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How Can I Exercise With Chronic Pain?

When The Cochrane review recently did an overview of all the trials it’s covered in the past for long-term pain, it found that strength building, endurance, and range of motion exercises could have an impact on moderate pain. Few participants reported any harm, but many experienced improvements in their physical function and quality of life.

Runner’s High

There is no miracle therapy for pain, regardless of how much you need one, but find the right kind of exercise for your unique condition, and you have an excellent chance of improving your symptoms. Increased blood flow to the pain site can even promote healing, but that exercise high might be even more potent. Endorphins are nature’s painkiller, and exercise raises these levels.

Muscles and Pain

If your condition involves muscle spasms—and many do—the right form of training can release them. Core muscle strengthening exercises are important for post-operative care and stubborn injuries. They’re also far easier to do than you might imagine and are useful for those who can’t manage anaerobic workouts.

If your pain causes anxiety, or if your anxiety worsens your pain, some kinds of exercise can teach you mindfulness, which is a powerful tool to add to your coping kit. Yoga performs well in trials for patients with chronic neck pain, but it’s even better as a cognitive behavioral tool to help you stay present—an important skill for any chronic pain patient.

Getting Started

Your physiotherapist will have an arsenal of evidence-based exercises for your condition. Strength training is best reserved for supervised exercise as it can cause further injury. Your surgeon or specialist will be able to recommend a program that suits your body and fitness level.

You will most likely feel soreness or discomfort at first with any exercise program as your muscles become used to stretching and strengthening. Breathe through the pain, and if you are concerned about the pain level you experience while exercising, speak up. We may be able to adjust the exercise. However, don’t quit!

The major exception to the rule that exercise helps reduce pain: if you are recovering from an injury and/or if your doctor prescribes rest. There is, after all, a difference between healing and strengthening. Both are important elements of recovery.

Changing Attitudes About Chronic Pain

Ableism says, “if you aren’t as able as I am, you are less.” This can filter into a huge variety of attitudes towards chronic pain patients, many of them well-meaning yet not particularly thoughtful. Chances are, you want to be supportive.

If you experience chronic pain, different comments will bother you while others will roll off your shoulders. Everybody is different. What doesn’t vary from person to person, however, is the desire to be accepted and supported where appropriate.

Resist the Urge to Offer Cures

When faced with an unfamiliar challenge, people feel uncomfortable. To alleviate the awkward feeling, they often try to be helpful by suggesting magic cures and treatments. You should understand that people with chronic pain conditions know more about their treatment options than you do, because they have been dealing with it for longer, and they’ve been in consultation with medical professionals. Even an evidence-based treatment that worked for your great-aunt won’t work for everybody.

It’s possible that you have new information about a treatment that might help, but perhaps less likely than you want to believe. Whatever you do, don’t get defensive or judgmental if the person rejects your advice. They probably have good reasons.

Practice Empathy Instead of Pity

It may be true that you “wouldn’t want to live like that.” It might be the case that “oh, you poor thing” is the only thing you can think of to say in the moment. But if you put yourself in the other person’s shoes, you’ll realize such expressions of sympathy function as huge downers. They’re isolating.

That doesn’t mean you should say you understand, especially if you don’t. Empathy involves listening. You might be able to relate to severe pain, or you might have a chronic condition of some kind, but saying you understand can be dismissive. Sharing is caring, but only when you have listened long enough to know it’s your turn to share.

Don’t Be Silly

It’s silly to assume that somebody in chronic pain will always go around with a strained grimace on their face. People with pain conditions do, indeed, smile and laugh, even when experiencing intense pain. Pain levels and productivity levels aren’t based on a simple inverse relationship. Some days, people rally. If you’ve ever hid your emotions in order to focus on a situation, you can grasp that people sometimes hide their pain.

Maybe Don’t Award Medals

Pushing through pain and other physical limitations in order to achieve goals is admirable. There are times when it’s appropriate to voice admiration. For instance, if someone you know tells you they’re in a lot of pain but they’re going to go for it anyway, by all means praise them for going for it, and ask if there are any ways you can help. But don’t heap unsolicited praise on a complete stranger simply for managing to exist in society. Pedestals are isolating, and saying “wow, you’re disabled and you made it all the way up here by yourself?!” in tones you would use with a toddler or pet? No, thank you.

Don’t Be Mean

Judge not, lest ye be judged as rude or worse. It’s not fair to assume someone taking narcotics is a helpless addict. It’s not cool to decide that someone is faking it because they aren’t adequately playing the part of a person in pain. It’s not nice to accuse someone of seeking a pity party when they honestly answer the question, “How do you feel?”

In our culture, we like to be problem-solvers. We like to judge situations, because defining and categorizing a problem simplifies the solution. We like to apply our solution and then be done with it. If chronic pain were so simple to deal with, it wouldn’t be chronic pain. Dealing with chronic pain takes chronic commitment and a willingness to work through it one day at a time (good days and bad days). To show support, all you have to do is respect that simple fact.

If you are ready to work through your pain with a team of pain specialists in Phoenix, get in touch with Pain Stop today.

Should Massages Really Hurt?

Massage therapy was once the stomping grounds of physiotherapists alone, but in recent years, CAM practitioners have stumbled into it head first. They offer everything from acupressure to trigger point release, the results of which range from beneficial to non-existent to downright dangerous. If you have non-malignant pain, massage therapy might improve your symptoms, but the type of specialist you visit will directly influence the results you get. The question is thus not whether massage should hurt, but which specialists know enough to hurt their patients without causing harm.

Scars and Risks

Some conditions involve scar tissue that should not be touched by alternative practitioners. Repetitive strain injuries, torticollis, and similar conditions should only be cared for by an accredited physiotherapist. Physical therapy is the only specialty with enough supporting evidence and knowledge to care for patients safely.

Massage outside this discipline has been studied in-depth, and results have been patchy at best. Some of your physiotherapist’s work will hurt, both during and after care. Don’t think of pain as a sign that your treatment has been more effective, but do understand the intent of your physical therapist. They’re in it to release, stretch, and strengthen your muscles, which can be painful initially. They may also help to establish your diagnosis. However, they are capable of helping you relax, too, if that is part of your treatment plan.

What to Expect

Physical therapy is only as good as its results. It should return you to active life, rehabilitate you, and help you to prevent injuries. It’s as much about educating patients as it is about diagnostics and care. You will learn how your body responds to your condition, how your daily life affects your pain levels, and what you need to do daily to bring genuine relief. Will it hurt? If it does, you should be informed as to why and how much pain to expect. Let your therapist know if you experience unexpected pain levels, and make sure a doctor is overseeing your care.

Self-Care Tips from People with Chronic Pain

Self-care is a powerful coping mechanism that can reduce the intensity of your pain, act as a powerful adjunct to your therapy, and help you to cope with the emotional effects of your illness. Four pain patients speak of the self-care they find most helpful:

1) “Sometimes I just need to get my anger […] and depression out.” LaPiccolaSirena

Journaling helps you to process your feelings and vent your anger. If you’re facing depression and insomnia, these need urgent medical care. Still, writing out your feelings keeps you self-aware so that you can better manage your symptoms.

2) “March or roll yourself to a damn tub.” Emilya497abb1

Heat therapy has been shown to reduce pain intensity and increase mobility in some pain sufferers. A luxurious bubble bath before bed won’t hurt your psyche, and it might help you relax enough to get some sleep. If your muscles are cramped, heat will improve circulation, which can promote healing, too.

3) “[Yoga] is the best thing I could do for my back.” Jacqui Prochaska

Hatha yoga can release muscle cramps and is particularly effective in lower back pain patients. Used together with mindfulness training, it will let you manage pain more easily and improve your coping skills.

4) “Aquatic physical therapy is a huge help.” FutureKitLady

Physiotherapists are fond of aquatic therapy for arthritis sufferers because the water protects your joints and keeps movements slow. This way, you’re less likely to injure yourself, and your posture may even improve in time. Add warm ups and warm water and your body will thank you.

It’s easy to forget that self-love is a proactive habit. If you feel trapped in a pain cycle that’s creating too many bad days, simply remembering to be kind to yourself can ease your suffering.

Quotes from Buzzfeed users. The original list should not be taken as medical advice. For an individualized assessment and treatment plan, talk to a pain specialist.

10 Steps from Patient to Person from ACPA

Scratching an acceptable quality of life out of the mud that is chronic pain is difficult, but not impossible. The American Chronic Pain Association suggests 10 coping skills that will clear your way.

1) Acceptance

Pain is a part of your life that may not be curable. Wishing won’t make it true, but acceptance of pain has been proven to improve treatment outcomes. It even improves your emotional state and social functioning.

2) Be involved

Patient empowerment improves outcomes, too, so becoming active in your care will help your emotional state and enable you to fine tune your treatments more effectively.

3) Prioritize

Your life is still important, even if it’s mired in pain. List your life’s priorities so that you use your “spoons” wisely.

4) Create realistic goals

Make sure you can accomplish them, then celebrate your successes.

5) Know your rights

As a patient and as a friend, you have a right to respect, to make mistakes, and to defend your boundaries without guilt.

6) Honor your feelings

Your emotions have a powerful impact on your physical wellbeing. Notice them and cope with them because they’re one of your most important tools for dealing well with your pain.

7) Find peace

Stress makes pain worse and harder to manage. Tools like mindfulness and meditation improve both pain acceptance and quality of life.

8) Stay Active

Exercise can keep your muscles flexible so that they feel less pain. Develop a strength and flexibility program with your doctor or physiotherapist that respects your abilities while improving your condition.

9) See the whole picture

Your rights, priorities, and goals will show you that pain needn’t be your primary focus in life. You can live a normal life.

10) Ask for help

One in three people live with chronic pain. That gives you an enormous resource for support and learning.

If you are ready to take control of your pain, schedule an appointment at Pain Stop Clinics today.

Risks of Long-term Over-the-Counter Drug Use

“Over the counter” is not a synonym for “no side effects.” Any medicine that can treat a symptom will also be powerful enough to cause harm. If you don’t know what to watch for, you put your health at risk, especially if your care isn’t overseen by a doctor.

Kidney and Liver Function

Any prolonged or chronic usage of medications can be harsh on your kidneys and liver, which are responsible for detoxifying the body. If you regularly take NSAIDS, opioids, and anti-convulsants, your doctor should be checking your kidney and liver function every six months.

Stomach Ulcers

While NSAIDS are some of the safest OTC pain medications on the market, they can have surprising effects on some patients. They’re harsh on the stomach, so prolonged usage can cause stomach ulcers and gastritis. This is why your package inset tells you to take them after meals and for no longer than 10 days in a row. Their harshness doesn’t stop at the stomach: some can cause irritation throughout the gastrointestinal tract. Aspirin is equally corrosive.

Heart Attacks

The FDA has issued a warning of NSAIDs increasing the risk of stroke and heart attack.

NSAIDS and Blood Thinning

Aspirin and NSAIDS can thin the blood, making it difficult to clot, so they shouldn’t be taken with other blood thinners like Warfarin. Speak to your doctor about discontinuing them two weeks before surgery, too.

Hyponatremia

Tegretol and opiates can lower your sodium levels, causing cramps, headaches, drowsiness, and memory loss. It’s critical to have your sodium levels tested often if you take these drugs, and to treat these symptoms as emergencies until you know their cause.

Your doctor should be involved in your treatment, even if your medication is offered over the counter. Long-term use of any drug requires careful monitoring.

What is Biofeedback for Chronic Pain?

Neurofeedback techniques are heaving with contention, myth, and misunderstandings, so it’s no surprise they find themselves in evidence-based medicine blogs so often. The therapy works on the basis of abnormal brain patterns. Patients are hooked up to an EEG and trained to relax or focus. Neurologist Steve Novella calls biofeedback a cognitive behavioral therapy that teaches patients to “adapt and adjust”.

What Biofeedback Can and Cannot Do

It’s not possible to train the brain to have “normal” EEG patterns, but it is possible to learn how to relax. Your emotional state has a powerful effect on how well you cope with pain. It can even push your symptoms to new heights, throwing down the first domino in a complex anxiety/pain cycle. Neuropathic pain’s expression responds directly to stress, possibly because the chronic pain pathways intersect with the brain’s emotional center.

Neurofeedback is sometimes done with EMGs, which measure muscle tension. This may help patients to become more aware of their bodies’ response to pain. Relaxation techniques and mindfulness have a varied effect on different kinds of pain. Small trials suggest that lower back and neck pain may respond well to progressive muscle relaxation, which can be learned through EMG biofeedback.

Biofeedback’s reliance on brain wave patterns can distract from its role as a CBT technique. Any form of relaxation can benefit symptoms that are exacerbated by anxiety, including chronic pain. Since pain itself often causes depression and anxiety, cognitive behavioral therapy is a much needed and too often ignored treatment.

Magical Cures and Snake Oil

Alternative medicine practitioners have embraced biofeedback as a therapy for everything from ADHD to high blood pressure. Clinical trials have yet to show any results, but neurofeedback is as adequate as any other cognitive therapy for pain patients needing to reign in their anxiety.

The Relationship Between Emotional and Physical Pain

The space between physiology and emotion grows smaller with each passing study, and the reasons are more obvious than you might think: The physiological and emotional pain centers in the brain overlap.

fMRI studies show that pain intensity shrinks when the hippocampus reflects patients’ optimism, and other studies have shown that chronic pain damages some sections of the brain in the same way psychological trauma does. The anterior cingulate cortex is responsible for feelings of rejection and pain, but there are other, more important, regions involved in both. Some forms of emotional and physical pain share a neural pathway, which seems to respond to acetaminophen.

The Studies

In 2013, researchers found that Tylenol dulls your response to grief. More recently, 62 people were given acetaminophen or a placebo for three weeks and exposed to social rejection. A second study used MRIs to find out how the drug affected emotional pain. Chief researcher DeWall will be doing follow-up studies to find out if the aggression, risk taking, and overeating so often related to social rejection might be kept at bay by analgesics, too. The trials were small ones, but they follow years of research that’s showed similar results.

When Pain is a Healthy Response

The question emerging from these trials is whether turning to painkillers is the answer to life’s ordinary emotional ups and downs. Of course, when depression or other mood disorders are a part of the picture, medical treatment is critical, but if you’re facing nothing more than a broken heart, feeling your emotions might be necessary since numbing everyday pain is unhealthy enough to create an entirely new set of symptoms.

Medicating normal feelings is a disorder in itself. The best (and only) way out of emotional pain is through it, because numbness only postpones difficult emotions for later. As with physical pain, treating the cause beats treating the symptoms, and meaningful treatments often take time. That doesn’t mean you shouldn’t ask for help if you are really hurting, because you could benefit from short-term or long-term therapies. Talk to your doctor if you are worried about your quality of life.

Opioid Deaths Among Veterans Highlight Need for Better Treatments

Between 2000 and 2012, opioid painkiller prescriptions rose by an alarming 270%. Fatal overdose rates were twice the previous national average, and veterans were twice as likely to die from opioid overdose. The Wall Street Journal blames the Nineties prescription epidemic.

Opioids are also fueling heroin addiction, as users build tolerance to milder painkillers. Half of vets who were involved in Middle East conflicts report chronic pain, so the problem is dire for more than one reason. Alternative therapies such as physiotherapy and off-label prescriptions can help greatly. Opioids should not be the first port of call.

Signs of Addiction

Dependency and addiction are different things. The former refers to a physical set of symptoms, which arise in response to tolerance of the drug. If you have a dependence, your body has become so used to your painkillers that you will develop side effects when you stop using them, so your body may need help to wean off opioids safely. Since you will also crave opioids when you stop, it’s important to get professional support.

In contrast, substance abuse disorder includes these symptoms:

  • Repeated failure to fulfill social, work, and family obligations.
  • Repeated use that puts you in harm’s way.
  • Recurrent legal problems.
  • Continued use even though social and physical problems are exacerbated by it.

Opiate dependency can cause rebound pain and mood swings. As a vet, it might also exacerbate PTSD. This raises your odds of a fatal overdose, which is why opioid addiction among veterans has produced such startling effects.

Military-specific help is available for counseling to support recovery from addiction or psychiatric-behavioral issues. However, your chronic pain treatment partner is also core to your recovery. Pain Stop Clinics will cope with your symptoms without over-prescribing painkillers. You deserve reduced pain that doesn’t have negative consequences.

Opioid Overprescription Among Veterans With Chronic Pain

The Tomah facility earned its nickname, “Candyland”, for its over-prescription of opioid painkillers. Chronic pain is the most common reason Middle East veterans seek care. It’s often suffered together with post-traumatic stress disorder, with 66% of PTSD vets having a coexisting chronic pain condition. By the same token, 47% of vets in treatment for neck and back pain also have PTSD.

The VA is working on adding new types of chronic pain treatments to its arsenal, but many of the therapies it’s selected don’t come close to having a foundation in evidence-based medicine. This leaves veterans with few recovery options, but funding has been pushed through to improve the situation.

One of the most important tools to fight the prescription epidemic is by offering treatment alternatives that genuinely reduce pain. Since emotional states have a powerful impact on pain levels, treatment of psychiatric disorders is equally key.

Coping Tools

Over the last 30 years, multidisciplinary pain clinics have shown themselves to be 75% more effective than conventional care. Pain patients should be taught how to manage their pain behaviors and use cognitive tactics to manage their symptoms. Of course, physical care cannot be ignored, and there is a host of treatment options that don’t include opioid prescriptions.

Medical innovation leaps forward every day, and chronic pain is one of its core focuses. This has created an entire set of evidence-based treatment types that can reduce pain and symptoms of PTSD. Pain Stop Clinics offer the multidisciplinary approach that has shown itself to be so powerful among veterans. You deserve the best care, and that’s what we provide.

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