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Postherpetic Neuralgia

Postherpetic Neuralgia

What Is Postherpetic Neuralgia?
Postherpetic neuralgia is a painful condition that affects your nerves and skin. It is a complication of herpes zoster, commonly called shingles.
Shingles is a painful, blistering skin rash caused by a reactivation of a virus called varicella-zoster, which people usually get in childhood or adolescence as chicken pox. The virus can remain dormant in your body’s nerve cells after childhood and can reactivate years later.
When the pain caused by shingles doesn’t go away after the rash and blisters clear up, the condition is called postherpetic neuralgia. Postherpetic neuralgia is the most common complication of shingles, and it occurs when a person’s nerves are damaged during a shingles outbreak. The damaged nerves can’t send messages from the skin to the brain and the messages become confused, resulting in chronic, severe pain that can last for months or years.
According to a study by the American Academy of Family Physicians, about 20 percent of people who get shingles also develop postherpetic neuralgia. Additionally, this condition is more likely to occur in people over the age of 60.
What Are the Symptoms of Postherpetic Neuralgia?
Shingles typically causes a painful, blistering rash. Postherpetic neuralgia is a complication that only occurs in people who already have had shingles. Common signs and symptoms of postherpetic neuralgia include:
severe pain that continues for more than one to three months in the same place that the shingles occurred, even after the rash goes away
burning sensation on the skin, even from the slightest pressure
sensitivity to touch or temperature changes

What Are the Risk Factors for Postherpetic Neuralgia?
Age is a high risk factor for getting both shingles and postherpetic neuralgia. People over 60 have an increased risk, and people over 70 have an even higher risk.
Those who have acute pain and severe rash during shingles are also at a higher risk of developing postherpetic neuralgia.
People with lowered immunity due to disorders like HIV infection and Hodgkin’s lymphoma, a type of cancer, have an increased risk of developing shingles. A study by the American Academy of Family Physicians shows that the incidence of shingles is up to 15 times greater in patients with HIV than in those who don’t have the virus.

 

How Is Postherpetic Neuralgia Diagnosed and Treated?
Tests are unnecessary. Most of the time, your doctor will diagnose postherpetic neuralgia based on the duration of pain symptoms following shingles.
Treatment for postherpetic neuralgia aims to control and reduce pain until the condition goes away. Pain therapy may include the following treatments.
Analgesics
Painkillers are also known as analgesics. Common analgesics used for postherpetic neuralgia include:
capsaicin cream: an analgesic extracted from hot chili peppers
lidocaine patches, a numbing medicine
over-the-counter medications such as acetaminophen (Tylenol), or ibuprofen (Advil)
stronger prescription drugs, such as codeine, hydrocodone, or oxycodone
Tricyclic Antidepressants
Tricyclic antidepressants are normally prescribed to treat depression, but they are also effective in treating pain caused by postherpetic neuralgia. They often have side effects, like dry mouth and blurred vision. They do not act as quickly as other types of painkillers. Commonly used tricyclic antidepressants to treat postherpetic neuralgia include:
amitriptyline (Elavil)
desipramine (Norpramin)
imipramine (Tofranil)
nortriptyline (Pamelor)
Anticonvulsants
Anticonvulsants are normally used for seizures, however clinical studies have shown that lower doses can be effective in treating pain for postherpetic neuralgia as well. Commonly used anticonvulsants include
carbamazepine (Tegretol)
pregabalin (Lyrica)
gabapentin (Neurontin)
phenytoin (Dilantin)

How Can Postherpetic Neuralgia Be Prevented?
A herpes zoster vaccine called Zostavax reduces the risk of shingles by 50 percent, and also protects against postherpetic neuralgia. The Centers for Disease Control and Prevention (CDC)
Trusted Source
recommends that the vaccine be given to all adults over the age of 60, except for people with a weakened immune system. These people may be advised not to receive the vaccine because it contains a live virus.
The herpes zoster vaccine, Zostavax, is different from the chicken pox vaccine, Varivax, that is usually given to children. Zostavax has at least 14 times more live varicella viruses than Varivax. Zostavax can’t be used in children, and Varivax can’t be used to prevent herpes zoster.

Outlook
Painful, postherpetic neuralgia is treatable and preventable. Most cases disappear in one to two months, and rare cases last longer than a year.
If you’re over the age of 60, it’s wise to get vaccinated against it. If you do develop it, there are many analgesics and even antidepressants you can take to manage the pain. It may just take some time and patience.

Article Provided By: healthline

Carolina Pain Scrambler Logo, Chronic Pain, Greenville, SCIf you would like to discuss what Carolina Pain Scrambler do to help relieve your chronic pain symptoms or receive more information on our treatment process, please do not hesitate to call us at 864-520-5011  or you can email us at info@carolinapainscrambler.com

 

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Chemotherapy-Induced Peripheral Neuropathy

Chemotherapy-Induced Peripheral Neuropathy
Timothy J Brown, MD; Ramy Sedhom, MD; Arjun Gupta, MD
Article Information
JAMA Oncol. 2019;5(5):750. doi:10.1001/jamaoncol.2018.6771

Peripheral neuropathy refers to symptoms arising from damage to peripheral nerves. These nerves carry sensation, control movements of the arms and legs, and control the bladder and bowel. Chemotherapy and other drugs used to treat cancer can cause peripheral neuropathy. This is termed chemotherapy-induced peripheral neuropathy (or CIPN).

What Increases the Risk of Developing CIPN?
Certain chemotherapy drugs are more likely to cause neuropathy. These include: platinum drugs, such as oxaliplatin; taxanes, such as docetaxel; vinca alkaloids, such as vincristine; and myeloma treatments, such as bortezomib.
Other chemotherapy drugs can also cause neuropathy. The risk of developing CIPN is higher with higher doses, multiple courses, and combination chemotherapy. Patients are more likely to develop CIPN if they are older or have diabetes, vitamin deficiencies, or preexisting peripheral neuropathy.
How Can I Reduce My Risk of Developing CIPN?
No medication or supplement has been shown to definitively prevent CIPN. Regular exercise, reducing alcohol use, and treating preexisting medical conditions (vitamin B12 deficiency) may reduce the risk of CIPN.
What Are the Symptoms and Complications of CIPN?
Depending on the nerves affected, symptoms include:

Tingling (“pins and needles”)
Pain, which may be severe and constant, may come and go, or may feel like burning
Decreased sensation (“legs feel like jelly”)
Increased sensitivity to touch, temperature, pressure, pain
Muscle weakness

Symptoms can appear hours to days after chemotherapy and may reduce in intensity with time. Commonly, symptoms occur weeks to months after chemotherapy. They can get worse with additional cycles of chemotherapy.
What Should I Do If I Develop Symptoms?
You should notify your care team. Symptoms are likely to worsen if not addressed. Your oncologist can diagnose CIPN based on symptoms and by examining you. Specialized testing is rarely needed.
I Have CIPN—What Now?
One should avoid injury by paying attention to home safety, such as by using handrails on stairs to prevent falls and potholders in the kitchen to avoid burns. Your oncologist may choose to discontinue or reduce the dose of a chemotherapy drug. Your oncologist may recommend over-the-counter pain medications, lidocaine patches, menthol creams, or a medication called duloxetine. Physical therapy, occupational therapy, and rehabilitation may be helpful to regain function. Studies are researching how novel therapies (biofeedback or scrambler therapy) can help. Improvements in function may be gradual. In some cases, nerve damage may be permanent.

Article Provided By: JAMA

 

IfCarolina Pain Scrambler Logo, Chronic Pain, Greenville, SC you would like to discuss what Carolina Pain Scrambler do to help relieve your chronic pain symptoms or receive more information on our treatment process, please do not hesitate to call us at 864-520-5011 or you can email us at info@carolinapainscrambler.com

 

 

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Nerve Pain Therapy, Pain Therapy, Chronic Pain, Calmare Scrambler, Chronic Pain Therapy, Neuropathic Pain Therapy, Greenville SC

Sacroiliac Joint Dysfunction

Sacroiliac Joint Dysfunction

Dysfunction in the sacroiliac joint is thought to cause low back pain and/or leg pain. The leg pain can be particularly difficult and may feel similar to sciatica or pain caused by a lumbar disc herniation. The sacroiliac joint lies next to the bottom of the spine, below the lumbar spine and above the tailbone (coccyx). It connects the sacrum (the triangular bone at the bottom of the spine) with the pelvis (iliac crest).

The joint typically has the following characteristics:

  • Small and very strong, reinforced by strong ligaments that surround it
  • Does not have much motion
  • Transmits all the forces of the upper body to the pelvis (hips) and legs
  • Acts as a shock-absorbing structure

Symptoms

The most common symptoms for patients are lower back pain and the following sensations in the lower extremity: pain, numbness, tingling, weakness, pelvis/buttock pain, hip/groin pain, feeling of leg instability (buckling, giving way), disturbed sleep patterns, disturbed sitting patterns (unable to sit for long periods, sitting on one side), pain going from sitting to standing.


Causes and Risk Factors

While it is not clear how the pain is caused, it is thought that an alteration in the normal joint motion may be the culprit that causes sacroiliac pain. This source of pain can be caused by either:

Too much movement (hypermobility or instability): The pain is typically felt in the lower back and/or hip and may radiate into the groin area.

Too little movement (hypomobility or fixation): The pain is typically felt on one side of the lower back or buttocks and can radiate down the leg. The pain usually remains above the knee, but at times pain can extend to the ankle or foot. The pain is similar to sciatica — or pain that radiates down the sciatic nerve — and is caused by a radiculopathy.

Diagnosis

Accurately diagnosing sacroiliac joint dysfunction can be difficult because the symptoms mimic other common conditions, including other mechanical back pain conditions like facet syndrome and lumbar spine conditions including disc herniation and radiculopathy (pain along the sciatic nerve that radiates down the leg). A diagnosis is usually arrived at through physical examination (eliminating other causes) and/or an injection (utilized to block the pain).

Treatments

Treatments for sacroiliac joint dysfunction are usually conservative (meaning nonsurgical) and focus on trying to restore normal motion in the joint:

  • Ice, heat and rest.
  • Medications: acetaminophen, as well as anti-inflammatory medications (such as ibuprofen or naproxen) to reduce the swelling that is usually contributing to the patient’s pain.
  • Manual manipulation provided by a chiropractor, osteopathic doctor or other qualified health practitioner may help. This can be highly effective when the sacroiliac joint is fixated or “stuck.” It may be irritating if the sacroiliac joint is hypermobile. The manipulation is accomplished through a number of methods, including (but not limited to): side-posture manipulation, drop technique, blocking techniques and instrument-guided methods.
  • Supports or braces for when the sacroiliac joint is “hypermobile,” or too loose.
  • Controlled, gradual physical therapy may be helpful to strengthen the muscles around the sacroiliac joint and appropriately increase range of motion. In addition, any type of gentle, low-impact aerobic exercise will help increase the flow of blood to the area, which in turn stimulates a healing response. For severe pain, water therapy may be an option, as the water provides buoyancy for the body and reduces stress on the painful joint.
  • Sacroiliac joint injections.

When these treatments fail, surgery may be offered. In surgery, one or both of the sacroiliac joints may be fused with the goal of eliminating any abnormal motion.

Article Provided By: Cedars-Sinai

Back Pain Relief, Nerve Pain Treatment, Pain Relief, Perpipheral, Greenville, South Carolina

Adopting an Attitude that You’re Healthy

Adopting an Attitude that You’re Healthy despite having Chronic Pain: Coping with Pain Series

Chronic pain rehabilitation programs are a traditional and effective treatment for chronic pain. Such programs are based on cognitive-behavioral principles that aim to change how you experience pain. By doing so, chronic pain rehabilitation programs help you to a) reduce pain and b) return to meaningful life activities even though some level of pain may persist. In other words, by participating in chronic pain rehabilitation, you change your relationship to chronic pain. You no longer perceive pain as an alarming and disabling condition, but develop the know-how to understand your pain as a benign condition that no longer needs to disrupt or prevent your daily life activities.

Wouldn’t it be good to become so competent at dealing with persistent pain that you no longer are disabled by it?

Pain would continue to occur, of course, but it would now be occurring in the background of your day-to-day life. The reasonable activities of life, like work and family activities, would become what occupies your time and attention, not pain. Again, wouldn’t it be good to learn how to do it?

Everyday, people with moderate to severe chronic pain learn to do it in chronic pain rehabilitation programss across the world.

There are countless strategies for coping better with pain, which can be learned in chronic pain rehabilitation programs. One strategy, which has been taught ever since there have been such programs, is to adopt an attitude that you remain a healthy person even though you have chronic pain. By assuming this attitude, you come to change your understanding of how you should relate to chronic, or persistent, pain.

Do you remain a healthy person when having persistent pain?

Like many questions in life, the answer to the above question depends on whom you ask. There may or may not be a universally correct answer for all people across all conditions and all situations. Pragmatically, however, the answer is important because it can determine how well you cope with persistent pain.

Many people with persistent pain consider themselves injured or ill. It’s common, for instance, for those with chronic low back or neck pain to think of themselves as injured. Another possibility is that individuals with such pain might have been told they have degenerative disc disease and as such they consider themselves to have a disease of the spine. Still others might consider migraine headache (aka, “sick headache”) or fibromyalgia as an illness. In all these scenarios of thinking of pain as the result of injury or illness, the implication is that you are unhealthy.

Indeed, this way of understanding pain goes hand in hand with seeking healthcare for it. It’s what sick or injured people do. You go to the doctor in order to get better. In this light, pain medications are often thought of as “medicine”.

It can also lead those who conceptualize chronic pain in this manner to engage in other behaviors associated with injury or illness, such as stopping life activities, staying home from work, and resting. It’s what injured or sick people do to get healthier, right?

Together, these beliefs and behaviors make up what’s called the sick role. They are the normal ways of understanding yourself as injured or ill and therefore what you do when you think of yourself in this manner.

Is there really any other way of thinking about it?

For many, this way of relating to chronic pain doesn’t involve a choice. It’s just how they experience pain. The presence of pain is simply and necessarily a sign of injury or illness for which there is nothing you can do but stay home and remain inactive. It’s never questioned and when it is, such questioning is perceived as invalidating or stigmatizing the reality of the pain as it is experienced.

This way of experiencing pain is apparent when people express such beliefs as “I can’t work” or “I can’t go to my kids ball game this afternoon” or “I have to take pain medicines.” For them, the presence of pain requires certain behaviors like staying home and resting or taking pain medicines. Open discussion of other possible ways of reacting to pain is perceived with skepticism at best and as invalidating or stigmatizing at worst. “You just don’t understand,” they might say. There really is nothing else they might do in the presence of pain, for its very experience requires that one must stay home, rest or take pain medicines. It’s just how it is.

What we are trying to articulate is the underlying conceptual framework or categories through which people experience pain.

Or, more specifically, we’re trying to articulate the conceptual lens through which some people experience pain (see also, Jensen, et al, 1999).

Do all people experience persistent pain in this manner?

While the above noted ways of experiencing pain are common, they are not universal to all people with chronic pain. We know, for instance, from empirical research but also from everyday experience, that some people with moderate to severe pain don’t take opioid pain medicines or don’t perceive themselves as disabled and so remain at work (see, for example, this article here).

For them, the presence of pain doesn’t rise to any level of urgency that requires action. It’s experienced as inconvenient or bothersome, but largely normal. “It’s just what happens when you get old” or “My migraines are a barometer that tells me I’m not taking care of myself very well” or “I heard that back pain is just something we have because early humans stood up on two feet” or “Doesn’t everybody have back pain?” Notice the lack of alarm or urgency with which these people experience pain. They have pain, but there’s no need to do anything about it. They accept it as normal. They don’t enjoy it, of course, but neither are they distressed by it. Pain is something we have and it’s accepted as a bothersome fact of life that we put up with.

One way in which people experience pain in this manner is that they don’t understand pain as a health problem. In other words, pain lies outside of the conceptual categories of health or disease or injury. For them, knees and hips and backs and stomachs and necks and heads hurt because that’s how we’re made. It just comes with the territory of playing sports or getting older or getting stressed. It’s the given. It’s not abnormal. It’s normal.

This conceptual lens through which they perceive pain has for them no bearing on whether they are healthy or not. They might, for instance, consider themselves healthy even though they have to mind their persistent knee pain because of the sports they play. Indeed, the presence of chronic pain can sometimes serve as the cause of maintaining a healthy lifestyle. “I have a desk job and so when I sit all the time my back tends to hurt a lot and so it makes me insistent that I block my lunch hour so that I can walk everyday.” “I’m prone to migraines, almost everyone in my family gets them, and so I really have to stay on top of my stress and get regular exercise.”

Notice in these scenarios that pain isn’t understood as in itself an injury or illness. Rather, it’s due to playing sports or sitting too much or getting older or having too much stress. These ways of understanding pain don’t lead to illness behaviors such as staying home or resting or taking pain medicines. Indeed, it just might never occur to them that they should respond to their pain by staying home or taking pain medicine.

To learn to cope better, you have to be open to learning how

What we are trying to do in this discussion of contrasting experiences of pain is to articulate the underlying conceptual frameworks with which people understand pain. Pain is a complex subjective experience and we are attempting to make apparent the possible differences in the subjectivity of these experiences. Pain may be a universally human sensation, but it is subjectively experienced differently by different people in part because different people perceive pain through different conceptual frameworks.

For some, the sensation falls into the categories of injury or illness and poor health. From this way of understanding and perceiving pain, pain is an abnormal sensation that requires actions that sick or injured people do: seeking the advice of healthcare providers, getting tests and medical procedures, staying home from work, resting and taking medicines.

For still others, the sensation of pain falls into different conceptual categories, such as a sign of a hard fought sports game or getting really good work outs or getting older or sitting too much or having too much stress. From these ways of experiencing the sensation, there’s no sense of urgency to do something about it. It’s because they are understood as normal experiences.

The observation of these differences involves no intention to stigmatize. There are times, of course, when pain is due to injury or illness. Acute pain, for instance, is commonly the result of an acute injury or illness. So, it is not inherently wrong to conceptualize pain within the frameworks of injury or illness.

Not all pain, however, falls into these categories and it is sometimes in the best interest of those with chronic, or persistent, pain to begin to understand their pain differently.

It’s possible to learn how to experience pain differently. You have to be open to learning and it helps if you can learn from teachers or coaches within a non-judgmental or stigma-free environment. People with moderate to severe chronic pain learn everyday in chronic pain rehabilitation programs across the world.

Adopting an attitude that you remain healthy despite persistent pain

More often than not, if you see healthcare providers for chronic pain, they will encourage you to remain active, use the painful body part, exercise, manage your stress, stay at work, and try not to take opioid pain medications. Sound familiar? Despite these common recommendations, there’s often little instruction as to how to do these things when actually having pain. In fact, it almost seems impossible because the presence of pain seems to demand that you rest, guard or stay off the painful body part, stay home and take pain medicines. So impossible, it seems, that maybe they don’t really get how much pain you have or otherwise they wouldn’t recommend doing things that you know you can’t do.

With the discussion above, however, we can now begin to articulate how you might actually go about engaging in these recommendations, despite how impossible it might seem at first. It starts with adopting an attitude that you are healthy even though you have chronic pain.

Begin by reflecting on this essay. Consider the possibility that understanding your chronic pain as a long-lasting injury or illness leads naturally to behaviors that healthcare providers recommend against doing: staying home from work, resting, guarding the painful body part, taking pain medicines. This combination of beliefs, perceptions and behaviors lead to what we call identifying with the sick role. It puts you in a dependent role to your healthcare providers, on whom you rely to make you better. It also often puts you in a dependent role to family members, on whom you rely to take up the slack of what you can’t do. However, healthcare providers don’t have many effective ways to make you better, short of helping you to engage in the above recommendations. Reliance on family can foster guilt in you or increased stress and conflict with them. So, in all, experiencing pain through the lens of the sick role doesn’t typically amount to much improvement and sometimes it can even make your overall situation in life worse.

Maybe, then, it’s time to re-think how you think about pain.

Once you decide that it is in your interest to be open to learning new ways to respond to pain, then practice thinking of yourself as a healthy person with persistent pain. Recognize that healthy people have pain, even persistent, or chronic, pain. Low back pain, for instance, is by far the most common form of chronic pain and to manage it well you have to engage in behaviors that healthy people do – stay active, remain at work, use your back, get regular exercise, manage your stress, and maintain a healthy weight.

To adopt the attitude that you remain healthy despite having persistent pain, it helps to recognize that persistent pain is common. A third or more of the population has persistent pain. As we age, pain becomes increasingly more common (Fayaz, et al., 2016). It isn’t, therefore, abnormal to have chronic pain.

From this understanding, the occurrence of persistent back, neck, joint or head pain doesn’t have to be cause for alarm. It’s not signaling a state of urgency. Pain can be accepted as a fact of life. Many of us, as we get older, have a harder time keeping weight off. This biological condition isn’t a pathological condition of illness, but rather just something that is accepted. Most forms of chronic pain can be considered in a similar light – not something that is a pathological condition of illness or injury, but just something that tends to happen. It may occur because of sedentary lifestyles or sports activities or age or stress or maybe we don’t even question why because it happens to so many of us. From this way of understanding it, pain isn’t abnormal and it’s not alarming, but just bothersome.

This way of experiencing pain seems considerably more preferable than experiencing it as an abnormal and alarming event for which valued life activities must be given up. Rather, pain is something for which you stay active. Motion is lotion, as the old saying goes. Experiencing it this way, pain persists, but occurs in the background of daily life in which you stay active, remain at work, get regular exercise, manage your stress, maintain a healthy weight, and otherwise engage in the healthy behaviors of the healthy person you are.

Now that’s what really good pain management looks like.

Article Provided By: Institute for Chronic Pain

Carolina Pain Scrambler Logo, Chronic Pain, Greenville, SC
If you would like to discuss what Carolina Pain Scrambler do to help relieve your chronic pain symptoms or receive more information on our treatment
process, please do not hesitate to call us at 864-520-5011 or you can email us at info@carolinapainscrambler.com
Pain Management, Chronic Pain, Nerve Pain Treatment, Pain Therapy, Chemotherapy, South Carolina

5 Ways to Boost Your Pain Management

Right about now there is a good chance that you have been thinking about ways you might “hit the refresh button” on your pain management approach in the coming year. As you’re thinking about what you’d like to change, make sure that whatever goal you’re shooting for is both impactful and sustainable.

And, as with starting anything new, try to set yourself up for success. First off, make it easy to do. Look for options that are not too time-consuming or taxing. Seek out strategies or therapies that you can ease yourself into, one step at a time. Also, keep your plan affordable and try to get as much value as possible out of the time and money that you spend. And try to make it fun. The more enjoyment, inspiration, and fulfillment that you get out of whatever you do, the more likely you are to make it a lasting part of your routine.

Now let’s look at some easy ways you can spruce up your approach toward making chronic pain more manageable and better controlled –

  • Unplug an hour earlier. Research has shown that when we sleep better at night, we experience less pain during the day. I also know that one of the most frequent complaints I hear from my patients is that they just don’t sleep well at all. While there are many strategies that can improve sleep, an easy one to try is to simply disconnect from your smart phone an hour earlier at night. Stopping whatever stimulation and agitation that you could get from looking at emails or social media well in advance of bedtime helps the mind and body wind down to fall asleep more easily.
  • Download a meditation app. Over the last several years, a number of studies have found that meditation can play an important role in pain relief. But finding the time and inclination for meditation in our busy and over-stimulated culture can be a real challenge. While attending an 8-week mindfulness course can have serious benefit, that is not something most folks can commit to. But downloading a meditation app, most of which are free or low cost, puts a daily 5-minute mediation at your fingertips, making it easier than ever.
  • Exercise smarter, not harder. While getting enough exercise is critical to both physical and mental health, this can be a real struggle for folks with challenging pain problems. In many cases, trying the typical gym exercises will only flare-up the pain even more, making the whole subject of exercise even more frustrating for patients. This is where looking outside the box can pay off by exploring other movement strategies, some of which, like tai chi and yoga, can even be done in a chair. When trying a new activity, go slow and gentle, and consider breaking it up into smaller sessions during the day instead of doing it all at once. Adding good music and making it social can boost the fun value of whatever you are doing.
  • Start event planning. Commit to doing at least one joyful activity each month. Spend some time planning to do something that is special and has meaning for you, and then book it on your calendar. It can be as simple as going to the movies or taking a walk in the park. The anticipation of having something fun coming your way can boost optimism, improve mood, and lower stress.
  • Take it outside. Make a habit of going outdoors and getting some fresh air in the middle of the day on a regular basis, even if it is for just a few minutes. Midday sunlight increases vitamin D levels, helps set our biological clocks, and can improve mood.

No matter what new, exciting, or different therapies or strategies that you explore this year, try not to fret about any hiccups or missteps that you encounter along the way. Appreciate each moment of the process as meaningful in some way. And if you can get through the first few months, there is a better chance that the new resolution will become a lasting habit.

Article Provided By: WebMD

Carolina Pain Scrambler Logo, Chronic Pain, Greenville, SC
If you would like to discuss what Carolina Pain Scrambler do to help relieve your chronic pain symptoms or receive more information on our treatment
process, please do not hesitate to call us at 864-520-5011 or you can email us at info@carolinapainscrambler.com
Pain Therapy, Pain Relief, Nerve Pain Treatment, Nerve Pain Therapy, South Carolina

Can Your Gut Health Impact Your Pain?

Gut Health & Pain

You may have noticed that at any given moment your pain levels can fluctuate based on many different variables, including the weather, how much sleep you got the night before, and whether or not you are having a stressful day. But you may not have given much thought to the role that bacteria might be playing in how you feel. You have hundreds of different types of bacteria living inside the gut that make up what is referred to as the microbiome, and like a fingerprint, each person’s microbiome is a bit unique but swayed by factors like diet, the environment, and lifestyle habits. Research has shown that the composition of the gut bacteria in healthy people often differs from those with certain diseases, including obesity, heart disease, inflammatory bowel disease, diabetes, autoimmune disorders, and even depression.As we start to learn more about how our microbiome affects our overall health, we are also starting to see evidence that it can also play a role in how much we hurt. Consider a recent study published by researchers from the University of Rochester that looked at the effects of the microbiome on joint pain and swelling in mice. In comparing the gut bacteria of mice that had been plumped up on an unhealthy diet with mice kept on a healthy diet, they found that the obese mice’s gut bacteria was not only different than that of their slimmer counterparts, it also included inflammation-causing strains. These gut changes coincided with signs of inflammation throughout their bodies, including their joints. The researchers also found that when both sets of mice experienced cartilage damage to their knees, the obese mice with the inflammation-causing gut bacteria experienced a rapid deterioration of their joints compared to the other mice.In a short amount of time, these unfortunate mice developed advanced osteoarthritis of their knees. When the researchers treated the obese mice with a prebiotic (a food source for growing healthy bacteria in the gut), they were able to prevent the inflammation and arthritic deterioration in their knee joints, without changing their body composition.
This is very interesting research, but despite this and other evidence suggesting that the microbiome can directly impact the amount of inflammation, arthritis, and ultimately the amount of pain that we experience, it is still unclear how to take advantage of this information to treat pain in our everyday lives. Unfortunately, in humans we have not found that simply adding a prebiotic to our diet will make all of the pain and swelling magically disappear. There may be a number of reasons for that, including the wide variation in microbiomes from person to person, and the unique environments that we each live in. But, just because we don’t know exactly which foods might help improve gut health doesn’t mean we can’t give it try. I’ve personally made it a point to increase my intake of both prebiotics and probiotics (live, beneficial bacteria). Prebiotics can be found in fiber-rich fruits and vegetables, and you can get probiotics in foods like yogurt, kefir, kombucha, kimchi, and sauerkraut, or via supplements. As always, make sure to talk to your doctor before making any big changes or starting a supplement.
Article Provided By: WebMD

Carolina Pain Scrambler Logo, Chronic Pain, Greenville, SC
If you would like to discuss what Carolina Pain Scrambler do to help relieve your chronic pain symptoms or receive more information on our treatment
process, please do not hesitate to call us at 864-520-5011 or you can email us at info@carolinapainscrambler.com
Nerve Pain Therapy, Peripheral, Carpal Tunnel, Pain Center, Pain Relief

Let People In With Chronic Pain

How to Let People In When You Have Chronic Pain

When someone is in pain, their whole family is impacted.

I was reminded of this truth recently as visitors approached my booth at the Los Angeles Times Festival of Books. I was struck by how many people were stopping by my booth on behalf of somebody in their lives who was having a difficult time with chronic pain. The most memorable was when a brother and sister, probably about 5 and 6 years old, dragged their mom over to talk to me about their grandfather, who was struggling with neck pain. At their young age, they shared powerful insights about their grandfather’s condition, not to mention a strong sense of wanting to help.

Though you might feel isolated in the midst of a pain experience, those around you are likely deeply impacted by what you are going through – and there’s a good chance that they really want to be with you in this experience. They may just not know how to get in.

Here are a few ways you can share your pain experience with people who care about you:

  • Education: The better others understand your health challenges, the more helpful they can be. I recommend you share some of the books or articles that you have found helpful, and consider inviting them to join you at some of your doctor visits or physical therapy sessions.
  • Recreation: To build better bonds, try to have some fun together. If there are activities, sports, or hobbies that you no longer do, now is the time to find new pursuits that you can share with others. Whether it is going on walks together or hosting a movie night, plan activities that are joyful for everyone. Try to use this as an opportunity for growth.
  • Communication: It is easy to feel closed-off from others and to not want to engage when you don’t feel well, but it’s important to make an effort to create dialogue between you and your family. If you feel a strong instinct toward isolation, you may need to create a deliberate plan to combat it – consider scheduling a specific time to chat. Of course, it’s reasonable to spend some of the time talking about your own challenges, but to truly connect with others, you’ll want to talk about things going on with other members of your circle as well.
  • Expression: Nonverbal communication plays an important role in how we connect with others, especially when we are in pain. Facial expressions and grimacing can say a lot without uttering a word, and how we say things, or the tone that we use, also influences how others receive our message. I am not recommending that you try to hide how you feel or present yourself in a way that is false, but it might be worth taking stock of your nonverbal communication patterns to see if any subtle changes might make it clearer to the people around you that you are open to  connecting with them. Eye contact can boost connectivity during a conversation, and a smile can go a long way to letting someone know how much you appreciate them.

Hopefully, adding a few of these strategies can help open the door to connection, and possibly even strengthen your relationships.

Article Provided By: WebMD

Carolina Pain Scrambler Logo, Chronic Pain, Greenville, SC
If you would like to discuss what Carolina Pain Scrambler do to help relieve your chronic pain symptoms or receive more information on our treatment
process, please do not hesitate to call us at 864-520-5011 or you can email us at info@carolinapainscrambler.com
Chronic Pain, Neuropathy Treatment, Pain Relief, Pain Therapy, Pheripheral Neuropathy

When It Hurts to Be Touched

Our sense of touch is a fundamental part of the human experience. Being touched by others a powerful tool of communication, whether it is through a handshake, a hug, or a pat on the back, and it can also boost a sense of general well-being.Unfortunately, living with chronic pain can interfere with your ability to touch, feel, hold, or be held by others. One of the most challenging examples of this occurs when we develop extreme sensitivities to touch from things that aren’t usually painful. The medical term for this is allodynia, and it means that something is painful from a non-painful stimulus. Imagine lightly brushing the back of your hand with a cotton ball. That should not hurt in the least, but now suppose doing so is all of a sudden associated with the feeling of intense pain in the hand.This type of extreme sensitivity to touch can have a dramatic effect on a person’s life. They may completely avoid using an affected body part, like a hand in our example, or they may avoid even leaving the house out of fear that being around others may risk contact with the sensitive body part.One of the most common types of pain that can lead to something like allodynia is nerve pain, also known as neuropathic pain. One nerve pain syndrome, in particular, that is often associated with cantankerous forms of allodynia is complex regional pain syndrome, or CRPS. CRPS can be a debilitating pain problem that usually involves an extremity, like an arm or leg, after some type of tissue injury has taken place.Allodynia can be associated with other types of chronic pain problems, as well, including fibromyalgia, migraine headaches, TMJ, painful surgical scars, and skin damage from ultraviolet radiation. In fact, migraine sufferers have been reported to have pain with hair combing, shaving, and putting in contact lenses.Researchers believe that allodynia is a result of the amplification of pain signals going on in the brain – a problem called “central sensitization” – though it is still unclear what causes it.

Fortunately, allodynia can be successfully treated under the right circumstances, so it is important to find health care providers who understand this problem and can help. Desensitization techniques are one way of reducing the hypersensitivity of the skin or tissues, and you can even learn how to do some of this at home on your own. For example, placing a sensitive hand or foot into a bowl of uncooked rice or lentils is one tool we use with some of our patients. Other topical treatments include things like contrast baths, paraffin wax, and clay. Because desensitization can be a painful process to start, it helps to have as much support and guidance from your treatment team as you can get.So, if you are struggling with hypersensitivities and it is interfering with your quality of life, ask your health care team for help.
Article Provided By: WebMD
Carolina Pain Scrambler Logo, Chronic Pain, Greenville, SC
If you would like to discuss what Carolina Pain Scrambler do to help relieve your chronic pain symptoms or receive more information on our treatment
process, please do not hesitate to call us at 864-520-5011 or you can email us at info@carolinapainscrambler.com
Back Pain Relief, Pain Relief, Nerve Pain Relief, Pain Therapy, south carolina

Traveling with Chronic Pain

Traveling With Chronic Pain? Tips From a Spoonie

I love to travel. My favorite way to deal with stress is to plan my next adventure. My husband and I go on getaways whenever we have the chance. So, I didn’t think it was a big deal when I applied for a graduate school program that would require me to fly across the continental U.S. on a monthly basis.Then, last January, I had a terrible flare of what I soon learned was psoriatic arthritis. I had to learn how to travel across the country by myself with an uncontrolled autoimmune disorder. I had to adjust my daily life to being a spoonie. (“Spoons” are finite units of measurement that those of us with chronic illnesses use to budget our energy throughout the day – more explanation here.)  But how could I adjust my travel plans?I researched bloggers, I asked Twitter, and I reached out to family and friends who had traveled on a low-spoon budget. After a few trial weekend trips with my husband, I had to travel across the country alone. All told, I’ve traveled 47 days this year, including 2 camping trips, and 2 trips that were over 2 weeks long.Here are some spoon-saving strategies I’ve learned (so far):

Airports Are Big. Flights Are Long. Plan Ahead.

• Purchase your tickets well in advance so you can select your seat – and buy as much comfort as you can afford. Take Business class if you can swing it. If you’re in economy, try to get a seat with extra legroom. And take the window seat. If I can avoid basic economy center seats for the rest of my life, I will.

• Get to the airport early and check your luggage. Even if it’s a carry-on size roller-bag. When I fly by myself, I only carry on the backpack that I can put under the seat in front of me. Managing extra luggage just means additional pain for my hands and wrists.

• Use a wheelchair. When I asked for traveling with chronic pain tips, one of the things my friends and family repeatedly advised was “swallow your pride.” I have a hard time with this. I want to muscle through. But, even in small airports, I find it’s a mistake to think I can muscle through and go without a wheelchair. (And even if I can, I’ve then spent a spoon or two that I might want to save for after I land at my destination!)

You can reserve a free wheelchair service when you buy your ticket. But whether you reserved it ahead of time or not, when you arrive at the ticketing counter to check that luggage, let the agent know that you need a wheelchair. Usually, someone wheels a chair out for me to sit in while they dispatch a “pusher” out to me. Again, planning well in advance is necessary, because this can take a while if it’s a smaller airline and has a shared pool of wheelchair attendants. The service is always free, but it is customary to tip your wheelchair attendants. They are so nice and friendly, it’s hard not to overflow with gratitude. The wheelchair attendant will scan your boarding pass – this is very important, because for some airlines, that’s the only way to ensure you’ll have one waiting on the ramp upon arrival at your destination. (Yes, you added it to your ticket when you bought it, but that doesn’t guarantee someone will be waiting. Also, just because you added it to your ticket doesn’t mean anyone will notice until you say something at check-in.)Using a wheelchair, for me, isn’t so much about saving me from walking – my body seems to be okay with a slow walk. I can shuffle along terminals all day. But what my body hates is standing still. You know what involves a lot of standing still? TSA lines. I’ve learned the hard way that TSA lines become a struggle for me if there are even 5 or 6 people in front of me, let alone 500 or 600.• Consider getting TSA Pre-check. The $ 85, 5-year membership doesn’t guarantee you’ll be able to avoid lines entirely, but it does guarantee that you won’t have to take off your shoes or unpack liquids or electronics from your bags. For me, that’s worth the extra expense.

The All-Important Carry-on

•  Carry on all of your meds. All of them. The drug companies that make my various injectables always have a free travel kit to transport syringes. I’ve never been stopped about my prefilled syringes or my autoinjectors, but I carry a doctor’s note with them just in case. I’ve also never had anyone ask me about my loose supplements, so my favorite way to pack meds is an extra-large pill organizer with everything already counted out and sorted. All of these things have to be in my carry on, because once I had a 24-hour delay between flights and didn’t have access to my pain relievers. I’m never checking them again.

•  Bring an empty, reusable water bottle. I use a massive Nalgene. Most airports have bottle-filling stations at the drinking fountains along the terminal. This is not just economical and good for the environment, it also ensures I get more than a Dixie cup of hydration along those long flights.•  Treat yourself with stick-on, disposable heating pads. I keep a “lower back” sized one in my backpack, because it can provide the warmth and relief of a heating pad without needing batteries or a plug, and I can just put one on in the restroom when I really need it.• Don’t forget a jacket. You’re probably dressing in layers if you’re traveling with chronic pain between climates anyway, but keep in mind that planes can get chilly. I am almost never fine without my jacket. And even if I don’t need it, it makes a nice pillow against the window. What do they say? Get warm and stay warm? I curl up inside my poncho every flight.• Pack snacks. Depending on the airline you fly, the free snacks (or even the costly ones!) might not be what you need for your health. (Many airlines still don’t worry about gluten – ugh.) I usually pack nuts, because I feel like I need protein on long flights.

• Try other travel tricks. There are lots of gadgets and do-dads that may or may not make your flights more pleasant. Personally, I am on the fence about my neck pillow. When I’m in the middle seat, I love it. It’s the only way I can sleep. When I’ve been able to plan ahead and get a better seat, then I don’t need it. I prefer to lean against the window with my jacket, and the neck pillow takes up so much room in my carry on, I almost resent it.

I’m also up in the air about compression socks. Some people swear by them. They are uncomfortable to me, and the compression doesn’t help my pain. It’s worth experimenting with, though.

What to Pack in Your Suitcase• Take everything you need to sleep comfortably. Because I am traveling with chronic pain across the country every month, I have adapted this plan according to the hotels where I know I’ll be staying.• Take care of all 5 of your senses. For me, this means packing chamomile tea bags, a small candle and a lighter (which I put in my checked luggage without a problem), essential oils, electric blanket, knee pillow, eye pillow, sunglasses, earplugs, headphones, fuzzy socks. All of these things are a waxing and waning part of my list, depending upon how I feel. My destination hotel often has enough pillows I can forgo the knee pillow. Sometimes, I can skip the headphones. But think about your senses when you pack – aim to make comfort portable.• Pack 2 pairs of shoes. Minimum. You can pack more than that, but I don’t recommend packing fewer. If one pair gives you a blister, without a second pair as backup, you are in for a miserable time.

• Don’t forget bath supplies. A long, warm bath is sometimes the best thing for me after traveling with chronic pain.

Once You Get There, Rest.

• If possible, take a full day to rest after you arrive at your destination and again when you return home. When I fly from Atlanta to California, I leave in the morning and make no plans until the following day. It makes me more patient about flight delays, for one thing. But more importantly, the only thing I need to do when I arrive is check in at my hotel and get comfy. I give myself that whole evening to just relax. I order room service. I take a bath. I change into pajamas at 5:30 PM. I go to sleep at 8. It makes me better able to face the next day!

On the other end of the trip, I almost always end up crashing for nearly 24 hours after I get home. At this point, it’s lower stress to just plan for it and let it happen. I feel better afterwards, anyway.

During Your Trip, Think of Every Stop as a Rest Stop.• Rest whenever you can. As an adult, I’ve learned that if the opportunity arises to go to the bathroom, I’m going to try to pee on principle. I’ve cultivated the same rule when it comes to people standing around and stopping for any reason. If we stop, I sit. Period. And on my next sightseeing trip, I plan on trying a new energy-saving trick — I just learned that scooters are able to be rented in most major cities, so you can ride while others walk. Most of these rental companies will drop the scooter off at your hotel, and pick it up from there at the end of the trip.Traveling with chronic pain or not, traveling is overwhelming and exhausting – even for people who aren’t spoonies. I find it helps to keep that in mind. Be gentle with yourself.Article Provided By: WebMD

Carolina Pain Scrambler Logo, Chronic Pain, Greenville, SCIf you would like to discuss what Carolina Pain Scrambler do to help relieve your chronic pain symptoms or receive more information on our treatment process, please do not hesitate to call us at 864-520-5011 or you can email us at info@carolinapainscrambler.com

Neuropathy Treatment, Pain Relief, Pain Therapy, Pain Center, Chronic Pain

What is your relationship to chronic pain?

What is your relationship to your chronic pain? At first thought, it seems like an odd question. But, if we stop to reflect on it, couldn’t we have a relationship to pain? Don’t you already have one?

The Merriam-Webster Dictionary (n.d.) defines the word ‘relationship’ as “the way in which two or more people, groups, countries, etc., talk to, behave toward, and deal with each other.” We usually think about relationships as applying to people, such as our spouses, children, family, or enemies, but we also have relationships to non-human beings, such as God and pets, and even inanimate things, such as our work, our children’s schools, our own alma maters, our country, or nature. We also have relationships to things that are somewhere in between, such as our bodies. Might we not have a relationship to chronic pain?

Let’s look at a number of different possible relationships to chronic pain. We’ll simply try to take an inventory of different relationships without judging whether they are good or bad or better or worse than any of the others. Our only goals for taking this inventory are to see how people relate to chronic pain and to see how different people relate to chronic pain differently.

Chronic pain as something that we must get rid of

In the acute medical model of healthcare, we often treat pain as something that we must get rid of. It’s a bad thing. It’s so bad, in fact, that we might unquestionably go to great lengths and almost all costs to get rid of it. As healthcare providers and as patients, we try one therapy after another, one procedure after another, and one medication after another.

All this healthcare hardly ever requires justification: our relationship to pain is such that it is something, which is assumedly bad — so bad, in fact, that we must get rid of it.

Chronic pain as something that we fight against

Indeed, pain is something that we declare war on. For after all, it is often thought of as fighting us. It’s stabbing, piercing, jolting, burning, and pounding. It’s like hand-to-hand combat, but it’s our hand, or arm, or leg, or neck or low back that’s fighting us. Our bodies have turned against us and the pain is insidious and relentless. It’s taken our life away. Our relationship to pain in such instances is one of fighting and war. Like any people under siege, we vow to maintain hope by never giving up the fight.

Chronic pain as something that imprisons us

Patients commonly tell me that they wish the painful part of their body could just be cut off. When you think about it, there’s something very primitive about this wish. It brings connotations of what an animal might do when caught in a steel jaw trap: it chews its limb off.

Pain can indeed capture our attention and ensnare us. We might find ourselves entertaining doing most anything in order to become pain-free. Our relationship to pain at such times is one of having been taken prisoner. Having lost our abilities to move about freely, we have to stay at home and rest day after day. Our sentence: house arrest.

Chronic pain as a mechanical problem that requires a fix

We can also think of pain as a mechanical problem for which there must be some type of fix. Both providers and patients can relate to pain in this way. Spine surgeons and interventional pain physicians commonly conceptualize back pain as ‘mechanical back pain.’ A common explanation for sciatica is that a disc in the low back has ‘slipped’ or ‘ruptured’ and is now ‘pinching’ the nerve that extends down the leg. It brings connotations of a car engine part slipping out of place or breaking altogether and is now pinching some important cable or hose. In a procedure called a ‘discectomy,’ a spine surgeon attempts to free the pinched nerve by scraping away the part of the disc that’s impinging the nerve. Interventional pain physicians attempt to temporarily reduce the inflammation around the ‘pinched’ nerve with epidural steroid injections. They might also attempt to temporarily deaden the nerve altogether with a rhizotomy (i.e., a radiofrequency neuroablation procedure, or what is called a ‘nerve burning’ procedure).

Chronic pain as something that is the result of a long-lasting injury

We can also relate to chronic pain as something that is the result of a long-lasting injury. In conditions that are acute, such as a bone fracture, pain occurs and we think of it as the result of the underlying acute injury. In such cases, we tend to react to the pain by staying home and resting. Commonly, people think of and react to chronic pain in similar ways. Even if it has been years since the onset of the initial injury that started the pain, we can think of the original condition as remaining unhealed (or even getting worse) and continuing to cause the chronic pain.

As such, we might remain concerned about making the underlying injury worse and engage in behaviors that we think will prevent harm. Similar to what we might do with acute injuries, we might stay home and rest. We also avoid activities that we think have a chance of making the underlying injury worse. In these ways, we tend to think of the pain that occurs with activities as a sign that we are in fact making the underlying problem worse.

Chronic pain as an illness

Sometimes, people with chronic pain think of themselves as ill. Their relationship to pain is one of illness even in cases of chronic pain that started with an injury or had no identifiable cause. They hear explanations for back pain, such as ‘degenerative disc disease,’ and understandably think of themselves as having a disease. People with headaches too can often refer to themselves as ‘being ill with a headache.’ Conceptualizations of chronic pain as an illness naturally lead to the above behaviors that we do when ill: we stay home and rest. Frequently, pain relievers subsequently get referred to as ‘medicines,’ a term that has connotations of something one takes to cure an illness.

Chronic pain as something that is alarming

In all the above ways of relating to pain, there is a common element: it’s that chronic pain is alarming. Whether it is war or imprisonment or a mechanical problem or an injury or illness, pain is an object of concern. It’s not only bad; it is bad enough to do something about it. In other words, it impels us to act like a fire alarm. Such alarms are emotionally distressing. We become concerned and aroused with some degree of fear. We can also cry when in pain. We don’t jump up and down for joy. Rather, we are emotionally distressed while in pain. As such, pain is alarming.

Differing relationships to chronic pain

As is clear, different people can have different relationships to chronic pain and an individual might have different relationships to his or her pain at different times in life. Moreover, this inventory of possible relationships is not exhaustive. There are more relationships that we could describe.

The point is important to remember because when you are in one of these relationships to pain they seem obviously accurate to the situation at hand. It’s hard, for instance, to recognize that it is just one perspective that you might take on pain when you are in one of these relationships. It can be hard to understand how someone might have a different relationship to his or her chronic pain. For instance, one might say, “Of course, you are going fight against the pain… Who wouldn’t?” The relationship to pain as alarming and something that must be gotten rid of seems so obviously true. What the inventory makes clear, though, is that each relationship is but one perspective and that it is possible to have different perspectives that you can take on your pain.

Are there other relationships to chronic pain? Ones that are very different than the above?

Sometimes people with chronic pain have none of the above relationships to pain and are, in fact, not very alarmed by their chronic pain. Rather than fighting against it, they have made peace with it. They are no longer alarmed by it and instead have learned to live with it.

Some people with chronic pain treat their pain like a noisy neighbor next door or in the apartment above. They once tried to get the neighbors to quiet down, but were unsuccessful and so have come to accept that they must learn to live with them. While the neighbors are still noisy, they no longer allow the neighbors to occupy too much of their time and attention. They still hear their neighbors but they then move on with the rest of their day.

Many people with chronic pain have a similar relationship to their pain. They are no longer alarmed by their pain. It’s there, but they realize that there’s not much they can do about it. So, ‘why fight it?’ they might ask. Instead, they move on with their day and get busy with other things. Of course, they would rather not have it, if they had a choice. But, they recognize that they don’t and so accept it. Part of acceptance is that they are just not that alarmed by pain anymore.

Their relationships to chronic pain involve understanding pain as something that is not alarming. They see chronic pain as part of life – the bad, along with the good, that we just have to put up with.

Now, what might that look like?

Chronic pain as a stable condition

Some people with chronic pain see their pain as a stable condition that doesn’t have any bearing on whether they are healthy or not. They might think of it or refer to it as ‘my old war injury’ or ‘my trick knee’ or ‘my old high school football injury’ or ‘my bad back’ or the like. The connotation in these ways of thinking about pain is that chronic pain is an old condition that isn’t going anywhere. That is to say, it’s stable and not going to get much better or much worse. In its familiarity, there’s not much cause for concern. While they may have seen a healthcare provider initially, a long time ago, there’s no need now to get it checked out. They know what it is and know that it is stable.

Notice too that people like who I’m describing tend not to view chronic pain as a health problem. They don’t see themselves as ill or unhealthy or in need of healthcare because of it. It’s a condition that they put up with. We all have things about our bodies that we don’t like or are bothersome, but we don’t feel any strong need to do anything about it because they are not indicators of an illness or poor health. Sometimes, it can be really big things, such as an old spinal cord injury that led to a paralysis. We don’t consider people in wheelchairs as ill. Paralysis is a stable condition that you live with. It is not an indicator of illness. Some people with chronic pain might see chronic pain in a similar way – it’s a stable condition that doesn’t lead to considering oneself as ill or unhealthy or in need of healthcare.

In these ways, they relate to chronic pain in ways that have taken the sense of alarm out of being in pain. As such, it makes it easier to put up with and they move on with their lives. The ‘bad back’ or the ‘trick knee’ or ‘the old war injury’ comes along for the ride, of course, but it is relegated to the background of their life. It is not a daily cause for much concern.

Chronic pain as part of growing old

Some people with chronic pain relate to their pain as something that just happens to most of us at some point in life. [They are not too far from the truth, in this regard. Anywhere between 20-30% of the general population haschronic pain and the percentages increase as we get older (Andersson, 1999; Manchikanti, et al., 2009; Toblin, et al., 2011.)] In this way, it’s not cause for much concern. It’s not unusual or startling. It’s an expected part of life and so it is not especially alarming. “Things are gonna hurt,” they might say with a certain amount of acceptance. Now, they might do things to manage pain, such as staying active, exercising, pacing themselves, and not doing any one thing for too long of a time. At the end of the day, though, they accept it and have made a place for it in their life.

Chronic pain as a broken check-engine light

A common cognitive behavioral intervention in chronic pain rehabilitation is to teach patients to relate to their chronic pain as a broken dashboard check-engine light. It goes something like the following. Acute pain is like a working check-engine light. When it comes on, it signals or warns us that something is wrong in the engine. As a result, we become mildly alarmed, pull over, and bring the car to the mechanic.

Acute pain has a similar function. It’s a danger signal that warns us that something is wrong in the body. As result, we become alarmed, stop what we are doing (i.e., pull over, as it were), and go see a healthcare provider.

Chronic pain is like a check-engine light that’s broken and remains stuck in the on-position. It doesn’t serve any useful function. The nerves are chronically reactive but they are not signaling any corresponding problem in the body (i.e., engine). Even if it is signaling some underlying problem, there isn’t much you can do about it. So, the check-engine light – the chronic pain – remains lit.

What if you had a check-engine light that remained lit up, but your mechanic says that, while there is a problem in the engine, its basically not fixable. He adds that as long as you drive reasonably, such as not driving a hundred miles an hour, it’s safe to drive. He concludes that you should just ignore the check-engine light and learn to drive with it on. You don’t have to become alarmed by it, pull over or bring the car in every time it comes on or remains on. Now, you are no longer alarmed by it and you know that the car is safe to drive as long as you are reasonable about it. After awhile, you may not notice it as much. The check-engine light remains on, but it doesn’t capture your attention as much any more.

Similarly, for most people with chronic pain, it’s safe to keep living life and engage in your normal activities as long as you are reasonable about what you do. With such reassurance from your healthcare provider, you can learn to ignore the pain, relegate it to the background, and not be concerned by it. You don’t have to pull over, as it were, and seek healthcare. You’ve had it checked out and your providers tell you that you should stay active.

The metaphor of the check-engine light takes the alarm out of pain. You still have it. The light is still on when you look at your dashboard, but it is not cause for alarm. So, you keep driving, or living life, engaged in your normal activities, as long as you are reasonable about it.

Some people with chronic pain relate to their pain as if it is a check-engine light that is broken. It provides no useful information. So, they keep living life despite it.

Chronic pain as something you get up and get out of the house for

As we described above, some people with chronic pain relate to pain as an injury or an illness and as such they react to pain as something for which they should stay home and rest. Other people with chronic pain, however, relate to their pain in almost the exact opposite way. When they have a bad pain day, they think to themselves, ‘I got to get up and get out of the house and go do something!’ They tend to think that, if they don’t get out of the house and get busy, all they’ll do is think about how much pain they’re in and how hard life is. In other words, they know they don’t cope very well when they don’t stay actively engaged in the activities of life. As such, they do the exact opposite of those who stay and rest: they get up and get out of the house!

This relationship to pain tends to involve continuing to work despite having chronic pain. For people who relate to pain in this manner, work is not something that one does after they get pain adequately managed; instead, work is a form of pain management. Work helps them to cope with pain. It allows them to get out of the house, structure their day, be involved with others, feel productive, feel good about themselves, and reduces financial stress. All these things buffer their pain by helping them to cope and all of it makes up for any added pain that they may have by being active. Contrariwise, they think that staying home and resting makes them not cope very well. It gets too depressing, for instance, if they don’t have anything else besides pain to hold their attention. They end up feeling unproductive and socially isolated.

Chronic pain as a barometer of what else is going on in life

Some people with chronic pain see their pain as a barometer for what’s happening in their life and how well they are managing it. While they might recognize that they will always have some baseline level of pain due to the medical aspects of their condition, they also understand that the overt fluctuations of pain – whether for the better or worse – are due to how well they are managing the stress in their lives. For instance, they notice that they are having more frequent headaches recently. Rather than understanding it as progression of an illness, they identify that the more frequent headaches are due to the stress of their recent insomnia. Maybe, they notice that their low back pain is worse in the last week. Rather than understanding the increase in pain as the result of ‘degenerating’ discs, they identify that they have been overly busy at work for the last few weeks and as a result they have fallen out of their usual mild aerobic exercise routine.

Understanding fluctuations of chronic pain as reflective of the stress in one’s life allows for people to then do something about it. They work on their insomnia or the workload at work. In other words, they take steps to manage their stress better.

Their relationship to pain is one that involves seeing fluctuations of pain as providing important information. It is not to be dreaded. They don’t feel vulnerable to pain as something that seems to come and go out of nowhere. Rather, they feel empowered by the important information that fluctuations of pain provide them. It allows them to know what they are doing works when their pain reduces or what they need to work on when their pain increases. They know that on most occasions there is a reason for the fluctuation of pain and it involves how well they are managing the stress of their lives. In other words, the relate to chronic pain as a barometer of what’s going on in their lives.

Different relationships to chronic pain for different people

As our short inventory reveals, people relate to chronic pain in different ways. Each relationship to chronic pain can feel like the truth. They each seem obviously accurate to the situation at hand. It’s important, however, to recognize that it is possible to relate to chronic pain in very different ways. You don’t have to be stuck in any one particular relationship.

I’ll leave it to the reader to reflect on your personal relationship to chronic pain. You might see yourself in one of the relationships in the inventory above. Or maybe you have an altogether different one. Maybe you could comment on this post and describe it for us. I’ll also leave it to you to consider whether your particular relationship is the most accurate understanding of pain and the one that’s best for you. It may be. However, it might not be.

It is therefore important to reflect on your particular relationship to chronic pain and whether you might change it if it’s not working for you. If you feel stuck, it’s possible to change your relationship to pain. It likely will take some work on your part. It may even require the assistance of some chronic pain rehabilitation providers or a full-fledged chronic pain rehabilitation program. But, it is possible to do. You can change your relationship to chronic pain.

Article Provided By: Institute for Chronic Pain

Carolina Pain Scrambler Logo, Chronic Pain, Greenville, SCIf you would like to discuss what Carolina Pain Scrambler do to help relieve your chronic pain symptoms or receive more information on our treatment process, please do not hesitate to call us at 864-520-5011 or you can email us at info@carolinapainscrambler.com

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