Learning to live with pain that just won't go away

By Body and Mind staff

December 08, 2009, 12:00AM

"I am the original decrepit old man,” jokes Sal Pantano, 81, of Penbrook.

But Pantano’s pain is no laughing matter. As a victim of frostbite and a broken tailbone suffered during the Korean War, this father of five and grandfather of five has lived with pain for more than 40 years. He now walks with a cane, and when he moves, the pain is written all over his face.

“I don’t like to take pills,” he said, but his doctor has told him to swallow some pain relief before the pain “gets too hard.”

Compounding his war injuries are a stubborn case of shingles, osteoporosis, arthritis and the recent loss of his wife. His doctor is now considering a nerve block for his shingles. Pantano describes his pain as “atrocious,” “horrendous” and “like a knife is going through you.”

Experts estimate that as many as one in three Americans suffer from chronic pain — pain that lasts longer than three months and alters a person’s lifestyle.

Garry Esworthy, 55, of Lower Paxton Twp., also has been struggling with chronic pain for more than eight years, after fracturing his back, undergoing a spinal fusion and enduring several subsequent, failed surgeries. For the past three years, his pain from scar tissue on his nerves escalated, forcing him to step down as a Central Dauphin School Board member, and to enroll in a pain management clinic, called Rehab Options, at Pinnacle Health System.

The clinic sees itself as the “end of the line,” when all other pain management techniques have been exhausted.

Paula Spoonhour, a registered nurse and program manager of Rehab Options, said most chronic pain sufferers they treat, usually in 20 to 60 daylong sessions, are suffering from arthritis, auto- or work-related accidents, diabetic neuropathy or other neuromuscular issues.

For Esworthy, prescription painkillers, steroid shots and intravenous pain medications administered more than a dozen times in the hospital’s emergency room, would not stop the pain. This one-time exercise enthusiast was frequently reduced to tears. On a scale of one to 10, his pain was a 10, all the time.

PinnacleHealth psychologist Christopher Ziegler describes chronic pain as a “black, foggy place where escape isn’t readily apparent. They feel they’ve been sentenced to a global sense of doom and fear that each day will just bring more of the same.”

Pain can range from sharp and stabbing, to dull or throbbing.

For Esworthy, he said it was like “Groundhog Day over and over again,” knowing that the next day would deliver more pain. The multi-pronged approach at Rehab Options has taught him how to “manage his pain instead of pain managing you.”

Rehab Options draws on professionals trained in psychology, physical therapy, nursing, vocational counseling and biofeedback to help pain sufferers. They try to help patients develop skills that will let them manage pain through changes in behavior, an increase in activity and use of medicine.

While Esworthy knows pain will always darken his life, he has learned how to deal with it, through drug-free actions such as pacing, proper breathing and other efforts. His pain has dropped from a 10 to a one on the pain scale. He knows to get up from his desk and walk at the first sign of pain and is able to exercise again.

Pain “is the most personal thing in the world,” Pantano said. “Pain screams out at you, but nobody else hears it.” Finding the right person to share the pain helps a lot, he said.

“Never underestimate the power of positive thinking,” said Ziegler. “And remember, you don’t have to go through it alone.”

The most effective tool in Ziegler’s arsenal: “other clients.”


  • Medications. Relief can come from over-the-counter or prescription drugs, but they can be hard on the stomach and interfere with daily functioning, so they might not be a perfect or permanent panacea.
  • Topical pain relief. Safe, topical analgesic patches and lotions, such as Ben-Gay, are available over-the- counter and might provide short-term relief.
  • Biofeedback. PinnacleHealth psychotherapist Doug Brown said computer- assisted equipment can identify information that helps sufferers better control muscles, breathing and heart rate.
  • Exercise. It might seem counterintuitive to exercise, but it can help to strengthen the muscle surrounding arthritis-inflamed joints. Exercise also releases endorphins, the body’s natural painkillers. Some types of exercise might be off-limits, though, so pain sufferers must talk with their doctor first.
  • Hypnosis. PinnacleHealth psychologist Christopher Ziegler said hypnosis works for some people. It can promote relaxation, positive thinking and pain distraction. Hypnosis is particularly good for helping pain sufferers unlearn bad habits, such as limping, carrying heavy objects incorrectly and excessive muscle guarding.
  • Joint protection techniques. Carrying items properly; knowing how to sit and stand; avoiding bouncing, jerking and clenching; and using good posture and body mechanics can all ease aches.
  • Massage therapy. Trained massage therapists can hasten pain relief, by soothing stiff sore muscles, reducing swelling and inflammation, and helping to increase circulation.
  • Chiropractic treatments. Chiropractor Thomas Gault of Gault Wellness Center in Lower Paxton Twp. said gentle manipulations, not the stereotypical “snap, crackle, and pop kind of chiropractic” can be truly healing.
  • Nutrition counseling. Being overweight can affect weight-bearing joints and increase arthritis pain. Gault said diets loaded with sweets and highly processed foods can cause inflammation, which is at the root of all pain. Keeping a food journal can help sufferers track foods and swap out bad ones.
  • Supplements. Gault believes many dietary supplements can be anti- inflammatory. Ginger, tumeric, cumin, curamin and fish oil, for example, can give some relief, he said. Garry Esworthy, a pain sufferer from Lower Paxton Twp., has found that vitamin B6 helps with nerve pain. The best diet for pain is a well-rounded one, Ziegler said.
  • Surgery. Often viewed as a last resort, surgery can eliminate pain in a specific joint.
  • Warm water therapy. Rehab Options utilizes aquatics therapy at its pool in Dillsburg. In water, arthritis-wracked joints are relieved from the force of gravity, decreasing pain and stiffness.
  • Acupuncture. Some pain victims have found that inserting needles at specific points can redirect energy.
  • Psychotherapy. “Most people with chronic pain develop depression or some other form of psychological distress,” Ziegler said. Antidepressants are one option, as are coping strategies and behavior modification to take away physical and emotional pain.
  • Low-level laser therapy. Gault dubs this therapy, also known as cold therapy, or 3LT, his “secret weapon.” Used by professional athletes and not seen much on the East Coast yet, Gault has used 3LT to reduce the inflammatory response and disperse swelling. This is done in 15-minute visits and doesn’t cut or burn.
  • Relaxation. Other pain relief options include meditation, music therapy and yoga.