Creating a New World of Understanding Concerning
Chronic Pain Management

I am attempting to create a new world of understanding to better educate the public, but more importantly medical personnel, insurance companies and third-party payers, as well as judges and lawyers, that viable, cost-effective pain management programs are currently available, but seldom utilized. Hopefully, a better understanding of chronic pain management will provide a basis for more favorable consideration, so instead of continuing to depend on costly "fixes" supported by the medical model to provide a "cure", chronic pain sufferers will be referred to psychologists trained in pain management and/or to proven behavior modification programs.

THE IMPORTANCE OF
DIFFERENTIATING BETWEEN
ACUTE AND CHRONIC PAIN

Acute and chronic pain may occur independently or concurrently. Therefore, when people do not appropriately differentiate between the two, major confounds (evident or unknown interactions) can influence the perceptions that people develop. In other words, invalid conclusions can result from insidious factors that can often remain unnoticed, but persist to affect interpretation of the behaviors being observed. This fallacy applies not only to the interrelationships between treaters and patients, but also to almost everyone who relates with chronic pain patients (spouses, children, other family members, coworkers, friends, acquaintances, etc.). Therefore, it seems appropriate to define some of the unique features of acute and chronic pain with which they may not be familiar.

Acute Pain:
SENSATION OF PAIN attributed to disease, injury, and/or a medical or surgical procedure. Usually resolved using medical interventions. SERVES AS A WARNING that something is wrong and ALERTS SUFFERER TO TAKE NECESSARY PRECAUTIONS to reduce or prevent further harm or consequences.

Chronic Pain:
Distinctly different from acute pain. Type of pain resulting from the PERCEPTION OF DISCOMFORT that continues to persist after the period of time when normal healing would reasonably have been expected to occur. CAUSATION MAY NEVER BE IDENTIFIED and A VIABLE PURPOSE HAS NOT BEEN IDENTIFIED to explain the experience of chronic pain symptomatology.

Can such dissimilarities, when not identified or considered, alter consequential conclusions affecting the most appropriate mode of pain care delivery? What can happen if medical practitioners rely upon acute pain treatments when attempting to provide care for chronic pain patients? Could these sufferers be required to undergo numerous acute pain regimens that are inapplicable to their conditions? If so, doesn't it become vitally important to distinguish between acute and chronic pain prior to initiating treatment modalities? Likewise, can't decisions based upon inadequate diagnoses also adversely affect interpersonal relationships?

PAIN MANAGEMENT

The act, manner, or practice of managing pain; handling or control of an unpleasant sensation occurring in varying degrees of severity as a consequence of injury, disease, or emotional disorder.

Although the "medical model" is mandatory for dealing with acute pain, it produces little success in helping people to deal with chronic pain. When acute pain modalities fail, practitioners tend to discount patients' reports of pain because a viable source for continued perception of their pain can not be found. In turn, patients are dealt with as if their pain is not "real", it is "in their heads", and therefore, they have a psychological problem causing them to be in pain to "fill the patient role" to achieve some form of secondary gain. Consequently, patients are not referred to psychologists early in the process. The "mind-body model", on the other hand, helps them to learn how to better deal with their emotions regarding a loss of functioning, to more effectively cope with life circumstances, and to become self-sufficient in applying pain management techniques. Instead, psychologists are not normally consulted until all medical procedures have failed to identify causation or to provide relief, and all other options have been exhausted. This leaves chronic pain sufferers with a feeling of being totally helpless and hopeless, which further challenges their ability to cope, especially when almost every facet of their lives has been changed by the experience of persistent, nagging pain, they have been told that a "fix" does not exist, and this pain is "in their heads". Is it any wonder that these individuals become irritable, angry, and difficult patients, who in turn, suffer anxiety and depression?

Pain management techniques, are best developed when presented to a diverse group of people who suffer from chronic pain. "Common ground" is established, a greater willingness ensues to help each individual better understand certain principles, and all involved persons are able to established improved dialogs.

This can be best accomplished in group sessions presented weekly to address these areas. Participants can develop a better understanding of the lifestyle changes necessary to enhance their personal control of pain. Activities should be assigned at the end of each session to allow group members to practice what they have learned to do. Thus, they develop the "HOW TO" and "CAN DO". In turn, become motivated to develop a "WILL DO" attitude toward producing individualized programs which can result in lasting habits to manage their pain levels and improve their functioning. Brief weekly reports, presented at the following session, should describe practice successes and/or setbacks. If participants desire to achieve greater control over their chronic pain, and in turn, improve the quality of their daily lives, a positive attitude must be developed as the basis for assuring them that they can make changes. Only then will they become sincerely committed to follow-through. A successful program will require each participant to look inward, focus upon what they "CAN DO", and to discontinue the practice of placing total emphasis upon looking outward for a "cure".

CONTROL:
INTERNALIZED
VS
EXTERNALIZED

When management of chronic pain is to be seriously considered, sufferers must assume that the pain will continue at an equal or greater level unless they take personal control of their lifestyles and establish an individualized system for coping with their pain. In no way is this statement intended to advise people that they should discontinue hope that their pain will either become less severe or cease to exist. Nobody can provide a concrete prognosis as to how long a person may suffer pain. However, sufferers need to establish and practice successful pain coping techniques to better manage their pain level while awaiting the granting of that wish. To motivate them to make such changes in their current lifestyles, sufferers need to take that first step in taking responsibility for managing their chronic pain by developing a positive "I NEED TO, I WANT TO, show me "HOW TO", so I CAN DO, and I WILL DO" attitude. The majority of chronic pain sufferers have the "NEED TO" and "WANT TO", but focus upon what they "CAN'T DO" rather than on what they "CAN DO" because they are unsure of what to do.

Many have been told to "deal with it", but have received little or no guidance on how to do so. Unfortunately, to receive whatever limited benefits that may be available, society expects them to fill the stereotypical pain patient profile. Consequently, even when they have a desire to "get on with their lives", they either maintain a sedentary or disabled role. In turn they lose their ability to support themselves and their families and become dependent upon society. Thus, those involved in the practice of medicine, insurance companies and third-party payers, the legal system, and other involved agencies need to revise their philosophies concerning the treatment of chronic pain. As long as chronic pain patients are expected to be "handicapped" to receive benefits, they will maintain a "CAN'T DO" attitude and be unwilling to even consider developing and implementing a program for taking personal responsibility for their pain management. They must be not only allowed, but be encouraged, to project a positive "CAN DO" attitude to begin doing those things within their capabilities. In turn, they can acquire the "WILL DO" attitude necessary to learn new coping skills, to make changes to develop a more healthful lifestyle, to follow-through, and improve their level of functioning to again become an asset to themselves and a productive member of our society.

Thank you for investing your valuable time to review my opinions!

Currently working on the following manuscript:

TABLE OF CONTENTS (draft)

ATTITUDE, THE SELF, AND OTHERS
1. What's In It For Me
2. Why Most People Seek Help
3. The Futility of Over-control
4. Identifying Current Patterns
5. Developing a "Can Do" Attitude

ATTITUDE AND APPLICATION
6. Identifying Stressors and Stress
7. Developing Relaxation Techniques
8. Sleep Cycles and Improving Sleep Practices
9. Establishing an Exercise Regimen
10. How Endorphins Affect the Psychophysiology of Pain
11. Changing What We Consume
12. Developing a Personal Pain Management Plan

Hopefully, this work will assist all persons involved in dealing with the management of chronic pain to develop "CAN DO" attitudes. Dialogs should be enhanced between chronic pain patients and any other persons involved in the processes of treating, making payments for, and litigating cases relating to such pain. Patients, who are motivated to take personal responsibility for managing their chronic pain and improving functioning, embrace a reduced need to utilize healthcare facilities and to appear disabled. Likewise, treatments focusing upon utility can become more cost-effective. Improved diagnoses, treatment plans, and patient compliance can result in better outcomes. Thus, it is possible for all involved parties to experience a "WIN-WIN" condition.

FOCUS OF INTRODUCED IDEAS

A positive orientation can be expected when readers begin to focus more upon "wellness" and less upon the "illness" or medical model. Concepts are based upon COMMON SENSE. Positions presented herein were derived from personal experience or "real world" situations where improved communication and motivation resulted in the development of "CAN DO" attitudes. Many have not been supported by any empirical (scientifically based) research. Thus, researchers are highly encouraged to either support or invalidate presented data in order to expand scientific knowledge in the area of chronic pain.

METHOD OF PRESENTATION

Practical terms will be the norm to ensure a level of communication acceptable to most persons. It is intended that laypersons as well as learned professionals will be able to develop a "common ground" to enhance their understanding of each other. To provide greater emphasis, and to further amplify "what this author really meant to say", additional clarifications immediately follow erudite (scholarly) terms as shown in the parentheses hereinabove. "HOW TO" scripts will not be provided. Instead, questions are asked to arouse curiosity to encourage readers to ponder, possibly agree with, and even consider adopting some of the presented concepts.

CREDIBILITY OF DATA

I am a chronic pain sufferer who became extremely dissatisfied with received care. In the 20+ years since my accident, I have endured almost every possible medical protocol identified as a viable chronic pain treatment. Unfortunately, none successfully relieved my pain.

I was required to develop a sedentary lifestyle so as to limit additional damage or injury. Nothing further could be done. I received the "disabled" label which precluded me from most forms of employment. Because medical treatments had not produced expected results, I was treated as if the problem was my fault. I was told that either it was "in my head" or that I maintained a "patient profile" for secondary gain purposes. As a result, I was totally frustrated with the healthcare field, became argumentative with almost anyone who insinuated that I should be getting better, and was irritable with just about everyone else, thus displaying the expected stereotypical pain behavior. I can truly empathize with others who have become victims of an iatrogenic process (complications induced in a patient by a physician's activity, manner, or therapy, and/or the unfavorable responses to medical or surgical treatments that result from delivery of such care, itself....medically created).

After feeling sorry for myself for 1½ years, I decided to "get on with my life", and pursued a doctoral degree in Health Psychology and Behavioral Medicine, with primary emphasis upon Pain Management.

Sincerely,

Harold A. Rumzek, Ph.D.

Ph.D., Health Psychology and Behavioral Medicine [August 1997]
University of North Texas, Denton, Texas

M.S., Psychology [December 1993]
University of North Texas, Denton, Texas

M.A., Communication [May 1982]
University of Oklahoma, Norman, Oklahoma

B.S., Occupational Education [September 1976]
Wayland Baptist University, Plainview, Texas

INTERNSHIP & POSTDOCTORAL TRAINING

Research & Education, and Psychiatry Department [January 1998 - January 2000]
Scott & White Hospital & Clinic, Temple, Texas
- Postdoctoral Research Fellow
- Adult Outpatient Therapy
- Hypnotherapy
- Pain Management Relaxation, Autogenic Training, and Imagery Instruction (Passive Biofeedback)
- Pain Management Group Therapy
- Rehabilitation Management Team

Pain Management Intern [October - December 1996]
Mid-Atlantic Center for Pain Medicine, Charlotte, North Carolina
- Full-Day; and Intermediate Six-Week, Half-Day, Twice Weekly Pain Rehabilitation Programs

Clinical Psychology Intern [September 1995 - September 1996]
Carolinas Medical Center (CMC), Center for Mental Health, Charlotte, North Carolina
- Primary rotation, Center for Mental Health, Adult Outpatient Therapy Department
- Primary rotation, Charlotte Institute of Rehabilitation, Spinal Cord Injury Treatment Teams 1-4
- Minor rotation, Center for Mental Health Psychiatric Emergency Room
- Minor rotation, Charlotte Institute of Rehabilitation, Rehabilitation Advantage Rehabilitation Programs
- Minor rotation, Center for Mental Health Adult Outpatient Assessment Team

PRACTICA

Department of Physical Medicine at the Health Service Center of Arlington Memorial Hospital [Fall 1994]
Arlington, Texas
- Work Hardening (Active Biofeedback)
- Pain Management Relaxation, Autogenic Training, and Imagery Instruction (Passive Biofeedback)
- Pain Management Group Therapy

Psychology Clinic at the University of North Texas [Fall 1993 & Spring 1994]
Denton, Texas
- Adult Assessment
- Adult Therapy
- Pain Management Relaxation, Autogenic Training, and Imagery Instruction (Passive Biofeedback)
- Coping with Stress and Smoking Cessation Group Therapy

Inpatient Pain Management Program, Dallas Spinal Rehabilitation Center, Inc. [Summer 1993]
Dallas, Texas
- Adult Assessment
- Pain Management Relaxation, Autogenic Training, and Imagery Instruction (Passive Biofeedback)
- Pain Management Group Therapy

Psychiatric Department, Texas College of Osteopathic Medicine [Fall 1991 & Spring 1992]
Fort Worth, Texas
- Adult Therapy
- Pain Management Relaxation, Autogenic Training, and Imagery Instruction (Passive Biofeedback)

RESEARCH

Post-Doctoral Research:
- Early childhood diagnoses and later risk for multiple attempts. [1998]
- Predicting response to treatment for suicidal behavior. [1998]
- Online Therapy and Telehealth: Promises and Pitfalls Reducing the Risk of Mental Disorders: Psychology, Practice and Knowledge. [1998]
- Research Grant: Standards of Care: Assessment of Suicidal Risk. [1999]

Dissertation Research:
- Does Unemployment Become a Major Stressor in the Evolution of Chronic Pain? [1996-1997]

Graduate School Research:
- The Viability of Dynamic EMG Measurement in Diagnosing Chronic Pain: An Evaluation of the Utility of Cluster Analysis. [1994]
- Diagnosing Chronic Low Back Pain: Can Surface Electro-myograph Activity Provide Viable Data? [1993]

PUBLICATIONS

Peridicals
- Rudd, M., Joiner, T., & Rajab, H., & Rumzek, H. (1998). Early childhood diagnoses and later risk for multiple attempts. Journal of Abnormal Psychology.
- Rudd, M., Joiner, T., & Rajab, H., & Rumzek, H. (1998). Predicting response to treatment for suicidal behavior. Journal of Consulting & Clinical Psychology.
- Rudd, M., Rumzek, H., & DelVecchio, T. (1998). Telepractice: Implications for clinical practice.

Dissertation:
- Does Unemployment Become a Major Stressor in the Evolution of Chronic Pain? (1997)

PROFESSIONAL PRESENTATIONS

- The Texas Psychological Association (TPA), 51st Annual Convention [1998]; Online Therapy and Telehealth: Promises and Pitfalls Reducing the Risk of Mental Disorders: Psychology, Practice and Knowledge. Elaborated on research data to assisted M. David Rudd, Ph.D., ABPP, presenter.

- Mental Health Center, Department of Psychiatry, Scott & White Clinic [1998]. Chronic Pain: A Complex Phenomenon With individualized Symptoms That Make It A Private, Personal Experience.

- Center for Mental Health, Department of Psychiatry, Carolinas Medical Center [1997]. The Role of Unemployment in the Treatment of Chronic Pain.

Your interest is truly appreciated. Should you desire a personal response, you can contact me via E-mail: hrumzek@sbcglobal.net

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Updated May, 2011

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