& Increased Pain Problems
By Avram Goldstein
Washington Post October 1, 2001; Page A01
Tens of thousands of people whose chronic
physical pain is usually kept in check have suffered setbacks since the
terrorist attacks on New York and Washington, according to pain management
specialists across the nation.
Those who regularly treat pain say that
since Sept. 11 they have been inundated with
complaints of worsening pain from patients who suffer from cancer,
back problems, arthritis, diabetic neuropathy, chronic headaches and other
At Washington Hospital Center, pain
management specialists said complaints about flare-ups have been five
times greater than usual. In Houston, specialists reported that pain
complaints from cancer patients are up 33 percent, and in Buffalo, they
The widespread reaction, they said, was
clearly triggered by stress over the attacks, fear of more terrorism and
concern for what the future will bring their children.
"A lot have been stable for years on
their medication, but after [the attacks], we are getting flooded with
phone calls saying that their pain has gotten quite out of control,"
said Lee Ann Rhodes, the medical director of pain management at Washington
Hospital Center. "Patients who normally are happy that their pain is
under control are coming in in tears."
The phenomenon was evident in the first
week after the attacks. At George Washington University Hospital,
physicians said complaints about pain and other symptoms of chronic
ailments climbed abruptly.
"The medicine department was swamped
with . . . patients with rheumatoid arthritis, pain, asthma," said
James L. Griffith, associate chairman of the psychiatry department. All
kinds of chronic medical disorders were aggravated,
Physicians said stress levels across the
country have increased as Americans fret over the risks of bioterrorism,
the ailing economy, grief for those who died and anger at the attackers.
Moreover, they said, the suffering has been
amplified by insomnia, as millions of Americans stay glued to televisions
into the wee hours or simply lose sleep to worry. They go through their
days on less rest, and doctors said sleep deprivation intensifies the
perception of pain.
Peter Staats, chief of pain medicine at
Johns Hopkins University in Baltimore, said the reaction leaves no doubt
about the strength of the mind-body connection. "Pain more than any
other area of medicine has the mind and the body interlinked," Staats
"When patients are in an emotional
state of anxiety and anger, there is symptomatic magnification. It doesn't
mean they don't hurt. But pain involves emotions," and physicians
must understand that and not automatically prescribe more painkillers.
Estimates of the number of Americans who
suffer chronic pain range from 45 million to 100 million.
Many are treated with drugs, but
specialists also provide counseling, biofeedback and other relaxation
techniques to help patients diminish discomfort.
But anger and angst can
cut through such efforts without a patient's awareness, said David
Borenstein, a rheumatologist and clinical professor of medicine at George
Washington University. He said the many patients who have perceived more
pain were unaware that their bodies were reacting to world events.
"When you tell people this is a
natural response to a loss and stress, I think many have come to
understand it and don't necessarily require additional medicines," he
said. "Those more on the edge have needed more."
Judy Denny, 55, of the District, has had
chronic pain in her right leg since she emerged from failed back surgery
as a paraplegic four years ago. The pain has mostly been controlled with
the help of her physician, Rhodes.
But the past two weeks have not gone well
for Denny, who said she has felt anguish for the attack victims and fear
for what the future will bring her two teenage children. After speaking
with Rhodes, she said, she realized why she was in greater pain.
"I never, ever put it together before,
but I have been having particular problems with my right leg in the last
weeks," she said. "There are earthquakes in other countries that
kill thousands of people, and we don't see that as a major thing in our
lives, but when it's the Twin Towers, it really gets
Roberta Hagen, a Bethesda nurse who has
suffered from chronic back pain for 10 years, said her
pain skyrocketed the day of the attack when her family was worrying about
a nephew who worked in the World Trade Center. Even after learning
that he was alive, she said, her symptoms did not ease.
"It was absolutely miserable,"
she said. "Obtaining information about my nephew helped, but then
there was a secondary effect of sympathy for the rest of the folks who
didn't survive. . . . Normally, you think you have such good control, and
then you find with these outside stressors [that] you lose that and the
condition just goes out of control."
Physicians across the country who treat
cancer patients for pain report the same phenomenon.
Jessie Leak, an associate professor of
anesthesiology at M.D. Anderson Cancer Center at the University of Texas
in Houston, described the problem as endemic and said complaints to her
office have risen 33 percent. Most of MD Anderson's patients come long
distances, so the complaint volumes there are representative
of the nation, Leak said.
"This extraordinary event is beyond
anything we normally deal with," she said. "They are
experiencing a tremendous sense of displacement and anxiety about this
event added to their cancer and pain."
Mark J. Lema, chairman of anesthesiology at
the State University of New York at Buffalo, said clinic traffic at the
Roswell Park Cancer Institute there has doubled in recent days because of
pain complaints, and he said those complaints stem from the stress of
Sept. 11 and the worry that there will be other attacks.
"Everyone's been worried," Lema
said. "People are tense because they are waiting for the other shoe