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Pain Index

Posted by john h on 8/05/01 at 19:14 (055569)

somewhere along the way glenn i have seen a medical pain index. i know what you mean when you say you go into denial when posting in your personal log about your pain for the day. i am much the same way. i do not like to admit that i am worse than the day before and take great pride in showing improvement. this of course, colors your perception of your pain level. i have a calendar on my computer and i simply post my pain level for the day 1-10. i am not sure but i guess i use my overall average for the day. after some months it all sort of evens out i think. the only activity i enter is formal walking,biking, or exercise. i do no that my pain level for the past two year has been from 1-4 and has averaged a 2. this is enough to prevent me from running. i really never know why it jumps up or goes down. it went down for a few weeks after ESWT and for a week after a cortisone shot. some of you who are surviving on crutches are a tougher lot than I.

Re: Pain Index

Glen X on 8/06/01 at hrmin (055626)

John: Hear you. I'm not sure where my own propensity for denial comes from, and for a long time I think I've worn it as some sort of boy scout badge. But increasingly I see it getting in the way of my healing. Putting a positive spin on things avoids too much reality in these delayed-consequence PF circumstances. For instance, 2 or 3 weeks ago I asked you what bi-lateral PF was. Friday I learned I have it, and today it has me missing my first day of work from this affliction.

Your clarification about your pain levels the past few months greatly helps me understand your situation. Recalling some of your history, it even gives me more hope. Thanks.

I think too you're right about things averaging out over several months. Yet when you say, 'I really never know why it jumps up or goes down,' I wonder if it might not be worth tracking with more precision. There's a reason why our pain goes up or down. Perhaps more accurate tracking of pain levels, other symptoms, levels of activity, treatment regimens and changes, and other factors -- on a daily basis -- can teach and guide us some. It's a way of 'actively' listening to our bodies as in, 'I hear you saying . . .' This could be all the more helpful if we keep a 2 or 3 day window of information in view, thereby factoring in the often delayed-consequence nature of this malady.

Re: Pain Index

john h on 8/06/01 at 16:04 (055671)

glenn: after reading your followup to my post i am thinking about starting a journal to more closely follow my activities which might give me a clue to my ups and downs with pf. i also started running through my mind when my pf started and how i got to where i am today. i researched some of my medical records and find i first went to an orthopedic foot an ankle specialist some 10 years ago. she stated in a letter to me that she thought i had PF but if the 'burning' i described at the time did not subside we should conduct some test on the nerves. i have a small trophy on my table where i placed 2nd in a 10k race in 1996 so i must have been doing ok at that time. i know about 1998 my feet were really hurting and i was considering and did have surgery on one foot. two years ago i remember flying to oklahoma to pickup a new car and no problems as i remember moving about the airport etc. there are just two many blanks in the past 10 years about how i felt. for the most part i remember 'pain'. i think anyone who has recently developed pf should keep a daily dairy to track how you feel, what you do that might increase pain, your perceived pain level, etc. scott seems to have been a master at this. we do so many things during the day that we do not notice that may be causing us difficulty ( you may squat and be up on your toes, you may sit at your computer with your feet in some awkward position, pushing a mower is not just walking as you are stressing the fascia as you push against the resistance, you may come up on your toes as you pickup your child, the little things are endless that you are mostly unaware of). i shall try and recreate how i got to where i am because my history is not one of constant pain, constant progress but one of steps forward and backwards. certanly i was at my worst when i decided on surgery some 2.5 years ago. i am better today than then. i also have had 3 ESWT treatments. the foot i had surgery on is the same pain level as the one i did not have surgery on. i would consider myself cured if i could run 3-5 miles but will accept being able to walk 3-5 miles with a pain level of 1. during the period 1991-1996 i must have been somewhat cured if i ran a fast 10k in 96. my activities after 96 changed in my running was uphill a real bad no no for your fascia which was the start of something real bad.

Re: Tracking Log

Glenn X on 8/06/01 at hrmin (055691)

John: I'm adding detail and definition to my log too. I keep mine in a Palm Pilot Database (ThinkDB). I use yes/no checkboxes, pull-down lists, some integer entries, and a couple of remark fields. Takes about a minute to enter the day's info. Easily uploads to a PC. (ThinkDB is a fine (I believe free), user-friendly little database). Also works on a Handspring.

Fields I use are date, swelling level, pain level, frustration level, progress (-/o/+), what kind of stretching I've done, use of splints?, ice, bike mins, taping, ultrasound (if at PT), and some checkboxes for Vitamin C, meds, arch support worn, pedometer strides, and a couple of other things -- and also a remark field for a thought, and another for a milestone, say a visit to a doctor, or PT. One could also track cherry juice, jade, massage, myofascial release, ART, runs, hikes, swims, climbs, etc. Sounds like a lot, but in a simple database, or spreadsheet, (using default values) it shouldn't take but a couple of minutes at most to update. I find it helpful, therapeutic even, to reflect on the day and do this. Imparts a modest sense of control.

The database (or spreadsheet) allows for easy filtering of information. i.e., I can set the ' taping' filter and see that I've taped my foot 30 days (out of 441 days of tracking). Only recently started taping. I find it useful to more simply look back on the past couple of weeks and see my progress (- / o / +) (backward, neutral, forward). Several in sequence of either of these marks are not hard to relate to what I've been doing lately.

This has more potential in longer-term analysis, particularly in a situation where one has more mobility than I have right now. For instance, you could use a pedometer every day and record total number of strides (miles walked), and also pain level (1-10). After a couple of months you'd have 60 data points to calculate a correlation with. i.e., what's the relationship between strides and pain level? This could be even more valuable moving just the pain data points out one day, then two days, and perhaps three days. (You'd just copy the pain numbers to an adjacent column and move them all down a row, then two, then three). Excel can easily analyze these different scenarios to see if pain is influenced by activity, and if so, how many days after activity is pain most likely to be affected? Similar correlations could be made with stretching efforts, bike miles, night splint usage (though this has a much longer correlation), the use of meds, icing, 90-proof cherry juice and so forth. As one gets out four and five months, confidence in the data increases, and perhaps clues unfold.

The history you resurrected above is informative even to me. A log certainly helps with that. I can imagine how useful it must be to you. Maintaining a one-page summmary history (like Scott's) is something I believe might benefit everyone approaching a healing.

(For those less familiar with statistics (and my knowledge is rudimentary), the above analytical stuff sounds more complicated than it really is. Wouldn't take more than 15 minutes to show someone how to chart and correlate two series of data points in a spreadsheet). The result could be a visual AHA.

Re: Tracking Log

john h on 8/07/01 at 10:08 (055765)

glen: you really have got a handle on your PF history. i think the first thing i would advise someone who develops PF is to start a detailed journal of the list of things you mention. at one time i was an analysis officer for all avionics,radar,electronic counter measure equipment, bomb/nav equipment aboard B-52's. we compiled failure data and thus recommed measures to prevent future failures such as changing a black box on a time interval rather than wait for it to fail. like any problem we need to approach PF with the best knowlege we can gather about how we are effected, what effect certain activities have on us, what meds,balms,juices for us,what causes pain etc. Each of us respond to various things in different ways and the very helpful data scott accumulates may not always apply to us. Like all things problems need to identify the problem clearly and precisely and proceed to take measures to solve it. if we do not keep good data we are doomed to keep reapeating our mistakes over and over. i have done a very poor job in my own case. the more i reconstruct my medical history the more i see my perception of the past is not what i have come to think it was. if we do not clearly understand our PF history our doctors sure cannot.

Re: Pain Index

Glen X on 8/06/01 at hrmin (055626)

John: Hear you. I'm not sure where my own propensity for denial comes from, and for a long time I think I've worn it as some sort of boy scout badge. But increasingly I see it getting in the way of my healing. Putting a positive spin on things avoids too much reality in these delayed-consequence PF circumstances. For instance, 2 or 3 weeks ago I asked you what bi-lateral PF was. Friday I learned I have it, and today it has me missing my first day of work from this affliction.

Your clarification about your pain levels the past few months greatly helps me understand your situation. Recalling some of your history, it even gives me more hope. Thanks.

I think too you're right about things averaging out over several months. Yet when you say, 'I really never know why it jumps up or goes down,' I wonder if it might not be worth tracking with more precision. There's a reason why our pain goes up or down. Perhaps more accurate tracking of pain levels, other symptoms, levels of activity, treatment regimens and changes, and other factors -- on a daily basis -- can teach and guide us some. It's a way of 'actively' listening to our bodies as in, 'I hear you saying . . .' This could be all the more helpful if we keep a 2 or 3 day window of information in view, thereby factoring in the often delayed-consequence nature of this malady.

Re: Pain Index

john h on 8/06/01 at 16:04 (055671)

glenn: after reading your followup to my post i am thinking about starting a journal to more closely follow my activities which might give me a clue to my ups and downs with pf. i also started running through my mind when my pf started and how i got to where i am today. i researched some of my medical records and find i first went to an orthopedic foot an ankle specialist some 10 years ago. she stated in a letter to me that she thought i had PF but if the 'burning' i described at the time did not subside we should conduct some test on the nerves. i have a small trophy on my table where i placed 2nd in a 10k race in 1996 so i must have been doing ok at that time. i know about 1998 my feet were really hurting and i was considering and did have surgery on one foot. two years ago i remember flying to oklahoma to pickup a new car and no problems as i remember moving about the airport etc. there are just two many blanks in the past 10 years about how i felt. for the most part i remember 'pain'. i think anyone who has recently developed pf should keep a daily dairy to track how you feel, what you do that might increase pain, your perceived pain level, etc. scott seems to have been a master at this. we do so many things during the day that we do not notice that may be causing us difficulty ( you may squat and be up on your toes, you may sit at your computer with your feet in some awkward position, pushing a mower is not just walking as you are stressing the fascia as you push against the resistance, you may come up on your toes as you pickup your child, the little things are endless that you are mostly unaware of). i shall try and recreate how i got to where i am because my history is not one of constant pain, constant progress but one of steps forward and backwards. certanly i was at my worst when i decided on surgery some 2.5 years ago. i am better today than then. i also have had 3 ESWT treatments. the foot i had surgery on is the same pain level as the one i did not have surgery on. i would consider myself cured if i could run 3-5 miles but will accept being able to walk 3-5 miles with a pain level of 1. during the period 1991-1996 i must have been somewhat cured if i ran a fast 10k in 96. my activities after 96 changed in my running was uphill a real bad no no for your fascia which was the start of something real bad.

Re: Tracking Log

Glenn X on 8/06/01 at hrmin (055691)

John: I'm adding detail and definition to my log too. I keep mine in a Palm Pilot Database (ThinkDB). I use yes/no checkboxes, pull-down lists, some integer entries, and a couple of remark fields. Takes about a minute to enter the day's info. Easily uploads to a PC. (ThinkDB is a fine (I believe free), user-friendly little database). Also works on a Handspring.

Fields I use are date, swelling level, pain level, frustration level, progress (-/o/+), what kind of stretching I've done, use of splints?, ice, bike mins, taping, ultrasound (if at PT), and some checkboxes for Vitamin C, meds, arch support worn, pedometer strides, and a couple of other things -- and also a remark field for a thought, and another for a milestone, say a visit to a doctor, or PT. One could also track cherry juice, jade, massage, myofascial release, ART, runs, hikes, swims, climbs, etc. Sounds like a lot, but in a simple database, or spreadsheet, (using default values) it shouldn't take but a couple of minutes at most to update. I find it helpful, therapeutic even, to reflect on the day and do this. Imparts a modest sense of control.

The database (or spreadsheet) allows for easy filtering of information. i.e., I can set the ' taping' filter and see that I've taped my foot 30 days (out of 441 days of tracking). Only recently started taping. I find it useful to more simply look back on the past couple of weeks and see my progress (- / o / +) (backward, neutral, forward). Several in sequence of either of these marks are not hard to relate to what I've been doing lately.

This has more potential in longer-term analysis, particularly in a situation where one has more mobility than I have right now. For instance, you could use a pedometer every day and record total number of strides (miles walked), and also pain level (1-10). After a couple of months you'd have 60 data points to calculate a correlation with. i.e., what's the relationship between strides and pain level? This could be even more valuable moving just the pain data points out one day, then two days, and perhaps three days. (You'd just copy the pain numbers to an adjacent column and move them all down a row, then two, then three). Excel can easily analyze these different scenarios to see if pain is influenced by activity, and if so, how many days after activity is pain most likely to be affected? Similar correlations could be made with stretching efforts, bike miles, night splint usage (though this has a much longer correlation), the use of meds, icing, 90-proof cherry juice and so forth. As one gets out four and five months, confidence in the data increases, and perhaps clues unfold.

The history you resurrected above is informative even to me. A log certainly helps with that. I can imagine how useful it must be to you. Maintaining a one-page summmary history (like Scott's) is something I believe might benefit everyone approaching a healing.

(For those less familiar with statistics (and my knowledge is rudimentary), the above analytical stuff sounds more complicated than it really is. Wouldn't take more than 15 minutes to show someone how to chart and correlate two series of data points in a spreadsheet). The result could be a visual AHA.

Re: Tracking Log

john h on 8/07/01 at 10:08 (055765)

glen: you really have got a handle on your PF history. i think the first thing i would advise someone who develops PF is to start a detailed journal of the list of things you mention. at one time i was an analysis officer for all avionics,radar,electronic counter measure equipment, bomb/nav equipment aboard B-52's. we compiled failure data and thus recommed measures to prevent future failures such as changing a black box on a time interval rather than wait for it to fail. like any problem we need to approach PF with the best knowlege we can gather about how we are effected, what effect certain activities have on us, what meds,balms,juices for us,what causes pain etc. Each of us respond to various things in different ways and the very helpful data scott accumulates may not always apply to us. Like all things problems need to identify the problem clearly and precisely and proceed to take measures to solve it. if we do not keep good data we are doomed to keep reapeating our mistakes over and over. i have done a very poor job in my own case. the more i reconstruct my medical history the more i see my perception of the past is not what i have come to think it was. if we do not clearly understand our PF history our doctors sure cannot.