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Category: Chronic Fatigue Syndrome

A detailed guide to Chronic Fatigue Syndrome (CFS), including its symptoms, causes, and effective treatment strategies to improve energy and well-being.

  • Controlling pain with nerve block injections

    The most common way to control pain is with oral medications, such as non-steroidal anti-inflammatory drugs (nsaids) or opioids. Some people don’t respond to these medications, though, while others are unable to tolerate oral pain medications. Nerve blocks are another way of treating pain with medication, but nerve blocks are injected, which increases efficacy and reduces the likelihood of other side effects.

    Nerve block injections allow the delivery of pain-relieving medication directly to the location where the medication will have the most impact.

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    When a nerve block is performed, it usually begins with the application of a topical anesthetic to numb the skin before the injection. Then imaging equipment, such as fluoroscopy or X-ray, is used to ensure the correct placement of the nerve block needle. Often, contrast dye is injected before the medication, to make doubly sure that the needle is placed correctly.

    The primary medication in a nerve block can vary. Usually it includes a numbing medication to deaden the nerves, such as lidocaine. Sometimes a steroid is also included to reduce inflammation. If the nerves or surrounding tissues are painfully irritated or inflamed, a steroid can help reduce pain, too.

    Individuals undergoing a nerve block can experience pain relief immediately, although for some people it may take a few days to experience pain relief. The length of the nerve block’s efficacy can vary from a month or two, up to several months in some cases. Often, the nearness of the injection to the nerves influences how long the effects last. The closer the injection is to the nerves, the longer the medication works.

    Because of their versatility, nerve block injections are able to provide relief from a wide variety of conditions.

    Conditions that might respond well to nerve blocks include:

    A physician will discuss pain symptoms and conduct tests and examinations. This will help him or her determine which nerves are being affected, and it’s why it’s so important to discuss pain symptoms as openly and fully as possible with the physician. For example, a complaint of leg pain is very general. However, shooting pain from the buttocks down the leg suggests a very different condition than aches in the knee joint. More specific knowledge about the type of pain being experienced will allow a more specific diagnosis, which will increase the likelihood that a nerve block will be successful.

    Nerve block injections can be applied to almost any painful area of the body.

    When a physician has determined which nerves are involved in a painful sensation, he or she will decide which type of nerve block will work best. For face pain, an occipital or sphenopalatine ganglion nerve block can provide relief. Back pain may respond to a facet joint, medial branch, or superior hypogastric plexus block. Celiac plexus or splanchnic nerve blocks may relieve abdominal pain. Pain in the chest may be lessened by intercostal or stellate ganglion blocks. Low back pain can potentially be relieved by a variety of nerve blocks, including cluneal, coccygeal, ganglion impar, lumbar facet, or lumbar medial branch blocks. Interscalene or sciatic nerve blocks may relieve limb pain.

    Another type of nerve block is sympathetic, meaning it’s delivered directly to the sympathetic nervous system via the spine. Because all the body’s nerves eventually lead to the spine, a sympathetic nerve block has the potential to relieve several different kinds of pain, as explained by the Pain Doctor article on sympathetic nerve blocks:

    “Reports show that sympathetic blocks are effective at treating pain in different body parts including the neck, head, back, tailbone, and limbs.”

    The placement of a sympathetic nerve block will determine which areas of the body experience pain relief. For example, a lumbar sympathetic block treats pain that originates in the nerves of the lumbar area, or lower back.

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    Nerve blocks can also help people who experience pain after the installation of spinal hardware. This type of hardware may be surgically implanted to treat spinal stenosis, injuries, trauma, degeneration, or deformities. Clamps, screws, and bone grafts can all be used, but they can also cause pain. A hardware block is a nerve block injected near the hardware to relieve the pain it may be causing.

    Sometimes, rather than the traditional injected nerve block, a continuous catheter nerve block is used. It involves a catheter inserted below the skin near the nerves. A small container of pain medication is attached to the catheter, which allows the medication to be delivered continuously to provide long-lasting pain relief.

    In addition to providing pain relief, a nerve block injection can be used as a diagnostic tool.

    The source of pain, especially chronic pain, can be difficult to diagnose. By extension, it can be difficult to successfully treat pain when the underlying condition isn’t clear. For this reason, nerve block injections are often utilized as diagnostic tools.

    A nerve block injection is relatively low risk. As with any injection, there’s always a risk of infection, irritation, or bruising at the site. Additionally, there’s an extremely low risk that the nerve block injection will miss the nerve and instead hit an artery. However, as compared to other interventional pain management techniques, nerve blocks are very low-risk.

    This makes nerve blocks a good choice to test a physician’s diagnosis. For example, if a person is experiencing acute headaches, the cause could be one of several underlying conditions, as noted in the Pain Doctor article on acute headaches:

    “In fact, there are over 150 different classifications of headaches. Given this wide range of symptomatology, determining the cause of a headache can be somewhat difficult at times. Indeed, in some instances physicians are not able to clearly identify the precise cause of acute headache pain at all.”

    However, if a nerve block injected into the occipital nerve relieves the headaches, it can confirm a diagnosis of occipital neuralgia. Then, if the pain returns after the nerve block has worn off, another nerve block injection can be applied. Alternatively, other treatment methods, such as radiofrequency ablation, can be utilized after the nerve block has worn off, with confidence that the correct nerves are being targeted.

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  • How to treat a herniated disc?

    A herniated disc is one of the most painful, debilitating lower back pain conditions. The pain caused by herniated disc is different for each person who experiences it and can even change as the condition progresses. Because this condition can be unpredictable, a herniated disc treatment that works can also vary from person to person. Here’s how to treat a herniated disc.

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    What is a herniated disc?

    The spine consists of 33 individual vertebrae, each stacked upon a fluid-filled sac that keeps the bones cushioned from rubbing against each other. This fluid-filled sac is called an intervertebral disc.

    The spine consists of individual vertebrae with a spongy cushion separating each. The discs have a gel-like substance in them (like the gel in the insoles you put in your shoes or the gel in an eye mask) called nucleus pulposas. These oval discs help the spine be more flexible because each vertebra isn’t locked into another, and they also contribute to the spine’s flexibility.

    When an intervertebral disc herniation occurs, the outer layer becomes weakened, allowing the nucleus pulposus to leak out. The cushion between the bones is gone, and the result can be very painful.

    Over time and left untreated, disc herniation can cause permanent nerve damage.

    Herniated disc causes

    A herniated disc can be caused by a number of different factors:

    • Time: The continued action and pressure of gravity as people age can begin to wear down the annulus fibrosis
    • Injury: If the spine is injured (i.e., as a result of a car accident or other trauma to the back), the intervertebral disc may be weakened and begin to leak
    • Improper use: A sudden, awkward movement such as lifting a heavy object improperly can cause a herniated disc

    There are also several risk factors that increase the likelihood that a person will experience a herniated disc. These include:

    • Age: Because herniated discs can be caused by bone deterioration, older adults have a higher incidence.
    • Genetics: There is a potential hereditary connection to disc herniation.
    • Weight: Being overweight or underweight increases an individual’s risk for developing herniated disc.
    • Lifestyle: Smoking contributes to bone density loss and can increase the spine’s vulnerability to fracture, either from injury or wear-and-tear. Excess consumption of alcohol and prolonged use of steroids can also contribute.
    • Occupation: Occupations that feature repetitive motion and twisting or bending increase a person’s risk of a herniated disc.

    Herniated disc symptoms 

    Symptoms of a herniated disc are as varied as the condition itself, and vary from person to person. Herniated disc symptoms may include:

    • Pain: Pain location varies depending on which disc is herniated. A herniated disc in the lower back can produce pain in the buttocks, thigh, and calf (and possibly the foot). If the disc is herniated in the neck, pain may be shooting in the arm and shoulder area.
    • Tingling
    • Numbness
    • Weakness

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    Herniated discs vs. Bulging discs

    When your back is aching, especially along the spine, you may leap to the conclusion that you have a herniated or bulging disc. Many people use the words interchangeably, but there is a difference between the two conditions. How to treat a herniated disc may differ from how you treat a bulging one.

    Bulging discs–sometimes also called slipped discs–are “contained.” This means that there are no tears in the disc itself, just that the disc is protruding out from between the vertebrae.

    A herniated or ruptured disc has a tear or a rupture and is “uncontained.” The disc is not merely pushing out from between the vertebrae. It is torn, and some or all of the nucleus pulposas has leaked out. A herniated disc may be the second stage of a bulging disc. The vertebrae may have put so much pressure on the bulging disc that it ruptured.

    Whichever condition you are suffering from, the result can be tingling, muscle weakness, pain that ranges from moderate to severe, and numbness. Always talk to your doctor to get an accurate diagnosis.

    How to treat a herniated disc

    Poor posture, age, repetitive motion, injury due to strain, and normal wear and tear all contribute to herniated discs. Sometimes a herniated disc does not cause pain, but it can be addressed generally with a combination of pain treatments, either natural or prescribed.

    What herniated disc treatment works varies widely depending on many different factors. These include:

    For some patients, a course of over-the-counter non-steroidal anti-inflammatory drugs (nsaids) combined with targeted exercise and strengthening may be all that is necessary.

    Step 0: Get a diagnosis 

    Any treatments are only started after your doctor has diagnosed the cause of your pain. Always work closely with them to explain all of your symptoms so they can make the most accurate diagnosis.

    The Mayo Clinic has more information on the diagnostic tests for a herniated disc here.

    Step 1: Anti-inflammatory medications

    Whether over-the-counter or prescribed, a herniated disc treatment generally begins with a period of anti-inflammatory drugs used to control pain and inflammation. For some patients, this is enough to allow them to begin exercise or other activities to heal the herniated disc.

    Step 2: Injections

    Epidural steroid injections or nerve blocks may be recommended for those patients who find no relief with nsaids. These injections target the affected nerves directly. Steroid injections are anti-inflammatory and offer pain relief but have only been proven effective for approximately 50% of patients. Nerve blocks numb the nerve so that other treatments can begin.

    The following video shows you what you can expect during an epidural steroid injection procedure. Overall, this is a safe and effective option for many people, especially while also undergoing physical therapy or chiropractic care.

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    Step 3: Physical therapy or chiropractic care

    Because a herniated disc can be the result of decreased space between the vertebrae, doctors may recommend chiropractic care to help lengthen the spine and physical therapy to strengthen the supporting muscles.

    Physical therapists may design an exercise plan, offer manual therapy, apply hot and cold treatments, or administer electrical stimulation. In combination with pain-relieving therapies, physical therapy can go a long way towards rebuilding the muscles around the spine.

    Step 4: Surgical options

    Surgery is an option that you should exercise only after you’ve attempted other treatments. If pain and numbness persists, a pain management specialist may recommend a surgical procedure called a discectomy. This procedure removes the herniated material that is pressing on the nerve and causing pain.

    For more serious and unresponsive pain due to a herniated disc, your doctor may recommend removing the entire disc. This is a rare procedure that includes inserting metal hardware to connect the remaining vertebrae for stability.

    If a patient experiences sudden loss of bowel or bladder control, this is considered a medical emergency that is often addressed with surgery. This condition can become very serious very quickly, and patients should go to the emergency room if this arises.

    How to prevent a herniated disc

    As with many lower back pain conditions, the best way to treat a herniated disc is to take steps to prevent it from occurring in the first place. There are ways to keep your lower back safe and healthy. Here’s how.

    Exercise

    Regular exercise that focuses on strengthening the abdomen and lower back is the best way to prevent a herniated disc.

    Rather than spending hours doing crunches, exercises that focus on the whole body are just as valuable. Swimming, balancing poses in yoga (including planks), and targeted exercises for the back are excellent ways to help strengthen the muscles that support the spine.

    Eat well

    A well-balanced diet that includes plenty of calcium and vitamin D-rich foods helps maintain strong muscles to support the spine. A healthy diet also helps maintain an appropriate weight for your frame.

    Stop smoking

    Among other things, smoking contributes to a loss of bone density that can contribute to spinal fractures and herniated discs. Quitting smoking is one of the best things you can do for your health, with benefits that start just 20 minutes after your last cigarette. It may be difficult, but there are many resources out there to help.

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  • Fibromyalgia Pain | 48-Pain Full Hours Recovery Period in Fibromyalgia & Chronic Fatigue Syndrome

    Have you ever noticed it takes you a couple of days to recover from a stressful event or over-exertion? A 48-hour recovery period is something you commonly hear about from people with fibromyalgia and chronic fatigue syndrome.

    We don’t yet know why we need a couple of days to recover from … well, just about anything, but a lot of chronic fatigue syndrome research is focusing on post-exertional malaise—the intensified fatigue and flare of other symptoms following exercise.

    Several research groups have identified genetic and blood abnormalities in the following exercise and have documented participants’ inability to perform as well on the second day.

    What we do know about this recovery period is that we’re stuck with it. For many of us, it means taking it really easy for a couple of days after anything big, such as a holiday, a vacation, or an unexpected stressful event.

    It can be a real problem for people who work or go to school full time. Just getting through a day can drain you enough to need recovery time, yet you have to get up the next morning and do it all over again. So while you may feel pretty decent on Monday, especially if you rested the whole weekend, Tuesday will be a little hard, Wednesday a little harder still. By Friday? It’s not pretty.

    When your routine is enough to drag you down, you don’t have the reserves to deal with anything else on top of it. Who hasn’t been there?

    Halfway through the week, you have to deal with some kind of crisis that gets your adrenaline pumping. Now you have more to recover from.

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    Any of our symptoms can flare up after a stressful or strenuous event. The most common ones include:

    • pain
    • fatigue
    • fibro fog/brain fog
    • anxiety
    • depression
    • flu-like symptoms (in chronic fatigue syndrome)

    Setting Aside Recovery Time

    It’s likely not realistic for you to just go to bed for two days after every workday, or every stressful event in your personal life.

    What we can do, though, is recognize what circumstances are likely to trigger a need for recovery and plan accordingly. For instance, don’t do anything for the two days after Christmas. When possible, schedule time off after big events you know are coming.

    If you have some flexibility in your work schedule, you might want to consider a day off in the middle of the week so you can do some recovering before jumping back in. Taking more breaks may also prevent you from needing as much recovery time.

    When you can’t schedule an actual recovery period or rearrange your life around your chronic illness, make sure to pare down as much as you can. Order groceries online rather than trying to shop near the end of your workweek. Can someone else get your kids to soccer? Can your kids help more around the house? What jobs can you delegate to someone else? Call in the reinforcements!

    You may also benefit from getting extra rest before a big event. That could help your body get through whatever is coming a little better, which might speed up your recovery time.

    Life doesn’t always work out how we want. You’ll probably have to go to work or school with a symptom flare or try to get laundry done on your days off instead of resting, because when else are you going to do it, right? When that’s your reality, it becomes all about pacing yourself so you can keep moving forward.

    Also, learn to be patient with yourself. At times, you’re like a car that runs out of gas but keeps going anyway. Don’t be too hard on yourself when it’s difficult to keep push, or when you have to take some time off in order to feel better and be a better employee or student.

    Be sure to talk to your doctor about this symptom, especially if it’s becoming a big part of your life.

    He/she may have ideas about treatments or lifestyle changes that might be able to help you.

    You may also benefit, in general, and when it comes to recovering if you build better habits when it comes to sleep and your diet.

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  • Physicians Recommend Cannabis As An Effective Treatment of Chronic Pain

    What Is Chronic Pain?

    Pain is a complex phenomenon made up of physical, mental, and social components. At a basic level, the ability to perceive pain has helped people survive throughout the ages. Without feeling the uncomfortable sensation when you touch a stove, which causes you to remove your hand, the heat from the stove would end up causing far more damage to the cells in your hand, than it did before you felt the pain.

    In essence, pain is the body’s way of letting you know something is wrong. However, it is when pain fails to subside, despite removing the initial cause, that it becomes pathologic, and known as chronic pain.

    “The origins of chronic pain can be categorized into visceral (internal organs), somatic (skin and deep tissue), and neurogenic (nerves).”

    Chronic pain can have a wide range of causes and can be associated with a number of different disease processes, thus the ability to diagnose chronic pain syndromes has been a widely debated topic within the medical community for many years.

    Earlier this year, the American Pain Society, released a framework that attempts to account for all of the various factors that encompass chronic pain syndromes: physical, pathological, neurobiological, psychological, and social. Broadly speaking, however, the origins of chronic pain can be categorized into visceral (internal organs), somatic (skin and deep tissue), and neurogenic (nerves).

    The Institute of Medicine reports that common chronic pain affects approximately 100 million American adults at a cost of $560-635 billion in direct medical treatment cost and lost productivity. However, while the impact of chronic pain is wide-reaching across the population, its effect on the individual person is unique; there is variation in the source(s), severity, duration, response to treatment, and psychological impact from person to person.

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    Conventional Therapies For Chronic Pain

    Given the variety in the spectrum of chronic pain, it is no wonder why clinicians at times find difficulty in helping patients manage their chronic pain. This difficulty in management has contributed in part to the wide range of therapies that are used to treat chronic pain, such as aspirin, ibuprofen, and other drugs which are classified broadly as non-steroidal anti-inflammatory drugs (NSAIDs) and can be purchased over over the counter.

    These medications may work well for short-term relief of mild to moderate pain, but they can create side effects such as ulcers and potentially damage the liver when used continuously, such as in a chronic pain scenario. It is for these reasons that most clinicians avoid relying on this type of medication for long-term pain relief.

    A more powerful alternative to NSAIDs is the opiates, such as morphine, oxycodone, codeine, and hydromorphone. The drugs have been well described in the scientific literature, and work by affecting the body’s natural opioid receptors to prevent the nerves responsible for sending pain signals from firing.

    These medications have the ability to provide tremendous pain relief and provide clinicians the opportunity to perform life-saving therapies which would otherwise be impossible (e.g. surgery). However, in the treatment of chronic pain, opioid therapy by itself can become problematic for patients – the body begins to develop a tolerance to these medications, thus the dose required in order to get symptomatic relief continues to increase over time.

    Additionally, the side effects of taking opioids (sedation, nausea, constipation, and potential respiratory depression and death) make physicians reluctant to continue to raise dosages for patients out of fear of causing dependence. This fear is not ill-conceived either; in 2007, the US Substance and Mental Health Services Administration declared that the dependence on and abuse of pharmaceutical medications is the fastest growing form of problematic substance use in America.

    Recently, the argument has been made that the growing rate of prescription drug abuse in the first decade of the 21 century, has been the foundation for the emerging heroin epidemic which characterizes this decade. Due to the issue of tolerance and dependence on opioids, many physicians, supplement the therapy with anti-depressants, muscle relaxants, and additional interventions when treating patients with chronic pain in an attempt to provide relief.

    Cannabis And Chronic Pain

    The use of cannabis to treat chronic pain has had a long history, with written references of its use dating back to around 2700 B.C.E. The first records in the nineteenth century were recorded by the Irish doctor William B. O’Shaughnessy, who described the use of cannabis in the treatment of cholera, rabies, tetanus, menstrual cramps, and delirium tremens.

    In modern times, significant research has been done around cannabis therapy in the treatment of chronic pain with very promising results.

    “Medical cannabis is a very effective therapy for chronic pain patients because it affects people’s perception of pain, has the ability to mitigate the inflammatory process, and has been shown to affect voltage-gated sodium channels in nerves in a way similar to lidocaine.” – Dr. Mark Rabe

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    “Medical cannabis is a very effective therapy for chronic pain patients because it affects people’s perception of pain, has the ability to mitigate the inflammatory process, and has been shown to affect voltage-gated sodium channels in nerves in a way similar to lidocaine,” reports Dr. Mark Rabe, Medical Director of Centric Wellness, am integrative holistic healthcare practice in San Diego CA and Chairman of the Scientific Advisory Board at Medical Marijuana Sciences, Inc.

    The ability of cannabis therapy to help relieve chronic pain on multiple fronts rests squarely in the cannabinoid receptors – cannabinoid receptor type-1 (CB1) and type-2 (CB2). Studies have shown that CB1 receptors are located all over the body, however, they have a particularly high concentration in the central nervous system in areas that control pain perception. CB2 receptors, on the other hand, are primarily located in areas of the body that control immune function, such as the spleen, white blood cells, and tonsils.

    The fact that these receptors are found in the two major body systems responsible for producing the sensation of pain, the immune system and the nervous system is what gives cannabis its therapeutic relevance in the chronic pain space. Additionally, and importantly, there is a lack of cannabinoid receptors in the brainstem region, the area of the brain responsible for controlling breathing, thus the dangerous side effect of respiratory depression found with high dose opioid use is not a factor in cannabis therapy.

    In practical application, cannabis therapy can be used in conjunction with other chronic pain therapies. In his clinical practice, Dr. Rabe reports, “We have many patients who come in on higher doses of opioid medications. Through using cannabis, in conjunction with other therapies, they are able to lower their daily opioid requirement.”

    Numerous studies support these findings, including a 2011 study published in the Journal of Clinical Pharmacology and Therapeutics which showed that vaporizing cannabis increased the patient-reported analgesic effect of opioids, without altering plasma opioid levels. Moreover, there is an emerging body of research whose findings suggest cannabis can be used as an effective substitution therapy for patients with opiate abuse issues.

    Overall, we are just at the beginning of our understanding of the possible therapeutic benefits associated with cannabis in the treatment of chronic pain. In addition to the wide range of possibilities in targeting CB1 and CB2 receptors, scientists are beginning to look at targets within the body’s endocannabinoid metabolic life cycle for potential opportunities for therapeutic intervention. Given the growing need for clinicians to transition away from an opiate–dependent treatment protocol for chronic pain, hopefully, these breakthroughs happen sooner rather than later. Naturally, the relaxation of government prohibition would go a long way towards supporting these efforts.

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    References:

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  • When Chronic Pain Leads to ‘Appointment Fatigue’

    Breaking the Cycle of Appointment Fatigue in Chronic Pain Management

    Living with chronic pain means navigating a constant balancing act—managing symptoms, medications, work, relationships, and self-care. At the core of this juggling act lies an unspoken burden many patients face: appointment fatigue. This term refers to the emotional, mental, and physical exhaustion that comes from attending endless medical appointments, undergoing tests, meeting new specialists, and often, repeating the same explanations of symptoms without seeing long-term improvement.

    For individuals dealing with persistent pain, medical visits become a routine, yet their frequency can slowly wear down one’s motivation and hope. What begins as a path to healing may transform into a cycle of burnout, disillusionment, and disengagement from healthcare altogether.

    This article dives deep into the phenomenon of appointment fatigue, what causes it, how it impacts chronic pain sufferers, and how patients can reclaim their autonomy in the face of healthcare overload.

    Understanding Appointment Fatigue in the Context of Chronic Pain

    Chronic pain is not simply a lingering ache. It is a long-term condition that can stem from various sources including autoimmune diseases, nerve damage, past injuries, fibromyalgia, and musculoskeletal disorders. Unlike acute pain that resolves with treatment, chronic pain persists beyond the typical healing window and often requires ongoing care from multiple providers.

    As a result, patients may attend appointments with:

    • Primary care physicians
    • Pain specialists
    • Physical therapists
    • Psychologists
    • Rheumatologists
    • Occupational therapists

    Each of these visits involves waiting times, transportation planning, paperwork, billing concerns, and sometimes disappointing news. The repetitive nature of these experiences, coupled with limited improvements or inconsistent care, builds up over time. This accumulation can give rise to a deep sense of frustration, helplessness, and a strong desire to simply stop showing up.

    Common Signs That Indicate Appointment Fatigue

    Recognizing appointment fatigue early can prevent further deterioration in one’s healthcare engagement. Some common signs include:

    • Canceling or rescheduling appointments frequently, even when not sick or physically unable
    • Feeling dread, anxiety, or anger when thinking about medical visits
    • Becoming emotionally numb or indifferent during consultations
    • Not following through with referrals, tests, or treatment plans
    • Avoiding contact with healthcare providers or clinics altogether
    • Declining in health due to untreated symptoms or complications

    It’s important to understand that appointment fatigue is not laziness or irresponsibility. It is a valid response to an overextended emotional bandwidth in an already stressful healthcare experience.

    The Emotional Toll of Navigating a Fragmented Healthcare System

    For chronic pain sufferers, the road to diagnosis and treatment is rarely straightforward. Often, it involves seeing multiple specialists who may offer conflicting advice. Patients may be forced to re-explain their pain journey at every appointment, recount failed treatments, or defend their need for pain management, especially amid growing stigma around opioid use.

    All of this contributes to a feeling of being unheard, unvalidated, and overly medicalized. Instead of feeling supported, patients may feel reduced to a list of symptoms on a chart. This emotional toll erodes trust and contributes to appointment fatigue.

    Financial and Logistical Strains Amplify the Burden

    The cost of chronic pain management is another contributor. Even with insurance, copays, transportation costs, unpaid time off work, and prescription expenses add up quickly. If appointments don’t deliver tangible results, the perceived cost-benefit ratio becomes unfavorable. Patients begin to question, is this really worth it?

    Logistical hurdles like coordinating care between specialists, scheduling appointments months in advance, and finding available practitioners who truly listen can become overwhelming. These tasks consume energy that patients would rather use for daily life or symptom management.

    Healthcare Inequities Worsen the Experience for Some

    Those from marginalized communities may experience even deeper levels of fatigue due to systemic barriers. Language differences, implicit bias from healthcare providers, lack of nearby specialists, or financial instability can all lead to fewer options and worse experiences. Appointment fatigue for these individuals often includes an additional layer of distrust or previous medical trauma, further discouraging engagement.

    How to Cope and Break Free from Appointment Fatigue

    While appointment fatigue is real and challenging, it doesn’t have to become a permanent obstacle. There are steps chronic pain patients can take to regain control over their healthcare experience.

    Prioritize Appointments Based on Value

    Not every follow-up is essential. Patients can work with a trusted provider to identify which appointments are crucial and which can be delayed, reduced in frequency, or combined. Prioritizing value over volume gives patients more control over their time and energy.

    Set Clear Goals for Each Visit

    Approaching appointments with a purpose can help reduce frustration. Write down specific questions, concerns, or goals beforehand. If possible, share these in advance with your provider to focus the conversation and avoid wasted time.

    Use Telehealth When Available

    Virtual appointments eliminate travel time, reduce scheduling stress, and may be more manageable on bad pain days. While not ideal for every visit, they are a helpful tool for routine check-ins or medication management.

    Track Symptoms and Share Concisely

    Using pain journals or digital symptom trackers can streamline communication during visits. When providers see patterns and progress laid out clearly, appointments tend to be more productive and less repetitive.

    Build a Core Care Team You Trust

    Rather than relying on multiple specialists, try to work closely with a few key providers who understand your history and goals. A coordinated team reduces duplication and provides more personalized care.

    Take Mental Health Seriously

    Psychological support is vital. Seeing a therapist familiar with chronic illness can help process the emotional exhaustion that feeds appointment fatigue. Therapy can also provide strategies for setting boundaries and communicating more effectively with medical professionals.

    Reclaiming Your Voice in a Complex System

    Chronic pain does not just impact the body; it infiltrates every aspect of a person’s life. When medical care starts feeling more like a burden than a support system, it’s a sign that the balance needs to be restored. Patients have every right to advocate for themselves, to ask for care that meets their needs, and to opt out of what is not serving them.

    This might mean switching providers, taking breaks between appointments, or even re-evaluating which symptoms need professional management versus home care. The most important thing is for patients to feel like active participants, not just subjects of an endless medical routine.

    Frequently Asked Questions

    1. What is appointment fatigue?
    Appointment fatigue refers to the mental and emotional exhaustion experienced from attending frequent medical appointments, particularly when managing chronic illnesses like chronic pain.

    2. Is appointment fatigue common among chronic pain patients?
    Yes. Many people with chronic conditions report feeling overwhelmed by the frequency and burden of medical visits, especially when results are minimal or progress is slow.

    3. Can appointment fatigue lead to worse health outcomes?
    Avoiding or skipping appointments can result in missed diagnoses, unmanaged symptoms, or complications, potentially worsening a patient’s condition over time.

    4. How can I talk to my doctor about appointment fatigue?
    Be honest and specific. Explain how the frequency of visits impacts your life and ask whether some appointments can be spaced out or handled differently, such as via telehealth.

    5. Are there ways to manage my care with fewer appointments?
    Yes. Coordinating care through a central provider, using digital symptom logs, and setting clear health goals can reduce the need for frequent appointments.

    6. Should I feel guilty for needing a break from medical visits?
    Absolutely not. Taking a step back to recover emotionally and mentally is valid and may ultimately improve your engagement and outcomes in the long term.

    Conclusion

    Appointment fatigue is a real and often overlooked side effect of managing chronic pain. It affects motivation, emotional well-being, and the overall healthcare journey. Understanding this phenomenon allows patients to take proactive steps toward regaining control, creating more meaningful medical interactions, and protecting their energy for healing. Empowerment begins when patients recognize they are not just their symptoms—they are people who deserve respect, rest, and choices in how they pursue wellness.

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  • If You’ve Ever Been Called Overly-Emotional Or Too Sensitive, This Is For You

    Emotional: a word used often nowadays to insult someone for their sensitivity towards a multitude of things. If you cry happy tears, you’re emotional. If you express (even if it’s in a healthy way) that something is bothering you, you’re sensitive. If your hormones are in a funk and you just happen to be sad one day, you’re emotional AND sensitive.

    Let me tell you something that goes against everything people have probably ever told you. Being emotional and being sensitive are very, very good things. It’s a gift. Your ability to empathize, sympathize and sensitize yourself to your own situation and to others’ situations is a true gift that many people don’t possess, therefore many people do not understand.

    Never let someone’s negativity towards this gift of yours get you down. We are all guilty of bashing something that is unfamiliar to us: something that is different. But take pride in knowing God granted this special gift to you because He believes you will use it to make a difference someday, somehow.

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    This gift of yours was meant to be utilized. It would not be a part of you if you were not meant to use it. Because of this gift, you will change someone’s life someday. You might be the only person that takes a little extra time to listen to someone’s struggle when the rest of the world turns their backs.

    In a world where a six-figure income is a significant determinant in the career someone pursues, you might be one of the few who decides to donate your time for no income at all. You might be the first friend someone thinks to call when they get good news, simply because they know you will be happy for them. You might be an incredible mother who takes too much time to nurture and raise beautiful children who will one day change the world.

    To feel everything with every single part of your being is a truly wonderful thing. You love harder. You smile bigger. You feel more. What a beautiful thing! Could you imagine being the opposite of these things? Insensitive and emotionless?? Both are unhealthy, both aren’t nearly as satisfying, and neither will get you anywhere worth going in life.

    Imagine how much richer your life is because you love others so hard. It might mean more heartache, but the reward is always worth the risk. Imagine how much richer your life is because you are overly appreciative of the beauty a simple sunset brings. Imagine how much richer your life is because you can be moved to tears by the lessons of someone else’s story.

    Embrace every part of who you are and be just that 100%. There will be people who criticize you for the size of your heart. Feel sorry for them. There are people who are dishonest. There are people who are manipulative. There are people who are downright malicious. And the one thing people say to put you down is “you feel too much.” Hmm.

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  • Fibromyalgia Supplements | A Miracle Thyme Tea Reliefs Fibromyalgia and Chronic Fatigues

    Thyme is an herb from the mint family. This is a truly ancient herb, used by the Egyptians, Greeks, and Romans for ceremonial and ritualistic purposes. Through the Middle Ages where it was also used for religious and medicinal reasons. It is an incredibly potent yet simple herb affecting multiple systems in the body and capable of treating dozens of diseases. It contains one of the strongest antioxidants known and is proven to kill 98% of breast cancer cells.

    Thyme contains thymol which is a natural antiseptic, antibacterial, and an expectorant, making this tea with honey and lemon a delicious remedy for all of you suffering from sore throats and coughs.

    Wild thyme tea is recommended for cough, hangover, flu, and sore throat. Thyme has primarily been used for respiratory ailments for its infection-fighting and cough suppressive qualities. Thyme honey is ideal for sweetening herb teas. Blend thyme with nettle for allergies and mints for colds and congestion. It is also help’s if you have fibromyalgia, rheumatoid arthritis, lupus & multiple sclerosis.

    Thyme Tea Recipe

    Ingredients:

    -1c Boiling Water
    -1tbs dry or 1T fresh Thyme
    -1tbs dry or 1T fresh sage
    -1-1 Ginger slices
    -Honey to taste

    Directions:
    -Warm your teacup with hot water.
    -Pour away the water.
    -Put herbs in the cup. Add fresh boiling water and cover.
    -Leave to steep 3 to 5 minutes. Add more herbs for a stronger flavor.
    -Steeping too long will make the tea bitter. Use Honey or a natural herbal sweetener like Stevia.
    -Add ginger slices and/or lemon slices if desired.

    Other Health Benefits Of Thyme

    -Lower Blood Pressure
    -Boost your Immunity
    -Boost your Mood
    -Improves bone health
    -Antioxidant Capacity
    -Immune System
    -Anti-fungal Ability

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  • CFS | Light and Noise Sensitivity in Chronic Fatigue Syndrome

    CFS | Light and Noise Sensitivity in Chronic Fatigue Syndrome

    Light and noise sensitivity in fibromyalgia (FMS) and chronic fatigue syndrome (ME/CFS) have been scientifically established since the early 1990s, but they’re still underrecognized and rarely make symptoms lists. Rest assured that you’re not alone in experiencing this symptom!

    When I used to take my kids to daycare, some mornings the noise would hit me like a brick wall. In an instant, I’d have pain, nausea, dizziness, trembling, and a looming panic attack.

    More than once, I had to call in sick as a result of it. I’ve had similar experiences with bright or flashing lights, or with visual chaos in general.

    Causes

    We don’t know the causes of light and noise sensitivity, but they’re often called “generalized hypervigilance.” That means our bodies are constantly on high alert. It’s also a symptom of post-traumatic stress disorder.

    Hypervigilance is beneficial for people in potentially dangerous situations, such as soldiers or police officers, because it speeds up to several processes and helps with crisis response.

    In FMS and ME/CFS, however, hypervigilance overwhelms us. We don’t know why, but possibilities include:

    • Nervous system abnormalities
    • Stress-system (HPA axis) problems
    • Neurotransmitter dysregulation
    • Blood pressure irregularities

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    Symptoms of Generalized Hypervigilance

    Common symptoms of hypervigilance include:

    • Anxiety
    • Rapid heartbeat
    • Trembling
    • Rapid or labored breathing
    • Sweating
    • Irritability
    • Fatigue
    • Sleep disturbances

    Treatments

    So far, we don’t have research showing that specific treatments alleviate light and noise sensitivity in FMS and ME/CFS.

    In people with PTSD, treatment for the anxiety related to generalized hypervigilance can include mental-health counseling and medications, especially antidepressants.

    Supplements for anxiety and stress may help you cope better with light and noise sensitivity as well. Some people also benefit from treatments such as massage or acupuncture.

    Coping

    Light and noise sensitivity can have a huge impact on your life. You may avoid certain situations and even fear them, which increases anxiety. It can also contribute to social isolation, which is common in people with FMS or ME/CFS and can worsen depression.

    Some work environments are difficult to endure. I used to be a television news producer, which meant sitting under a lighting grid in a room with dozens of TVs and ringing phones. I went from thriving in the chaos to having regular anxiety attacks. I decided to leave the job. Other people may be able to get reasonable accommodation to lessen the impact of this symptom.

    You might be able to eliminate or avoid many sources of excess noise and light, but you probably can’t eliminate all of them. Several simple things can help you deal with light and noise sensitivity in your daily life:

    • Sunglasses are a must outside.
    • If fluorescent lights bother you, lightly tinted sunglasses or a hat with a brim may help.
    • In a noisy environment, earplugs or listening to music on headphones may help some people.
    • Deep breathing and other relaxation techniques can help you get through episodes of sensory overload due to light and noise.
    • Teach your family and friends about the impact that light and noise have on you so they understand your requests to turn off lights or turn down the volume.
    • If your computer screen bothers you, try adjusting the brightness and contrast.
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  • Medications | Why Doctors Over prescribing Gabapentin and Pregabalin (Lyrica) for Pain?

    Let’s be perfectly honest. Most doctors have a difficult time with chronic pain patients. One physician described it to us many years ago: “When I see a patient suffering severe chronic pain come in the front door I want to go out the back door.” That’s because there are few good options. Drugs like hydrocodone or oxycodone used to be prescribed in huge quantities. Now gabapentin (Neurontin) and pregabalin (Lyrica) are on the ascendency and opioids are shunned.
    The Opioid Epidemic:
    Doctors are dismayed by the opioid epidemic sweeping the nation. Over the last year, the drumbeat of headlines about opioid overdoses and deaths has scared a lot of physicians into cutting back on prescribing drugs like hydrocodone or oxycodone.

    Many of the overdose deaths are caused by illicit fentanyl. People OD because they have no idea how potent the narcotics are that they are snorting, swallowing, or injecting. According to the CDC (Nov. 3, 2017):

    “Preliminary estimates of U.S. drug overdose deaths exceeded 60,000 in 2016 and were partially driven by a fivefold increase in overdose deaths involving synthetic opioids (excluding methadone), from 3,105 in 2013 to approximately 20,000 in 2016. Illicitly manufactured fentanyl, a synthetic opioid 50–100 times more potent than morphine, is primarily responsible for this rapid increase. In addition, fentanyl analogs such as acetylfentanyl, furanylfentanyl, and carfentanil are being detected increasingly in overdose deaths and the illicit opioid drug supply.”

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    Fentanyl powder does not come from your local pharmacy. Most of it is illicit and is coming from foreign countries (CBS News; New York Times, Aug. 10, 2017). China and Mexico are major suppliers. It is being added to heroin or even counterfeit opioid pills that look like Percocet (CNN June 8, 2017) or Oxycontin. The government does not seem to know how to stem the flow of illicit fentanyl that is flooding the country.
    Doctors and Opioids:
    It is hardly any wonder that doctors have cut back on prescriptions for hydrocodone and oxycodone. Like the rest of us, they read horrifying reports about opioid deaths. The evening news often leads with graphic accounts of accidental overdoses. Federal guidelines and restrictions have made it harder for physicians to prescribe opioids.
    Gabapentinoids: What Are They?

    As a result of the negative publicity and constraints about opioids, many people who are in severe pain have been left without relief. Consequently, physicians are searching for other drugs they can prescribe instead of narcotics. They may turn to gabapentinoids (gabapentin and pregabalin).

    Gabapentin (Neurontin) and pregabalin (Lyrica) are both used to treat nerve pain. Doctors prescribed these medications three times more often in 2015 than they did in 2002, despite no radical change in the number of patients with neuropathic pain (JAMA Internal Medicine, online Jan. 2, 2018).
    The author advises his colleagues to use these drugs cautiously:

    “The combination of a dearth of long-term safety data, small effect sizes, concern for increased risk of overdose in combination with opioid use, and high rates of off-label prescribing, which are associated with high rates of adverse effects, raises concern about the levels of gabapentinoid use. While individual clinical scenarios can be challenging, caution should be advised in the use of gabapentinoids, particularly for those individuals who are longterm opioid users, given the lack of proven long-term efficacy and the known and unknown risks of gabapentinoid use.”

    A perspective published in the New England Journal of Medicine goes even further (Aug. 3, 2017).

    The authors note that guidelines from the CDC recommend acetaminophen and NSAIDs as first-line options for osteoarthritis and low back pain. The physicians point out that “acetaminophen is often ineffective, and NSAIDs are associated with adverse effects that limit their use…”
    They go on to say:

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    “The CDC guidelines also recommend gabapentinoids (gabapentin or pregabalin) as first-line agents for neuropathic pain. We believe, however, that gabapentinoids are being prescribed excessively — partly in response to the opioid epidemic”

    They conclude:

    “Patients who are in pain deserve empathy, understanding, time, and attention. We believe some of them may benefit from a therapeutic trial of gabapentin or pregabalin for off-label indications, and we support robust efforts to limit opioid prescribing. Nevertheless, clinicians shouldn’t assume that gabapentinoids are an effective approach for most pain syndromes or a routinely appropriate substitute for opioids.”

    Gabapentin Side Effects:
    The history of gabapentin (Neurontin) is fascinating. It was originally approved by the FDA for treating epilepsy in 1993. There is a tale of woe and intrigue about how the company that marketed Neurontin got into trouble with the FDA for illegal off-label marketing practices. We won’t go into that here, but you can read all about it in this article:
    Surprising Gabapentin Side Effects
    Gabapentin has become a go-to drug for doctors who are trying to control chronic pain problems. At last count, dispensed prescriptions have gone from 39 million in 2012 to 51 million in 2014 to 64 million in 2016 (Quintiles IMS, May 2017, now IQVIA Institute).

    Gabapentin can cause depression, dizziness, fatigue, drowsiness, digestive tract upset, trouble with balance, cognitive difficulties, and visual problems. The official prescribing information warns:

    “Antiepileptic drugs (AEDs), including gabapentin, increase the risk of suicidal thoughts or behavior in patients taking these drugs for any indication. Patients treated with any AED for any indication should be monitored for the emergence or worsening of depression, suicidal thoughts or behavior, and/or any unusual changes in mood or behavior.”

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  • Researchers Find Main Source Of Pain In Blood Vessels

    Are you experiencing constant muscle pain and fatigue? There is a good chance that you are suffering from fibromyalgia. As many as 5 million Americans that are aged 18 or older are affected by it. Women are the primary targets of this chronic disease, affecting up to 90% of them, and it’s very hard to treat.

    For many years, research has pointed to this pain and fatigue just being “in the patient’s head.” It’s been characterized as a psychosomatic disorder, which means that it’s caused by mental factors that attribute to a person’s imagination.

    Many people complain about pain in their neck, shoulders, back, and legs. But no research has been able to pinpoint what is causing this pain. Until now! Recent research has finally determined that this pain is in fact not just an imagination, but actually caused by a sensory nerve in blood vessels found in the palms!

    Scientists at Integrated Tissue Dynamics were responsible for the study. They found that the fibres that were supposed to be only responsible for the blood flow in the skin are also responsible for sensing touch and pain.

    In order to be sure about their findings, the team conducted a second study to see if they could locate any pathology in the blood vessels that could also contribute. After analyzing skin samples they collected from women who suffered from fibromyalgia, they discovered that there was a large increase in sensory fibres at certain sites within blood vessels of the skin.

    These nerves are part of the arteriole-venule shunts, which are responsible for heat regulation in our body by controlling the blood flow in our blood vessels. In warm conditions, the shunts shut down which forces blood into the skin surface so it can be released.

    In cold conditions, the shunts open up and allow the veins to conserve heat, thus our hands and feet become cold.

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    The lead scientist on the study, Dr. Albrecht, explains that this excess sensory innovation may be because of painful hands that fibromyalgia patients experience.

    “Since the sensory fibres are responsible for opening the shunts, they would become particularly active during cold conditions, which are very bothersome times for fibromyalgia patients.”

    The research team also came to another conclusion; they explain that our hands and feet usually contain more blood than they needed, so they’re used as reservoirs for blood which can be delivered throughout the body. Because of the pathology that occurs in these shuts, the blood flow is usually mismanaged.

    President of Integrated Tissue Dynamics, Dr. Rice, elaborated on their findings, “The pathology discovered among these shunts in the hands could be interfering with blood flow to the muscles throughout the body. This mismanaged blood flow could be the root cause of muscle pain and achiness and the sense of fatigue that fibromyalgia patients experience.”

    These findings are a step in the right direction for those suffering from fibromyalgia; it offers a proper treatment instead of the usual painkillers and antidepressants.

    So if you’re suffering from fibromyalgia, or know someone that is, it’s good to finally know that you’re not crazy, and you can certainly be sure that fibromyalgia is real!

    Causes of Fibromyalgia: Doctors are not completely sure of what actually causes a person to get fibromyalgia, a variety of factors may work together.

    Genetics: In most cases, fibromyalgia runs in the family, so there could be a certain genetic mutation that can cause you to be more susceptible to the disorder.

    Infections: Certain illnesses have the ability to trigger fibromyalgia.

    Physical or Emotional Trauma: Fibromyalgia can sometimes be triggered by physical trauma, like a severe car accident. Psychological stress can also be a triggering factor as well.

    Just because there is a new breakthrough that has discovered what might cause the pain for fibromyalgia patients, doesn’t mean that they should stop doing certain things that keep it from acting up. You need to continue taking care of yourself and layout a program that helps with that.

    You should first try and reduce the amount of stress in your life. This could mean putting some time aside to just relax. Getting enough sleep is another key point. Since fatigue is one of the main characteristics, getting enough sleep is essential. Also, you should try and exercise regularly. It may hurt at first but it will eventually reduce the pain significantly.

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