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Pain: It's Not All in Your Head - The Tests Don't Show Everything

by Jay Tracy PA-C, Psy.D., L.P.

143 pages; quality trade paperback (softcover); catalogue #02-0228; ISBN 1-55369-415-5; US$22.95, C$35.95, EUR23.40, £16.20

Pain: It's Not All in Your Head - The Tests Don't Show Everything can help you to understand what is right and wrong in your body, why you hurt, what can be done about it, and what to expect for the future.

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about the book      about the author      excerpts      catalogue info

About the Book You've been injured in a car accident or on the job. You are continuing to experience neck pain and associated headaches. You are worried about symptoms of numbness, tingling, weakness and pain in your arms and fingers. You are experiencing low back pain with radiation into your buttocks, legs and feet. You've seen a doctor or several doctors. You've had some tests that have come back "normal". You've tried several treatment approaches but have only experienced temporary relief. You are having difficulties keeping up at work. You have cut down on certain activities at home, with friends, or for enjoyment. You don't know what to do or where to go from here. You are irritable, frustrated, afraid and worried about the future. You wonder if you're going crazy and if others think "the problem is all in your head". DO NOT DESPAIR! THERE IS HOPE!YOU ARE NOT ALONE!THERE ARE MANY THINGS THAT CAN BE DONE. THERE ARE MANY ISSUES THAT NEED TO BE ADDRESSED. First of all, you're not crazy. You are a normal person. The sources of the pain are not "all in your head." They are usually in the body. Medical tests and technology still do not show everything. If the doctor says, "Your test is normal," just remember that the tests don't show everything . However, you are responsible for what is in your head. What is in your head affects how you recover. Information helps. No information confuses. Options help. No options make you feel trapped, imprisoned, tense and tight in your own muscles, thoughts, feelings, and lifestyle.

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About the Author Jay F. Tracy, PA-C, Psy.D., L.P.is a physician assistant and clinical psychologist. He is also an RN, registered nurse, and CCM, certified case manager. He was co-director of Rehabilitation Associates, Back and Neck Rehabilitation and Pain Management Program at The Minneapolis Clinic of Neurology, Ltd. in Minneapolis, Minnesota. He worked at this clinic from 1975 through 2001. He has also worked in the Department of Neurosurgery at the Veterans Administration Hospital in Minneapolis. He completed his doctorate in clinical psychology in 2000. His internship was at the Chronic Pain Program at Sister Kenny Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota. This is where he has continued working since mid 2001. He has worked closely with physicians, psychologists, nurses, physical therapists, exercise physiologists, vocational counselors, and various other allied health personnel in caring for patients dealing with pain and other neurologic problems. He has authored many articles and lectured widely on these topics.

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Excerpts

Table of Contents

Introduction
13

Chapter 1:Normal Anatomy and Physiology
25

Chapter 2:Abnormal Conditions
41

Chapter 3:General Ideas About Pain
69

Chapter 4:Types of Pain
83

Chapter 5:Chronic Pain
89

Chapter 6:Commonly Asked Questions and Answers
107

On Second Thought
139

About the Author
143

Frequently-Asked Questions

If he can go to a play or do some other recreational activity, why can't he work more hours? If the person can ride a motorcycle, why can't he work?
    Each person's medical problem is unique. Recreational activities are very important for almost everybody to help maintain mental health. Recreational activities are good for stress management. Each person's job, the physical and emotional demands and responsibilities, and each person's abilities are unique. A person may be able to perform certain recreational activities but be unable to return to a specific job that involves activities that are outside of certain limitations for safety and comfort. Sometimes riding a large, well-cushioned motorcycle can be much easier than a job that involves heavy lifting, standing or bending repetitively for extended lengths of time. While all of these factors have to be considered, simply because a person is trying to maintain some recreational activities, does not automatically mean that he or she can work more. Return to work depends on the specific activities and demands of the job along with specific medical limitations and restrictions.

I've been to several doctors. One tells me this, another tells me that. They can't agree and I am in between.
    Such differences of opinion are often the case in trying to diagnose and treat certain medical problems. One doctor's medical opinion may differ from another physician's opinion. As in any area of life, two people looking at the same problem can view it in different ways. Also, tests can be interpreted differently. The same CAT scan films or MRI films, for example, could be read by three different radiologists with three differing results. Each person dealing with long-term pain must find a physician that he or she trusts and respects. Second opinions are fairly common and standard procedure in cases of surgery or difficult medical problems. Often the patient will need to work on treatment approaches that make sense to that person. Knowledge and assertiveness may help the injured person to be more in control. Also to look for areas of agreement or overlap in the various opinions can be helpful.

If I just didn't have this pain or if they could just fix the pain problem, I wouldn't have all these other emotional, financial, relationship, vocational and recreational problems.
    Most likely, this is a true statement. Sometimes, however, in reality the person did have significant life difficulties before the injury. Let us consider that the pain problem comes first and the other problems secondarily develop because of the pain. It is of interest to know that these other psychosocial problems and resulting stresses can actually worsen the pain. Pain is worse when one is depressed or more tired. Pain is worse when one is not sleeping well. Anger and anxiety tend to make muscles more tight. Therefore, working on the other problems and stresses can sometimes lessen the pain.

What about diet and pain control?
    Dietary and nutritional information is often controversial, unclear, and unproved scientifically. However, some very good ideas, all of which have some basis in fact are presented. At least four obvious ways in which nutrition and eating habits can influence the health of your back, including the spinal column and its supporting muscles and connective tissues are: 1. Your weight (ideal versus overweight). 2. Vitamins, minerals, and nutrients which are necessary to build and maintain strong bones and connective tissues. 3. Excessive consumption of sugar and/or animal protein which can rob the body and bones of vital nutrients. 4. General physical health and stamina.     Let's examine these areas in more detail. Overweight often leads to poor posture, both of which cause excessive strain on the vertebrae and supporting tissues. This strain can contribute to muscle fatigue. The excess load of body weight the back must support can easily pull the vertebrae out of alignment when doing very little activity. This, of course, can be worse when the body is subjected to a stress such as lifting, pulling or twisting. A healthy back in good condition should more easily be able to withstand the stresses of daily movements as long as the movements are not excessive. When one's back has already suffered a strain or injury, such as from an accident, any overweight or poor posture places an additional burden on already tender and weakened back structures. Eating out of boredom is one of the primary reasons for compulsive eating, poor nutrition and overweight. Many people use food as a crutch to protect themselves from emotional or physical pain--a way to "forget"for a while.
    Another cause of overweight is nutritional deficiencies due to consumption of refined, denatured foods, which disrupt the appetite mechanism, resulting in overeating. The body craves the nutrients which it lacks to function properly and this signal is misinterpreted as hunger and food cravings. Eating a proper balance of whole foods containing all the necessary nutritional elements will help to normalize the appetite. An adequate intake of certain vitamins, minerals, and nutrients are necessary to build and maintain strong bones and healthy connective tissue structures. Calcium, magnesium, and phosphorous must be supplied in the proper balance together with vitamin D which aids in the assimilation and use of these minerals in the body. When too little calcium is supplied, minerals are withdrawn from bones, causing decalcification, and porous and fragile bones. A calcium deficiency can also lead to nervousness and muscle cramps and spasms. Lack of magnesium can cause muscle weakness.
    Some back problems are caused by disintegration and weakening of the vertebrae and connective tissue of the back. Vitamin C is essential to the formation of collagen, which holds body cells together and is concentrated in connectivetissue, cartilage, and body ligaments. This vitamin can help rebuild these tissues to increase back strength and allow a return to a more active life. Adequate calcium is also necessary to help in the formation of collagen.
    A lack of vitamin E can cause weak muscles and poor posture, leading to pressure on the nerves of the back, and back pain. Bone porosity and calcium migration to deposits in the soft tissues ("bone spurs")can also result from a vitamin E deficiency. An adequate intake of vitamin E also increases physical endurance due to more efficient oxygenation of body tissues. Other nutrients which are especially important for the health of the back include manganese and adequate dietary protein. Excessive sugar consumption distorts the calcium-phosphorous relationship in the blood, causing a calcium imbalance. This may result in brittle and easily fractured bones. An overconsumption of meat robs the body of calcium, magnesium, niacin and vitamin B6. Beef, which contains 25 times as much phosphorous as calcium, can cause calcium and magnesium deficiencies. Processed, refined and denatured foods also rob the body of vital nutrients. Emphasis on eating mineral-rich "whole"foods will provide these necessary food elements.
    Besides these specific factors, proper nutrition is essential to promote general health, improve body strength, and increase endurance and resistance to disease.

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Catalogue Information

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