Coping With Crisis -- What's Your Experience?

There was what I will always think of as my own personal "dark moment".

My fiance and I were house and dog sitting for the parents of my late husband whilst watching the movie "Pirates of the Caribbean". I remember trying to concentrate on the movie that it seemed, everyone in the world had seen except for myself. The pain in my teeth and gums, that day, was not allowing me to do so. I remember, I kept eyeballing the teeth and oral areas of the characters in the movie, and some of the faces of the non-human-like characters, and thinking to myself "my face feels like that creatures face looks", or "I wonder if Jack Sparrow's teeth hurt as much as mine, and if so, how is he able to concentrate on anything but that fact". I felt gruesome, both inside and out. My entire lower face was an aching, throbbing, mess of different stimuli consisting of jabs, pinching and all sorts of pressure to go along with these sensations. It seemed a horrid nightmare, but it was one I had lived with for so long by then. This was the winter of 2009. My first symptoms had presented

When the movie was over, with my children safely out of earshot as they were traveling back home with my mother and father in-law, I began to sob and perched on the chair beside my fiance. It was then that the rambling gush came out of me . . . ."I -I - I want-to-die! I can't go on living like this. I'm in such pain everyday", I said (or something like that. I was too upset to remember my exact words). I continued," You are better off without me. I'm broken. My kids are better off without me in their lives. They need to be with someone else . . .someone who deserves them and can be a good parent!!! I DON'T WANT THEM TO SEE ME LIKE THIS ANYMORE!!! THEY DESERVE BETTER! YOU DESERVE BETTER! " I kept rambling on for awhile until my face, nose and eyes were all drippy.

My fiance tried to comfort me. I cannot even remember how now. What he was saying was really of no consequence. I felt I had just unearthed my darkest of secrets, that I didn't want to exist inside this pain any longer. Sharing a body with it was more than I could bare.

I won't name names here, but whenever my mother and father-in-law came home, it became known that I was having a crisis, and an "angel", as I will call them armed me with seven Hydrocodones, which they really could not spare. (I did have a script for 1 a day, at that point, from a small town doctor who didn't believe I really had anything wrong with me. His office staff all encouraged me in whispers one day, previously, to seek other help as he didn't seem to be taking me seriously, even for what my diagnosis was at the time, which was TMJ. My point is that I did have to pay these back, because most chronic pain patients need their entire prescription, and this person is no exception. I thank God sometimes for the windfall of relief they provided which would allow me to get my head together and do what I am about to tell you. Pain had taken away my ability to even think straight. So, I treated these like god and used them sparingly).

Armed with these seven Hydrocodones, and the backing of my earthly father, I managed to make the phone calls (after a long time for searching for answers many different places ie. chiropractic, psychotherapy, diet, exercise, other medications) to the pain clinic where one of my friends, who is a back patient had been going for some time, one with a particularly compassionate nurse practitioner. COMPASSION! Sounded good to me!

I did a lot of soul and web searching those two weeks while I awaited my first appointment. On one of those nights, I unearthed for the first time, the diagnosis, Atypical Trigeminal Neuralgia. I felt as if I were reading a description of my pain word for word. I phoned both of my parents, told them to go to their computer and READ! I cried as I exclaimed, "THAT'S ME!" My symptoms had really never fully seemed to be that of a classic TMJ patient. I had tried to believe it for years, since my General Practitioner diagnosed me with TMJ in 2003, that it was what ailed me. He had treated it with Diazepam. I had kept working. The Diazepam had been providing just enough relief for me to get by. However, the pain had gotten too bad. It simply no longer worked. The pain ruled my life.

I was honest about everything I had tried when I went to go see my first Pain Management Specialist for the first time. I had to see the doctor before I could request to see the Nurse Practitioner I had heard raved about. I told him that I had tried opiates for my condition, the ones I had tried and that they were the only things which seemed to help me. By this time, I had also tried a slew of other treatments, TENS unit included, and countless other types of meds, each time believing it may help. Diazepam and Hydrocodone had worked the best of anything I had ever been given.

I didn't tell the Pain Management Physician that I thought I had Atypical Trigeminal Neuralgia whenever he told me that it is what he suspected was my correct diagnosis. I was rather opoid naive, at the time, so the prescription of 3 5 mg. Hydrocodone per day, at the time, seemed almost miraculous, to me. He also gave me something called Gabapentin (Neurontin). I couldn't tell (and still cannot tell to this day) to what degree it helps, but I still take it to this day.

Now, I've been in Pain Management for around three years. Opiates have been the only thing which have brought relief enough to speak of. I've read books. My newest trial is one of Acupuncture. I am always looking for an alternative, as I am aware that opiates can be an upwards, spiraling staircase.

The one I have tried which brought the best relief with the least side-effects happened to be Methadone, which has a long half-life, seems to be tolerated well by my system, and in essence, at the right dosages, gives me my "normal life" back.

Luckily, I have found another Pain Management doctor willing to prescribe it to me. I am so glad to be titrating down from MS Contin and up on Methadone. That is the way they have to handle it, I am told. MS Contin has such horrible side-effects, for me, that it was all but intolerable. If it weren't for the minimal relief it was providing at a median dose, I would have stopped this drug. It is like poison to my system. But, my poison was keeping me from pulling my hair out with Atypical Trigeminal Neuralgia pain.

My story with this illness is so long. I cannot sum it up here. I have also typed this at breakneck speed, as I am supposed to be watching a movie with my now "husband", who was with me on my "dark day", the day I wished for death above life. Please forgive bad grammar and omissions in the above. There are many gaps here, as I cannot begin to tell you the impact that Atypical Trigeminal Neuralgia has had on my life and on the lives of those who need and care about me.

Atypical Trigeminal Neuralgia is my formal diagnosis from a Neurologist who specializes in "Head and Face Pain". By the time I saw her, I had already tried all of the treatments she offered. I will be leaving my Pain Management to those who specialize in Pain Management.

I look forward to the coming month, whenever the change from MS Contin to Methadone is realized for me. I think that this will bring about positive changes in my life and in the lives of those who I stated both "need and care" about me.

As an only Grandchild on both sides, two aging and ailing parents and two girls who need me to be more than good, but organized and on top of things, I am excited that I may finally be getting the treatment which has historically worked the best for me.

One day, I hope to watch "Pirates of the Caribbean", and actually pay attention this time. Hopefully, research and hope for my illness will prevail before Methadone quits working (my system tolerates it, or such), or some unfeeling doctor denies me of what helps. ATN has no magic bullet cure. But, hopefully, my life holds no more "dark moments", such as described above, one in which I would, in all honesty, choose death over life with the agony of Atypical Trigeminal Neuralgia.

The story I told you is the one of my desperate moment.

To sum things up, crisis is a part of my day to day life with Atypical Trigeminal Neuralgia. Without the proper type and dosage of analgesia, I am now left to suffer pain levels ranging between solid 5-9's on a daily basis.

I have tried almost every route one can try, aside from surgery (which may not help, but could make things worse), to better myself and condition.

The ONLY relief and quality of life which has ever been found anywhere for me since my symptoms got horrid in 2009, has been via the hands of professionals at a Pain Management Clinic. Unfortunately, Opiod Therapy has provided the only major reduction of pain and quality of life to be had since that time.

I have received horrible service and bad treatment and also very good and compassionate treatment at these facilities.

I've tried almost every opiate/opoid out there too now. I dislike using them. I don't like the stigma. I don't like the fact that they are unnatural, but I must find a way to be somewhat "okay" for the sake of those who need me, to manage their affairs as well as my own.

I've been judged by pharmacies, doctors, friends, family, and even my own children for the kind of help I need to maintain.

Methadone has been the best answer, thus far, for my ATN pain. I read that, of the opiate types of medication, it is especially useful in treating Neuropathic pain. It works with all three "opiod receptors" within the brain.

Years ago, I had a sister-in-law who abused this drug. She was given it for back pain. I watched her life crumble from around her. I watched her lose everything.

It escapes me why a chronic pain patient would abuse prescription medication. But, that is not what this thread is about.

Red, I hope I have answered your question correctly.

As always, thank you for all of the hard work you do on behalf of all of us who suffer with chronic pain due to Type I and Type II Trigeminal Neuralgia.

God bless all.

Your friend,

Stef


Stef said:

There was what I will always think of as my own personal "dark moment".

My fiance and I were house and dog sitting for the parents of my late husband whilst watching the movie "Pirates of the Caribbean". I remember trying to concentrate on the movie that it seemed, everyone in the world had seen except for myself. The pain in my teeth and gums, that day, was not allowing me to do so. I remember, I kept eyeballing the teeth and oral areas of the characters in the movie, and some of the faces of the non-human-like characters, and thinking to myself "my face feels like that creatures face looks", or "I wonder if Jack Sparrow's teeth hurt as much as mine, and if so, how is he able to concentrate on anything but that fact". I felt gruesome, both inside and out. My entire lower face was an aching, throbbing, mess of different stimuli consisting of jabs, pinching and all sorts of pressure to go along with these sensations. It seemed a horrid nightmare, but it was one I had lived with for so long by then. This was the winter of 2009. My first symptoms had presented

When the movie was over, with my children safely out of earshot as they were traveling back home with my mother and father in-law, I began to sob and perched on the chair beside my fiance. It was then that the rambling gush came out of me . . . ."I -I - I want-to-die! I can't go on living like this. I'm in such pain everyday", I said (or something like that. I was too upset to remember my exact words). I continued," You are better off without me. I'm broken. My kids are better off without me in their lives. They need to be with someone else . . .someone who deserves them and can be a good parent!!! I DON'T WANT THEM TO SEE ME LIKE THIS ANYMORE!!! THEY DESERVE BETTER! YOU DESERVE BETTER! " I kept rambling on for awhile until my face, nose and eyes were all drippy.

My fiance tried to comfort me. I cannot even remember how now. What he was saying was really of no consequence. I felt I had just unearthed my darkest of secrets, that I didn't want to exist inside this pain any longer. Sharing a body with it was more than I could bare.

I won't name names here, but whenever my mother and father-in-law came home, it became known that I was having a crisis, and an "angel", as I will call them armed me with seven Hydrocodones, which they really could not spare. (I did have a script for 1 a day, at that point, from a small town doctor who didn't believe I really had anything wrong with me. His office staff all encouraged me in whispers one day, previously, to seek other help as he didn't seem to be taking me seriously, even for what my diagnosis was at the time, which was TMJ. My point is that I did have to pay these back, because most chronic pain patients need their entire prescription, and this person is no exception. I thank God sometimes for the windfall of relief they provided which would allow me to get my head together and do what I am about to tell you. Pain had taken away my ability to even think straight. So, I treated these like god and used them sparingly).

Armed with these seven Hydrocodones, and the backing of my earthly father, I managed to make the phone calls (after a long time for searching for answers many different places ie. chiropractic, psychotherapy, diet, exercise, other medications) to the pain clinic where one of my friends, who is a back patient had been going for some time, one with a particularly compassionate nurse practitioner. COMPASSION! Sounded good to me!

I did a lot of soul and web searching those two weeks while I awaited my first appointment. On one of those nights, I unearthed for the first time, the diagnosis, Atypical Trigeminal Neuralgia. I felt as if I were reading a description of my pain word for word. I phoned both of my parents, told them to go to their computer and READ! I cried as I exclaimed, "THAT'S ME!" My symptoms had really never fully seemed to be that of a classic TMJ patient. I had tried to believe it for years, since my General Practitioner diagnosed me with TMJ in 2003, that it was what ailed me. He had treated it with Diazepam. I had kept working. The Diazepam had been providing just enough relief for me to get by. However, the pain had gotten too bad. It simply no longer worked. The pain ruled my life.

I was honest about everything I had tried when I went to go see my first Pain Management Specialist for the first time. I had to see the doctor before I could request to see the Nurse Practitioner I had heard raved about. I told him that I had tried opiates for my condition, the ones I had tried and that they were the only things which seemed to help me. By this time, I had also tried a slew of other treatments, TENS unit included, and countless other types of meds, each time believing it may help. Diazepam and Hydrocodone had worked the best of anything I had ever been given.

I didn't tell the Pain Management Physician that I thought I had Atypical Trigeminal Neuralgia whenever he told me that it is what he suspected was my correct diagnosis. I was rather opoid naive, at the time, so the prescription of 3 5 mg. Hydrocodone per day, at the time, seemed almost miraculous, to me. He also gave me something called Gabapentin (Neurontin). I couldn't tell (and still cannot tell to this day) to what degree it helps, but I still take it to this day.

Now, I've been in Pain Management for around three years. Opiates have been the only thing which have brought relief enough to speak of. I've read books. My newest trial is one of Acupuncture. I am always looking for an alternative, as I am aware that opiates can be an upwards, spiraling staircase.

The one I have tried which brought the best relief with the least side-effects happened to be Methadone, which has a long half-life, seems to be tolerated well by my system, and in essence, at the right dosages, gives me my "normal life" back.

Luckily, I have found another Pain Management doctor willing to prescribe it to me. I am so glad to be titrating down from MS Contin and up on Methadone. That is the way they have to handle it, I am told. MS Contin has such horrible side-effects, for me, that it was all but intolerable. If it weren't for the minimal relief it was providing at a median dose, I would have stopped this drug. It is like poison to my system. But, my poison was keeping me from pulling my hair out with Atypical Trigeminal Neuralgia pain.

My story with this illness is so long. I cannot sum it up here. I have also typed this at breakneck speed, as I am supposed to be watching a movie with my now "husband", who was with me on my "dark day", the day I wished for death above life. Please forgive bad grammar and omissions in the above. There are many gaps here, as I cannot begin to tell you the impact that Atypical Trigeminal Neuralgia has had on my life and on the lives of those who need and care about me.

Atypical Trigeminal Neuralgia is my formal diagnosis from a Neurologist who specializes in "Head and Face Pain". By the time I saw her, I had already tried all of the treatments she offered. I will be leaving my Pain Management to those who specialize in Pain Management.

I look forward to the coming month, whenever the change from MS Contin to Methadone is realized for me. I think that this will bring about positive changes in my life and in the lives of those who I stated both "need and care" about me.

As an only Grandchild on both sides, two aging and ailing parents and two girls who need me to be more than good, but organized and on top of things, I am excited that I may finally be getting the treatment which has historically worked the best for me.

One day, I hope to watch "Pirates of the Caribbean", and actually pay attention this time. Hopefully, research and hope for my illness will prevail before Methadone quits working (my system tolerates it, or such), or some unfeeling doctor denies me of what helps. ATN has no magic bullet cure. But, hopefully, my life holds no more "dark moments", such as described above, one in which I would, in all honesty, choose death over life with the agony of Atypical Trigeminal Neuralgia.

I think I have been in total denial of this happening to me…Imean I was such an active person on the gp constantly then one day it all just came to a screeching halt. thank God my husband understands what is happening and gets me to the dr, or the er. suiside wasnt far from my mind at some point thinking Icould not keep living like this, I know I have put my husband thru alot and he has stood by me every step of the way, not understanding why but looking for answeres. I hope to make new friends here ans gain insight to this monster called TN

Stef,

Like a lot of other things in facial pain, there is no one "right" answer to the question I've posed. You've shared your experience, and that experience was valid for you. I will try to generalize from your experience helpfully in the suggestions I will offer to others in a page dealing with "Coping With Crisis". The attitude I am trying to take to all of this is that I don't have all of your answers or anybody else's. I'm merely a research "guy" who has been around for a lot of years in the venues of chronic pain patients. I've also lived with a chronic pain patient as a care giver and change agent. I'll try to collect the experience of others who have been through this journey, and add to that experience from the skills and professional grounding of doctors who have published work on crisis intervention, suicide prevention, and crisis SELF-management. But I am often humbled by the endurance and positive attitudes that I encounter in people such as yourself.

Go in Peace and Power

Red

Yes, I used one to go to my dentist that I downloaded from the TNA site. He was very appreciative of the information.


Carolina
Richard A. "Red" Lawhern said:

Bob, there are no perfect solutions...

Thank you, Red.

Ever so humble, you are, indeed.

I did post a glance at my most profound moment of crisis with Type II, Trigeminal Neuralgia pain. However, I was just checking to make sure that this was the type of content of answer which you may be looking for when you asked the question.

Since my prescription has been changed to what has always seemed to work best for me, I feel much more peace and power. I am looking forward to the titration up to the complete change, as my system is not handling my former long-acting pain medication. It seems to handle the new one fine, and it is working better for the pain, as well.

Thank you for your reply!

Stef


Richard A. "Red" Lawhern said:

Stef,

Like a lot of other things in facial pain, there is no one "right" answer to the question I've posed. You've shared your experience, and that experience was valid for you. I will try to generalize from your experience helpfully in the suggestions I will offer to others in a page dealing with "Coping With Crisis". The attitude I am trying to take to all of this is that I don't have all of your answers or anybody else's. I'm merely a research "guy" who has been around for a lot of years in the venues of chronic pain patients. I've also lived with a chronic pain patient as a care giver and change agent. I'll try to collect the experience of others who have been through this journey, and add to that experience from the skills and professional grounding of doctors who have published work on crisis intervention, suicide prevention, and crisis SELF-management. But I am often humbled by the endurance and positive attitudes that I encounter in people such as yourself.

Go in Peace and Power

Red

Red,

There have been quite a few members on our site who have posted about their experiences with one or another type of 'pain management' or coping program. Johanna mentioned a similar program in this discussion.

I know most of these programs are attended in person over quite a length of time and monitored by various professionals - is there some kind of 'self-study' program that we can post on our site that all our members can access? Or even some small snipets? There are a vast number of topics covered but even if we could hit upon a few key subject matters it might give our members some tools to handle some of the more urgent / difficult situations.

Perhaps the format could be an on- line pre-recorded seminar format. I know I got a tremendous amount of information from the Dr. Ken Casey video seminar that was linked on our site. Or even the old-fashioned workbook style format. Alternatives to the usual reading, if we are looking for alternatives.

Elaine

Elaine,

A video seminar is an interesting thought. But it's beyond my personal resources to produce one. It would have to be scripted, acted under controlled lighting, and professionally recorded if it's to resemble the Casey video seminars -- and a seminar implies an in-person audience. The details on a thing like that quickly mount up. So I'm afraid I must do what I can do, and those interested may have to do some further reading.

The following is a work-in-progress outline:

Coping With Crisis

- Who is the audience?

-- Pain patients

-- Family members

-- Other care givers, advocates and friends

- What kinds of "Crisis" are you dealing with?

-- Day to day chronic pain, sleep disturbance, anxiety

-- Major incident of extreme breakthrough pain

-- Toxic side effects or drug reactions

-- An important member of family who "doesn't get it".

-- A doctor who doesn't get it

-- Job loss, financial difficulty or bankruptcy issues

-- Filing for disability

- What can you do for yourself?

-- Know the signs of depression

-- Refuse to be defined by your pain

-- Taking back your power

--- Change your own attitudes

--- Enlist an advocate to help you do things you can't do alone

-- Preparing to cope with crisis before you're in one

--- Developing local help networks

--- On-line mutual support communities

--- Psychological or psychiatric support

--- Attending Physician Advisory Form

- When you 'just can't take it any more'

-- Local emergency help

-- Transportation when you can't drive

-- Access to a hospital emergency room

-- Post-discharge care planning

-- Crisis intervention centers (world wide)

I have begun writing to this outline, this week.

Go in Peace and Power

Red

Hi red.

When I read Stef's post it dawned on me that there must be support out there for those of us who need to take opiate pain medication. As she wrote, it is very difficult to find doctors who believe that you're in excruciating pain, who believe that your pain is reduced when taking an opiate pain med, and then further finding a doctor who will prescribe them.

I quickly perused the American Pain Foundation website, which I have looked at before, and it seems that they might be useful for those who find themselves in a similar situation to Stef and myself. I saw that they offer online support and have a link to find pain management resources.

Perhaps a link to add to the Coping with Crisis page. I don't know if anyone has had success in working with a group such as this in terms of advocacy. I would be interested to know if anyone has had success as I am, yet again, bumping up against some problems with meds. The nearest Pain Management Clinic is a 2 hour ferry ride and a 2 hour drive. That's some effort just to get pain medication and as always I feel guilty for even thinking about doing so.

take care. Johanna

Here's another brick for the building we're all contributing to.

As part of my pending article on coping with crisis, I have designed a one-page form for patients to fill out in advance of need and carry with them in a wallet or purse. The form is intended to be offered to an admissions clerk or admitting physician at emergency care facilities where patients might go for interventional help in a major pain crisis -- at a time when some are unable to speak clearly or even think clearly.

This form should be up on our website at some point in the next few days. Ben has approved that step. Meantime, being the impatient sort of guy I am, I have already published the form on my own website at http://www.lawhern.org/AttendingPhysicianAdvisory.doc It has also been offered to the Trigeminal Neuralgia Association as a possible part of their patient information package, to be mailed to new members.

Feel free to download this form for your own use. Fill it out in advance of need. For pain patients, there are whole new dimensions to the motto "be prepared", and perhaps this is one of them. Likewise feel free to show this document to your physicians, for their use with other patients. Although I'm not advertising my own ego in this, please do not remove the copyright notification from the foot of the document. That notification is intended as a draw for more members to join our community.

Regards and best,

Red

For those following this thread, this note is to announce the posting of our long article on "Coping With Crisis". It may be read at http://www.livingwithtn.org/page/reserved-tab-b . Comment is invited and welcome in the text box at the foot of the page.

Regards all,

Red

Doc Red, this is exactly what I am looking for within this website…where to go for help. If we read between the lines on most comments, that’s what ALOT of us are looking for. You know my situation somewhat. Question: I’ve had 3 mri’s that showed Flow Voids and Prominient Vascular Loops on the right side but couldn’t read anything well due to all of the “hardware” in my face especially on the left side leaving “artifact” or ghostly streaks across the slices so the couldn’t tell if the same was on the left side or what might be pressing against what. The vessels showing weren’t quite normal anyway. If you were me , what might be your next step? This daili bilateral constant pain is wearing me down but making it worse scares me , however, making it better excites me to think this pain could be lessened or go away. Penny for your thoughts? Tiinkerbell

Tink, with your history, practically any further form of surgical intervention is probably a lousy idea. If I was advising a member of family concerning a case as complex as yours, I'd say that you need to find a medication regime and/or delivery method that works. Because of its positive effect on Seratonin Re-Uptake and other pain-related processes, I'd say it would make sense to try you on Methadone, if you can find a pain management doctor who is willing to manage you. There's a fair amount here on the site about Methadone. Try the term in our search window top right.

[NOT a medical doctor]

Hi, I'm a newbe & so have not had a chance to read back thru all the blogs/ messages. So it might be that the subject I raise has been dealt with. Has anyone suggested or commented upon the practice of Mindfulness as an aid to dealing with pain? Best wishes, T.

Meditation in all of its forms is referenced, though perhaps not emphasized in the "Facial Pain Information" article. I will do some further writing in our Coping With Crisis article. Thanks for the reminder.

Red

In part at the suggestion of members who have commented in this thread, the following material has been added to "Coping With Crisis":

-- Explore the spiritual and mindful dimensions of pain management

The phrasing of this advice might be a little unfamiliar both to some patients and to their doctors. However, there truly is both a spiritual and mindful dimension in pain management. The spiritual dimension is familiar to many people as prayer, and the mindful dimension as meditation or "centering of consciousness". [Ref 8]

What might not be as familiar is that there is emerging scientific evidence that prayer and meditation may actually influence the vulnerability of the body to pain, and the intensity with which pain is felt. A large body of medical and scientific literature is now devoted to what is called "placebo effect". [Ref 9, 10] When patients who have pain are told by a doctor or other figure of authority that a therapy "is known to help many patients", and then given an inert pill that has no medical properties, a substantial proportion of them will report improvement in their sensations of pain or discomfort, their levels of measurable depression, and their overall feelings of well-being.

Their expectations literally change their experience of medical therapy as well as daily life.

However, this effect is more than a matter of emotions or a positive attitude at work (as helpful as a positive attitude can be). By means of functional MRI, the activity levels of small areas of the brain can now be monitored and traced in real time. The activities of the brain display substantially different patterns when a person is expecting a positive result from medical treatment, versus when they are simply given a pill in a randomized trial. Different centers of physical regulation and response in the brain are involved when expectations are engaged, versus when they are not. Pain regulating centers are significantly reinforced by expectations of a positive outcome.

Less known to popular and medical literature, is the phenomenon of "nocebo effect". When patients are offered a therapy by physicians or other providers toward whom they have negative feelings or expectations, even valid medical therapies are less effective than when offered by a provider toward whom the patient has positive feelings. This effect has been documented in several pain conditions. [Ref 9]

These effects are not marginal or second-order to some "real" level of medical treatment. In many medication trials, it is found that the range of positive outcomes attributable to the patient's expectations can be larger than the effects produced by the medication itself. And when a positive relationship is established to the therapy provider, the amount of positive "placebo effect" in some trials may double. [Ref 10]

These effects have two rather profound implications. First, a positive approach and expectations of successful medical treatment on the part of the patient can have a direct and constructive impact in generating better outcomes. Second, your doctor needs to listen to the science and realize that it is no longer permissible within the guidance of modern medical ethics to objectify patients or distance themselves emotionally from the patient's pain and suffering. The stronger the patient's trust and positive feelings are toward the doctor, the more likely it is that the patient will get an improved result from treatment.

"Bedside manner" and a positive doctor patient relationship matter in patient outcomes. Caring is an important resource in effective care-giving.

For many people, one of the strongest resources in coping with bad events or experiences in life, may be prayer. [Ref 8] By "giving the problem to God", or praying for personal strength and healing, some people are able to step back from their anxiety and fearfulness, reduce their stress levels and feel significantly less pain. Whether one believes in the intervention of a Divine Creator in such outcomes or not, patients benefit from reduced stress. For those who are believers, prayer can thus become a part of healing or reducing pain.

The positive effects of stepping back and letting go are not restricted to the religious. Another avenue to similar results exists side by side with prayer. Across the world, millions of people meditate for 20 minutes at least once per day, to achieve a mental state of quiet mindfulness and release of stress. There are both religious and non-religious forms of meditation, and they work to generate positive outcomes in reducing pain and reclaiming mental clarity even under the influence of drug side effects. Quite possibly, prolonged mindfulness and release of the ego-mind may positively affect the same centers of neuro-biological activity that are engaged in placebo effect.

For further exploration of this dimension of coping with crisis, the reader is referred to the references below.