Category: Chronic Pain

A comprehensive guide on chronic pain, its causes, symptoms, and effective management strategies to improve your quality of life.

  • In a World of Pain

    In a World of Pain

    When Marin Hinkle tells you about her work, family and friends, you can hear the excitement and love in her voice. But behind that serene smile you see on television, in her roles on shows such as “The Marvelous Mrs. Maisel”and “Two and a Half Men,” is a woman who struggles daily with agonizing chronic pain.

    “My pain originated in my pelvis, and it’s around my pelvic girdle on the left side of my body,” explains Hinkle. The pain began in 2015 and took a long time for doctors to identify. “It’s one of the most difficult areas to diagnose, and it’s one of the most painful areas a human can experience pain.”

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    Hinkle had a history of kidney stones, so when the pain began, that’s what she thought it was. Because she was shooting a television pilot, she tried her best to ignore it. That didn’t last.

    “I was in excruciating pain, and I didn’t understand why it was lasting so long,” she recalls.

    When the pain just wouldn’t stop, Hinkle ended up in a pain program at Cedars-Sinai Hospital. Doctors initially tried to break her pain cycle by giving her an epidural injection, which numbed her pain for six hours. For some patients, that’s enough. Unfortunately, it wasn’t for her.

    “After it wore off, the pain came racing back,” Hinkle says.

    Hinkle was temporarily prescribed opioids to help her get through work. But she didn’t like how they made her feel — sleepy and drugged. When the pilot project finished, she stopped taking them.

    The pain returned.

    “I began a journey that took about two years. [I had] to figure out how I was going to live with this kind of pain,” says Hinkle.

    For four months after the pain returned, she was bedridden and for a year and a half after that, she didn’t work. “I didn’t even want to get into cars to go places because every time I sat, I had pain in my pelvis.”

    Hinkle saw specialist after specialist, and each one seemed to think her pain was caused by something different.

    “I had seven different diagnoses,” says Hinkle. One of those was interstitial cystitis, which resulted in her trying everything from changing her diet to having her bladder numbed. Nothing worked.

    Searching for an answer

    “I was my own advocate,” Hinkle says. “I basically had to crusade to figure out what was wrong. I would often meet with doctors who weren’t sensitive, and some thought I was being overly emotional because I’m an actor. One neurologist actually said to me, ‘You’re too smart for all this.’ I started to think I had become crazy. I remember weeping in doctors‘ offices.”

    Six months later, having seen doctor after doctor and undergone test after test, Hinkle found a female physician who took her seriously. “She was kind and thoughtful. She started writing letters to get me seen at the Mayo Clinic in Minnesota for a week and then in the chronic pain program at Cleveland Clinic for a month,” says Hinkle.

    At the Cleveland Clinic, during a pelvic pain workup, Hinkle was given a diagnosis of pudendal neuralgia, which occurs when a major nerve is damaged in the lower body and can cause everything from pain and discomfort to numbness in the genital region. Doctors aren’t sure how she damaged the nerve; it could have been the result of a gynecological procedure where a nerve was pinched, along with her exercise of choice, which had been cycling.

    Although she finally had a diagnosis, the pain remained. The pain program, however, taught her how to live with it. “They taught me that I can still do all the physical stuff I used to. I’m just going to be doing it in pain,” says Hinkle.

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    A couple of months after she completed the pain program, Hinkle went on her first audition in a long time. She was cast as Dr. Miller in the sitcom ” Speechless.” “That reignited my career and allowed me to prove to myself that I could work with the pain,” Hinkle says. In fact, she based the optimistic character in the sitcom on a woman who is in pain and has decided she won’t let it get to her.

    Hinkle’s next audition was for the role of Rose Weissman in “The Marvelous Mrs. Maisel.” Landing that part changed her life; in 2019 it earned her her first Emmy Award nomination for outstanding supporting actress in a comedy series.

    Hinkle as Rose Weissman in “The Marvelous Mrs. Maisel,” Courtesy of Amazon Prime Video

    “Through this, I was able to show that I’m back working. At the end of the day, when the work is finished, the pain surges again. So that’s not to say I don’t feel it when I’m working, but the work is so much more than the pain.”

    During her search for the source of her pain, Hinkle says that the intimacy in all her relationships — with her husband, son, mom, and her friends — was altered and stressed. Nevertheless, they all supported her. “I thank God that I had love in my family because the isolation of pain is so difficult. I see why people crumble. You feel like you’re in a nightmare, and no one understands,” she says.

    Friends helped her too. A women’s group she belongs to called The Hyphenates — they’re all actors who are also writers, directors, teachers and the like — sent her books, tea, cups, handmade bookmarks in beautiful fabric and letters in which they expressed their compassion and love for her. “That buoyed me and kept me going,” she says.

    At the time, her son was in middle school. Before the pain, Hinkle had been the fun mom who would clown around with her son and attend all of his school events. But when she was in so much pain, that stopped.

    While writing an essay to get into a private high school, her son was asked, “What’s the greatest challenge that you’ve faced?” His answer, Hinkle says, broke her heart: “When my mom wasn’t able to do all the fun things that she used to.”

    Today, Hinkle says she’s still in pain all the time. In the morning, it’s less, but by nightfall, it fires up. She takes an anti-seizure medicine and a low-dose antidepressant to help with the pain. Although Hinkle can’t exercise like she used to, as even yoga hurts, she finds gentle movement on an elliptical machine helps. “The only other thing I let myself do is walk, and I walk as much as possible,” she says.

    For other women with chronic pain or other chronic health problems, Hinkle suggests they look at what they loved doing before their issues began. “Let yourself indulge in them in a way that’s even more enhanced … Rely on loved ones for support, take in the outdoors when you can, and take in the little details of life, like making a pie or taking a shower.”

    Hinkle says another thing that helped her was adopting a rescue dog, and she highly recommends having the gentle love of an animal.

    During the 12 years she acted on “Two and a Half Men,” Hinkle always performed in a play each year as well. But with her pain at night, she stopped. “My dream,” she says, “is to get back on the stage.”

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  • Minimizing Back Pain While Doing Dishes and Cleaning the Floor

    17 Expert-Backed Ways to Dramatically Minimize Back Pain While Doing Dishes and Cleaning the Floor

    Back pain is one of the most common complaints among adults, and surprisingly, everyday household chores like washing dishes and cleaning the floor can be significant contributors. These tasks, though simple on the surface, require repetitive motions, bending, and prolonged standing, all of which can strain the lower back. The good news is that by making small changes to your daily routine and technique, you can dramatically reduce your risk of discomfort or long-term injury.

    This article explores practical, expert-backed strategies for minimizing back pain while doing dishes and cleaning the floor. By implementing these techniques, you can keep your spine supported and your muscles relaxed, ensuring your home stays clean without taking a toll on your body.


    Understanding the Root Causes of Back Pain During Chores

    The human spine is designed for movement, but it thrives on proper alignment and balanced activity. When you bend forward at the waist, twist repetitively, or remain in one position too long, you stress your lumbar spine and surrounding muscles. Dishwashing often involves leaning forward over a sink, while floor cleaning requires bending and twisting—especially when using traditional mops or cleaning on hands and knees. These positions lead to muscle fatigue, poor posture, and increased pressure on spinal discs.


    Ergonomic Positioning at the Sink

    Standing at a sink for long periods while doing dishes can cause a slight but continuous forward lean, which puts pressure on the lower back. To counter this:

    • Elevate one foot on a small stool or open cabinet base while you stand. This shifts weight and eases spinal pressure.
    • Lean slightly forward by hinging at your hips, not curving your back. Maintain a straight spine.
    • Stand close to the sink, so you’re not stretching your arms out for too long. This reduces upper back and neck tension.

    You can also place a thick anti-fatigue mat under your feet to cushion your stance and encourage better posture.


    Choosing the Right Tools for Floor Cleaning

    Floor cleaning often leads to discomfort because of repetitive bending, kneeling, or twisting. Consider these tool upgrades:

    • Use a long-handled mop or broom that allows you to stand upright. Avoid hunching over.
    • Choose lightweight cleaning tools to reduce strain on your back, arms, and shoulders.
    • Opt for a microfiber mop that glides easily across surfaces, requiring less physical effort.

    If you’re cleaning manually, such as scrubbing a floor by hand, consider using knee pads and placing one hand on a surface for support while the other scrubs.


    How to Bend Safely

    Incorrect bending is one of the fastest ways to trigger or worsen back pain. The key is using the hips and knees, not the spine.

    • Always bend at the hips and knees, not your waist.
    • Keep your back straight when lowering yourself.
    • Engage your core muscles for additional support during movement.
    • When picking something off the floor, use a squatting technique instead of bending forward.

    Pacing Yourself with Breaks and Movement

    Even when practicing good posture, prolonged periods of dishwashing or floor cleaning can still cause fatigue. It’s important to introduce frequent breaks:

    • Take a break every 20 to 30 minutes. Walk around, stretch gently, or shift tasks.
    • Alternate between tasks that require standing and those that allow you to sit.
    • Perform light back stretches before and after chores to keep your muscles flexible and warm.

    Keeping a small timer or reminder can help ensure you don’t forget to pause and reset your body.


    Engaging the Core and Improving Strength

    One of the most effective ways to minimize back pain during chores is to strengthen the muscles that support your spine, particularly the core. A strong core stabilizes the lower back and reduces the chance of injury.

    Incorporate these habits into your routine:

    • Practice light core exercises such as planks, bridges, or abdominal tightening routines.
    • Engage your abs gently while doing chores, particularly when bending or twisting.
    • Focus on posture throughout the day, even when not cleaning.

    Over time, stronger muscles will make household tasks feel less tiring and risky.


    Wearing Supportive Footwear

    Many people do chores barefoot or in soft slippers, which may not provide adequate support. The result is misalignment through the legs, hips, and back.

    • Choose firm-soled, supportive shoes when standing or walking for extended periods.
    • Avoid flip-flops or completely flat footwear.
    • If you’re working on tile or hardwood floors, proper shoes can prevent slipping and help with posture.

    Designing a Back-Friendly Cleaning Routine

    Smart planning can reduce the physical toll of housework.

    • Break large cleaning jobs into shorter sessions over several days.
    • Use tools like robot vacuums or automatic scrubbers for basic cleaning.
    • Store cleaning supplies at a mid-level height to avoid bending or reaching.

    This proactive approach helps reduce cumulative strain on your back while still keeping your home in top shape.


    Using Temperature and Relaxation Techniques

    After cleaning, your muscles might feel tight or sore. Taking care of your body post-task is just as important.

    • Apply a warm compress or heating pad to your lower back to soothe tense muscles.
    • Try gentle yoga or stretching to increase blood flow and flexibility.
    • A short warm bath or shower can relax overworked muscles and reset your posture.

    When to Seek Help

    While mild back pain is common, recurring or severe discomfort may signal an underlying issue. If your pain persists:

    • Consult a physical therapist for personalized ergonomic advice.
    • Speak to your doctor if you notice pain radiating to the legs or worsening over time.
    • Consider a chiropractic evaluation for alignment issues.

    Early attention to symptoms can prevent chronic issues and help you return to pain-free living faster.


    Frequently Asked Questions

    1. Can dishwashing really cause back pain?
    Yes, standing in one position for extended periods and leaning forward over the sink can strain the lower back, especially without proper posture.

    2. What’s the best posture for mopping or sweeping?
    Keep your back straight, bend slightly at the hips, and use long, sweeping motions with minimal twisting. Switch hands regularly to balance the strain.

    3. Should I wear shoes while doing chores?
    Yes, supportive footwear can reduce the impact on your spine by aligning your feet, knees, and hips correctly during movement.

    4. Is it better to use a mop or scrub on my hands and knees?
    Using a mop is generally better for your back. If you must clean by hand, use a cushion under your knees and keep your back as straight as possible.

    5. How can I strengthen my back to prevent pain during cleaning?
    Incorporate core-strengthening exercises like planks and pelvic tilts into your weekly routine. This builds support for your spine during physical activity.

    6. Are ergonomic tools really worth the investment?
    Yes. Long-handled, lightweight, and well-designed tools can drastically reduce the need to bend or twist, preventing fatigue and injury.


    Conclusion

    Minimizing back pain while doing dishes and cleaning the floor isn’t just about avoiding discomfort—it’s about protecting your long-term health. By applying ergonomic principles, using proper tools, and staying mindful of posture and movement, you can transform your daily cleaning routine into a safer, more comfortable experience. These small adjustments may take time to adopt, but they offer lasting benefits for your spine and overall well-being.

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  • Resilience and Other Tools for Overcoming Barriers to Care for Women with Chronic Pain

    We can all build resilience, but our circumstances are not all the same. Some women face more barriers than others. The common barriers we all face include:

    • Poor reimbursement by health insurance for many pain treatments
    • A society where pain is undertreated, and the conditions causing it are often misdiagnosed
    • Stigma associated with chronic pain
    • The lack of medical education about pain
    • The lack of pain specialists in the U.S.
    • The lack of research funding compared with pain’s prevalence and its impact, especially on women, among so many other obstacles

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    I discovered this world of barriers in 1994 after a surgical injury to my spine caused severe pain, and I was unable to sit, stand or walk more than a couple of feet with a walker for the next 15 years. I basically had to navigate the world lying down.

    “Resilience” is often defined as the capacity to recover from difficulties—having a certain toughness. When you have chronic pain, it is less about recovering and more about adapting to new circumstances, because the pain persists; it is ongoing or continuous. Perhaps the definition of resilience as “springing back into shape” or “elasticity” is a better fit. All of us have the capacity for resilience, and tapping this resilience can help us move forward.

    To me, resilience is the ability to adapt and thrive despite ongoing and difficult circumstances. For example, figuring out how to continue to do my job when I could only lie down enabled me to continue to pursue my interests and have an income, although I couldn’t do things in the same way or participate in work that required travel.

    It’s a fact that resilience in our society is mostly about resources. Women with good medical care, a job that offers a living wage and access to sick leave fare better—whether the difficulty is coping with an inadequate health care system or recovering from the impact of a natural disaster, for example. This matters because resilience is partly about our inner reserves and partly about what comes to us from the outside in terms of both resources and difficult experiences.

    Trauma occurs when difficult experiences overwhelm our inner reserves. If we have more resources, the difficult experience may not overwhelm us. Regardless of our circumstances, cultivating resilience can help us buttress those inner reserves.

    How can I harness resilience?

    First, focus on those things you can control. Chronic pain is difficult because it endures; it can feel like it has always been and will never end. Taking things a day or even a moment or an hour at a time can really help because the pain intensity is rarely exactly the same at every moment. Seize moments that give you an opening to do something that feels useful; often, those moments can accumulate. If you are having an especially grueling period, give yourself permission not to be productive and be kind and gentle with yourself.

    Second, use any social and cultural resources available to you. They provide emotional buffers. Pain is an assault on intimacy. You may not be able to participate in shared social activities, and your family and friends can’t see or experience what you do. Chronic pain can separate us from others. But we have to find ways to cultivate this needed connection. Early in my pain experience, I found it helpful for my friends to sit with me and describe their vibrant hiking and camping experiences—the activities that once were such a big part of my life. When I was bedridden, I would sometimes virtually accompany friends to dinner or small parties or even join via cell phone while my friends ran errands or went through the ordinary tasks of their days.

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    I’ve tried numerous techniques over the years that helped, including meditation and relaxation therapy, journaling, drawing and deeply taking in fine art. Resilience can show up unexpectedly. For example, when I started to draw, I barely had the energy to put pen to paper. Then, I noticed that sketching helped me focus outside of myself and awakened different parts of my brain. An entirely new reserve of energy surfaced. Looking at art on the thousands of museum websites that have their collections online opened up new worlds to me, while not requiring the focus of reading an entire novel or watching a play.

    Third, don’t expect too much of yourself. The only way to be resilient is to accept the new normal and your current capabilities. We can’t expect to do all the same things in the same ways that we did before chronic pain. If your work life is challenging, consider asking your employer for accommodations. Under the Americans with Disability Act, employers are required to make appropriate accommodations for you. You can ask to telework or request projects that are less deadline-intensive when you are in a flare-up. If you can afford it, consider a part-time or flexible schedule when things are especially difficult. Whether these accommodations will be provided will depend on your employer’s circumstances too—such as how large and well-resourced they are.

    I was fortunate because I worked in the Civil Rights Division at the Department of Justice when my pain began—the office that enforces the Americans with Disabilities Act—so they were especially accommodating to me.

    And, reach out: Ask for help. Resilience isn’t about going it alone. When things get rough, I try and focus on these five concepts:

    1. Pleasure. Find what makes you feel good and hold on to it.
    2. Patience. Pain is an endurance test, so it is really important to be patient with yourself.
    3. Perseverance. Find a way to reach out to others, to make and sustain social contacts.
    4. Pause. Take time out when you need to rest, and try and find those things that give you a sense of relaxation and stillness.
    5. Perspective. Even with the most intractable chronic condition, there are always ebbs and flows. Holding on to the times that are better and remembering them is important, so you don’t feel like you’re just stuck in an unrelenting rut.

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  • Anti-Inflammatory Herbs and Spices

    What is inflammation?

    Derived from the Latin word “inflammo,” which means, “I set alight, I ignite,” inflammation is the body’s natural self-protectant against potentially harmful stimuli. When a part of the body becomes irritated or damaged, the body responds to protect it from further injury and restore tissue function. Inflammation can be beneficial when, for instance, you sustain a broken knee and the tissues surrounding the area need extra protection and care. In other cases, inflammation can cause further inflammation and get in the way of other normal processes of the body.

    Chronicillness.co Site of United States staff is dedicated to giving patients their life back. Chronic pain symptoms can have a great deal to do with the foods you are consuming, and choosing nutritious anti-inflammatory foods are a great way to combat pain.

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    Top 12anti-inflammatory herbs and spices

    • Black Pepper
    • Basic
    • Cardamom
    • Cayenne
    • Chamomile
    • Cilantro
    • Cinnamon
    • Cloves
    • Garlic
    • Ginger
    • Rosemary
    • Turmeric

    Turmeric is commonly used in Indian cuisine and has a peppery, bitter flavor. Some people say it has a hint of orange or ginger to its taste. Turmeric has a mustard-yellow color. For centuries, turmeric has been used to treat wounds, colds, liver disease, and fight infections. Curcumin is a compound of turmeric, and also helps reduce inflammation.

    Ginger root is better known for its ability to heal travel sickness, nausea, and indigestion. However, some people use this zesty spice as a remedy for colic, irritable bowel, loss of appetite, flu, menstrual cramps, and chills. Because ginger is filled with many anti-inflammatory properties, it is great to use for arthritis, tendonitis, headaches, and cholesterol and blood pressure aid.

    Garlic has many anti-inflammatory properties, which studies show help ease arthritis pain. Allicin, a substance found in garlic is filled with anti-bacterial properties that work like penicillin.  Garlic is a natural antibiotic that helps boost the immune system, improve circulation, and lowers blood pressure.

    Almost all other anti-inflammatory herbs and spices are filled with other nutrients and properties that help keep the body healthy. Dr. Andrew Weil is an expert on the anti-inflammatory diet. Before making any changes to your diet, consult with your physician first.

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  • 3 Easy Desk-side Stretches to Keep Muscle Pain at Bay

    If you’re not taking regular breaks to move around during your workday, your muscles may rebel after being scrunched in your desk chair hour after hour.

    The rebellion might be felt in your neck, shoulders, back, hips and legs when you do finally stand up. Stop the insurrection with these three simple stretching exercises you can do without even leaving your workstation or office.

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    Start with the lateral lean. Stand up straight and clasp your hands behind your head. Turn your head toward your left elbow and then lean your torso in the same plane to the right — don’t bend forward or backward. Hold the stretch for 30 seconds and then repeat the stretch to the opposite side.

    Next move to the standing hip flexor. Despite its name, it helps the legs as well. Lightly place your left hand on your desk for balance and bend your right knee, bringing your right foot behind you toward your right glute. Grip the right ankle with your right hand to gently press the heel toward your butt. Contract both sides of your glutes and keep your knees close together and your spine straight. Hold for 30 seconds and then repeat with the left leg.

    Finish with the open and closed upper body stretch. It helps prevent both lower back and shoulder pain. From a standing position, hinge forward from the waist, letting your arms hang toward the floor. Take a few deep breaths and then slowly stand up straight as you move your arms out to the sides in line with your shoulders. Rotate your thumbs backwards with your palms facing the ceiling. Think of bringing your thumbs together behind you as you open your upper chest toward the ceiling. Hold for 30 seconds and repeat up to four times in total.

    Take three minutes every two or three hours — more often if you can — to do these simple moves. Your body will thank you.

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  • Zumba Sentao for Chronic Pain

    Exercise is important, and not only when you’re healthy. Here at Chronicillness.co Site of United States, we know that patients dealing with chronic pain also need to exercise. But when pain is radiating through the body, it can be difficult to find the energy to work out. This is why Zumba Sentao is a great workout for chronic pain patients.

    Zumba Sentao is a spin-off of regular Zumba, the popular cardio dance class that has become all the rage recently. It is a great all-over body toning workout using a chair and Zumba moves.

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    Zumba Sentao combines strength and resistance exercises with cool dance moves on and around a chair while still keeping the Zumba party dance rhythms and international flavors.

    Zumba creator Beto Perez came up with the idea for Sentao when he arrived to demonstrate a Zumba class in Italy and found everyone sitting on chairs ready to “watch” the show. He quickly improvised and taught simple Zumba routines in the chair. Then he got the class up off the chair, moving around the chair, using the chair for simple toning and strength exercises. The class loved it and Zumba Sentao was born.

    While currently there are only a few hundred licensed Zumba Sentao instructors worldwide (meaning there may not be a class near every patient), patients can ask a Zumba Fitness instructor about the program and when it is coming to their part of the world.

    One of the main advantages of the Zumba Sentao class is being able to effectively work the core muscles, which include the abs and midsection.

    When sitting on the chair and lifting the knee up, having your feet off the ground activates the lower abdominals. Normally this kind of exercise is very hard for most people to do while lying on the ground (think of the V-sit or bicycle exercise).

    Exercises are much easier to do in a chair and very effective. Sentao is also very functional. This means it is a great workout for everyday life. How many times a day do we sit and stand? A lot. And we all need good balance and posture to get through the day without aches and pains.

    Because Zumba Sentao is based around a chair it is a great class for those who look at a regular Zumba class and think they could never do that. Zumba Sentao is also perfect for those who can’t stand for long periods of time. The addition of a chair can also make the class appear more comfortable and achievable for the beginner exerciser.

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  • Chronic Pain Is a Disease and It Should Be Treated Like One

    More than 20 years ago, a heavy filing cabinet fell on Cindy Steinberg at her office and caused nerve and ligament damage to her back. The pain never went away. In the years after, she became an advocate for people who experience chronic pain and is currently the national director of policy & advocacy for the U.S. Pain Foundation.

    In 2011, a landmark report titled “Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research,” made the case for the National Institutes of Health (NIH) to define chronic pain as a brain and nervous system disease. However, the change has not been implemented, in part because awareness among other organizations and practitioners is still lacking.

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    “The problem is that [chronic pain being a disease] is not widely understood by the public or even (healthcare) providers because pain and advances in pain neuroscience [are] rarely if ever taught in medical school or other professional schools and the public is completely in the dark about this … until it happens to them or a loved one,” Steinberg wrote in an email.

    If chronic pain was better understood as a disease, those who live with chronic pain as well as those who research it would benefit immensely. The classification could unlock research funding as well as open the door to drug approvals, and help change attitudes in medical communities. Most important, for consumers, it could pave the way for chronic pain to be covered under health insurance.

    According to Monica Mallampalli, Ph.D., senior advisor, scientific & strategic initiatives at chronicillness.co, classifying chronic pain as a disease could create a structure for how pain can be addressed. She emphasized the need for advocacy and education to make that happen.

    “Advocacy can help Congress to mandate [chronic pain] as a disease and ask for funding to be allocated to study it as a disease,” Mallampalli, who is also a member of Chronic Pain Advisory Council, wrote in an email. “If that happens, NIH will be asked to put a budget on how to address this.”

    “The problem is chronic pain is so complex and includes many diseases and conditions,” she added. “I think it will take time and effort to break those silos.”

    What is chronic pain?

    There are two types of pain: chronic and acute. Acute pain is usually the result of a specific cause — think broken bone or a burn — and goes away once that injury heals. Chronic pain lasts for longer than six months after an injury heals or an illness ends.

    There’s also high-impact chronic pain, which NIH defines as pain that has lasted at least three months and restricts someone’s ability to work, go to school, or accomplish household tasks.

    “It robs your life of any quality,” said Steinberg, who cannot sit or stand for more than an hour at a time.

    How many people have chronic pain?

    Fifty million people in the U.S. — 1 in 5 Americans — live with chronic pain, according to a 2018 study from the Centers for Disease Control and Prevention (CDC).

    Additionally, of the nearly 50 million Americans with chronic pain, about 20 million have high-impact chronic pain, and 11.3 million of those are women, according to the CDC.

    How is chronic pain treated?

    “The historical view of chronic pain and pain in general has been that pain is a symptom of some other derangement in the body, and the pain is important only in that it’s a signal of something else that is wrong,” said Dr. Roger Fillingim, a professor at the University of Florida who has spent more than 25 years researching chronic pain.

    Under the traditional mindset, healthcare providers (HCPs) would then follow a basic biomedical method: Find the source of the pain, treat it, and the pain goes away.

    “Frankly that would be just fine if that perspective worked, but for the tens of millions who currently have high-impact pain and have sought many treatments to try to get rid of whatever the derangement that physicians think is causing it, that approach to chronic pain hasn’t been very effective,” Fillingim said.

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    When part of your body suffers harm, it sends signals to your brain — known as neurotransmitters — that cause you to feel pain. But with some forms of chronic pain, those neurotransmitters don’t turn off, causing a type of feedback loop where the pain continues even though the initial injury has already healed.

    “Increasingly, it’s clear that the brain seems to change significantly in people with chronic pain,” Fillingim said. “Regardless of where pain starts, it’s only pain if it’s in the nervous system. No brain, no pain.”

    Instead, researchers including Fillingim are studying how to treat the nervous system and how it processes pain. Rather than searching for a source outside the brain, they’re focusing on the brain itself.

    How does chronic pain affect women in particular?

    Numerous studies have shown that HCPs are less likely to take women’s pain seriously, especially when it comes to chronic pain, than they are for men. Antidepressants may be prescribed to treat chronic pain, and women are more likely to end up with a referral to a mental health provider than have their pain taken seriously.

    This is where it gets complicated because chronic pain is a risk factor for people to develop anxiety and depression, and vice versa. As a result, medical providers may dismiss patients’ pain as part of their mental health disorder.

    “The concern is that people with chronic pain conditions will have their pain minimized and perceived as just another symptom of their psychological condition,” Fillingam said.

    How can classifying chronic pain as a disease help chronic pain sufferers? 

    Recognizing chronic pain as a disease would be a game changer in terms of how insurance companies address treatment options. A 2017 review of state-based health insurance plans found that the majority did not cover nonpharmaceutical treatment options for people with chronic low back pain, for example.

    “Acknowledging the burden of pain and how this disease has affected so many millions of people should lead to pressure on insurers to approve coverage for more treatment,” Steinberg said.

    Maria Willson, senior policy advisor at chronicilness.co, said getting the condition classified as a disease is a concept that has value because insurers pay medical bills based on CPT codes for disease evaluation, diagnosis and treatment submitted by providers. This can give insurers control over which treatment doctors can give a patient so that they will be reimbursed and not have to pay out of pocket for costly care that they may not be able to afford otherwise.

    “While I think this is changing slightly, it is more likely HCPs have figured out ways to bill,” Nolan wrote in an email. “With the bias toward treating something recognized as a disease as opposed to something unidentifiable or harder to classify, making the change could help with coverage as well as people with chronic pain not being dismissed by doctors.”

    By increasing chronic pain research and training, experts hope that HCPs will be better informed when speaking to patients about their pain and that if HCPs understand that this is disease like any other disease, patients will in turn receive better treatment.

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  • The Pain Gap: Why Women’s Pain Is Undertreated

    When Karen Finney went into the hospital for brain surgery, she was well aware of the gender pain gap: women in pain are taken and treated less seriously than men in pain. Women of color are affected even more severely, and as a Black woman, Finney knew the hill to relief would be even steeper to climb.

    When she woke up after surgery to remove her brain tumor, she was in excruciating pain. She was given painkillers every four hours but said she began to notice that the effects of the drugs would wear off 20 minutes before the four-hour mark — and then they would take another 20 minutes to kick in once they were dispensed again. “I was in this cycle [where] I was in so much pain and it was … up and down and up and down,” Finney recently recounted to Chronicillness.co.

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    When a nurse asked her where her pain was on a scale of 1 to 10, Finney told her the truth: It was a 12. Despite the fact that she had just undergone brain surgery and had damage to her vocal chords that made it difficult to speak, Finney tried to advocate for herself. “I said, I understand some people have biases about Black people and our pain levels, but when I say I’m at a 12 out of 10, I’m not exaggerating.” The nurse told her she understood and wanted to take the issue seriously — then she offered Finney the opportunity to fill out a report about the experience.

    Recounting this moment in her journey, Finney’s voice is clouded with pain and tears. She was in the hospital after brain surgery in horrific pain and all that was offered to her was paperwork.

    Days after her surgery, she was finally given a morphine drip that she could control herself, but those couple of days of needless, intense suffering have stuck with her.

    Women’s pain is often dismissed or not believed

    It’s widely known that although women experience more chronic pain conditions than men — whether it’s fibromyalgia, endometriosis, or migraine — their pain is treated less seriously. In a 2019 Chronicillness.co survey, 45% of respondents said they didn’t think their healthcare providers took their pain seriously. And there are facts behind those feelings: Women experiencing pain are more likely than men to receive a sedative prescription instead of a pain medication prescription.

    The gender pain gap extends to the emergency room, where men wait an average of 49 minutes before receiving pain medication in instances of acute abdominal pain while women wait an average of 65 minutes in the same situation. Women are even half as likely as men to receive painkillers after a coronary bypass surgery.

    In the paper, “The Girl Who Cried Pain: A Bias Against Women in the Treatment of Pain,” Diane Hoffman and Anita Tarzian found that “women report more severe levels of pain, more frequent incidences of pain, and pain of longer duration than men, but are nonetheless treated for pain less aggressively.” But what is it about women in pain that is so easily shrugged off by healthcare providers?

    Dr. Sharon Allison-Ottey, an internal medicine physician and a member of Chronicillness.co’s Women’s Health Advisory Council (WHAC), says women are often considered histrionic when they complain of pain. “They’re not taken as seriously, whether that’s chest pain and they’re having a myocardial infarction or they’ve just broken a bone,” Allison-Ottey said.

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    “There is the perception of the big, strong male who says he’s in pain being taken more seriously by healthcare professionals and therefore acted upon [rather] than the weak little woman in the corner who is complaining about pain, and she’s just had major surgery as well. She’s often thought of as weak and not being able to tolerate pain or overstating her pain level.”

    Another member of the WHAC, Dr. Daihnia Dunkley, whose background is in maternal child health and labor and delivery, said it’s been disturbing to see how differently female pain is perceived — and under prescribed. “There’s an implicit bias there between the two sexes when it comes to pain management,” Dunkley said.

    The pain gap is even worse for Black women

    In a 2016 study, half of medical students and residents believed one of the three erroneous beliefs: “Black people’s nerve endings are less sensitive than white people’s”; “Black people’s skin is thicker than white people’s”; “Black people’s blood coagulates more quickly than white people’s.” These kinds of false perceptions, Dunkley said, need to be addressed during medical education and training so they aren’t perpetuated further.

    According to Allison-Ottey, the change in treatment between Black women and white women can sometimes be understood by implicit bias. It may not be that a doctor or healthcare provider is racist, but they’re surrounded by the stigma of the Black patient coming into the emergency room with drug-seeking behavior. “Really, they’re in excruciating pain and you want to give them extra strength tylenol, but that same person in the next room who’s white is getting hydrocodone,” Allison-Ottey said.

    If she were to advise other women, Finney said she would tell them to talk to their doctors and anesthesiologist and create a plan for pain management before heading into surgery. If possible, she says, it’s best to bring someone with you who can understand the plan and advocate for you because it can be difficult, and sometimes impossible, to advocate for yourself when you’ve just undergone surgery. And, she said, don’t be afraid to use your voice.

    “Remember it is your right to ask as many questions as you need because you deserve to feel comfortable with the plan,” Finney said. “I think sometimes any of us can get intimidated and think the doctors and nurses know best. It’s your right to ask questions. It’s their job to answer those questions.”

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  • Why Do Migraines Make You Nauseous?

    A migraine is a serious chronic condition where a person has a severe headache lasting anywhere from hours to days. It can be felt on either side of the head, temples, and even behind the eyes and ears. They generally do not come on suddenly – most will have warning signs like seeing spots (auras) or having a tingling feeling. Migraine sufferers have to deal with plenty of symptoms in addition to debilitating headaches. Over one-third of migraine sufferers experience sudden nausea and vomiting.

    So why do so many people feel nauseated with their migraine? Why do people get migraines in the first place? The answer to both of these questions is the same: we do not know! However, here are a few theories:

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    • When someone has low serotonin levels in their brain, blood vessels swell up starting the migraine in the first place. Low levels of serotonin have been linked to nausea.
    • Women are known to get more migraines than men. Scientists are looking into the idea that nausea associated with migraines in women could have to do with changing estrogen levels.
    • High blood pressure experienced during migraines could cause vomiting, as a side effect of hypertension is nausea. However, the relationship between high blood pressure and migraines is still being investigated.

    These are just a few theories as to why people vomit during migraines and no one theory is more likely than the other. Testing these answers, or even coming up with a new hypothesis altogether, could take several years of research.

    It can be difficult to take migraine medication if the patient will vomit it up, and the pain is often worse enough without the addition of vomiting. If you experience nausea with your migraine, here are a few ways you can help.

    Ginger is a go-to herb that is available in the pharmacy section of most grocery stores. It can be taken as a pill or, more commonly, in the form of ginger ale. Flat sodas like 7-UP can help ease the stomach as well, but start off with slow sips so you do not aggravate your stomach more with the presence of a lot of liquid at once. The same rule applies to easy-to-eat foods like salted crackers or bananas.

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  • Should You Have Back Surgery for Your Pain?

    Should You Have Back Surgery for Your Pain?

    Back pain is extremely common, with experts estimating that up to 80 percent of the population will experience back pain at some point in their lives.

    If your back pain is disabling and persistent, your health care provider may recommend diagnostic tests like an XRAY or MRI to determine if surgery may be the best option for you.

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    Back surgery can help relieve some causes of back pain, but the key is the ability of your physician to identify key signs of symptoms to determine whether surgery is needed.

    Some other reasons you may want to ask your health care provider for more information about surgery include: bone spurs in your spine; trouble walking; a degenerative spinal condition that’s causing side effects like weakness; a slipped disk that isn’t improving; a tumor on your spinal cord; or a broken or dislocated bone in your back. In most cases, your surgeon will discuss with you appropriate treatment based on your clinical history. However, it is important that you let you your surgeon know if you have unrelenting pain, neurological issues or a serious problem like a spinal cord injury.           

    Types of surgery
    Some minimally invasive procedures are outlined below.

    Balloon kyphoplasty
    Balloon kyphoplasty (BKP) is a minimally invasive surgery that can stabilize a fracture or compressed vertebrae due to osteoporosis, cancer, or noncancerous tumors. It can alleviate your back pain from a spinal fracture and restore vertebral height and proper spinal alignment. Other benefits include improved mobility, ability to perform daily tasks and better quality of life. During surgery, balloons are used to elevate the fractured vertebra to return it to the correct position. The balloon creates a cavity that is filled with a special cement to prevent collapse from happening again. Good candidates are people with severe pain, those too frail or old or whose bones are too weak for spinal surgery, or younger people who have osteoporosis (where bones become weak and brittle) caused by steroid treatment or a metabolic disorder.

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    Diskectomy
    Here, the damaged portion of a herniated disk is removed from the spine to relieve irritation and inflammation of a nerve. A herniated disk happens when some of the softer material inside the disk pushes out through a crack in the exterior. Typically, surgery involves full or partial removal of the back portion of a vertebra to get to the ruptured disc. It’s most effective for treating pain that radiates down your arms or neck pain. It’s less helpful for treating back pain. But your health care professional may suggest it if other treatments haven’t worked or your symptoms worsen.

    Laminectomy
    Here, bones overlying the spinal canal are removed. That enlarges the spinal canal and creates space, relieving pressure on the spinal cord or nerves. Typically, the pressure is caused by bony overgrowths in the spinal canal, also known as bone spurs. These growths can happen in people who have arthritis in their spines and are also a normal part of aging. A laminectomy is generally only used when more conservative treatments haven’t relieved symptoms or symptoms are severe or worsening.

    Spinal fusion
    Spinal fusion permanently connects two or more bones in your spine with metal plates, screws or rods. That fusion forms one, immobile unit. The surgery improves stability, corrects a deformity and relieves pain. It can be used to stop the progression of a spinal deformity (such as scoliosis), spinal weakness or instability, or a herniated disk.

    Artificial disk replacement
    Here, worn or damaged disks are removed and replaced with artificial ones. The procedure aims to help relieve back pain while maintaining normal motion. In general, good candidates for disk replacement have no prior surgery on the spine, no spinal deformity, back pain that’s caused by one or two problematic disks, and no significant joint disease in the spinal nerve.

    Make sure to speak with a health care professional about both the benefits and risks of these procedures.

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