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Saturday, December 1, 2012

"You Will Always Have the Poor Among You" - Money and Chronic Pain








Although the results of this research come as no surprise, I think people should wrap their minds around the message. Let me give you the findings, and then let's think about the core of the problem. Maybe some new understandings will surface.

"Adults under the age of 50 who live in low-income neighborhoods experience more chronic pain than those in more affluent communities, new research finds.

"Blacks, however, experienced more chronic pain and disability than whites regardless of where they lived, according to the researchers from the University of Michigan.

"The study, published in a recent issue of The Journal of Pain, included more than 3,700 adults under age 50. Men and women who lived in poorer neighborhoods had more pain, pain-related disability and mood disorders, such as depression and anxiety, the investigators found.

"The link between pain and the economic status of a neighborhood was especially strong among young black Americans, the study authors pointed out.

"'Our findings show an unequal burden of pain in blacks and among those living in poor neighborhoods among the 116 million adults who experience chronic pain,' lead study author Dr. Carmen Green, a pain medicine expert at the University of Michigan Health System, said in a university news release.

"Reasons for the disparities may include barriers to good health care, including adequate pain management, the researchers suggested."

("People in Poor Neighborhoods Have More Pain, Study Finds," CNN Health provided by HealthDay, March 1 2012)


Definition of Chronic Pain

You need to know a couple of definitions of “chronic pain” – from a layman's view and from a medical view.

Chronic Pain may be defined as "an unpleasant sense of discomfort that persists or progresses over a long period of time." In contrast to acute pain that arises suddenly in response to a specific injury and is usually treatable, chronic pain persists over time and is often resistant to medical treatments.

Chronic pain may be related to a number of different medical conditions including (but not limited to) diabetes, arthritis, migraine, fibromyalgia, cancer, shingles, sciatica, and previous trauma or injury.

The medical definition of chronic pain must be more specific in terms of time. In medicine, the distinction between acute and chronic pain has traditionally been determined by an arbitrary interval of time since onset; the two most commonly used markers being 3 months and 6 months since onset, though some theorists and researchers have placed the transition from acute to chronic pain at 12 months.

Others apply acute to pain that lasts less than 30 days, chronic to pain of more than six months duration, and subacute to pain that lasts from one to six months.A popular alternative definition of chronic pain, involving no arbitrarily fixed durations is "pain that extends beyond the expected period of healing."

The truth about discomfort (pain) is that no diagnostic tests that can determine the quality or intensity of an individual's pain. A medical examination that includes a lot of questions about where the pain is located, its intensity, and its nature is normally performed to access the type of pain. Questions are directed at what kinds of things increase or relieve the pain, how long it has lasted, and whether there are any variations in it.

So, you can see problems with diagnosing the condition of chronic pain. First of all, discomfort is a subjective experience, and it may be very difficult for a patient to communicate its exact quality and intensity to other people. Descriptions can range in intensity from a mere ache to unbearable agony.

Here is a simple example of how doctors determine severity. Perhaps you have suffered from pain, and a medical professional asked,"On a pain scale that would indicate no pain as 0 and 10 as the worst pain you have ever experienced, what number would you rate your pain?" Pretty subjective, wouldn't you agree? And, these discomfort scales are modified for infants and children to accommodate their level of comprehension.

Another frustrating aspect of chronic pain is that the stimulus may be unknown. For example, the stimulus cannot be identified in as many as 85% of individuals suffering lower back pain. Pain is a complicated process that involves an intricate interplay between a number of important chemicals found naturally in the brain and spinal cord. In general, these chemicals, called neurotransmitters, transmit nerve impulses from one cell to another.

Yet, there are many different neurotransmitters in the human body; some play a role in human disease and, in the case of pain, act in various combinations to produce painful sensations in the body. Some chemicals govern mild pain sensations; others control intense or severe pain. Determining the stimulus of pain can be difficult. Sometimes, sometimes pain arises in the absence of any detectable stimulus, damage or disease. And pain pain can persist despite removal of the stimulus and apparent healing of the body.

Pain perception also varies depending on the location of the pain. The kinds of stimuli that cause a pain response on the skin include pricking, cutting, crushing, burning, and freezing. These same stimuli would not generate much of a response in the intestine. Intestinal pain arises from stimuli such as swelling, inflammation, and distension.



Extent of Chronic Pain

Approximately 35% of Americans have some element of chronic pain,and approximately 50 million Americans are disabled partially or totally due to chronic pain. Major effects on the patient's life are depressed mood, fatigue, reduced activity, excessive use of drugs, dependent behavior, and disability. You must also consider parental chronic pain increases the risk of internalizing symptoms, including anxiety and depression in adolescents.

(I. Gilron, D.Wajsbrot, F. Therrien F, J. Lemay. “Pregabalin for Peripheral Neuropathic Pain: A Multicenter, Enriched Enrollment Randomized Withdrawal Placebo-controlled Trial.
Clin J Pain. Mar-Apr 2011;27:185-93)

Low Income Neighborhoods

In order to be classified as low income, the household must earn 80 percent or lower than the median income of the county where you live. There are average amounts for 1-to-8-person households. Here are some U.S. Census statistics on our area.

            
U.S.
Average
$52,376
  
Ohio 
Average
$47,550


Scioto County
Average
$33,662


Needless to say, we here in the county scrape the bottom of the barrel even in our own home state. I'm sure you need no further explanation of low income living conditions in Scioto County.

Factors That Determine Low Income Living Conditions

“Times are hard.” You hear this from friends and neighbors every day. Do you need some confirmation? Another 2.6 million people slipped into poverty in the United States in 2010, the Census Bureau reported, and the number of Americans living below the official poverty line, 46.2 million people, was the highest number in the 52 years the bureau has been publishing figures on it.

(Sabrina Tavernise, “Soaring Poverty Casts Spotlight on
‘Lost Decade,’” The New York Times, September 13 2011)

You say, “Simple, I know why people live in poverty. They simply don't have the initiative to make more money. Anything is possible in America.” Well, folks, poverty is an exceptionally complicated social phenomenon, and trying to discover its causes is equally complicated.

Some theorists have accused the poor of having little concern for the future and preferring to “live for the moment”; others have accused them of engaging in self-defeating behavior. Still other theorists have characterized the poor as fatalists, resigning themselves to a culture of poverty in which nothing can be done to change their economic outcomes. In this culture of poverty—which passes from generation to generation—the poor feel negative, inferior, passive, hopeless, and powerless.

You must be careful of “blaming the poor” for their own lot. That view is stereotypical and not applicable to all of the underclass. Not only are most poor people able and willing to work hard, they do so when given the chance. Muxh of rhe real trouble has to do with such problems as minimum wages and lack of access to the education necessary for obtaining a better-paying job.

More recently, sociologists have focused on other theories of poverty. One theory of poverty has to do with the flight of the middle class, including employers, from the cities and into the suburbs. This has limited the opportunities for the inner-city poor to find adequate jobs.

According to another theory, the poor would rather receive welfare payments than work in demeaning positions as maids or in fast-food restaurants. As a result of this view, the welfare system has come under increasing attack in recent years.

Again, no simple explanations for or solutions to the problem of poverty exist. Although varying theories abound, sociologists will continue to pay attention to this issue in the years to come.


The “Working Poor”

How many poor families include people who work? Poverty is often associated with joblessness, but a large proportion of poor people are actually working or looking for work. In 2009, according to the US Census Bureau's official definition of poverty, 8.8 million US families were below the poverty line (11.1% of all families).

Of these families, 5.19 million, or 58.9%, had at least one person who was classified as working. In the same year, there were 11.7 million unrelated individuals (people who do not live with family members) whose incomes fell below the official poverty line (22% of all unrelated individuals). 3.9 million of these poor individuals, or 33were part of the working poor.

(“A Profile of the Working Poor,” US Bureau of Labor
Statistics, U.S. Department of Labor, 2009)




What Do the Poor Experience?

Most of America's "poor" live in material conditions that would be judged as comfortable or well-off just a few generations ago. Today, the expenditures per person of the lowest-income one-fifth (or quintile) of households equal those of the median American household in the early 1970s, after adjusting for inflation

(U.S. Department of Labor, Bureau of Labor Statistics, Consumer Expenditure Survey: Integrated Diary and Interview Survey Data, 2003)

According to the Institute for Research on Poverty, health in the United States is very strongly correlated with income. Poor people are less healthy than those who are better off, whether the benchmark is mortality, the prevalence of acute or chronic diseases, or mental health.

As a consequence, study of the physical and mental health of low-income populations has been a component of much IRP research. For example, IRP affiliates are currently undertaking a study of the effects of casino gambling income on health and health care among American Indian populations.

A sampling of the research currently being conducted by IRP affiliates addresses the following issues:
  • Children with emotional and behavioral problems

  • Health and health insurance status, particularly for low-income children and welfare leavers; and the role of expansions in public health insurance on health care coverage and labor force outcomes

  • Socioeconomic status and health over the life course

  • Aging and health, including the determinants of health status and mortality among the elderly, the economics of health and aging, inequality in health and well-being, and programs relating to long-term care for the elderly
The World Bank's "Voices of the Poor," based on research with over 20,000 poor people in 23 countries, identifies a range of factors which poor people identify as part of poverty. These include:

* Precarious livelihoods
* Excluded locations 
* Physical limitations
* Gender relationships 
* Problems in social relationships
* Lack of security 
* Abuse by those in power
* Dis-empowering institutions 
* Limited capabilities
* Weak community organizations





African Americans and Poverty

In 2003 numbers from the National Bureau of Economic Reseach showed that children were approximately 29 percent of the non-elderly population but they constituted 40 percent of the non-elderly poor; 17.6 percent of all children lived in households with incomes below the poverty line. Overall, only 7 percent of those living in households headed by a married individual were poor, whereas households with an unmarried head and children present -- 83 percent of which were headed by women -- had poverty rates of 40.3 percent.

Among those beginning a spell of poverty, about 83 percent of white children living in two-parent households headed by someone with at least a high school education will escape long-term poverty. In contrast, only 10 percent of poor black children in a household headed by a single woman without a high school diploma will avoid it.

According to the Children's Defense Fund, nearly one million black children in the United States are living in extreme poverty. While the official national unemployment rate is 4.4 percent, the official unemployment rate for blacks is 10 percent. Of course, the official unemployment rate does not include people who have given up looking for work and those who are underemployed. In 2003 in New York City, 48.2 percent of black men ages 16 to 64 were officially unemployed

I believe reporter Philip Jackson, founder and executve director of the Black Star Project in Chicago, Illinois, allows you further insight into problems concerning race and poverty. Many of his statements apply to poor Americans, no matter their race, so I think Jackson's advice is good for all who are mired in poverty.

“Black net worth declined to a paltry $5,998 per household, while the net worth for white households grew by 17 percent during the same period to $88,651. Twenty percent of black median net worth was in cash, approximately $1,200, with the balance comprised of home equity. The housing foreclosure crisis of the past eight years has caused Black America to lose between $72 billion and $93 billion in housing-equity wealth.

"'Black families lost 25 percent of their wealth during the jobless recovery from the recent recession,' said Thomas Shapiro, a Brandeis University professor of law and social policy.

'This means that more black people are struggling in 2006 with such basic conditions as securing employment, paying rent or a mortgage, paying utilities and insurance, obtaining affordable health coverage and buying food.

'Shapiro also stated that only 26 percent of black families could survive more than three months after a major income interruption. The other 74 percent would be forced to seek government assistance, dip deep into savings, sell off assets, relocate with a friend or relative, file bankruptcy or become homeless!

'In this economic depression, college is an unaffordable luxury for many black people. Higher education, once the reliable key to moving from low-income to middle-income status, is no longer an option. The portals that lead away from poverty, crime and despair are closing or have already closed.
“Generational poverty is inextricably intertwined with race. Hope for breaking the poverty cycle diminishes and another generation of the impoverished is born. Many blacks in America are slipping from poverty to deep poverty into a third-world status.

“Black American families cannot wait for the government to save us. Annually, black Americans generate about $700 billion within the U.S. economy. However, a 2005 report by the Target Market Group shows that we don't use our dollars wisely to improve our plight in America.

“For example, in 2004, we had collective purchases that included $22 billion for clothes, $10.7 billion for furniture, $28.7 billion for cars, $14 billion for phone service, $3.7 billion for consumer electronics (not computers) and $2.3 billion on alcoholic beverages.


“Unfortunately, the only area where we showed restraint in our spending was on books, where we spent only $257 million, down from $303 million in 2002. We spent more on our fingernails and our hair -- $6.3 billion on personal care -- than on books and reading materials.

“We must take control of our economic destinies to improve black personal finances, our family wealth and our community economies, and to help lift many blacks out of deep poverty."

TEN KEY SOLUTIONS FOR BLACK ECONOMIC WELL-BEING:

1. Start your own business. By starting your own business, you can hire family, friends, and community members.
2. Get as much education as you can.
3. Stop renting an apartment. Save enough money to make a down payment on a house. Then buy a house.
4. Open savings accounts for your children, teach your children the value of money and take personal finance classes.
5. First, invest your money and your time in your skills, your knowledge base and your self-improvement. Second, learn how to let big companies work for you rather than you only working for them through stock ownership. And third, invest your money in the U.S. and global stock markets.
6. Manage your credit carefully and avoid unnecessary debt
7. Get married! Two-person headed households are more viable economically. Marriage can be an economic advantage when both parties are aligned on financial priorities and fiscal realities.
8. Create a living strategy that includes good nutrition, plenty of exercise and proper rest so that you can share your good fortune in a long and healthy life. Health is wealth!
9. Contribute to your faith-based institution or invest in a social cause.
10. Create a will to pass on your accumulated wealth.

(Phillip Jackson, “Remembering the Millions the American Dream Left Behind,” New Black Magazine, September 10 2008)


Read Phillip Jackson's Article: http://www.thenewblackmagazine.com/view.aspx?index=1580

And, Finally, My Point

A great deal of the pain adults under the age of 50 who live in low-income neighborhoods experience is a condition that they, aided by more fortunate others, need to manage by joining together to change dreadful social conditions. Depression, anxiety, and other crippling diseases are being fed by lack of income and lack of commitment.

Low-income parents must be willing to sacrifice to improve their financial situations. At the same time, American employers must give them better opportunities to thrive including a decent wage, full-time employment, and worthwhile health benefits. Of course, training and education require commitments also.

Parents who fall victim to seeking pills to ease their “poverty pains” should instead devote their endeavors to strategies such as those suggested by Phillip Jackson. In order to break the cycle of generational welfare and reliance on medication for chronic pain, poor families must take initiative and support their children – both emotionally and economically. Now, so many single-parent families are potential welfare families.

How about a little folk wisdom for a change. Simply put, fathers need to forget some old, ornery advice when thinking with their “little brains.” Instead of living with morals that subscribe to “Why buy the cow when you can get the milk for free?” men should support any child they father and “Put their money where they sperm flows.” Honestly, righteous fathers hate man who refuse to work to support their offspring.

So, you see, what I am saying is that it is true – low-income families are suffering some tremendous pain. I know this and believe it with all of my heart and mind. However, one thing I always told my classes is “If you grow up poor and work hard to make a success of your life, you will be doubly respected.” And, I totally believe that.

I know poor folks do suffer from chronic pain, and some must seek medication. Chronic pain may worsen in response to environmental and/or psychological factors. On the other hand, I know all about opioid pain medications and getting high to escape reality instead of facing it. To say that you became an addict to pain medications because of your economic status is totally unacceptable.

There are a variety of treatment options for people with chronic pain. The goal of pain management is to provide symptom relief and improve an individual's level of functioning in daily activities, not to make him/her a zombie of rx dependence. A number of alternative types of therapies have been used in the management of chronic pain including exercise, physical therapy, counseling, electrical stimulation, biofeedback, acupuncture, hypnosis, and chiropractic medicine,

I'll leave the suffering poor with one finding:

A survey by the American Academy of Pain Medicine found that even comprehensive treatment with painkilling prescription drugs helps, on average, only about 58% of people with chronic pain.”

If you are planning on elevating your mood, I would suggest trying something other than a long regimen of potentially harmful opiates. Remember, being poor does not have to be a chronic condition. You do have many options to rising above that situation; however, you can easily self-medicate yourself into oblivion when you rely on dangerous pain medications to ease your burdens and solve your frustrations.




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