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Health experts weigh in on pain management

  • Lincoln Geiger feeds the dairy cows at the Temple-Wilton Community Farm. Geiger said that after an accident in September left him hospitalized, he's come back stronger than before. (Staff photo by Ashley Saari)
  • Dr. Andy Chevalier (Staff photo by Ashley Saari)
  • (Staff photo by Ashley Saari)
  • Dr. Michael Weil (Staff photo by Ashley Saari)
  • Lincoln Geiger of Wilton is back to work in the Temple-Wilton Community Farm's Hilltop Cafe, after a devestating farm accident six months ago had him in the hospital and rehabilitation for over two months. (Staff photo by Ashley Saari)
  • (Staff photo by Ashley Saari)
  • (Staff photo by Ashley Saari)
  • (Staff photo by Ashley Saari)
  • (Staff photo by Ashley Saari)
  • (Staff photo by Ashley Saari)
  • (Staff photo by Ashley Saari)
  • (Staff photo by Ashley Saari)
  • Dr. Terry McNamara demonstrates the use of a MRI machine to determine the cause of localized pain. <br/><br/>(Staff photo by Ashley Saari)
  • Libby Barnett of Wilton practices reiki on Casey Mathews of Wilton.<br/>(Staff photo by Ashley Saari)
  • Libby Barnett of Wilton practices Reiki on Casey Mathews of Wilton.<br/>(Staff photo by Ashley Saari)
  • Libby Barnett of Wilton practices Reiki on Casey Mathews of Wilton.<br/>(Staff photo by Ashley Saari)
  • Libby Barnett of Wilton practices Reiki on Casey Mathews of Wilton.<br/>(Staff photo by Ashley Saari)
  • Libby Barnett of Wilton practices Reiki on Casey Mathews of Wilton.<br/>(Staff photo by Ashley Saari)
  • Libby Barnett of Wilton practices Reiki on Casey Mathews of Wilton.<br/>(Staff photo by Ashley Saari)
  • Libby Barnett of Wilton practices Reiki on Casey Mathews of Wilton.<br/>(Staff photo by Ashley Saari)
  • Libby Barnett of Wilton practices Reiki on Casey Mathews of Wilton.<br/>(Staff photo by Ashley Saari)

Lincoln Geiger of Wilton’s Four Corners Community Farm is moving pretty well for a man in his 60s — rolling huge bales of hay to feed a line of dairy cows, hauling milk buckets, and chatting with customers at the farm’s on-site eatery, the Hilltop Cafe. To look at him, you wouldn’t know that just six months ago , he was flat on his back in the hospital, suffering from
multiple fractured bones and a severely lacerated liver.

In September 2012, Geiger was doing his daily chores, moving the farm’s herd of cows into the barn, when one of his breeding bulls decided to block the path. While Geiger was attempting to clear the path, he took his eyes off the 2 ton animal for just a few moments, and the bull took advantage of the opportunity, ramming into Geiger and sending him flying.

“At first I had no idea I’d been hit,” Geiger said in an interview at the farm’s cafe earlier this month. “Then, I just thought, ‘I’m going to have to go to the hospital.’”

Geiger suffered three fractures to his pelvis and three cracked ribs, but the real concern was his liver. It had been badly lacerated, and doctors ultimately had to remove about half his liver as well as his gall bladder.

Six weeks were spent at Boston Medical Center , before moving on to a physical rehabilitation center for another two weeks. After that, Geiger said he thought he was home free, but an ultrasound revealed some dark spots on his liver, landing him back in the hospital for another five days for testing of what turned out to be scar tissue

Geiger said the first few weeks were really the only time he was in serious pain. At first, the doctors allowed him to manage his own pain by squeezing a ball when he felt the need for a dose of morphine, and then they moved him to opioid-based pain pills. But Geiger said he didn’t like how the medication made him feel, clouding his mind and making it hard to think, so he tried to limit his doses as much as possible.

Dr. Terrance McNamara, a rehabilitation physician and pain specialist at Monadnock Community Hospital, said cases like Geiger’s are when opioid pain medication is most helpful, that is in the relative short-term and for acute pain with an immediate cause. If you break your leg and are experiencing a few weeks of pain while you recover, that’s when an opioid is the most likely solution, McNamara said.

But taking pills is what McNamara refers to as “passive” healing, or things that are done to you by your doctors, for example. And for Geiger, attributes much of his own recovery to something called “active healing” — the things he did for himself, including maintaining a positive attitude throughout the experience.

When the accident first happened, Geiger said, he received an overwhelming amount of support from the community. Four Winds Community Farm has long been a visitation site for the nearby schools and is a beloved meeting place for the community. And just about every member of the community who had ever visited sent Geiger a card or letter or drawing.

“The support of the community was what was really amazing,” he said. “Very quickly after the accident, I started getting postcard after postcard. The kids from the schools, people in town, I even got a letter from the Select Board. Everybody you could think of sent me a note. I was touched every time, to the point of tears sometimes.”

At one point, Geiger was told he was going to have a fifth tube inserted into his chest, to help assist with the draining of the dead tissue from his liver. Having expected instead to have at least one of the tubes removed on that particular occasion, he said he hit a huge wall of discouragement. And just when he was at an all-time low, he was hit with a wave of hope and joy. And that’s when he got a call from one of his partners at Four Corners, telling him about the crowd of people gathered outside the barn at the farm, holding candles and praying for him.

“That’s the first time I’ve ever felt the power of prayer and good wishes,” Geiger said. “That event brought me to another level. It was something really special. In retrospect, much of my healing came from the sense of support from the community.”

After that, he said he felt he owed it to his supporters, not only to get back to his former strength, but to come back with a vengeance. At his age, many people just accept that slowing down is a natural consequence of age, he said. But Geiger decided to view his recovery like an athlete and come back stronger.

Geiger said he was lucky in that he feels fully recovered now, and back to 100 percent. In fact, in some ways, Geiger feels better than he did before his accident, he said.

McNamara said this kind of attitude is important to the healing process. “In the Western world, we often rely on the passive approach. People want someone to fix them externally,” he said. “In the setting of chronic pain, the key to making progress is the active side. Doing individual physical therapy exercises, changing your diet, doing psychological pain management exercises. We want people to take charge of their own situation as much as possible.”

Geiger’s pain was relatively short-term, and he was able to use mainstream medical treatment to ease the pain and accelerate his healing. But for those who have to deal with pain on a day-to day basis, either as a result of an old injury or disease, there are plenty of options out there to consider.

Traditional medicine

Many hands make light work — and reduce pain. That’s the basic philosophy of the team approach for pain management at the Monadnock Community Hospital. Sometimes patients will be able to get a handle on a pain management process that works for them with their own general care provider, or an additional specialist. But in some cases, when a patient isn’t progressing, or their injury or pain is having a major impact on their quality of life, a more dynamic approach is called for.

Monadnock’s pain management program is made up of pain specialists, physical therapists and psychologists that work between themselves to help patients manage their pain.

“Each member of the team, even if we can each only help 10 to 20 percent each, if there’s six of us working, it can add up to a lot of relief,” said Dr. Terrance McNamara a physiatrist and pain specialist at Monadnock Community Hospital.

Most people, when they think of pain medication, they think of opioid-based medications, but that’s actually “a solution that works for a minority of patients in the long-term,” said McNamara. And while they are helpful for short-term acute pain, for a long-term recovery — more than six weeks or so — there are some serious drawbacks, McNamara noted. First, is tolerance buildup. A relatively small dose of a mediation like Percocet, for example, might be very helpful at first, but the longer you take it, you have to take more medication and still might not obtain the same results.

“They may find themselves taking very high doses, and not having much pain relief, and mainly just left with the side effects of the medication,” McNamara said. “And that in itself can have big impacts on quality of life, because they might be drowsy or sleepy, severely constipated, etc.”

There are other medication options that don’t have the same tolerance and addiction issues, McNamara said. For example, there are some anti-convulsants and antidepressants which are often used for chronic pain. Sometimes a mix of all three is the solution — each patient is different, he said.

Naturopathics

Sometimes what it takes is a mix of traditional and alternative medicines to ease the aches and pains of life. And according to Dr. of Naturopathics Andy Chevalier at the Monadock Natural Medicine in Peterborough that’s exactly what naturopathics is.

Chevalier went through medical school, and has the same education you would see from a doctor at a traditional hospital or clinic, but he also has additional training in natural therapeutics, including therapies that employ botanical extracts, nutritional concentrates and medical food.

“People tend to seek our care because whatever path they’re on conventionally isn’t working for them, so we try to come up with alternative strategies to conventional care,” said Chevalier in a recent interview at his Peterborough practice at the Strand Building on Concord Street. “We’re not opposed to conventional care, it’s just that for some people it’s not working, or needs to be adjusted in some way.”

Chevalier said naturopathic doctors can and do prescribe opioid pain relievers if necessary, but are always seeking to reduce the dose by treating pain in other ways. Like any medical profession, that starts with an initial assessment and exam. Usually, Chevalier will take at least an hour with a new patient to discuss history and do a preliminary exam and lab testing. While many of the tests are the same as what you’d see in traditional hospitals, there are also alternative tests to look for causes of chronic pain. For example, Chevalier said he might test for a dysfunction with the body’s neurotransmitters or in the body’s production of Cortisol, the main hormone for controlling pain in the body.

Also, naturopathics takes an in-depth look at diet. Even a minor food allergy or sensitivity can have a big impact, Chevalier said. They can test for those sensitivities.

“These are functional tests that can give them a little more insight into why they’re there. The frustrating thing for chronic pain sufferers is that they feel like no one believes them, and no one understands them, or thinks that they’re drug seekers,” said Chevalier. “This is a way we can help people understand their bodies and what’s actually happening to them. It takes some of the stigma off chronic pain.”

Hypnosis

Hypnotherapy, like naturopathics, was first born in the medical field before becoming considered an alternative form of treatment. And, also like naturopathics, is beginning to work its way back into the fold of traditional medicine as a supplemental therapy.

Most people think of hypnosis for things like anxiety or quitting smoking. But it can also be used for pain management, either by working to change a patient’s perception of the pain, or to physically relax the body and release tension that might be adding to the problem.

Dr. Michael Weil, a clinical psychologist and licensed hypnotherapist who works with Peterborough Clinical Associates at 20 Grove St., said that hypnosis works on some level for a majority of the population. But not everyone has the same reaction to it. In pain management, for example, the pain might be reduced for a number of hours or a number of days. Hypnosis, like anything else, is a management tool, designed to restore quality of life, but rarely offers a complete cure.

In his practice, Weil said most people that try hypnosis for pain are chronic sufferers.

“Usually what I hear is, ‘I’ll try anything,’” Weil said. “Because they’ve usually been through a gamut of other treatment options first.”

Unlike how Hollywood and stage hypnotists portray the work, Weil said people who are hypnotized are aware, and in control of themselves. The ultimate goal of hypnotherapy is to teach the client self-hypnosis techniques, so they can self-manage spikes of pain without having to take a pill or see a doctor, said Weil.

Reiki

Modern science doesn’t have an explanation for how or why reiki works, said local reiki master Libby Barnett of Wilton — it just does.

“No one really knows how it works, but when it’s you or a loved one in pain, you don’t really care how it works,” she said in an interview earlier this month at her home reiki office. “You only care that the pain is gone.”

Reiki, translated as “life energy,” is simply the process of transferring energy to a body through the power of touch, said Barnett, who has been practicing and teaching reiki for more than 30 years and is the longest practicing reiki master in the U.S.

“People are hungry for touch,” Barnett said. “Touch in general, there’s immediate connection, a soothing, a relaxing. Reiki is touch plus. The soothing comfort of touch, plus the opportunity to pull in the energy of life.”

Reiki helps to relax and comfort a body, and allows them to open up for healing. Like hypnosis, relaxation helps the body ease tension which can contribute to pain in the body, but reiki also works on an emotional and spiritual level. Sometimes, the extra tension and pain carried as a result of an emotional issue is causing the physical pain, and only once that is resolved will the pain be released, Barnett explained.

Casey Mathews of Wilton, one of Barnett’s reiki clients, said that her whole family uses reiki to accelerate healing. She is a habitual customer, using it to manage stress and for the daily pains of life, but her whole family — including her two children and even the family dog — have had sessions with Barnett.

“Reiki addresses all four levels,” Mathews said. “Body, mind, spirit and emotion. Sometimes I come in, and have pain in my physical body, and as those layers are peeled away, the real cause of the pain can be addressed. And when my body is ready, there are times I feel the pain almost fly out the window.”

Mathews’ husband received Reiki before and after a recent ACL surgery, and had an easy surgery and an incredibly fast recovery with minimal medication, she said.

“His healing, people have just been blown away,” said Mathews. “He’s not had one ounce of pain and he’s had his whole knee redone.”

Barnett agreed that reiki can be a useful addition to conventional healing practices. “It’s a perfect example of adding reiki to the surgery piece,” she said. “It allows the body to mobilize it’s healing resources quicker, faster. People under anaesthesia come out quicker and with less nausea. It’s a rising star in pre- and post-operations to manage that pain.”

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