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Terrorism & Increased Pain Problems

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Published On: October 1, 2001          Posted On: December 20, 2001

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Terrorism & 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 ailments.

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 have doubled.

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, he said.

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 said.

"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 to you."

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 to drop."


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