There is disagreement about the number of Americans who suffer from chronic pain. A 2011 Institute of Medicine (IOM) analysis estimated the number at 100 million, or nearly one-third of the population. Other researchers say that number is absurdly high. There’s also no agreement on when acute (short-term) pain becomes chronic – some sources say 12 weeks, others say 3 or even 6 months.
One thing is for sure, though – by any definition, Vero Beach resident Jay Kostanski is a chronic pain sufferer. He broke his C5 and C6 vertebrae in a 1986 car accident; the treatment was to fuse a piece of his right hip to his neck. He was in the hospital for a month before spending time in a rehabilitation center, and was out of work for a year. Jay now has arthritis in his neck as a result of the injury.
As serious as that injury was, it is not the primary cause of Kostanski’s chronic pain. In the early 1990s, he was diagnosed with spondylolisthesis, commonly known as slippage of the spine – a vertebrae slides over the bone below it. It most typically occurs in the lower spine, which is true in Jay’s case.
At the time of his diagnosis, Kostanski worked as a meter reader at a natural gas company in Massachusetts. It was a job he really liked – he enjoyed getting to know his customers and the exercise he got by walking his rounds. After a few years, he could no longer work, and he went on permanent disability in 1997, at the age of 39.
We spoke to Dr. Lynn Williams about conditions such as Kostanski’s. She is a licensed clinical health psychologist and family psychiatric nurse practitioner, who has a private practice on the barrier island. She works with patients who suffer from chronic pain, always in collaboration with their primary care physician. “That’s a critical component,” says Dr. Williams. “It’s important that these patients feel cared for and listened to by a pain management team.”
Most pain medications fall into one of two drug classes – opiods (e.g. morphine, hydrocodone, oxycodone) or non-steroidal anti-inflammatory medications (e.g. aspirin, ibuprofen, naproxen). There is research that indicates some types of antidepressants may be effective for some kinds of chronic pain.
While Dr. Williams, as a nurse practitioner, can prescribe certain pain medications, the patient’s primary care physician is often the prescriber. If this is the case, Dr. Williams instructs her patients to take their medication as prescribed, which is consistent with her philosophy of a team approach.
In Kostanski’s case, the medication he takes regularly helps, but is not a panacea. “It gives me a little relief for a short amount of time,” he says.
In her practice, Dr. Williams sees that chronic pain can cause feelings of anger, sadness, anxiety, and hopelessness. To help her patients view their pain differently, and stay positive, she sometimes uses cognitive behavioral therapy, a type of psychotherapy. CBT focuses on the relationship between thoughts, feelings, and behaviors. Unlike traditional psychotherapy, the therapist and patient actively work together by being problem-focused and goal-driven. Through CBT, patterns of thinking can be modified to improve coping.
Chronic pain can usually be traced to an old injury or an underlying condition such as osteoarthritis, multiple sclerosis, fibromyalgia, shingles or nerve damage or spondylolisthesis. In her practice, Dr. Williams sees cases of neuropathic pain, in which the nerve fibers themselves may be damaged or dysfunctional. Chemotherapy and diabetes are a couple of the many conditions that can cause neuropathic pain. Sometimes, chronic pain has no apparent cause; the medical term for this is “idiopathic.”
Dr. Williams spoke of the importance of endorphins, which are called the brain’s “feel-good” chemicals. When released, endorphins can decrease feelings of pain. They are released by a number of stimuli, including laughter. “I tell my patients to watch movies or shows that make them laugh,” says Dr. Williams. I take the culture of their generation into consideration. If they’re over 65, I may tell them to watch Sid Caesar shows. For younger patients, it may be Seinfeld.”
Since his diagnosis, Kostanski has been treated at Dartmouth Medical Center in New Hampshire. He has never been operated on for his spondylolisthesis. “My doctor says that if I had an operation 20 years ago, I would have had 4 by now. He says that operations for my condition have a very low success rate, and he will only operate if I come to him crying and crawling.”
Nighttime is difficult for Kostanski. He only sleeps about three or four hours a night, then tosses and turns until dawn. To compensate, he takes a long nap each afternoon. His pain never goes away. “I can only be on my feet for five or 10 minutes at a time. My pain will go from moderate to excruciating. I kneel or sit for a little while, and can then be on my feet for another five or ten minutes.”
Kostanski has had to give up most physical activity – including the golf he used to enjoy – but has substituted swimming in his condo’s large pool. “It’s the only exercise I can do without pain. I try to swim every day, for about 40 minutes.” Dr. Williams says that many of her patients are afraid to exercise, but she encourages it, if it is undertaken slowly. She says it’s important to stretch, and water exercise can be particularly helpful.
Kostanski has found the right balance in his daily life. “I make sure I don’t overdo. Today, I stretched and then rested. I then watered my plants, then rested again. In a little while, I’ll swim.” Kostanski’s wife Pam, a nurse by profession, is extremely understanding. “Every day is a struggle,” Kostanski says. “Without her support, I could not live independently. I am thankful for her every day.”
Even with pain being a constant in his life, Kostanski is surprisingly happy and content. “I feel fortunate. I know I could have been killed in that car accident, or be in a wheelchair because of my spine problems.” His strong faith helps him maintain perspective. “Whatever I’m dealing with, I know there are many people who have it much worse. I just keep on moving.”
Dr. Williams’ office is located at 725 Flamevine Drive in Vero Beach; her office phone is 772-234-4511.
