Chronic Pain and Memory Loss

From the Calgary Herald – Monday, May 21, 2007

Chronic Pain May Lead to Memory Loss

Study reveals shorter attention span in sufferers
JODIE SINNEMA EDMONTON JOURNAL, EDMONTON

When Deana Adams sliced her left hand on a sharp piece of steel at work more than three years ago, a doctor gave her four simple stitches, unaware that the nerve between her thumb and index finger had been severed.

The pain since then — zinging like a shock from an electric fence and running up her arm to her shoulder, neck and head — has been at times so severe it has affected her marriage, interrupted her sleep and stolen the good memory she prided herself in.
“I forget things really easily,” says Adams, 41, who works as a surgical processor at the University of Alberta hospital, sterilizing, decontaminating and organizing hospital equipment. “The pain takes over. It sort of just swarms in and says, ‘ Here I am, listen to me,’ and you want to do anything to relieve it.”

Adams’s memory problems are common among people with chronic pain, says new research from the University of Alberta.

Bruce Dick, a clinical psychologist at the Multidisciplinary Pain Centre at the U of A hospital, discovered two-thirds of people with chronic pain had some measure of cognitive impairment that shortened their attention span and made it difficult to remember things. Half of those people had significant memory issues, especially when multi-tasking.

“Chronic pain is something that is disruptive,” said Dick, whose research paper appears in this month’s edition of the journal Anesthesia and Analgesia. “Part of the rationale for doing this study is we have some fairly good medical treatments aimed at helping relieve pain. What’s more difficult sometimes is affecting the bigger picture of people’s lives, so trying to lesson the disability or helping improve people’s quality of life.”

Knowing that chronic-pain sufferers may have difficulty remembering certain details during their day, pain therapists may be able to develop new strategies to help patients overcome the gaps.

Adams works through her memory lapses with cue cards that list the intricacies of putting together full surgical sets at work. If she’s called away from a task, these notes keep her on track.

At home, Adams’s attention has also suffered. She used to plow through paperbacks in hours, but now picks up a half-read book and can’t remember the plot line. She forgets conversations and birthday cards she’s sent.

“Emotionally, when it first happened, I got depressed really bad,” she said. “When you’re in pain, you don’t want anyone to touch you. You don’t sleep. You don’t eat. You’re constantly on guard.”

Since then, she has cut back on her medication, but still takes 27 different pills throughout the day.

Dick hopes his study will provide “some validation for the people who suffer with these complex pain problems. It can be easy for a patient to jump to a conclusion that ‘I’m crazy.’ ”

Wow - a week of rest. How cool is that. I've been doing research for the play, interviewing two, three sometimes four people a week. It's exhausting...for many reasons. First of all, trying to fit this in around full time jobs is always challenging, just ask any of us on the Advisory Committee for this project...or for that matter, just ask any artist in Canada. Most of us work day jobs.

So what do we all do during the day? I'm glad you asked.

Dr. John Clark is an renowned and respected expert in the field of treating pain. He is the Medical Director for the Calgary Health Region Chronic Pain Centre. On weekends he is usually off somewhere presenting papers, giving talks, teaching...and sometimes I think he fits in a ski weekend.

Dr. Chris Spanswick, also a well respected expert in the field of pain management, who wrote the textbook "Pain". He is also the Medical Lead for the Calgary Health Region Regional Pain Program and an avid hockey fan.

Dr. Paul Taezner is a clinical psychologist and founder of the Chronic Pain Centre Pilot Project (with Dr. Pam Barton). He is also in demand and often off presenting or teaching somewhere in the world, while juggling his duties with the Calgary Health Region, the Chronic Pain Centre and seeing patients.

Terry Kane, though retired from traveling with the Calgary Flames, is still a busy man. He is a physiotherapist at the Calgary Health Region Chronic Pain Centre and also maintains a private practice. He also presents and lectures, as well as spending time with his family.

Hal Kerbes normally would be in Calgary running his company Shadow Productions, writing and probably acting as well. But this summer he is in Chemainus, BC, at the theatre festival. You can see him starring in two different plays if you're out there. Plus he's still juggling the writing and trying to do some research for the play as well. You have to admire someone who can learn two plays at once and actually say the right lines on the right night!

And me, I'm at the Calgary Health Region Chronic Pain Centre during the daytime, faithfully transcribing medical reports. At night, I turn into a writer. I am currently working on editing my sixth murder mystery (Kate Carpenter Mysteries), selling a medical thriller (Mind Games), finishing a novel about a mother and her two daughters (Finding Evangeline) and writing a play that has affected my life deeply.

So there, that's the first reason it's exhausting. And the second is the emotional impact. I find it interesting that I thought as I researched this I would be able to distance myself from the emotions. But I underestimated the power of the stories that I am hearing.

And I forgot that us writers are kind of crazy people too. These characters float around in our heads and sometimes they become very real (to us) and you begin to feel the emotions as if they were your own. I have been known to drive down the Deerfoot in tears, sobbing because I've just written a scene in my head where my characters from my murder myster series have had a huge fight. I've laughed out loud in very inappropriate places when I've come up with a funny scene. Now you know why some of those really famous writer's drank so much...coping with all these extra emotions from all these imaginary characters!

But seriously, again I want to thank everyone who has shared their stories with me so far, and I look very forward to hearing more as the summer moves on!

Counting Blessings

It's my birthday. Yep, the same week as Shakespeare and Carol Burnett and Barbra Streisand. It's a lot to live up to. And I'm now closer to 50 than 40, but I managed to get this far relatively unscathed. I've got four scars from surgery, nothing life threatening and no organs gone I can't live happily without. My bones are strong but I need bifocals. My skin is acting like it did when I was sixteen again - not a good thing. My knees creak and it's costs me an average of $40.00 a month to remain a natural blond.

But there is nothing wrong with me that a little primrose oil or Advil won't fix. And now that I have started doing research interviews for the play, I am incredibly thankful for that. I could have woken up from any of my surgeries with permanent pain, many have. My mom has migraines, I could have inherited that, most do. My knees creak but they still hold me up and take me through life one step at a time, and I can flex my neck and look up into the sky to make a wish on the first star of the night. Not everyone can still do that.

So I am thankful for everything I have. And I am amazed at the courage that people with chronic pain conditions show us. They have pain all the time, but they get up every morning, they face the day and they, too, put one foot in front of the other. And I'm sure they do it with less complaining than I do, most mornings.

I remember reading The Shell Seekers, and one of the children asked their mother how she was. She replied that she was breathing when she woke up that morning, so it was a good day. It's hard to be grateful for the little things, but I think we should all try hard to do so and let the people who are struggling with pain know how much we admire their courage.

And that we believe them.

Well, the pencils are sharpened and the project is underway. I'm pleased to announce that we are now well underway with interviews of both medical personnel and patients. And man have I learned a lot! It is astounding to hear the stories, from both sides of the fence, of these people who wake up one morning and their lives are changed.

Arlene Cox, a psychologist at the CPC, said "Imagine one morning you woke up with the worst pain you have ever had, and then imagine it never goes away." Doesn't that make you think? We think that pain is finite. That we injure oruselves or get sick, that we suffer pain, and then it goes away and life returns to normal. But what if it didn't go away? How would you get out of bed in the morning, day after day after day? And to top it off what if no one believed you?

So, when I ask the medical people I'm interviewing what they admire about this patient population, do you know what they say? Their courage and their strength.

Or what about a patient going through yet another medical exam, ten years later, because her insurance company still wants her to go back to work, even though all her doctors have said no? What about the patient whose coworkers say things like "well I had a headache yesterday but I came to work" or "you must have a low pain threshold"?

When I ask the patients what the one message is that they would like to see the play deliver, do you know what they say? Believe me.

Not cure me, or help me, or treat me or prescribe for me. Believe me.

Just imagine.

I have already laughed and cried over these stories, and I've barely scratched the surface. I just hope I can do these stories justice as we start writing the play. Hopefully, with the input of our great advisory committee, we can get there.

So - do you have a great pain slogan? (like instead of no pain, no gain; how about "no pain is the gain"). If so, put it in the comments. We're looking for some catchy ones.

Deb

Some interesting facts about pain

Here are some really interesting facts about pain provided by Dr. John Clark of the Calgary Health Region Chronic Pain Centre.

Pain is one of Canada’s most serious health problems. Pain impacts emotional, physical and psycho-social well being of individuals/ families; our health care system and our economy.
People with severe chronic pain are 4 times more likely to be hospitalized, are 6 times more likely to suffer from clinical depression, and require 4 times the number of medical consultations than people without pain. Inadequately controlled pain is a patient safety issue associated with delayed healing; and increases in length of stay, disability and suffering (CCHSA, 2003). Statistics Canada (2005) estimates a cost of $10,000 to $14,000 per year per patient to treat chronic pain and $12.5 billion in lost productivity.

Despite known best practices that adequately address pain, pain remains under-treated in three out of four patients (Brookoff, D.,2001; Chapman, 2004). Approximately, 26% of adult Calgarians (200,000) experience chronic pain, of which 3% (30,000) suffer severe disabling pain (CPHS, 2001). Due to the aging population, the number of people in Calgary and Alberta with moderate or severe chronic pain is projected to increase by approximately 20% over the next 10 years.

The Canadian Pain Society Waitlist Task Force recently concluded that there is deterioration in health related quality of life and psychological well if patients wait for 6 months or more for treatment of chronic pain and that measures should be taken to ensure that wait times for chronic pain treatment should be no longer than 6 months.

Are we there yet?

Do you ever just get so excited about something you want it to be done and over and finished and complete? Yeah, that's me. When I've latched on to an exciting project, with incredible support, I just want to go. Just ask Hal - who keeps talking about how grass doesn't grow under my feet!

But honestly, I want to take a moment to thank everyone who has emailed their support to us regarding writing this play. There is an incredibly large population of people out there in pain, surrounded by people who love them but don't understand what they are going through. We hope we can touch even just one of those lives.

If you have a story you're willing to share, please comment and let us know. We have several months of research ahead of us, both in person and via computer. But I know that from the amount of positive feedback we have received already, there are lots of people willing to help us.

And we will keep you posted as to how things are going and any new developments in this exciting new project.

Deb

In the beginning

There was an idea. There is always an idea. The problem is whether one can germinate the seed into something...be it a novel, a short story, a play, a TV show... The other problem is getting other people to believe in the idea.

Well, I had the idea to write a play about chronic pain. It's something that's not understood and literally thousands of people suffer in silence. They suffer while those around them think it's all in their heads or that they're malingering. They lose their lives figurately, by not being able to work, to care for themselves, to play with their children or have relationships with their husbands and wives; and they lose their lives literally, when they think they can no longer cope.

And finding supporters was much easier than I thought it would be. There are hundreds of caring professionals out there that dedicate their lives to helping people with pain. But there are also hundreds of people that have been touched by pain themselves or know someone who has been touched by pain. I mean, think about it. Pain is universal. No matter where you go on this planet, everyone feels pain.

This blog is dedicated to the sufferers and their friends and families, and the people who try and help them. It will track the making of the play. All of us who are involved, and there are so many, will comment, and hopefully some patients may add their comments as well. If we can touch the life of just one person, we will have reached our goal.

Deb