Tag Archives: exercise

A Chronic Pain Primer – Part Two.

So you’ve got chronic pain. Now what? How do you go about getting your life back?

Treatment is possible. Its quality varies widely, unfortunately, but there are a lot of things that have been shown to be helpful, and a lot of other things which generally aren’t. Systematic reviews and meta-analyses of randomised controlled trials are generally the best place to start looking for evidence-based treatment, and there are a few available now that give us an idea of what will be helpful for most people.

Keep in mind though that, as always, research identifies what is helpful for the majority of people or the average person. There are outliers (people who don’t respond to treatments in the typical way) and you might be one of them. Individual differences are important. Use research recommendations regarding effectiveness as your starting point, to help you identify what will likely be the best investment of your resources. But, if you’ve exhausted all the best options and want to try second-best, or if you’re already doing something that doesn’t have great research support but is helpful for you, and is not causing you harm, which includes undue financial burden, stick with it. Do what works for you – but always check with your treating physician/s to make sure a specific treatment option is appropriate for you.

The best recommended course for pain management once it becomes chronic is multidisciplinary, intensive treatment involving a biopsychosocial approach and functional restoration. What does that all mean? A biopsychosocial approach to pain management essentially just requires that any treatment addresses physical, psychological, and social aspects of pain, because these are involved in every pain experience. All chronic pain management should incorporate this perspective (it’s been supported for forty years now), but not all of it does.

Physical aspects may be issues with tissue damage, or central sensitisation (your body’s alarm system continues going off in the absence of or disproportionately to damage).

Psychological aspects do not mean you are crazy if you have chronic pain. Some medical professionals take this stance, and they are ill-informed (and not doing their job properly). Everything we experience through any of our senses is interpreted by our brain, and thus influenced by our beliefs, thoughts, expectations, and previous experiences. Chronic pain is no different.

Social aspects can exacerbate or maintain pain. Things like loss of employment lead to financial difficulties, which limit treatment options and tend to be associated with less healthy lifestyle and dietary choices, and stress, which increases your body’s pain response. Social support and relationships are hugely important, as supportive relationships can protect against and reduce pain and distress. Interactions with health professionals also count as social aspects of pain, and I’m sure a lot of my fellow pain patients can agree that the health system can be a pain in itself!

Just as you need a doctor (and maybe a physiotherapist or exercise physiologist) to address physiological issues, you need someone in your team to help with the psychological and social side of pain to effectively manage it. Coping with chronic pain is hard! Help navigating it can make your life easier, even when the pain can’t be cured. Your GP (and maybe your pain specialist) won’t necessarily have the time, expertise, or inclination to help you with psychological or social issues. This is why multidisciplinary care is important – it’s recommended that individuals with chronic pain see at least a GP, psychologist, and physiotherapist, and if you have access to them, social workers and occupational therapists can be hugely helpful too.

Multidisciplinary pain clinics or centres tend to be the best way to get integrated care from several practitioners, but they vary in geographic and financial availability, and they often have long waiting lists. If you are seeing individual practitioners, it will likely be up to you to make sure they’re talking to each other. Keeping notes at appointments and asking that follow-up letters be given to you or sent to the other people managing your care can help keep everyone on the same page.

Intensive treatment means what you would expect – this is not an overnight fix. A lot of programs range from 6 – 10 weeks or so, so expect to invest a couple of months. As a caveat, not all health professionals are created equal, and just because you have a pain management team doesn’t mean they will be perfect for you. Health professionals are flawed human beings! Advocate for yourself if something goes wrong and find a new professional if necessary and possible.

Functional restoration means that your chronic pain management program should be aiming to help you get back function even where pain is still present. Bed rest and eternal avoidance of painful activities are not a treatment for chronic pain. They will lead to deterioration and further loss of function over time. If you have identified physical damage or abnormalities and your doctor has recommended avoiding a specific activity then listen, obviously. Since my back surgery, I am forbidden from skydiving, bungee jumping, contact sports, and the elliptical machine at the gym – all things I can live with 🙂 But around those restrictions, I am as active as possible, and have ridden horses, gone caving, and at least attempted everything else I used to or need to do. I take more frequent breaks while sitting, but I still sit down.

A physiotherapist is usually in charge of functional restoration. As a side note, I found the physio who worked with my surgeon’s patients post-surgery was far, far more knowledgeable than the other two I had seen previously. She was the first one to come out and say, “You will not re-injure yourself doing normal daily activities. You can’t stay in bed forever waiting for this to go away. You need to get strong and get on with your life.” Her approach was different and frankly kind of shocking to me at that point, but having reviewed so much research literature since seeing her, I now realise she was completely on the ball with the best-supported approach.

I’ll be compiling a Part Three, which will go over the evidence for some specific (conventional and alternative) treatments, beyond psychological and physiotherapy-with-functional-restoration. If there’s anything specific you’d like me to address, let me know! Let me use my university journal access for good 🙂 Do you have any questions about what I’ve covered? Do you disagree with this conceptualisation of and approach to chronic pain management?

In, On, Move: A Wellness Series.

Move: I’ve been having motivation issues lately. I know yoga makes me feel better when I do it, but I still have trouble talking myself into doing it every day. I’m a big fan of joyful movement, and the idea that, regardless of health, ability, size, or shape, pretty much everyone can find a way of moving their body that feels joyful to them. I made a decision to give myself a break from yoga and go with what feels good for a little while.

For me, what feels good is dancing. I love nothing more than getting dressed up to go bump and grind with friends in a dim goth or alternative club. Mostly, my fatigue and pain get in the way of such a massive undertaking these days. Since I like making things easy for myself, I figured incorporating dance into my day was a good way to get myself moving without it feeling boring and difficult.

I’ve noticed that there are a few songs on my Spotify list which make me inevitably start moving when I hear them. Whether I’m dancing as I do the dishes or make dinner in the kitchen, doing an improvised bellydancing routine in the bathroom, or just stretching and wiggling to the music in bed on a terrible pain day, I have to move to them.

I’ve started setting a mobile alarm with Rakim by Dead Can Dance on it once or twice a day. That way, I hear it and start dancing. I often replay it a few times because I start enjoying myself. And because it’s in the privacy of my own home, I can let loose and be my uncoordinated and ridiculous self and it doesn’t matter. I’m also a big fan of the album Beats of Ice and Fire by The Boomjacks.

Music on its own can be therapeutic anyway, and singing along helps encourage deep breathing and thus relaxation. So, in the spirit of sharing and increasing my repertoire, give me one song that makes you just have to move. I’d love a complete playlist to work through over the week.

Thought for the Day.

One of my favourite things to do used to be going out to this awesome little Pad on Thursday nights with my friends and dancing the night away. I haven’t been in months now – I blamed mostly giving up drinking, poverty, and being busy. Actually, I’m pretty sure I haven’t been since my back surgery last July… hmm.

But it’s a public holiday tomorrow, and my friends are going, and I agreed happily. And I’ve missed it, and I’m glad to be going. But at the same time, as the hours have passed today, I’ve been getting more and more anxious and felt panic tightening my chest.

What if I look awful, because I’m eczema-blotchy and purple-legged and my bald spot is showing? What if I can’t do it without my old, eight-times-what-I-currently-take levels of opiates? What if I’m hobbling and people look at me weird, or I look strange dancing because I’m in pain, or I’m just awkward and a fun-spoiler because it hurts?

So, it appears I may have had some serious fear-avoidance happening without realising it. But tonight I’m determined. What if the worst happens? Well, people will think I’m odd (won’t be the first time), my friends will think I seem grumpy but forgive me because they love me, and I’ll come home early but hopefully still feeling triumphant I gave it a go.

So send good, strong-backed vibes my way and wish me luck! I’m feeling the fear and doing it anyway.

Be Cool.

It’s cooling down! I’m so excited! I got to wear a scarf yesterday, and fall asleep to the sound of rain last night, and I can hear the wind howling around the house this morning. We’re nearly a month into autumn, but for the last couple of years summery weather has stretched well into late April / early May.

I’ve never liked heat. Even before I got sick, I come from a family of sweaty people. I’m pale, pink-toned rather than yellow, and get scarlet-faced very easily, which I’ve always found embarassing, so I blush and get even pinker. I was born in a town on a coast below a desert, so most of the time it was scorching hot and dry as a bone; I don’t enjoy that type of weather but I can cope with it. Here, however, it is humid and sticky, and in summer you feel damp within seconds of getting out of the shower.

Since being sick, I can’t stand the heat, at all. I get nauseated, dizzy and light-headed, and surly. It makes my pain worse, and the things that help my pain (heat pad, exercise, not lying in bed all day, hot baths) horrible and torturous.  It makes my brain fog worse and I get Raynaud’s phenomenon more frequently, which tells me my blood isn’t circulating properly (and also means people keep commenting on my weird zombie feet in shorts-and-thongs [flip-flops] weather).

When winter(y weather) comes, I am invigorated. I feel energised and excited. I don’t have to hide inside in the air con all day. I want to go out for walks in the bushland by my house in the rain. I know others experience worsening of joint pain symptoms or Seasonal Affective Disorder in these conditions, but I thrive – although that may have something to do with our mild winters (I don’t think it usually drops below about -5).

Since my circulation has deteriorated I do find it hard to get my extremities warm, and my hands and feet have started sweating when I’m cold now (I’m attributing that to a confused sympathetic nervous system), but for me those are small prices to pay, I can bundle up in my favourite clothes to keep warm: boots, long coats, scarves, tights and leggings, thigh high socks, leather gloves, cozy jumpers and cardigans. I can snuggle with my partner and my cat under the covers listening to thunderstorms.

It will even be cool enough to wear a corset under my clothes if I’m headed out for the night and need some secret support to eke out a few extra hours of socialising (if you’ve never worn one, corsets are boiling! They’re often three layers of fabric, and my favourites have top layers of leather or brocade, so they’re thick and they don’t breathe).

I can’t wait. My mood is already lifting and I’m looking forward to decreased pain and improved productivity. How does your pain or illness react to the weather or temperature? Do you have good seasons and bad seasons? Do you think I’m crazy for loving the cold?

Silver Linings and Small Victories.

Belated to include the long weekend this week. Yesterday was the first day back at uni, and between class, a supervisor meeting, travel, and a music festival, I was out of the house for 16 hours. I feel like lukewarm death today, and probably will be paying for it for a week, but I’m counting it as a victory (a big one!) because I did it and I didn’t die 😀 Also, A PERFECT CIRCLE WERE AWESOME!

In other good things, this week:

I am grateful for good days; although I’ve had fatigue and have been feeling low-grade-ill this week, my pain has been negligible (at least prior to yesterday), and that’s vastly preferable to dealing with everything at once.

I am grateful for my body’s muscle memory; my anxiety-relieving yoga routine is becoming habit and I’m becoming more able to relax my jaw, neck, and shoulders quickly when I get stressed, which seems to head off my more severe occipital neuralgia flares.

I am grateful for fleeting moments of confidence in my capacity to meet the challenges in my life (and would like to foster more).

I am grateful for miracle-find natural beauty products.

I am grateful to be able to move my body in ways that feel good to me.

I am grateful that I am developing the ability to be grateful to my body, and to love it now and then, instead of constantly berating it for not meeting a social ideal in appearance or function.

I am grateful for the (technical) end of summer (even though I know it will be another month or two until it actually cools down).

I am grateful for a winter holiday booked, and something delightful to look forward to.

I am grateful that my state is stunningly beautiful and affords so many and varied destinations that it doesn’t matter too much if getting on a plane is currently out of my reach.

I am grateful for hidden reserves.

I am grateful for positive feedback when I need reinforcement.

Link Round-Up.

Here’s what I’ve been reading this week:

Toni Bernhard, who blogs for my favourite magazine Psychology Today (yes, I am a nerd) has written a lovely piece on how to cope with bad days. I like that this is realistic; those sunshine-y ‘Think about bunny rabbits and cheer up!’ type strategies tend to leave me grumpier than when I started.

I realise my link round-ups seem like they are entirely composed of xoJane Healthy and It Happened to Me stories, but what can I say? I love xoJane and I find the stories individuals construct of their illness experiences fascinating. This one is by a young woman who rapidly developed Multiple Sclerosis.

Sarah Wilson, of I Quit Sugar fame, has Hashimoto’s disease (underactive thyroid) and wrote this interesting post on common exercise mistakes. It is largely geared towards weight loss, but I was particularly interested by the idea that excessive exercise (potentially in response to the ‘obesity’ and dieting epidemics) could be contributing to the rise of autoimmune disease. I think her exercise recommendations are well suited to people with chronic illness regardless.

Britt at the Hurt Blogger brought to my attention that ePatients (essentially anyone who uses the internet to navigate chronic illness) have the opportunity to apply for a scholarship to attend the Stanford Medicine X conference. Applications close March 15, so have a look if you’re interested (and able to travel to Stanford – I would love to but it’s a little far for me!).

And via the lovely Sarah of Fibro Feist, a link to a list of 20 things sick people never take for granted. I had to laugh at soap; my quest for (preferably nice smelling) things I can slather on my skin without breaking out into a rash is never-ending and expensive!

See-Sawing.

Growing up, I did ballroom dancing for several years. As an adult I’ve always wanted to get back into the Latin side of it (give me a Paso Doble over a foxtrot any day). My partner was wanting to give it a go too, so we bought an online voucher for eight weeks of lessons last year in June, around the time of my back surgery. We knew we had plenty of time to use them after a couple of months for my recovery.

We’ve talked about it intermittently since then, but never made concrete plans, since my recovery didn’t go as expected and I’ve had several facet joint and nerve flares since the surgery rather than the smooth sailing I was expecting. I thought we had until this June, he thought March, so we checked the voucher recently to confirm. Turns out it expired at the start of January and we had missed our chance. I was so upset.

It’s not just the waste of money (it wasn’t that expensive), although I did feel awful since he had paid for it and it was my fault we hadn’t used it. I was disappointed because it was something we had both been looking forward to (we’ll probably still get around it to eventually). But mostly, I was upset because it drove home the fact that, in the last seven months, I haven’t had eight consecutive weeks in which I was pain-free enough to go dancing, despite having spent roughly $7000 out-of-pocket on painful back surgery that was essentially guaranteed to fix me.

I had vastly different expectations for how the last six months were going to go, and it didn’t pan out, and I am disappointed and grieving my loss. That’s life, particularly with chronic illness and pain. On the plus side, I did a shoulder stand for about 2 seconds yesterday, which at any earlier point in the last five years would have been impossible, and I was filled with a massive sense of excitement, pride and achievement. Here’s to the ups and downs!