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Depression and Chronic Pain

Your frame of mind is inextricably linked to how well you cope with illness. Depression is not just chronic pain’s intolerable result, but its catalyst as well. The two are so commonly connected that 65% of depression patients suffer from pain. In the past, this link was poorly understood, and people with a desperate medical need were labelled malingerers. Researchers are still struggling with a chicken-or-egg riddle of which comes first. Does depression cause pain, or does pain precede depression? The answer seems to be both.

Research Findings on Depression’s Effect on Pain, and Vice Versa

To establish causation, researchers must find an unbiased way to assess these patients from the moment of their first psychiatric and physiological symptoms—and that’s a challenge that’s not been overcome yet. Researchers do, at least, know that physiological pain feels more intolerable when depression exists. The human body is remarkably reactive to feelings of optimism, as Amy Donaldson et al. discovered when they measured the pain intensity of coronary artery bypass surgery patients. The more optimistic they were prior to their procedures, the less pain they reported afterwards.

A sense of hopelessness and confusion can make symptoms more unbearable. Investigators have found that the more precise the diagnosis is, the less pain depression patients experience. Those with more than one symptom were also three times as likely to become depressed. Similarly, depression is linked to poorer outcomes.

Depression cannot simply be fixed overnight. If people with depression could simply decide to be more optimistic, there would be no depression. Understanding the link between depression and pain is not meant to discourage patients with both, but to examine ways that both can be treated to break the depression-pain cycle.

The studies of the last decade have led to a better understanding of how to care for people who have comorbid depression and pain. Specialists with a comprehensive understanding of these two conditions can mean all the difference for the prognosis of both. Pain Stop Clinics employ clinical staff from a range of different disciplines. This way, each unique case is treated from all angles by a clinical team.

Do Opioids Lead to Heroin Addiction?

Drug overdoses kill 29,000 Americans a year, with the majority of those deaths being from opiate and heroin abuse. While campaigners like to draw a link between opioid and heroin abuse, no studies have revealed anything beyond correlation. Most heroin abusers have used opioids before because most Americans have used opioids at least once in their lifetimes. By the same token, most heroin users have used soap in the past. This doesn’t mean cleanliness caused their addictions. The DSM, fortunately, provides a better idea of addiction’s cause.

Addiction vs Dependency

The DSM-V separates addiction into two separate diagnoses:

  • Substance dependency, which is a physiological tolerance to a substance without psychiatric involvement.
  • Addictive/Substance abuse disorder, which involves behavior.

The psychopathological model sees mental disorders as the cause of addiction. Saying opioid painkillers lead to heroin addiction is thus like saying razorblades are the cause of self-mutilation.

When Medication Creates Addiction

The circumstances surrounding a patient’s need to take painkillers should be carefully monitored. For example, if they are prescribed painkillers after undergoing a traumatic event, they may be at higher risk for self-medicating, which can lead to addiction.

If you’re taking opiates due to a substance dependency, the odds are excellent that you’ll never pick up heroin. If you have an underlying pathology like substance abuse disorder, your drug of choice is probably “more”—of anything, whether it be heroin or stronger opioids or a bottle of vodka.

It’s critical that opioid users receive the correct diagnosis because a substance abuse disorder requires specialized care. Those who have developed a dependency are generally able to take narcotic medications without abusing them, but those with substance abuse disorders should avoid that entire class of drugs, from benzodiazepines to pseudoephedrine and Oxycodone.

This doesn’t make dependency a pleasant problem. If you’ve developed a tolerance and are suffering from severe rebound pain, you deserve freedom from a toxic cycle that’s likely leaving your body in constant crisis. Besides, long-term side effects can create more health problems down the road. At Pain Stop Clinics, we treat pain with a holistic approach based on each unique patient profile.

Steroid Injections for Back Pain

Back pain is notoriously challenging to treat, but steroid injections could give you weeks of relief without drugs. The risks are rare, but significant, so your physician will try more conservative approaches before recommending them. They’re an invasive option given the sight of the epidural, but if you’re waiting for surgery or are struggling to cope with short-term pain, they may bring much-needed freedom.

Conditions Treated with Steroid Injections

Back pain isn’t a single diagnosis, but a symptom of a titanic collection of conditions. Epidural injections have proven themselves effective in two conditions: inflammation or nerve damage and spinal stenosis. The former usually affects the lower back and neck, with shooting pain that radiates into the limbs. A herniated disc is frequently the cause. If your spine has narrowed, whether from a herniated disc, misplaced bone spur, or tumor, steroid infections might ease your symptoms, too.

What to Expect from Steroid Injections

Your epidural should be effective for a few weeks. If your first one does its job well, you may be prescribed up to three a year, which means they can’t be a constant source of support. They’re also no substitute if surgery is needed. It’s important to approach this form of treatment from the right angle. Studies haven’t turned up any long term benefits, so they’re largely symptomatic.

Your injection will be given as near as possible to the source of your pain, which is why epidurals are only an option if your condition is highly concentrated to one area. Dispersed pain demands a more general approach.

Cortisone and steroids may be used as anti-inflammatories. Lidocaine or bupivacaine are often included, not only for their anaesthetic powers, but their tendency to flush inflammatory agents out of the area, too.

As always, to determine which treatment might be best for you, work with a caring medical team. If your back pain is affecting your quality of life, contact Pain Stop Clinics for a consultation.

Does Pilates Improve Posture?

You’d be hard pressed to find a fitness guru more obsessed with posture than your average Pilates instructor (perhaps a classical ballet instructor? We digress). Both forms of exercise focus on moving efficiently, and that requires core strength. If you’re relying on your superficial muscles to support you, you probably suffer from at least a little pain. Headaches, pinched nerves, and hip pain can all happen as the result of slouching, and Pilates will address the problem from a few different angles.

Why is Good Posture Important?

If your spine is poorly aligned as you work and play, some muscles must compensate while others become knotted and contracted. Your range of motion will be limited and some of your organs will be compressed. Inflammation can result from nerve compression, too.

Pilates teaches balance, which requires you to rely on core strength while teaching you to balance your weight onto the middle of your foot. You’ll learn a neutral spine position, which keeps your curvature relaxed and natural. If you overcompensate by opening your chest too widely and pushing your shoulders too far back, you will lose your balance, so the process teaches you good habits intuitively.

Pilates for Back Pain

Core strength is an obvious support for back pain, but flexibility has a role, too. By stretching out the muscles around the spine, it releases contractions while reinforcing a healthy curvature. Pilates is so effective at its job that trials have demonstrated improved endurance, flexibility, and posture within only 12 weeks. You needn’t turn your exercise into an obsession to enjoy results. Even mild Pilates routines, when performed twice weekly, have an impact.

Pilates specifically targets the hunched kyphotic lordotic posture, which brings hip spasms, neck tension, and weak abs. Your back pain deserves a proactive solution, and Pain Stop Clinics can help you design a treatment plan.

What is the WHO Pain Ladder?

The vast majority of doctors’ consultations focus on pain management, but before 1986, there was no universally understood way to communicate pain levels. Doctors had to intuit their way through pain care one adjective at a time. The World Health Organization developed the pain ladder as a three step grading system to solve this problem.

The WHO Pain Ladder has evolved from a cancer pain guide into a treatment framework for all chronic pain conditions. The ladder leaked into the medical industry, acting as a catalyst for global teaching campaigns that improved pain awareness. It also came at a cost, triggering a cataclysmic opioid crisis.

Treatment-Based Pain Relief

The ladder doesn’t only guide the kind of treatment you receive, but acts as a flag to alert doctors if your condition requires extra investigation. It’s divided into three levels:

  • Step Three: Severe pain levels: Morphine and other opioids are indicated.
  • Step Two: Moderate, constant pain: Codeine and milder opioids are suggested.
  • Step One: Mild pain rated at 1-3 out of 10: Nonsteroidal anti-inflammatories and acetaminophen are best.

The Problem with Pills

Pain management has come a long way since the Eighties. New, non-opioid medications have been developed that address the cause of pain instead of its symptoms without introducing risky, addictive substances. Symptoms should be taken seriously, not stifled thoughtlessly. All unrelieved pain deserves a second and even third assessment. Pain is, after all, a signal that something is wrong. There is a massive range of therapies, from spinal fusion surgery to neuropathic solutions, that treat the foundation of pain.

The pain ladder fails to address each unique case on its own merits. In medicine, it’s often said that you should treat the patient, not the numbers. Physicians must advance towards a more personalized approach to care. Pain Stop Clinics will support you and your condition compassionately.

Carpal Tunnel Syndrome Myths vs Facts

Carpal tunnel syndrome (CTS) is the result of a compressed median nerve in the wrist. It causes pain, numbness, or tingling in the thumb, index, middle, and ring fingers that usually worsens at night.

Myth One: Work-Related Stress Causes CTS

Correlation and causation are distinct, and while repetitive strain is associated with CTS, experts think it’s the final straw rather than the actual cause. CTS is strongly related to poor health, and doctors believe general improvements and prevention programs can produce measurable results. If your career entails repetitive trauma, a human risk factor evaluation is well worth doing since there are preventative programs for high-risk patients.

Myth Two: Surgery is the Only Cure

Surgery can have dramatic effects on CTS, but those who’d rather do The Ice Bucket Challenge than face invasive care have other options. Ice therapy, resting, wrist braces, and steroid injections can postpone surgery. NSAIDS, when used in the short term, can provide temporary relief.

Myth Three: CTS is Not an Emergency

Muscle wasting and permanent nerve damage are medical emergencies that often go hand in hand with carpal tunnel syndrome. With surgery having success rates of between 75 and 90% in trials, cutting can mean a complete return to full health.

Myth Four: CTS Always Recurs

Only 3.7% of patients need revision surgery despite the fact that surgeons frequently warn patients of the possibility.

Myth Five: Endoscopic Surgery is Too Risky

The less tissue is damaged, the better. Meta-studies show that open and endoscopic procedures have the same efficacy and rate of complication. Keyhole surgery restores grip better than invasive procedures.

CTS can drastically affect your quality of life and even steal your independence. All its effects are entirely unnecessary, though, given the high success rates of its many treatments.

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.

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