective incontrolling acute pain.

in chronic pain scenarios, it isa great medication if it is used in the proper population and inthe proper patients, and in the proper scenarios. give them a window to achievefunctionality so that they can improve their activities inadvance to a second level of their life. >> dr. janata, what do you seeas the benefit? >> the benefit is we can providepatients who are in pain with a window of opportunity they canuse to engage their own activity

and the pursuit of healing. >> it is like a transition tool. >> if you can relieve painenough that patients can exercise, that they canengage in recreation, reengage in social activity, go back towere, engage with their families. now you have created a systemthat gets the patient on the road to healing more quickly. >> what are some of the risks?

>> opioids are medications, itis funny that many elderly patients, for example, will say-- we give them vicodin, they come back and say dr. tabbaa, ido not want it. the constipation is morehorrible than pain, i would prefer to die in pain ratherthan have constipation. one of the examples of howhorrible the side effects are for certain people. we know there are some patientswho develop something called opioid induced hyperalgesia.

that means they become moresensitive to pain, despite the fact that they are getting largedoses of morphine or pain medication. the more medication you givethem, they become more sensitive to stimuli that causes theirpain. >> they can make pain worse? >> yes. now, we have respiratorysuppression. a patient may end up havingsignificant respiration,

especially in obese patient withsleep apnea. you give them these opioids andthey can stop breathing. >> breathing problems. >> sexual dysfunction is anotherthing that happens with chronic usage. >> dr. janata, what are otherrisks? >> three major risks -- thehyperalgesia dr. tabbaa mentioned, opiates can make painworse. the second is that weunnecessarily are providing an

opportunity to expose avulnerability to addiction in a population that may nototherwise be exposed to it. we have too be able to addressand assess that risk up front, which can be hard to do. and the third is that chronicpain is accompanied in the majority of cases by depression. and depression can masquerade ora company the symptoms of pain. or be expressed as pain. and so the risk is that if youapply a central nervous system

depressant like an opiate tosomeone who is already depressed, it can make thedepression worse. >> so they can feed off eachother in a negative way. >> no matter what treatment,whether it is the opioids, whether it is a surgicalintervention, it seems like the patient really has to take anactive role in this whole picture. >> when we think about theimportance of optimizing function.

if we use any medical treatment,opiate or any other, it has to be in the service of optimizingfunction. and so we can create a quid proquo, a patient uses an opiate but also engages themselves inthe active pursuit of health. >> the bottom line -- there isno magic pill to manage chronic here's the take away, if you ora family member suffers from chronic pain. number one, you will likelynever be completely pain free. number two, you can't bepassive, patients have to take

an active role in treatment. and finally, chronic painmanagement requires a multifaceted approach. which often includes lifestylechanges as well as therapies for the mind, body, and soul. >> to learn more about chronicpain, visit our website at health.ideastream.org. there you will find webexclusive material exploring complementary and alternativeremedies for pain, including

massage and acupuncture. a report on migraines. view special content provided byour partner, net wellness, a consumer health website offeredas a public service from medical schools at case western reserveuniversity, the university of cincinnati, and the ohio stateuniversity. there is also a place to shareyour experience with chronic go to health.ideastream.org. watch, listen, and click.

♪>> funding for "body in pain" comes from the dr. donald j.

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