PAIN RELIEF RESOURSES

For those needing pain relief after major surgery, doctors often allow patients to inject themselves with the right amount of drug, usually morphine, under a procedure called PCA - patient-controlled analgesia {analgesia means pain relief). This is done with a device attached to the tube that doctors use to transmit fluid into a vein. When the need for a painkiller arises, the patient just pushes a button, and a pump automatically injects a small regulated amount of the drug into the system.

Joan Glenn, a nurse from Bethel Park, Pennsylvania, had to have a cesarean operation to give birth to her son last May. She got PCA at Magee Women's Hospital in Pittsburgh. "The pump freed me from excess pain," says Mrs. Glenn. "It lets you treat yourself instantly, without waiting for a nurse."

In another important advance, doctors also now inject narcotics - chiefly morphine - directly into the spine rather than into a vein, frequently sidestepping some of morphine's side effects (nausea, itching, and the retention of urine).

And, in really bad cases, surgeons cut the spinal nerves. Pain relief is often instant. However, for some reason still unexplained, the pain returns after 8 months to a year.

There's help, too, for people with moderate pain, as well as for those with acute pain. It's called TENS - transcutaneous (through the skin) electrical nerve stimulation. When it was introduced a decade ago, direct electrical stimulation of the nerves seemed a panacea, but doctors now know that it works for only up to half of such sufferers and that in some cases its effect eventually wears off.

Another pain-relief resource is acupuncture, the Chinese method of sticking needles into various parts of the body. Chinese surgeons long have eliminated patients' pain responses with acupuncture. And many an athlete has had sore tendons and muscles relieved by an acupuncturist's needles.

But, again, acupuncture doesn't work for everybody, and there is no way to predict for whom it will work and how effective it will be.

Somewhat the same is true of hypnosis, one of the oldest methods of dulling pain. Probably you've seen a stage show in which the hypnotist sticks a pin into the palm of a hypnotized person and that person feels no pain. Dr. Martin Orrie, professor of psychiatry at the University of Pennsylvania in Philadelphia, an expert in hypnosis, says, "About 90 percent of the population in pain can benefit from hypnosis, and 10 percent of these can so effectively block pain that they can undergo surgery without anesthesia." Hypnosis has proved especially helpful to those patients with a clearly physical source of pain - like arthritis, shingles, or muscle pain.

Sheryl Johnson, a nurse from Panarama City, California, mastered her arthritic pain by learning self-hypnosis from a qualified doctor. "I have controlled my pain for myself," says Ms. Johnson. "I still feel pain, but I can manage it. I have not taken pain pills for 4 years." Previously, she had been unable to work for 7 months.

Dr. Orne says that if you're in pain, rather than shop for a hypnotist on your own, it's much better to seek out a doctor or pain clinic willing to both deal with your pain and find the best treatment for you. Wilbert Fordyce, a professor of psychology in rehabilitation medicine at the University of Washington School of Medicine in Seattle, runs such a pain service for patients experiencing chronic pain from accidents, surgery, or back trouble. Fordyce says his program is for "those who have healed but still are hurting more than they need to." Using behavioral therapy, he makes patients do physical things that relieve their pain. He pushes them to move, even if it hurts.

Sarah Abbott, of Seattle, injured her lower back in high school. Back surgery relieved her sharp pain, but chronic aches persisted. "I learned in the clinic to get up and bend over and touch the floor whenever I think I must take it easy," she says. "A year ago, I would have sworn this might kill me. I had the thought pattern of a cripple. At one point, suicide had seemed my only option."

Despite the discomfort and difficulties of this approach, Sarah Abbott says it's worth it: "The pain clinic turned me around. It has saved my life."