Considered an effective therapy for many conditions, biofeedback is just one of the many services offered at Chronicillness.co Site of United States. Biofeedback can help improve your health by training you to control certain bodily functions that normally happen involuntarily. These functions include skin temperature, muscle tension, blood pressure, and heart rate. While biofeedback is helpful in many cases, those struggling with high blood pressure, tension headaches, migraine headaches, and chronic pain may find the process most useful.
Explaining how biofeedback works are slightly difficult because, despite its high success rate, researchers still aren’t exactly sure how biofeedback is so beneficial. The one thing most pain doctors agree on is that the people who benefit the most have conditions that are brought on or made worse by stress. Therefore, relaxation is most likely the key to successful biofeedback therapy. Being under chronic stress causes blood pressure to become overactive, but with the help of a biofeedback therapist, you can learn to control your blood pressure with relaxation techniques and mental exercises.
To see the full results of biofeedback, a behavioral therapist (such as the one we have on staff at Chronicillness.co Site of United States) will help you learn to change your heart rate or blood pressure. During a biofeedback session, our expertly trained pain management specialists attach electrodes to your skin. The electrodes then send information to a monitoring box that translates the measurements into a tone that varies in pitch, a visual meter that varies in brightness, or a computer screen showing lines moving across a grid. Your biofeedback therapist will lead you in mental exercises, and soon you can learn to identify the mental behaviors that bring about the physical changes you want. Sessions generally last less than an hour but the number of sessions required depends on the condition being treated. Results may be seen within 8-10 sessions.
There are three types of biofeedback that are the most commonly used among pain specialists. The first, electromyography (EMG), measures muscle tension. Thermal biofeedback measures skin temperature. Neurofeedback or electroencephalography (EEG), measures brain wave activity.
So how do you know if biofeedback is the right choice for you? Chances are, if you’re suffering, Chronicillness.co Site of the United States can help you. The number of conditions biofeedback helps treat is endless. Because of the lack of side effects, many people choose biofeedback over drugs. Not only is biofeedback effective in adults, but children can also reap the benefits. Studies have shown improved behavior in children with ADHD and migraines and chronic headaches after going through biofeedback. Research shows that biofeedback helps treat urinary incontinence, insomnia, depression, diabetes, back pain, anxiety, head injuries, and muscle spasms. There are many other conditions biofeedback treats as well. If you are suffering any kind of chronic pain due to a condition or injury, and you feel this might be the right treatment for you, please do not hesitate to call Chronicillness.co Site of United States.
Our United States pain specialists are often confronted with one very prominent question; How can I increase my energy levels even as I live with chronic pain? The easy answer is exercise and a proper diet. The answer that most people want to hear is energy drinks and coffee. With that said, nothing beats maintaining a healthy lifestyle, decreasing toxins, eating right, and exercising to keep energy levels high and stress low. However, energy drinks are all the rage right now, so let’s take a moment to evaluate how detrimental these drinks can be to your already compromised health.
While many studies have shown how small amounts of coffee can be beneficial to our bodies in terms of decreasing the overall risk for certain cancers, Parkinson’s, and heart disease, it can also be detrimental for those who already suffer from chronic pain. Caffeine increases stress and tension, two of the main factors for increased pain in many of our United States patients.
“The effects of coffee drinking are long-lasting and exaggerate the stress response both in terms of the body’s physiological response in blood pressure elevations and stress hormone levels, but it also magnifies a person’s perception of stress” Caffeine’s Effects are Long-Lasting and Compound Stress – Duke Health
Large amounts of caffeine can also disrupt sleep patterns, something that is crucial to keeping stress, tension, and pain levels low for our chronic pain patients. When the body is allowed to sleep and recover from the day’s events, pain decreases and the immune system is more capable of handling stress. However, when caffeine disrupts sleep patterns, increased pain and stress very possible results.
Energy Drinks
Since Red Bull burst onto the market in 1997, energy drinks have been huge. They propose increased energy through supplements like taurine and extreme levels of vitamin B. But what are these supplements and are they even good for you?
The problem isn’t the taurine, which is naturally found in meats and fish, or the vitamin B, which is also a natural supplement that is found in nearly every food, or the ginseng, which has been found to actually relieve stress. The problem is the massive amounts of caffeine stored within energy drinks. While energy drinks are not regulated as other foods because they are sold as “dietarysupplements,” they contain a great deal of caffeine that consumers might not know about. Energy drink companies do a wonderful job of distracting consumers from the caffeine amounts by focusing them on the supplements such as taurine and ginseng; the ‘natural’ energy-producing aspects of the drinks. However, it’s still the caffeine that does the trick:
(The caffeine content is in milligrams per serving. Although serving sizes vary, Griffiths contends that most people will drink the entire can, whatever the number of ounces.)
Living with chronic pain is not easy, and when it’s time to seek out a pain specialist who understands the intricacies of chronic pain and the options for treatment, your family physician is your first resource. Most pain clinics require a referral from that family physician in order for the pain clinic to accept you as a patient. Chronicillness.co Site of the United States is no exception. In order to receive award-winning medical treatment from our pain specialists, a referral from your family physician is needed.
One of the most common questions that we get is “why do I need a referral?” The most common answer is that it’s really up to your insurance company, and to alleviate any insurance discrepancies we ask that patient’s come by referral. Without getting too complicated, referrals depend on whether you have a PPO or an HMO, whether you are using a provider within your network or not, and whether it’s an emergency situation. In any situation where you’d need to see one of our pain specialists, it’s your best bet to get a referral.
Can’t my family physician just treat the pain? The short answer is yes and no. Your family physician can prescribe over-the-counter medications to help alleviate the pain, but simply alleviating the pain is not diagnosing the problem or treating its source. If you’ve tried pain medication from your physician, and you’ve tried options such as massage and exercise (things that are probably not covered by insurance), and you’re still in pain, it’s time to get that referral to see a pain specialist.
How do I ask for a Referral?
Many family physicians have become much like family friends, treating you and your family for generations. So when it comes to asking to seek out a professional that isn’t your physician, sometimes it can be difficult to ask for that referral. And, in some cases, physicians don’t want to give you that referral. Either way, if you have been on pain medication and it’s not working, you must ask for a referral to see a pain specialist. Here are some tips for asking:
Discuss with your family physician the amount of pain you’re still in. Let him know that the medication is not working well enough, and you’d like to get to the source of the problem to solve it, not just cover it up with painkillers.
Discuss the various treatment options that you’ve already tried with your physician, and ask if he can suggest any others. If he has run out of options, it’s time to see a specialist.
Asking for a referral is like ripping off a band-aid. You know it has to be done, but you don’t want to make anyone feel bad.
As you ask for your referral, it is also a great time to ask your physician to send a letter to Chronicillness.co Site of United States explaining your medical situation.
Finally, check with your insurance to make sure that Chronicillness.co Site is within your network.
Do you have a high pain tolerance? How do you know it’s higher than another patient? One of the most difficult aspects of pain management that our doctors deal with is an individual’s pain tolerance. The infamous one-to-ten pain scale is unscientific, and inaccurate when dealing with individuals who feel pain differently. What might be a two-to-one person might be an eight. Even when the patient explains to the pain doctor the amount of pain they’re in, we’re still stuck as to how much pain they are truly feeling. But all of that might be changing.
Pain is subjective and unquantifiable. When you visit the physician for chronic pain symptoms, or perhaps when you’re in labor, your doctor will have you rate your pain on a scale of 1 to 10. When my wife was having our first little one, the nurse said “rate your pain on a scale of 1 to 10, 10 being the kind of pain you’d feel if you were hit by a truck and then run over twice.” It’s an interesting way to describe pain, but effective.
The pain scale, though not entirely effective, does make pain measurable for doctors. On your first visit, your pain might be an 8, but on your third visit, your pain might be down to a 3. This tells the pain doctor that they are doing the right things to get you back into life and relieve your pain.
Recently, scientists at Brigham and Women’s Hospital in Boston were able to “observe changes in blood flow to specific regions of the brain as chronic back pain patients held uncomfortable positions inside the scanner,” according to ABCNews.com. “As the patients’ brains were registering the distressing sensation, the investigators watched blood flow activate or ‘light up’ different regions. They could then measure that blood flow during those painful episodes.” This, many believe, is a huge step to categorically defining the amount of physical pain that a patient is feeling.
According to Dr. Ajay D. Wasan, an assistant professor of anesthesiology and psychiatry involved in the research study, the “network involved in processing pain” is well understood. The fact that a person’s attention to their pain is a key element in their pain tolerance leads Dr. Wasan to believe that “drugs that might change a person’s ability to pay attention to their pain or be distracted from their pain” might become exceedingly important aspects of pain management down the road.
Many of our United States pain patients love the outdoors, and the United States is a wonderful place to be over Memorial Day Weekend. Everyone in the valley heads north to escape the start of summer and relax with friends and family. However, if you can’t afford an RV, tent camping can be a seriously daunting aspect of the weekend.
Have the mindset that tent camping will be a breeze because mindset truly plays a large role in how you will feel this weekend.
Don’t take on too much. We can’t stress this enough. When it comes to tent camping, setting up the tent and getting it organized should not be one of your priorities. Do not overstress your body. Allow friends and family to do the work as you take on less strenuous tasks.
Have a big enough tent to give you room to stand up. Make it as convenient as possible for when you must climb into the tent, change in the tent, or anything else.
Place the tent in a shaded area. As we all know, this United States sun can sneak up on you and just a few moments of direct sunlight can truly heat up that tent and make it very uncomfortable.
Spend the money on a nice air mattress. United States pain specialists can’t stress this enough. Sleep is paramount, and being able to sleep comfortably while camping can make or break your Memorial Day Weekend. Have enough blankets to keep warm and a comfortable pillow.
Maintain a healthy diet and exercise routine. I know, it’s vacation, but that doesn’t mean you should skimp on your healthy lifestyle. One of the biggest downfalls of every patient’s camping trip is their lack of healthy alternatives to camping food. Changing your diet can dramatically affect your chronic pain.
Have a comfortable chair available. Whether you enjoy the hammock or a simple fold-up chair, make sure it’s comfortable for long periods of time. You want this weekend to be relaxing and calming, and a comfortable chair will help.
Choose a campsite near a bathroom. Once again, we can’t stress this enough. If you began to have a rough episode, walking to a bathroom that’s even 20 feet away can seem like miles.
Getting outdoors and back into life is paramount for patients living with chronic pain. Breathing in that fresh air, relaxing under those towering pine trees, and listening to the breeze without a care in the world can bring about much-needed calm and peace. The kind of calm and peace that has been known to ease chronic pain. While getting up north for a camping trip might not be your favorite thing to do, consider the benefits of spending time away from the stress of life. Those positives might outweigh the negatives when it comes to camping, whether you have an RV or tent.
Pain management is difficult, and if you’ve got a chronic pain condition, it can sometimes feel impossible to find just the right balance of medications to control your pain. Sometimes, though, pain management isn’t about treating your pain at all. Things like getting a good night’s rest, finding stress relief, and treating mental illnesses may not technically be pain management, but they still might be able to provide you with a lot of relief. This month at Pain Doctor, we tried to present with you as many round-the-clock pain management techniques as we could.
Sleep is a big part of life, so it’s no surprise that sleep can also play a big role in pain management.
Scientists still aren’t quite sure why we need sleep, but it’s abundantly clear that sleep is essential for health. Even infants and children who get less than the recommended amount of sleep experience increased health risks – specifically, an increased risk of obesity and overall body fat.
Adults who don’t get enough sleep are at an increased risk of obesity, too, along with a higher risk of heart disease, stroke, diabetes, and high blood pressure. A reduced sex drive, impaired decision making, and increased risk for mental disorders also accompany sleep deprivation. We also noted the relationship between sleep and pain, stating:
“Sleep deprivation lowers the pain threshold. This means that the more tired an individual is, the more likely he or she is to experience sensations as painful. The increased pain can make falling asleep and staying asleep difficult, which often leads to more sleep deprivation. This becomes a repeating cycle, until it’s difficult to tell which came first – the sleep deprivation or the pain.”
To help you manage your pain by getting a better night’s rest, we put together seven ways to help you sleep better at Pain Doctor. Some of these tips, like avoiding caffeine and getting a comfy mattress, aren’t too surprising. A few, though, might be surprising, such as avoiding electronic screens before bed to sleep better. However, if you’ve tried it all and still can’t get a good night’s rest, talk to your physician. He or she should be able to help.
Another potential way to both sleep better and find some pain relief is to find ways to manage your stress.
Stress is insidious. Short-lived, acute stress might make your heart pound or your palms sweat, but it’s frequent bouts of acute stress and long-term chronic stress that can really have an impact. Unfortunately, it’s long-term chronic stress that tends to sneak up on people, becoming such a regular part of life that it’s eventually unnoticed. Digestive issues, headaches, and even more severe allergy flare-ups can all be attributed to stress. Additionally, pain and stress are closely linked, as we stated on the Pain Doctor blog:
“Chronic stress causes changes in the brain. Over time, these changes can negatively impact the parts of the brain that manage pain, meaning that it can confuse the brain into thinking it’s experiencing new or worsened pain.”
If your stress feels overwhelming, talk to a physician or therapist. Along with your doctor’s recommendations, there are also ways to manage your stress levels yourself, though, check out our eight ways to reduce stress. Meditation, laughter, exercise, and lots of other at-home activities can help you get rid of your stress, which can help you lower your pain.
The Pain Doctor post on self-care might help you out with this, too. Self-care is, for all intents and purposes, pampering yourself. It’s doing something that you find relaxing or enjoyable to reduce stress. Taking a short break during a stressful day and doing a self-care activity, such as reading a book or savoring a cup of tea, can cut back your stress before it gets too bad. Keeping up with regular self-care can lower your overall stress levels, which can in turn improve pain, sleep, and overall health.
We also gave some of the best news ever to all the bookworms out there: reading and writing are scientifically proven to be good for you.
For National Library Week, we broke down the many ways that the library can help you. There is, of course, the obvious: libraries have lots of books, and reading is a fantastic way to lower stress. Additionally, libraries give you the chance to learn about your chronic pain condition. Aside from books, libraries have reliable internet access, journal and newspaper archives, movies, and audiobooks, all waiting for you to explore so you can get to know your pain condition inside and out.
The sense of empowerment from this knowledge might help to ease your stress a little, as well as make you better prepared to deal with your disease. Librarians, too, can be a big help with this. Ask for help, and a librarian will be able to direct you to the right book shelf, help you find and print off materials for yourself (and for friends or family, if you want), and find local support groups.
Your librarian might also be able to direct you to a few books that can help you through difficult times. As we explained in our post about reading and writing, the written word can do wonders for stress. The rule of thumb when picking out a book to lower your stress is to pick a book that you’ll enjoy, so go ask your librarian about your favorite topic.
Journaling can also lower stress. You may choose to write down your stressors, which can help you work through them, or you might prefer to keep a gratitude journal. Maybe you’d like to do both, or maybe you’d like to take up poetry or fiction writing. Writing can lower your stress no matter what it’s about, so long as it’s what makes you feel better. Keep in mind, though, that some types of writing – like keeping a stress-relief journal – might be difficult or upsetting at the time, but after a while you’ll likely start to feel better.
For a great example of how both knowledge and writing can make life a little easier, we introduced you to the chronicwoman this month on Pain Doctor. The Hurt Blogger has lived with chronic pain since childhood, but she’s learned as much as possible to help herself live with her pain. Hurt Blogger runs marathons and climbs mountains, and she also blogs about her life and the things that matter to her. She’s also got lots of tips, tricks, and information about living with chronic pain on her website.
Finding some support when you’re struggling is always a good idea, so we did our best to help.
Sometimes, no matter what you do, you may need help with your mental health. Taking the first step and reaching out for professional help is one of the most difficult and brave decisions that anyone can make, so we tried to break down the types of therapists and therapy for you in our Counseling Awareness Month post.
Chronic pain can sometimes be a result of untreated mental illness. Other times chronic pain can be a symptom of mental illness. Whatever the case, struggling with pain on a regular basis can increase the risk for mental illnesses. If you’ve ever wondered if you might have a mental illness, err on the side of caution and speak to your physician. They can help.
We also took a look at the use of antidepressants for pain patients on the Pain Doctor blog. Antidepressants are traditionally used to treat mental disorders, such as depression. However, there are a lot of pain conditions that can be relieved by antidepressants, too, such as:
If you’re not taking an antidepressant already and you’re experiencing pain, despite taking pain medications, consider speaking to your physician about trying an antidepressant.
As far as unusual pain management techniques, no one knows more than someone who’s lived with chronic pain. This is just one benefit of a support group; everyone there knows something that no one else knows. A support group can remove the isolation that often affects anyone with a pain condition. Both online and offline support groups have benefits, so we gave you tips on finding both.
We also gave you some information on mental health in children and older adults. These populations aren’t the typical groups thought of when you discuss mental health, but problems are just as prevalent here as everywhere else. Hopefully the warning signs of mental illness, such as mood and appetite changes, will help you keep an eye on your loved ones and know when to ask for help.
To top it off, we put together some general information we thought you might benefit from.
A lot’s been happening in Colorado. Our post about the latest medical news covered the highlights. From Colorado’s single case of measles to changes in healthcare to the ongoing fight against hospital-acquired infections, we tried to touch on the topics that would matter most to you.
As Dr. Siwek mentions in this week’s episode of the Pain Channel, April is Alcohol Awareness Month. When we think of alcohol awareness, the first things that pop into our minds are drunk driving, designated drivers, and sobriety tests, right? Popular culture has taught us to correlate drinking with driving consequences. But Alcohol Awareness Month is truly about the health consequences associated with alcoholism such as neurologic complications, vitamin deficiencies, liver disease, and much more.
Neurologic complications of alcohol abuse may also result from nutritional deficiency because alcoholics tend to eat poorly and may become depleted of thiamine or other vitaminsimportant for nervous system function. Persons who are intoxicated are also at higher risk for head injury or for compression injuries of the peripheral nerves. Sudden changes in blood chemistry, especially sodium, related to alcohol abuse may cause central pontine myelinolysis, a condition of the brainstem in which nerves lose their myelin coating. Liver disease complicating alcoholic cirrhosis may cause dementia, delirium, and movement disorder. _Healthline.com
Alcoholic neuropathy, also known as alcoholic polyneuropathy, is the direct result of overconsumption of alcohol over extended periods of time. Unfortunately, alcoholics do not eat right, nor exercise, so their bodies slowly become deficient in several nutritional areas. There is a continual debate over whether it is the alcohol itself, or malnutrition that accompanies alcoholism, which is the root cause of alcoholic neuropathy.
The causes of alcoholic neuropathy are extensive, from irregular lifestyles leading to missed meals and poor diets to a complete loss of appetite, alcoholic gastritis, constant vomiting, and damage to the lining of the gastrointestinal system. All of these symptoms cause nutritional deficiencies, and when the lining of the gastrointestinal system becomes compromised, the body is not able to absorb the proper nutrients.
Alcohol consumption in extremes can also increase the toxins within a person’s body such as ethanol and acetaldehyde, which many believe are directly linked to alcoholic neuropathy.
In most cases, alcoholic neuropathy sets gradually into the body so that the individual does not realize they have this condition until it is deeply rooted within their system. While weight loss is an early warning sign, it is also a side effect of heavy drinking, so most individuals with alcohol conditions do not realize what their body is trying to tell them. Painful paralysis and motor loss is the first symptom that individuals tend to truly take notice of. According to Alcoholism-Solutions.com, the following is a list of possible symptoms of alcoholic neuropathy:
autonomic functions are involuntary, like the heartbeat and respiration.
Because this chronic condition affects the brain and nerves, pain can be intense and constant, sharp and quick, or dull and prolonged, and cramping may occur in muscles without warning.
Most pain doctors in the United States will tell you that there is no known cure for alcohol neuropathy, but there are successful pain management and treatment methods to help patients get back into life. At this point, when a patient has been diagnosed with alcohol neuropathy, a pain doctor’s best intention is to control the pain. Once that damage has been done from this chronic condition, unfortunately, it cannot be undone. However, the pain can be controlled.
Obtaining alcohol consumption will be the pain doctor’s first course of treatment. Whether it’s through counseling, Alcoholics Anonymous meetings, or in-house psychological evaluations, kicking the habit is the first step. This will be the toughest step for anyone living with alcohol neuropathy.
Next, your pain doctor will want to manage your nutritional intake through medication and a strict diet. Using a multidisciplinary team of industry experts, your pain doctor will no doubt sit you down with a nutritionist to determine the best course to get you back on track with a healthy diet. Multivitamins are also a key aspect of nourishing your body.
Physical therapy is usually called for in cases of alcohol neuropathy due to the great damage that has been done to the nerves. Since motor loss is a symptom of this chronic condition, your pain doctor will want to bring blood flow and life back into the affected areas of your body. One of the best ways to do this is through exercise and physical therapy.
Most individuals who abuse alcohol are also at great risk for abusing pain medication while going through pain management treatment, which is always a concern for pain doctors in the United States. According to NYTimes Health, the least amount of medication needed to reduce symptoms is advised, to reduce dependence and other side effects of chronic use.
Common medications may include over-the-counter analgesics such as aspirin, ibuprofen, or acetaminophen to reduce pain. Stabbing pains may respond to tricyclic antidepressants or anticonvulsant medications such as phenytoin, gabapentin, or carbamazepine.
While it’s deemed impossible to reverse the damage already done to the body’s nerves, pain doctors can help patients living with alcoholic neuropathy reduce and control pain and get back into life. Of course, the best way to prevent this chronic condition is to respect your alcohol intake, but if you are suffering from this debilitating condition speak immediately to a United States pain specialist about your options.
In the fight against lower back pain, many people and their doctors reach for the same weapons: common over-the-counter (OTC) and prescription medications. New research on commonly recommended and prescribed lower back pain medications has found that many may actually be virtually ineffective for treating lower back pain and that medication for lower back pain may actually do more harm than good.
Nsaids are a standard go-to medication for lower back pain, but their effectiveness is being called into question. The common over-the-counter pain medications Tylenol, Advil, and Aleve are all types of nsaids. More powerful nsaids are also available by prescription from your physician. For many people with chronic back pain, it’s not unusual to keep a bottle of over-the-counter nsaids on hand to treat pain as needed.
A great many medications fall into the classification of nsaids, but all of them function in a similar way. Nsaids block an enzyme called cyclooxygenase (COX), which in turn inhibits the production of certain inflammatory responses like fever, swelling, and pain. Since many instances of pain are caused by inflammation or swelling, inhibiting inflammatory responses should reduce pain.
However, COX enzymes also aid in protecting the stomach lining, which is why using nsaids can sometimes lead to ulcers or bleeding in the stomach. Potential side effects of nsaids include digestive symptoms like heartburn, diarrhea, vomiting, or stomach pain.
Tylenol in particular has been widely advertised all over the world as a catch-all OTC medication for aches and pains of every variety. From acute back pain to achy knees and chronic pain, advertisements would have you believe that Tylenol is effective and safe for pain. A study from theBMJ(formerly the British Medical Journal) found that Tylenol’s claims of efficacy in the treatment of both back and knee pain were false.
A meta-analysis of randomized controlled studies focusing on Tylenol’s ability to relieve spinal pain and pain due to osteoarthritis found that for spinal pain, Tylenol showed no effect on pain in either short- or intermediate-term follow-ups. For osteoarthritis, the short-term efficacy of Tylenol for spinal pain was more pronounced than for intermediate use, but pain reduction was still rated as moderate. Any pain relief reported was clinically insignificant and similar to the placebo group. The studies included in the meta-analysis focused on just over 5,300 patients with lower back pain and knee pain and excluded any patients with previous surgeries for either condition.
While some patients suffering from chronic and acute back pain may find that any minor reduction in pain is worth the risk, the side effects may not be worth it. Since 2011, the Food & Drug Administration has required medications that use acetaminophen to carry a “black box” warning that highlights its risk for liver failure.
Many who take Tylenol for pain do not realize that other medications (e.g. Cold medicines) also contain acetaminophen. Exceeding the maximum daily dose by even a small amount can cause serious side effects and may even cause death. For anything other than acute, short-term pain, taking Tylenol is not recommended as a medication for lower back pain.
Opioids are a narcotic pain reliever. Previously used primarily for short-term relief of acute pain, or for pain relief in patients with a chronic condition like cancer, opioids have become part of mainstream pain management over the last two decades. The number of prescriptions written for oral opioid medications, such as hydrocodone, oxycodone, or hydromorphone, has more than tripled over the last 20 years. Despite the risks associated with opioid medications, they are becoming increasingly widespread as a prescribed medication for lower back pain, even though new research suggests opioids aren’t very effective for this type of pain.
While the risks of opioids have been well-documented, a study by the American Academy of Pediatrics found that the use of prescription opioids is linked to fewer positive outcomes after spinal surgery. The study of just over 500 patients used patient reporting to measure health preoperatively and at three, six, and 12 months post-operatively. Differences in recovery, mental health, and decreased pain was significantly influenced by opioid use in the following ways:
Patients who increased opioid use before spinal surgery did significantly worse post-operatively at three and 12 months
For every ten milligrams of increase in opioid use, the study found a significant decrease in mental and physical health scores
Patients who also suffered from comorbid conditions such as depression and anxiety were more likely to take opioids
Lead study author Clinton J. Devin, MD, assistant professor of orthopedic surgery and neurosurgery at the Vanderbilt Spine Center had this to say about the treatment implications of study’s findings:
“Our work highlights the importance of careful preoperative counseling with patients on high doses of preoperative opioids, pointing out the potential impact on long term outcome and working toward narcotic reduction prior to undergoing surgery.”
Even for those patients who choose not to undergo surgery, opioids have very little effect on chronic low back pain. While there seems to be some short-term analgesic benefit, the risk of dependence and other side effects likely outweighs the minimal benefit in intermediate- and long-term use for this medication for lower back pain.
Researchers have also been reevaluating the trials and evidence that support the effectiveness of opioid pain medications, and the evidence doesn’t hold up. The National Institutes of Health (NIH) convened a seven-member panel to examine the evidence for opioid medications. An article by the University of Connecticut summed up the results, noting:
“A National Institutes of Health white paper that was released today finds little to no evidence for the effectiveness of opioid drugs in the treatment of long-term chronic pain, despite the explosive recent growth in the use of the drugs.”
Additionally, a University of Colorado Boulder study showed that opioid use (specifically morphine) actually prolonged neuropathic pain in rats, suggesting that it could have the same effect on humans.
Finally, the BMJ published a clinical review of the efficacy of opioids as a medication for lower back pain. The conclusions in this article include:
Opioids don’t speed injured workers’ return to work
Opioids don’t improve functional outcomes of acute back pain in primary care
There is little evidence of opioid efficacy for chronic back pain
It was also pointed out that controlled trials of opioids for back pain tend to experience a high dropout rate among participants. The trials also have a short duration (generally four months or less) and have highly selected patients. This all suggests that the controlled trials that do support opioid efficacy for back pain are perhaps not reliable, or at least are not thorough enough.
Opioids also have a high risk of abuse and dependence. Using opioids before spinal surgery has been linked to a higher risk of negative surgical outcome. Slow-acting opioids, which have been assumed to be safer than fast-acting opioids, have been shown to make men five times as likely to develop low testosterone. More and more evidence continues to point to the fact that opioids are not a suitable medication for lower back pain, unless used for highly-controlled, acute cases.
Steroids are commonly used to treat inflammation associated with back pain, but they may not be as effective as previously believed. Steroids, also called corticosteroids, are a synthetic (man-made) version of a hormone naturally found in the body. Steroids are used to treat many different conditions, largely because they are cost-effective and can be applied in many different forms (oral, injected, inhaled, topically, etc.). Long-term or illicit use of steroids is associated with several potentially-serious side effects, but when used as directed, steroids are generally considered safe.
In a randomized controlled trial of 267 people with herniated disc, researchers found that there was no significant difference in pain relief between the group receiving oral steroids (prednisone) and the group receiving a placebo. Both groups saw improvement, but even after a year, there was no difference between the two (except in rate of disability, which was slightly lower in the prednisone group).
Likewise, a study originally published in the Journal of the American Medical Association (JAMA) looked at the efficacy of the oral steroid prednisone in treating sciatica-related back pain. In this study, half the participants were given a 15-day course of prednisone to treat sciatica resulting from a herniated disc, while the other half were given placebos to treat the same condition. Although both groups’ symptoms improved, there were no statistically significant differences in pain or disability by the end of six weeks.
Again, this is a case of the side effects outweighing the negligible benefits. In addition to headache, mood swings, and irregular heartbeat, long-term use of prednisone is a risk factor for osteoporosis, which may increase the risk of spinal injury leading to pain. Steroid injections, on the other hand, provide a targeted approach to using these medications which may work more powerfully for lower back pain patients.
Even with this research, this does not mean that you should stop your medication for lower back pain, especially if they’ve been prescribed by a physician.
If you’re taking a medication that relieves your symptoms of back pain, that’s great. Keep taking it. If your current medication doesn’t seem to be doing the job, keep taking it until you’re able to talk to your pain doctor and get an alternative medication or treatment (or are given the go-ahead to stop taking it). Stopping a medication prescribed by your doctor could be unsafe if you haven’t discussed it with them before.
And keep in mind that pursuing alternative, complementary, or interventional pain management techniques – either in conjunction with or (with your physician’s permission) instead of medication – might help you control your pain much more effectively than medication for lower back pain alone.
Staying physically active is an important treatment option for lower back pain. While it may seem counterintuitive to move when you are in pain, keeping your muscles strong and engaged can be the key to a healthy back. Focus on stretches and core work, but don’t forget low-impact cardiovascular exercise such as biking, swimming, and hiking.
Although it may not work as quickly as medication for lower back pain, eating a healthy diet full of anti-inflammatory foods can make a tremendous difference in treating chronic back pain. Adding these foods while eliminating common inflammation-causing foods like sugar, wheat, and dairy can help you manage pain.
The more weight we carry on our bodies, the more stress there is on our joints. Maintaining a healthy weight with diet and exercise can be an important part of treatment for back pain, especially in cases where back pain is due to compression injuries such as herniated discs or inflammation caused by spinal stenosis.
Acupuncture is gaining traction as an effective treatment for low back pain. Chiropractic care can also be an excellent first-line treatment that minimizes the chance of spinal surgery in the future. Mindfulness meditation and biofeedback have both been shown to diminish the perception of pain. All of these treatments are nearly side-effect free, and many are now covered by insurance.
Finally, if your pain doesn’t respond to medication for lower back pain or these complementary approaches, you could try more targeted therapies for resolving your back pain. This will involve identifying the underlying causes of your back pain and finding a therapy that can work to resolve or treat the symptoms of your pain. Once a correct diagnosis is made, your doctor may recommend any of the following therapies:
Living with fibromyalgia can be difficult and painful. When traditional treatments do not work, many patients turn to alternative therapies for pain relief. Chinese herbs and over-the-counter supplements have become popular in many patients’ efforts to relieve their pain. At Chronicillness.co Site, our pain management specialists recommend a comprehensive plan when treating the pain of fibromyalgia.
5-HTP (5-Hydroxytryptophan). This supplement is a building block of serotonin. Serotonin is a powerful brain chemical, and serotonin levels play a significant role in fibromyalgia pain. Serotonin levels are also associated with depression and sleep.
For those with fibromyalgia, 5-HTP may help increase deep sleep and reduce pain. In one study published in the Alternative Medicine Review, researchers reported that supplementation with 5-HTP may improve symptoms of depression, anxiety, insomnia, and fibromyalgia pains. However, there are some contradictory studies that show no benefit of 5-HTP.
5-HTP is usually well tolerated. But in the late 1980s, the supplement was associated with a serious condition called eosinophilia-myalgia syndrome. It’s thought that a contaminant in 5-HTP led to the condition, which causes flu-like symptoms, severe muscle pain, and burning rashes.
Melatonin. This natural hormone is available as an over-the-counter supplement. It is sometimes used to induce drowsiness and improve sleep patterns. Some preliminary findings show that melatonin may be effective in treating fibromyalgia pain. Most patients with fibromyalgia have sleep problems and fatigue, and it’s thought that melatonin may help relieve these symptoms.
Melatonin is generally regarded as safe with few to no side effects. Due to the risk of daytime sleepiness, though, anyone taking melatonin should use caution when driving until they know how it affects them.
St. John’s Wort. While there’s no specific evidence that St. John’s wort is helpful in treating fibromyalgia, this herb is often used in treating depression, and depression is commonly associated with fibromyalgia.
There are several studies that show St. John’s wort is more effective than a placebo and as effective as older antidepressants called tricyclics in the short-term treatment of mild or moderate depression. Other studies show St. John’s wort is as effective as selective SSRI antidepressants such as Prozac or Zoloft in treating depression.
St John’s wort is usually well tolerated. The most common side effects are stomach upset, skin reactions, and fatigue. St. John’s wort should not be mixed with antidepressants as can cause interactions with many types of drugs. If on medication, tell a doctor before taking St. John’s wort or any supplement. In addition, be careful about taking St. John’s wort with other drugs, including antidepressants.
SAM-e. It’s not known exactly how SAM-e works in the body. Some feel this natural supplement increases levels of serotonin and dopamine, two brain neurotransmitters. Although some researchers believe that SAM-e may alter mood and increase restful sleep, current studies do not appear to show any benefit of SAM-e over placebo in reducing the number of tender points or in alleviating depression with fibromyalgia. Additional study is needed to confirm these findings.
The studies are limited, but it’s thought that L-carnitine may give some pain relief and treat other symptoms in people with fibromyalgia. In one study, researchers evaluated the effectiveness of L-carnitine in 102 patients with fibromyalgia. Results showed significantly greater symptom improvements in the group that took L-carnitine than in the group that took a placebo. The researchers concluded that while more studies are warranted, L-carnitine may provide pain relief and improvement in the general and mental health of patients with fibromyalgia.
It’s been about a year since we became Pain Doctor and began sharing information with you about everything pain- and health-related. In that time, we’ve covered a lot of information, but we’ve tried to make sure that all of it is centered around the topics that you, as a health–conscious pain patient, might care about the most. It was tough, but we narrowed down a year’s worth of information into our top ten favorite posts from Pain Doctor, covering everything from resources to lifestyle changes.
In no particular order, here are our top ten favorite posts on Pain Doctor.
It can be hard to start a new exercise routine, especially if you’re in pain, but the payoff will be worth it. In this post, we touched on a few studies that looked at the benefits of exercise for people with chronic pain, noting:
“Several studies have looked at the effects of exercise on chronic pain conditions. The results are often very similar: decreased pain and a better quality of life.”
We also gave you some suggested types of exercise, along with a few tips, to get you started on your fitness journey.
We’ve mentioned several times on Pain Doctor that stress is bad for you, particularly if you live with chronic pain. Self-care is one of the absolute best ways to combat chronic stress and, by extension, improve your health and reduce your pain. Also, the more often you allow yourself a few minutes of self-care, the better, because your body will eventually come to associate a certain activity or routine (like the motions of brewing a pot of tea for an afternoon break) with relaxation. Once your body has built up this association, you’ll begin to experience the physiological signs of relaxation more quickly. If you need ideas for self-care or relaxation, look no further: this post has plenty.
Health literacy is all about knowing how to find and understand health information so you can make informed decisions about your own healthcare. Pain conditions, like lots of medical conditions, can get confusing and overwhelming very quickly, so having the health literacy skills to do research, find information, and know what questions to ask your physician is vital. This post breaks down how to judge the reliability of an online resource by asking five simple questions:
After you’ve been dealing with a chronic pain condition or medical condition for long enough, managing your medications will become almost automatic. If you’re newly diagnosed, or if your medication regime has changed recently, it can be scary trying to keep all those pills (and maybe even injected medications) straight. Here we gave you some tips and tricks about medication management, like using a medication sheet and letting your everyday activities (such as meals or bedtime) act as reminders. The bottom line is to make sure you talk about your medications with your physician and then take them as directed.
Sleep might not seem like that much of a deal, but it is. Getting enough sleep can have big benefits on your health, just as being chronically sleep deprived carries some serious risks. If you deal with pain on a regular basis, sleep can be a struggle. Hopefully this post convinced you that, if your pain is interfering with your sleep, you should talk to your physician about it. After all, as we noted:
“Sleep deprivation lowers the pain threshold. This means that the more tired an individual is, the more likely he or she is to experience sensations as painful. The increased pain can make falling asleep and staying asleep difficult, which often leads to more sleep deprivation. This becomes a repeating cycle, until it’s difficult to tell which came first – the sleep deprivation or the pain.”
There are a lot of surface similarities between chronic pain and depression. For instance, people suffering from these conditions often face similar misconceptions, like the problem being “all in your head” or that you can “just get over it.” With both chronic pain and depression, though, this is certainly not the case. Both conditions are serious, diagnosable medical conditions that need attention from a physician. And the similarities go even deeper, right down to some of the same centers of the brain being involved in both chronic pain and mood disorders.
This post is a must-read for anyone who takes opioids (or who has a family member or friend who takes opioids). It covers all the nuts and bolts of opioids, from how they work to the different types to what they treat best to the risks involved.
A common opioid painkiller, hydrocodone, was reclassified last year, along with hydrocodone-based painkillers. We know that for a lot of people with chronic pain, opioids are commonly used for as-needed or breakthrough pain relief, until a less risky pain management technique can be found. In this post we delved into why hydrocodone-based painkillers have been reclassified and how it might impact you.
Dogs are good for your health in lots of ways, and they can even help you manage your pain. For some people, it’s only thanks to their assistive or service dogs that they’re able to function independently. Therapy dogs can make a huge difference to people who are hospitalized or living in assisted care. What it boils down to, though, is that no matter the breed, age, size, or training, your canine best friend does more for you than you realize.
Hopefully this post was as interesting to read as it was to write. Dogs’ super-sensitive noses have been used for jobs like search and rescue or bomb-sniffing for years, but now they’re being trained and put to work in the medical field. Some of these amazing dogs can detect oncoming seizures, allergic reactions, or blood sugar fluctuations in their owners. Others are taught to identify infections or cancers. The really amazing thing is that oftentimes, the dogs are more sensitive than modern medical equipment.
At Pain Doctor, we try to help you live your best life possible, and we truly think that part of that is arming you with all the knowledge you need to make the best decisions about your lifestyle and healthcare. We hope we’ve accomplished that for you, and we hope that we can continue to help you control your pain and enjoy your life to the fullest.
