The Problem of Pain

This family caregiver were so glad that you with this hope the caregiver.calm caregiver.com. I have the opportunity journey and I'm always looking for ways to address a topic that affects so many of us as caregivers in one of those is pain, chronic pain, trauma, physical pain, all the things that go on when you deal with the kind of issues we deal with this caregivers. Most of you will know that my wife had a horrible accident when she was 17 to 1983.

Her body is an orthopedic train wreck and we talked with a lot of pain doctors over the years into this last surgery. She had one of those came into her room and we got to talk a bit and I was so moved by the way he approached her pain and how he interact with her and I've dealt with a lot of pain specialists since I met my first one in 1990 and 1990.

So that is how to give you an idea of how far back I go with this and this gentleman was just here. It really was extraordinary to watch him work and he had a whole bunch of residents in total with them and they're all taken notes and they came in the room and we just started to have these amazing conversations and I watched how gentle and tender he was with Gracie and an understanding and yet he was just bubbling.

He loves his work and so I wanted to have a mother program. This is Dr. Roland florescent he is at the University Colorado Medical Center, and he deals with his professor, pain management, acute care and and so I wanted just to introduce them to you all and let's have a dialogue so that you can understand a bit more about the story some of you are just now stepping into the world of chronic pain and I want to give you as much information as you possibly can so that you can navigate this a little calmer, it is not just the loved one that is in pain. Pain is a part of your life you're dealing with a chronic pain patient. There are multiple things going on and if we don't prepare herself for if we don't educate ourselves. It's going to take us under the duck forest. Thank you very much for taking the time with this. I really do appreciate it. Before we get too far down this road. I know the sales very fundamental very basic but share with us the difference between acute pain and chronic pain and how pain management teams approach those two different types of pain shirt so I think when I got started in the garage now going on almost 15 years ago there was a much larger differentiation between chronic and acute pain, chronic pain, as it is been traditionally defined as a painful condition that goes on for six months or more and cute and acute pain falls into the category. Essentially, pretty much everything that is not that the way I kind of go about it a little is that if you've been blown up, run over, stab shot had a difficult surgery some kind of injury or surgical trauma, then my team. I acute pain team is who is called to help manage that type of thing.

I think what has happened in black, probably decade makeable glasses that those lines have been blurred a little bit and what my practice now what I kind of see predominantly what I tried to focus my attention on is acute pain in the chronic pain patient someone who had a painful condition again before something happened to them, whether that's injury or surgery and and how those two things now interact with each other and so that's kind of my point of view like what what I specialized in the way that we approach that is the kind of figure out what happened to this patient. Initially, what is there chronic pain problem with chronic pain issues.

How has that been managed long term and then how this new traumatic event kind of fits into that whole picture. That's what really impressed me is because when you commit jealously doctors a keen and hot with Gracie and Saul. She's in pain. Okay, we just throw this brick of drugs that are to cut a get a pain but not not really understanding that this is a woman who's lived with pain now since Reagan's first term and she's had to work out some of that in her own mind and embodied everything else and you can't just jump into this parachute into this without understanding that kind of history and the way you approach this was what really touched my heart because I thought okay fine here somebody who speaks this language you get this and you guys came with this multimodal approach, which I thought was so effective with her, recognizing that okay there's no way we can take all of this away from grace.

There's no way that we can fix this problem.

But what we can do is better equip her to navigate through this and I thought, man, this is something we need to talk about on the program initiatives.

What would you like if you had your wish list. What would you like for every caregiver of a chronic pain patient to know that's a big big question understand it is a big one. You had your wish list… What would you like with the metal you know it.

It's kind of funny when I think about that a little bit. The first thing that popped into my mind actually is that I I need your help.

It's almost impossible for me to help people in these situations without the help of their family and friends become of the people that know them best and thought I really think when I can approach the situation. The thing I need most of for this to be kind of a team effort and I and I realized a lot of times when I meet patient that I meet their families and their caregivers for the first time. This is this is an incredibly stressful situation either something horrible has happened again some kind of verbal injury or a very difficult surgery very difficult diagnoses and so I'm meeting them at a very vulnerable time. Many of them have seen other pain management specialist have a lot of other specialized care kind of working for them but have some preconceived notions about what I do, how I can approach their loved ones of the person they're taking care of and I think one of the very important thing is that there's a lot of stigma. I think surrounding chronic pain management of chronic pain and that that the thing I really need from caregivers and from the people who know these patients. That is to really know everything that's happening that has happened for this patient, the things that work the things that haven't other side effects of treatment, how they dealt with certain for deletion from ecologically emotional and I think what I really want people to know is that I really want and need their help. I it's impossible to treat their loved ones. If I don't know everything. The only way that I can know everything is for us to work together. This is so important you right was so stressed about the situation and I member solely times when I would just go into a panic trying to get Gracie out of pain or talk to the doctor put pressure on do this, this, this, and I was I was just in a freefall state of panic because I never seen anybody in the kind of pain she was in its audit heaven expressing to teach me this a music school and so I had to learn I had to slow down, slow my heart rate down little bit and learn to speak a little bit more calmly and understand the process.

We didn't get here overnight were not to get out of this overnight and we may not get out of it at all, but what we can do is get through it and and and walk through it without having you a panic attack in it. I appreciate that very much of do that and I wanted people listen the show to understand that it is okay to be involved in this but it's okay, but was start off by having clarity of thought and being able to explain the patient history and all that comes stuff. What are some pitfalls that you would like. Families of pain patients to avoid some some real danger areas for the sheriff. I think the most probably the most difficult thing is when patients and their families come in with preconceived notions. Preconceived kind of a feeling of how things will have to go. I think that I'm every patient is different, every patient, kind of had their own idiosyncrasies and in terms of managing their pain and so often times they come with an idea of how things have to be certain management strategies. Certain ways that their approach store when a party to caregivers how their loved ones are approach it and I think what I'm what I would want people to know that we have so many different ways of tackling the issues that their family member or loved one is going through that, at least from the beginning kind of try to hear us out. Kind of credit fee is the ideas that we have kind of fit into the notions that they have about how they should be cared for how their loved ones should be cared for and I think more time, more often than not, what we find is that we actually are probably more on page about these things that and then goes preconceived notions which would allow them so I think that's probably one of the biggest pitfalls in terms of management. I imagine I don't have to tell your listeners this but the other part of this to the greatest pitfall of this we talk a lot about this. The medical training, but this is this is a marathon. These things that the issues that the people you're caring for going through many of them are not going to be salt overnight, that they may not ever be solved and so I'm what we can hope for. Many times is to improve people's quality of life to improve how their recovering from surgery or clinics, but that these things obviously are ongoing. They are long-term, month, week, month in years, if not forever, and so you have to take care of yourself and I imagine what you talk about this a lot but take care of yourself along the way. Marathon otherwise you just never going to be able to. You're lucky to be able to do your best to help manage the care of your family and so to really not let everything else go by the wayside as you're helping your family member your loved one out to make sure that your no self-care that you are managing your own life as well as you can, otherwise I don't know that that you can help your loved one is much as the wise words in this is the core message of this program healthy caregivers make better caregiver supports just that simple and and so you can bear with me for one more segment here you go to break in just a minute but I wanted to address that issue because this is an issue. I think that a lot of caregivers trip to that okay to see to our own emotional, physical, financial, special help. After all, the better. But we cannot wait to get better or worse to deal with the realities and also want to address impact of pain that is not just localized in that patient that it is part of every part of your life. If your relationship with the patient. Dr. Bowman, florist. He is a professor acute pain management versus Colorado Medical Center. He has my eternal gratitude Misty Roseburg will be like this is the program is a family caregiver. Hopefully caregiver.com that is my wife with staff on her CD, resilient, and the man who is been instrumental in helping her get back to that place. She's going to get back to singing in the studio is on the phone with me. Today's Dr. old Florida sees it acute pain specialist University Colorado Medical Center, and he's no longer treating Gracie that because she's slowly transitioning them to the chronic pain component of what she's going to be doing, but we met right after her surgery and I was fascinated by his approach by his enthusiasm. This is a hard field pain management is no easy place to go to as a physician because you're around very difficult things all day long and you can't solve a lot of the things you can help them. You can equip them. You could fortify that you can ease them but you can't solve it. You got to learn to to work with very high stressful situations and so I wanted to have this conversation with him today for your benefit, so that you can hear from somebody who was at the top of his game of dealing with this very painful issue difficult difficult things to talk about with patients and their families. And yet, okay, how do we do this because this caregivers this is our world so that divorce I just want to jump right back into something that you were addressing before the break about we caregivers learn to deal with this and what discouraged me and I and I've really been on a mission with this is that for so many years.

A lot of doctors through so many opioids at Grace try to do with her pain management. Turns out she didn't need to Smitty as they gave.

She did need a fraction of that she needed a different approach which we been working on for some time now, but they through all this, and during that time and I fill prescriptions.

This of this will horrify you, but I fill prescriptions of seven figures worth of prescription opioids with her over a period of time and not one Dr. not one nurse that one pharmacist ever said to me hey were putting a lot of behavior altering chemicals into your wife's body you might want to think getting some help for yourself and I and nobody ever said so I didn't know and edit it cost me to go into a dark place as well. And so that's what I'm trying to introduce this concept as best as I can to listeners to people to fill caregivers to help understand okay look if you're treating somebody for chronic pain and there are any kind of behavior altering drugs. Whether his benzos. Whether it's opioids whenever step back a little bit and see Some places for yourself to get some help some counseling some support groups recovery programs like Al-Anon or whatever, does whatever wherever you find people who are wrestling with something they can't control, and learning to live with it peacefully. That's a good place for you to go find some help and are you seeing that with family members along your journey that that that there there themselves so torqued up that they can't hardly function very well difficult that sometimes I might go okay on on the patient.

I think you know you hinted at something that I think is really important. Talking about certain classes of medications and how they affect people psychologically and affect people emotionally. I think we have to really be cognizant of the fact that obviously people who are suffering from chronic pain and chronic debilitating pain have a high incidence of depression and anxiety that is related to an associated with back pain and the suffering that's associated with that and that thump. Sometimes these medications can complicate those issues.

Sometimes people had those kinds of issues before what whatever caused their chronic pain and so I think, no I don't get that often in terms of kind of how family members are are helping themselves, but hate I do see it again. I only snapshot of that but I think complicated relationship that obviously we all have complicated relationships with each other but you see some of the conflict is maybe too strong of a term, but the interactions between people who often times are both suffering in different ways of the patients are suffering because of injury and surgery and difficult diagnoses and I think that caregivers are suffering from a feeling of helplessness and hopelessness watching their family members suffer as you just explain kind of an almost unimaginable way and I think that we again kind of dual ourselves, and I think of myself as a caregiver, but in a different emotionally different way we do ourselves caregivers a disservice when we ignore how these very difficult relationship can be for us to handle and I think that those things can manifest as pathologies in our own lives on that are completely separate from what's going on with those that were caring for and I think later that week. We ignore those problems to our to our detriment and you betcha something less like a will also touch base on we caregivers often feel unqualified to even have a conversation. Sometimes we get very intimidated by the.

The brainpower that can come into our loved ones room and it is we don't speak the language were not scientists were just somebody who loves somebody who was hurt and I have said for some time that we as caregivers need to recognize that we have what I call caregiver authority. I don't know the science of all the stuff that goes on with my wife but I know her and we can't speak to that and we can provide a historical context to anybody who's treating her, particularly when it comes to chronic pain and so and I would encourage those are out there right now to to make note of that that that that you have caregiver authority and it's okay to wield that in an appropriate way to say, look, here's what I've witnessed. Here's what I've seen, here's what I've experienced.

Here's what I've watched her or him go through and and these are things that will be extremely helpful to your physician about a pivot just a second here but can you to this topic.

Can you talk about this new study that's out on the long-term cognitive effects of of benzos, benzodiazepines, aspirins and what we as caregivers may need to watch for submissive or do you do you put a lot of stock in the I don't know the study that you're talking about specifically, but but I do think about the long-term sum of these kinds of medication, benzodiazepines, opioid other classes of medication they have affects that go beyond pain management and sometimes we talk about ways that I'm kind of in a technical way we talk about it in an allostatic reset button that no patients who may take benzodiazepines for anxiety may find that later in in their treatment that they have more anxiety that patients who undertake opioids for pain management may find that later on they have more pain and and I think these are our difficult kind of side effect of incredibly important and useful medication, and that we long-term use of the medication may have asked that I'm we are beginning to kind of be that picture more and more in in those patients and we really do need to kind of watch out for the long-term cognitive effects of many classes of drugs. Meet me now even with an anesthesiology talk about the long-term cognitive effects of anesthesia type drugs on patients and so these are not without know that often times many of those medications are used for the short-term management of certain conditions and that the side effects of their of their use for the long-term management may be an intolerable either to a patient or to those around them and that those kind of those issues require a lot of exploration for both us and find them. Will I want to address the subject, not just there. What we need to watch and revisit some of these things and please understand this to, but to the listeners here. Please understand that when you're dealing in this world. It's not a one and done kind of thing where okay we got this. This is the tract were to be this way and for decades and years of will just just to maintain the sinks need to be revisited. You're dealing with this kind of trauma or this kind of significant pain issues. They need to be revisited often and have those conversation enough.

Okay, do we need to tweak this to move this, whatever. And this is where we as caregivers can come into play because were observing this love one all the time in and out so I wanted to close up with this last question to you is what type of questions would you recommend that patients and caregivers have when they meet with their care team. Other patient care team and this is only got about a minute or so, but what what submitting questions are something you might want to have them write down very important part of it, but I think a lot of patient and a lot of caregivers what they really want to know is what the plan. What are we going to do right now if that works. What is going to be the next step in the next step in the next step because like that. I think that there is a lot of people coming would put preconceived. Most notions they come in with him again. Feelings of helplessness and hopelessness and I think what many people want is a plan and what the ABN fee is going to be in effect does the work what the X, Y, and Z is going to be in the timetable for that plan kind of when to expect results when to worry when not to worry, to really get a feeling that the person who's helping them that medical director is helping them and have an idea of where to go on in and have some options for the me other thing that I think really helped a lot of people feel more comfortable in the situation that I think both for caregivers and probation is who is going to be available to my loved one while they are here if they're having a real problem. Having a pain crisis of having a psychological crisis if they feel like they need help, and especially kind of the strange hours of the day at night and on weekends and during holidays on the quizzically, who's going to be able to visit them, evaluate them, manage them and and what is the plan for that. I really think that when maybe we don't necessarily have all of the answers but if we have a plan. We have options we have possibilities and some of that feeling of hopelessness. Some of that feeling that no one has heard them and figured out how to help manage that some of that anxiety can be as a people, said Bill Sadler at a time on this. I want you to know how much I appreciate this. You really give me a solid on this, so thank you for calling the doctor over Florida's University, medical, and he has brought so much insight to me through this journey with Gracie, and I thank him for today for spite. Mr. Rosenberger hopefully caregiver.com will be right back. Some of you know the remarkable story of Peter's wife Gracie and recently Peter talk to Gracie about all the wonderful things that have emerged from her difficult journey.

Take a listen Gracie. When you envision doing a prosthetic limb outreach. Did you ever think the inmates would help you do that, not in a million years. When you go to the facility run by core civic and you see the faces of these inmates that are working on prosthetic limbs that you helped collect from all of the country that you put out the plea for and their disassembly sell these legs like what you have your own prosody and arms and orange everything when you see all this makes me cry because I see this miles on their faces and I know I know what it is like someplace where you can't get out without somebody else allowing you to get out me in the hospital.

These men are so glad that they get to be doing is one thing said something good with my did you know before you became in a PT that parts of prosthetic limbs could be recycled and had no idea I thought Peg leg. I thought a wooden legs. I never thought of titanium and carbon legs and flexibly the legs and all that. I never thought about. As you watch these inmates participate in something like this, knowing that there helping other people available providing the means for the supplies to get over there. What is it do to you. Just on the heart level. I wish I could explain to the world. What I see in here and I wish that I can be able to come and say the this guy right here in East Africa with that. I never not feel that way out every time you know you always make me have to leave. I don't want to leave. I feel like I'm at home with them and I feel like we have a common bond that would never expected that only God could put together.

Now that you've had experience with it what you think of the faith-based programs.

The core civic offers. I think there is absolutely awesome and I think every prisoner out there could have faith-based programs because the return rate of the men that are involved in this particular faith-based program and other ones like it, but I know about this one car is an amazingly low rate compared and I think that is that is with me just has something to do with God broken people want to donate use prosthetic live with a loved one who passed away or you somebody well-groomed you donated some of your own for the data out of the please go to staining with.com/recycle gain. We