Guest: Dr. David Adams
Host: Dr. Linda Austin
Dr. Linda Austin: I am Dr. Linda Austin, talking with Dr. David Adams about an interesting topic that lots of people have experienced which is chronic belly pain or chronic abdominal pain. Dr. Adams, just how common is this problem?
Dr. David Adams: It is a common problem in my practice because we see a lot of patients with unusual abdominal conditions that are treated medically and many of them are treated surgically. There is a small number of patients who fail all traditional western treatments for their abdominal pain and it is for a number of reasons. What appears to me to be a common thread in these patients is that they have sort of a phantom limb type of pain. We have all heard of people who lose an arm for a variety of reasons and continue to have consistent and terrible pain at the site of their amputation, as if their arm was still there. So, for example, in my practice I see patients who have severe pain with chronic pancreatitis and we do pancreatic operations, and many of these patients may have their pancreas removed. But, they still have that same type of pain that is just severe and unremitting, leads to many emergency room visits, hospitalizations and it fails a lot of typical treatments.
One patient I like to remember is a patient I still see monthly, to treat him for his pain. He would come to an emergency room and say that he would much rather go back to Vietnam and get blown up in a jeep than have to show up in an emergency room with pain and have a nurse say he was not hurting and could not have his pain treated. So, the difficulty with pain is there is not an objective score to measure it; it is subjective. So, when the patient says they hurt, that is the measurement of pain. If patients have to go to emergency rooms to be treated when it gets out of control, their quality of life is very bad.
Dr. Linda Austin: You mentioned that this sort of pain for some patients is not amenable to treatment with western techniques. What techniques have you found to be helpful?
Dr. David Adams: Well, there a lot of things that you can do to improve the quality of life for patients. We have a behavior medicine group here that works with these patients and teaches them how to identify triggers of the pain, how to avoid those, and when they get pain, things they can do to help them[selves]. Then, for patients who have unremitting pain that cannot be treated with normal medications, there are many patients who can be treated with strong pain medicines, even narcotic pain medicines. There is a common thought that you cannot use narcotics for long term treatment; they are only used in terminal patients. But, many patients with chronic conditions can be managed on a safe schedule with chronic narcotic medication to manage difficult pain, particularly the pain of chronic pancreatitis.
Dr. Linda Austin: You had mentioned before we started talking today that you really like to work with these patients. I would imagine that it can be a frustrating problem to deal with. What is that intrigues you about this problem?
Dr. David Adams: Well, what intrigues me is just sort of the vast courage and fortitude of patients who are able to function with pain. We have all had pain or conditions we think well, how am I going to get out of bed, what am I going to do? These patients do terrific things. I remember one patient who spent about a year in the hospital and then we were able to get her on a pain management strategy. She still had great difficulties but once a year, she would come in dressed as beautifully as can be and she would say, “You know I’m lucky and I’m going to Vegas!” She would go to Vegas once a year and she would always win, she would say, but it was just sort of this will to maintain a quality of life and to live in spite of great adversity. A lot of these patients do very very well over long periods of time.
Dr. Linda Austin: With a compassionate physician who takes their problem seriously, I am sure.
Dr. David Adams: And with a whole teamwork of people that take care of them.
Dr. Linda Austin: Dr. Adams, thank you very much.
Dr. David Adams: Thank you.
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