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Remedy

Welcome to Remedy, a blog by U.S. Pain Foundation. Remedy aims to provide people with the support they need to thrive despite chronic pain. It features the information about promising treatments, tips and strategies for self-management, resources for coping with the emotional and social effects of pain, unique perspectives from patients, clinicians, and caregivers–and much more. To submit an article idea, email emily@uspainfoundation.org.

 

How to make flying less of an ordeal for your back

Living with chronic back pain is tough and it can really drain you physically, mentally and emotionally. So, if anyone needs a good holiday it’s us, right?

However, while thoughts of jetting off to a sandy beach paradise can get you through the darkest of pain days, when departure day finally arrives you are faced with a big problem: the long flight you need to take to get there.

Being cramped up in an uncomfortable seat and suffering the vibrations from the airplane for hours on end can be real torture for your back. And it can leave you feeling like rubbish for the first few days of your vacation—when you should be relaxing and enjoying yourself.

But flying doesn’t have to be such an ordeal. There are things you can do before, during, and after your flight that will help to keep your back feeling as well as possible on your journey instead.

Before your flight

If you already suffer from back pain, then your pre-flight preparations shouldn’t just include finding the best deal. You also need to prepare yourself for what’s to come to give yourself the best fighting chance. And you can do this by:

  • Booking the most direct route you can afford, as changing planes and waiting around airports for hours on end do your back no favours.
  • Calling the airline in advance to discuss any accommodations you may need, like a special seat request or a wheelchair in between gates.
  • Staying active and getting into the habit of stretching regularly in the weeks leading up to the flight. This will help improve your flexibility, keep your back supported, and give your body the best chance of withstanding the stresses and strains of air travel.
  • Not overloading your carry-on luggage, as dragging a heavy bag around the airport and straining your back muscles before the flight itself is a pretty bad idea! You might also consider purchasing lightweight luggage with wheels in advance.

During your flight

Once you’re on board, the battle against back pain truly begins as you are wedged into your seat. So, try to do the following to minimize any discomfort on your journey.

  • Sit with a good posture. This isn’t easy in an airplane seat but try to sit up straight keeping your neck and back in alignment and a slight ‘S’ shaped curve in your spine to relieve pressure. Also, keep both your feet flat on the floor to relieve some of the strain on your lower back.
  • Use travel pillows to help keep your body aligned. For instance, you can buy an inflatable lumbar support pillow to place between your lower back and seat to keep the healthy curve in your spine or you can use a wrap-around neck pillow to keep your head nicely balanced.
  • Recline your seat slightly to ease the pressure on your lower back.
  • Get up out of your seat regularly to move around the cabin and stretch. This will release any tension that has built up in your muscles and get the blood circulating again.
  • Try to relax, because when you’re stressed and anxious you can hold this tension within your muscles. Deep breathing exercises are good for this.
  • Drink plenty of water as the pressure in the cabin dehydrates you much more than usual so you need to keep topping up the tank. This will help to keep your joints and spinal discs lubricated.
  • Distract yourself with books, music and movies. Becoming absorbed in these things takes your attention away from the pain, which can block pain signals from reaching your brain.

After your flight

  • If you’ve been following these tips until now, then hopefully your back won’t feel too bad as you get off the plane. However, the flight likely will still have taken a toll on your body… so it makes sense to do a few things that will help you to recover faster and feel like yourself once more. These include:
  • Having a good post-flight stretch once you reach your hotel. This will help to loosen you up, release tension from your muscles, and get your circulation going again.
  • Going for a walk. Exploring your new surroundings and getting some fresh air into your lungs will do you the world of good after a long flight.
  • Taking a warm bath. If your hotel room has a bath, take advantage of it, as a nice soak will help to relax your aching muscles after a long and stressful journey. Even better if you have some Epsom bath salts on hand, too.
  • Trying to get a good night’s sleep as this is where your body and tired muscles can heal and regenerate themselves.
  • Hopefully, following the tips I’ve discussed here will go a long way in making flying out on your next vacation much easier and more comfortable.

Happy travels!

Daniel Singleton is the founder of Back On Site, a website designed to help people fight back against persistent back pain using his own personal experiences with the condition and the latest medical and scientific advice.

 

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How genetics might impact the way you respond to medication

By Scott T. Roethle, MD, FASA. Board certified, American Board of Anesthesiology.

Did you know that your genes can affect how you respond to certain medications and whether you experience adverse side effects? For example, about 10 percent of people will receive little or no pain relief from codeine because their genetics mean that their bodies don’t properly metabolize codeine into morphine[i].

For the 50 million Americans who experience chronic pain, it can be incredibly frustrating not to find adequate relief from prescription medication or experience adverse effects when trying a new prescription option. In the past, doctors and patients alike had to rely on trial and error to find out which medication and dosage would work best. Now, patients can access a simple genetic test which could tell them which pain medication might work best for them.

Genes determine your medication response

Your body has thousands of genes that you inherited from your parents. Your genes determine which characteristics you have, such as your eye color, hair color, or blood type. Some genes are responsible for how your body may absorb and/or respond to certain medications. This includes both prescription and over-the-counter medications.

Pharmacogenetic (PGx) testing is a type of genetic test that assesses how likely someone is to respond effectively, or to have an adverse response, to a certain drug. Recent advances in pharmacogenetic science have shown that 95 percent of a person’s response to a drug is determined by genetics.[ii] This means that two people can take the same dose of the same drug but respond in very different ways.

How does PGx work?

A PGx test uses a small saliva sample to analyze your DNA and look for the genetic variants that are associated with variable response to certain medications. The results of a PGx test, combined with other clinical and diagnostic information, can be very valuable and may allow physicians to create individually tailored treatment plans for their patients. Patients, particularly those taking multiple medications, could benefit from more effective treatments and potentially fewer adverse reactions thanks to PGx testing.

Fortunately, PGx testing is widely available and can be done from the comfort of your home. There are multiple companies who will send you a kit that allows you to mail in your saliva sample. From there, you’ll receive the results and even a consultation with a clinician.

About elicity: elicity is an online health platform offering easy, at-home access to medically actionable pharmacogenomics testing (PGx) combined with on-demand physician support and guidance. elicity is powered by InTeleLabs, a telehealth and personalized medicine company. To find out more about elicity and PGx testing, visit www.myelicity.com.

[i] Dean L. Codeine Therapy and CYP2D6 Genotype. 2012 Sep 20 [Updated 2017 Mar 16]. In: Pratt V, McLeod H, Rubinstein W, et al., editors. Medical Genetics Summaries [Internet]. Bethesda (MD): National Center for Biotechnology Information (US); 2012-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK100662/

[ii] Kalow W, Tang BK, Endrenyi L. Hypothesis: comparisons of inter- and intra-individual variations can substitute for twin studies in drug research. Pharmacogenetics. 1998;8(4):283–289.

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Finding balance between exercise and rest with chronic pain

By Ryan Drozd, Certified Personal Trainer, Registered Yoga Teacher, and Licensed Massage Therapist

Living with chronic pain makes it difficult to think about movement and exercise, but both are important components of effective self-care and even reducing pain. Our bodies are designed to move–movement is an integral part of life. The human body has about 650 muscles spread across our entire skeleton, creating an elaborate pulley system that helps your joints move. Chronic pain can limit or completely restrict movement across these joints or specific areas of the body. This is annoying at best… and debilitating at worst!

While rest and recuperation is necessary for many injuries and illnesses, over time, lack of movement can create stiff muscles, decreased range of motion, and loss of strength. Unfortunately, pain makes exercise more difficult: we may want to avoid certain exercises or certain areas for fear of exacerbating our pain. And it can be very discouraging to try to move or exercise, only to be left feeling worse the next day. The trick is finding the right type of movement and the sweet spot of duration that  will decrease pain, rather than amplify it.

I have been a competitive athlete for most of my life and personally began suffering from chronic neck, lower, middle, and upper back pain after several Brazilian Jiu-Jitsu injuries. It was (and is) very difficult for me to realize my limitations, yet still remain physically active. But it’s so important to establish a movement routine that works for your specific situation. For me, that meant giving up contact sports and endurance training for short, high-intensity yet low-impact exercise. I love to hike and trail run on my good days. Walking around the block, a 30-minute sauna session, or warm-flow yoga or gentle or Yin yoga help me get through my bad days. The secret is to find our edge, then work with it, not against it. We can try to lean into that boundary in a safe, minimally painful way while still improving our health.

I am a huge fan of sauna because it increases breath rate, heart rate, blood circulation, and skin and core body temperature. Sound familiar? These are almost identical to the benefits we reap through exercise! Heat also facilitates copious amounts of sweating, which may seem unappealing, but is actually high beneficial because sweating activates the lymphatic system. Traditional saunas, infrared saunas, and steam rooms can help combat muscle stiffness without movement as well.

Gentle, restorative, and/or Yin yoga are fantastic ways to generate movement without additional pain. Gentle yoga involves slow-paced, guided movement linked to breath. Restorative yoga is very slow as well, with the overall goal centered around mindfulness, relaxation, and opening. Yin yoga is based around asanas (poses) that are held for 2-5 minutes. This differs from restorative yoga because some discomfort is encouraged, rather than avoided, to facilitate muscular and fascial release.

I enjoy practicing yoga because it allows me to be more mindful with my body and find peace within it rather than just pain. Yoga does not have to incorporate movement, but it always involves the breath. Comfortably sitting, putting legs up a wall, or simply lying flat palms up with legs supported are all forms of practicing yoga, as long as our focus is continually being directed toward the breath. Developing a regular meditation practice through yoga has been very beneficial for me. Numerous studies have shown that 5-10 minutes of daily meditation can reduce inflammation, anxiety, increase mental focus, trigger the relaxation response in the brain, and improve sleep quality–all very good things for people with chronic pain. Try to find a yoga studio near you that has gentle or restorative yoga classes or simply look up some instructional videos online.

Walking is another low-impact option that facilitates blood flow. I have found that short walks and exercise under an hour are most effective for me. It is also possible to incorporate hills into walking outside based on location, or adding a slight incline the treadmill if a gym membership is an option. If you’re able to get outside, the added boost of fresh air and being in nature can really help your stress levels. The key is to start small and experiment with what works for your body.

Whatever movement or exercise looks like for you, the important thing is to try! Listening to what our body wants, throwing out what we “could” or “should” do based on past experiences, and being easy on ourselves, especially on bad days, sets us up for long-term success. When I am hurting badly I recognize that I need to rest, regardless of what I had previously planned for my day. I have learned the hard way that pushing through the pain on a bad day will only leave me exhausted and out of commission for days. We all have physical limits, but they do not have to define us. I encourage you to try to work toward understanding your personal limits and, then, find ways to still move your body within those limits.

Ryan Drozd is a National Academy of Sports Medicine-Certified Personal Trainer and Fitness Nutrition Specialist, RYT-200 Yoga Alliance Teacher, Licensed Massage Therapist, and Reiki Master. He has been coping with chronic upper back pain, neck pain, and rib pain for over seven years, which led him to begin learning anything and everything related to wellness. His goal is to provide others with viable options for pain relief through sharing his personal experiences. In his spare time he enjoys reading, yoga, cooking, and almost anything outdoors. Ryan is also an ambassador for the U.S. Pain Foundation.

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Life hacks for living with chronic pain

By Amy Orr, author of Taming Chronic Pain: A Management Guide for a More Enjoyable Life

No one needs to tell you that living with chronic pain is, well, a pain. Everything is just harder: it’s harder to work, harder to sleep, harder to think, harder to eat, harder to get through the day. Those of us who have been living with chronic pain for a long time have developed strategies to cope — little things to make each day just that bit easier.

Here are some of my favorites:

Doing Chores

  1. Slow Cooker

Slow cookers let you throw all of the ingredients in, then forget about it. The meal will cook itself without any further effort from you. This works for preparing meals in advance, for example, setting it at night for the next day’s breakfast.

  1. Batch Cooking

Batch cooking similarly helps with cooking fatigue; when able, make a whole batch of something, then freeze it into individual portions, to be reheated whenever.

  1. Place Items in Reach

Place the items you use more often on accessible shelves, to avoid having to stretch or bend over. This will save you on the bad days, by making whatever chore you’re doing as easy as possible.

  1. Tidy As You Go

Tackle chores in small, bite-size pieces. This avoids unnecessary fatigue, and relieves pressure. If you tidy up as you go, you won’t be faced with a single large task at the end of the day that you have to do, regardless of how you feel.

  1. Hire Help

If there are difficult or bigger chores, consider hiring some help. A cleaner doesn’t have to come every week – maybe you only need someone once a month to scrub the floors. But if it saves you unnecessary pain, it’s worth it.

  1. Prioritize Your Day

Not everything on your to-do list can be urgent. If you’re a busy person, make sure you organize your schedule so there is only one or two critical items within each week. Leave yourself wiggle room for flares or fatigue.

Taking Care of Yourself

  1. Explore Sleep Props

Use whatever you need to give yourself the best possible chance of a good night’s sleep. This could include: a better mattress, ergonomic pillows, cooling pillows, specialty pillows, pregnancy pillows, or bed wedges. It doesn’t matter who it was designed for – if it works, use it!

  1. Grooming Accessories

On those days you can’t manage a shower, avoid feeling gross with products like dry shampoo and wet wipes. If you’re able to shower, a shower chair (or modified lawn chair placed in the shower) can keep you safe. And hair wraps let you avoid having to blow-dry your hair.

  1. Heat Pads & Cooling Packs

There are a lot of different heat pads, ice packs, cooling masks, or combination temperature therapy packs; they come in a range of sizes and shapes, and soothe aches and reduce inflammation. Leave the ice pack and cooling mask in the freezer all the time, and find heat packs that can go in the microwave for quick use.

  1. Comfortable Clothing & Soft Fabrics

Make sure you have at least a few comfy options clean at all times. Soft materials are better, as are stretchy fabrics; yoga pants and soft layers will prevent further physical discomfort. Avoid tight clothes or anything sharp or rough. Don’t be dragged into a fashion debate – wear what makes you most comfortable.

  1. Inflatable Pillow & Fold-Up Chair

Keep a folding or deck chair in your car, as well as an inflatable pillow and blanket. Many travel pillows are compact in size and will fit in your purse. There are also lightweight, portable back supports for chairs, that you can easily transfer from the car to any chair.

Having Fun

  1. Audiobooks

Leave an audiobook playing as a way to distract yourself during pain, or as something to gently lull you to sleep. If you’re struggling to follow the plot, children’s books are perfect for an easy, non-stressful listen.

  1. Set a Time Limit for Events

Socializing is very important for your mental health. For occasions when you want to say “yes”, consider setting yourself a few hard limits to avoid breaching your physical boundaries. For example, set yourself a “must be gone by” time so you can still get the rest you need but participate in the fun.

  1. Google Everything

If you’re going out for dinner, check out the restaurant online beforehand. You can find out what they serve, the seating options, any accessibility issues, and more. You might find alternatives you wouldn’t otherwise have known about, or you may realize you are able to do something you thought you couldn’t. Addressing uncertainty proactively gives you the best shot at success.

  1. Calm Your Nervous System

Finding activities, habits or hobbies that help calm your nervous system will, over time, help you cope with and even alleviate pain. This could be anything – a hot bath, a manicure, a massage, a cuddle, meditating… as long as it makes you feel calmer and more relaxed, it is helping your body.

Medical Care

  1. Pill Organizers & Medication Alarms

A pill organizer (daily or weekly) is a very effective way of ensuring you always have your daily meds with you, and that you don’t forget any. Similarly, medical alarms through apps or via a wearable fitness tracker will keep your medication schedule consistent.

  1. Symptom Diary for Doctors

A simple symptom diary listing date, time, symptoms, severity, and medications will help you and your doctor frame your discussions, and will give you a better understanding of how your body works. It doesn’t have to be long – short notes suffice.

  1. Contact Physicians via Health Portals

A lot of health clinics have online portals for arranging appointments, retrieving test results, asking questions and sending information. Use these as much as you can; they allow you to phrase your questions or concerns in your own time, in your own words.

  1. Personal Trainer with Medical Experience

If you can, find a personal trainer or physiotherapist with a strong medical background, who can show you effective ways to exercise without stressing problem areas. It is particularly important to know how to properly stretch, so even on bad days you can alleviate tension.

Those of us who have been dealing with chronic pain for a long time already know that there’s no such thing as perfect; there is no perfect coping strategy, and every day is different. The important thing with coping strategies is to develop a suite of options for yourself, applicable to a range of situations, so that every day, no matter how you’re feeling, you have something you can do to make it just a little easier for yourself.

Amy Orr is a U.S. Pain Foundation Junior Ambassador and author. Her new book, Taming Chronic Pain: A Management Guide for a More Enjoyable Life, has hundreds of tips just like these. Amy has suffered from chronic pain for most of her life, and has an array of autoimmune disorders. Her work is centered on patient-led advocacy and care, and is based on over a decade of researching chronic pain while managing her own. Check out all of Amy’s work at www.amyorrbooks.com.

 

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Pick your pain

By Amber Fonseca

“Pick your poison,” or so goes the expression. But when it comes to living with multiple chronic pain conditions, I think “pick your pain” is more fitting. While I wish that I could choose to lessen my pain or to not have any pain at all, neither quite fits what I mean when I say “pick your pain”.

There are innumerable levels and types of pain: sharp, throbbing, piercing, stabbing, burning, aching, and more. Not all pain is created equally, and neither are the treatments. In fact, many of us with chronic pain find ourselves having to choose between which pain to treat when you have multiple conditions that involve pain, the treatments are different, and often cannot be combined. If you have ever had to choose between a migraine and back flare, you know what it means to “pick your pain.”

If this is you: I see you, and I understand your struggle. When your head feels as though it is going to explode, your back feels as though it is on fire, and your whole body is fighting against your attempts to move… I see you. I see you trying to decide which pain needs treatment the most. I see you frustrated because you need relief from all of your pain, but your medications can’t be mixed. I see you contemplating what will happen if you choose your head over your back, or your back over your head. I see you wishing you could take both medications. I see you considering what might happen if you risk taking both together–knowing it could end badly. Through all the pain, I see you.

Like it or not, a time comes when you must “pick your pain:” pick the pain to treat and the pain you must suffer through. You must pick the treatment that might bring relief, while also knowing that there is a risk that the treatment might not work, or worse– that the side-effects could exacerbate other symptoms. But of course, your ability to function depends on the success of your choice. If you pick your migraine, you risk the chance that your head won’t feel better, or you may be successful in lessening the pain in your head only to discover your mind is alive and racing while your body is locked inside the physical prison of your flared back. If you choose your back pain, you may still be laying flat unable to lift your head, or worse, the pain reliever for your back might make your migraine worse. Roll the dice, play the odds, it’s only one day in the bigger picture of life… Except when it isn’t.

If you are like me, the need to “pick your pain” is more common than just the occasional day here or there. The “right” choice is not always the same option. Some days, the pain I choose to treat is my back, other days it is my migraine. Some days I make the “right” choice and I am able to regain some level of function. Other days, I make the “wrong” choice and I lose the ability to function at all for that day. To my fellow pain warriors, know that there are others out there going through the same thing. When you have a day where you are forced to “pick your pain” in an effort to conquer your day, know that you are not alone and I see you.

Always take your medications as prescribed, and never mix medications, even supplements, without your doctor’s knowledge and permission. Before your appointment, you can use this online tool from the National Institute of Health to identify pills, or this one to check for interactions between different medications. Learn more at Painmedicine411.org.

Amber Fonseca is a high school English teacher, blogger, freelance writer, and has been a chronic pain patient for more than twenty years. She is also a single mom to a very special little boy with autism. Despite her multiple diagnoses and personal struggles, she has always found a way to advocate, educate, and support others along the way.

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The little things that make a big difference in my life with chronic pain

By Diane Talbert, a U.S. Pain Foundation advocate

I’m a “baby boomer,” and I’ve experienced psoriatic arthritis for over 25 years. It’s hard to explain what it’s like to be tired all the time or feel  pain 24 hours a day. The absurd part is that it doesn’t even bother me anymore. I just take my pain pills and go about my day. There are times I do face daily challenges and I know I’m not alone with this.

I remember the good old days when I could just jump out of bed, move furniture, around or even walk a mile. This is not the case anymore: just pushing a grocery cart is a chore. I have learned to educate myself about my disease. I know I need plenty of rest and a healthy lifestyle. I need to drink plenty of water and eat healthy.

Just walking up a flight of stairs can be draining. I decided years ago to find things to make my life easier. When I worked in an office, they always had someone come around to adjust our chairs and our computer monitors to make them more ergonomic. I always thought this was a waste of money until I started working from home–I soon realized that how I was sitting was putting more stress on my body and causing me pain. I was able to have someone from my company adjust my equipment and bring me a lumbar pillow, which has really helped my back.

Have you ever considered what else you could do to make your everyday life easier? Small things can make a big difference. My parents are 85 and they have always had a raised toilet seat–after getting myself one, I can tell you: it’s a secret game-changer. Also invest a jar opener and some type of long-handle reaching device. Both items have come in handy for me more times than I can remember.

Another thing that has made my life so much better is that I had a digital thermostat put in. My body temperature is up and down all day. This device allows me the freedom to adjust my room temperature when I’m stuck in bed all day. I need to conserve my energy on days like this and to me it’s worth it at the end of the day. There is nothing like a piece of mind to keep us going from day to day.

I don’t like admitting this, but I have had to call and have my groceries delivered and someone to clean my home. But I have also realized that there is no shame in asking for help.

Another big help is restaurant delivery services. If you have a pet, have a dog walking service on call for the days when you just can’t do it. Whatever your interests and passions, the rise of the gig economy means it’s easier than ever to find help. Your body will love you for it, and it will greatly benefit your mental health.

At the same time, I know a lot of us don’t have money lying around to make our lives more comfortable in this way, but try and treat yourself when and how you can. When you are in daily pain you need to make things easier for yourself, especially in your home. I work from home now because of my illness, so I need to make my space as comfortable as possible. As I’ve gotten to a certain age, I’ve learned just how important it is to not waste the energy I have.

Diane Talbert is a blogger, patient advocate and speaker for psoriasis and psoriatic arthritis. She has had severe psoriasis since the age of 5. The psoriasis covered over 70% of her body for the first 40 years of her life. She has had psoriatic arthritis for 25 years, but was only diagnosed 12 years ago. Diane presently blogs for Creaky Joints, The Mighty, Medium, Health Union and Patient Rising. She has been featured in Arthritis Today, Everyday Health, Arthritis Foundation, BlackDoctor.org, New York Times, and Health Central. She has spoken in front of the FDA about living with psoriasis and psoriatic arthritis, and was asked to be on a panel with several dermatologists as a patient advocate. She goes to Capitol Hill yearly to lobby and frequently speaks at town hall meetings. Diane ran a support group in the Maryland, D.C., and Virginia area for 10 years. She is also a volunteer for several organizations and vows to help find a cure for psoriasis and psoriatic arthritis. She loves being a wife, mother and grandmother. She has a great husband (Alvin), who is her number one supporter. She has two sons and four grandchildren. Her oldest grandchild, Nikyla, is attending college at Alcorn State University and wants to become a dermatologist.

 

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Locating the right doctor for you: Simple steps to get started

By Janet Jay

Finding a new doctor or other medical professional can be incredibly daunting– not only do you want to find someone good, but you have to also factor in cost, insurance, distance, compatibility, background, and dozens of other factors.

Luckily, knowing some basic search strategies can make your quest much easier and less stressful. Don’t let the pressure of trying to find a doctor keep you from getting treatment. You deserve a good medical team and are within your rights to keep looking until you find the right fit!

The first step is to figure out your specific needs. Maybe you need to find a GP (general practitioner) who has experience managing someone with complex medical issues; maybe you need a physical therapist who understands your particular structural problem; maybe you need to find a rheumatologist to investigate whether you have autoimmune problems. Maybe you’re instead looking for a nutritionist or a biofeedback practitioner!

No matter your target, before you search, here are some things to consider about your constraints and personal preferences.

Insurance coverage.

Like it or not, your insurance coverage is likely to be the most important factor in finding a new doctor. Every insurance plan is different, so make sure to familiarize yourself with how yours works. Does your insurance require a referral to see a specialist? What’s the difference between cost for in- and out-of-network providers? By searching your insurance’s website you should be able to find a list of providers that are covered / in-network for you.

Location. Location is another important factor. Pain can make it difficult to travel long distances, so finding someone nearby is, of course, ideal. That said, if you have a rare or complex disease, you are likely willing to travel long distances for the right care. In any case, make sure you are comfortable with the provider’s location. Keep in mind, too, the frequency of visits you’ll likely need. If it’s a one-time consult, you might be able to drive a little further to see a top-notch expert. If it’s weekly physical therapy, those miles and hours can add up quickly and cause more symptoms than they relieve.

Accessibility. This can cover range of factors. Perhaps it’s making sure the office has wheelchair access. Maybe it’s checking on their open hours. Do they offer evening or Saturday appointments so you can work around your schedule? Another thing to look for is whether they have long time wait times for being seen–even the best clinician isn’t much help if you can’t get to them in time to address your immediate needs. Finally, seeing a provider who has an electronic

medical system in place for emails and scheduling can be hugely helpful; consider asking about how they will communicate with you.

Experience. You deserve a provider who has experience with your condition. Through your insurance plan’s directory, or through the provider’s direct website, you should be able to access information about their training, education, years in practice, and clinical interests. Don’t be afraid to ask questions to ensure you’re seeing the right person for your health.

Personal characteristics. It’s OK to want to find a provider you feel comfortable with. Maybe you would prefer a female provider, because you’ve felt dismissed by male providers in the past. Perhaps you want someone who speaks Spanish because that’s your first language. Feel free to call and ask questions about the provider’s background.

Once you have a list of covered doctors and know what you’re looking for, start Googling. There is a

lot of useful information to be found on databases like Healthgrades.com, Vitals.com, or U.S. News & World Report’s Doctor Finder directory.

After finding information on your desired provider, here’s what you should look for:

  • Hospital affiliation
  • Educational background
  • Professional experience
  • Languages spoken
  • Awards and recognition
  • Board certifications in specialties
  • Check for any negative reports in your home state’s licensing website (Google “verify a medical license in [STATE]”)
  • Other patients’ comments and reviews
  • Any press coverage or interviews they’ve given
  • Online / social media presence

When you find someone who looks like they might be a good fit, first contact them to make sure they’re accepting new patients and that they are indeed covered by your insurance. (Just because a page on your insurance website says “accepting new patients” does not mean they actually are. You can rely on those databases for the broad strokes but always need to confirm specifics.)

If you’re looking for a mental health professional or a doctor for a more personal issue, you may want to try to get them on the phone before you make your first appointment in order to get a feel for whether they may be a good fit. Sometimes a conversation is enough to tell if you have a rapport with a medical provider.

And remember: you have the right to have a doctor who listens to you and who you feel confident about. If you don’t like your doctor, you can always use these steps to find one who is a better fit.

Janet Jay has been dealing with chronic pain and depression since she was in early high school and is currently recovering from surgery for a herniated disc. Despite these challenges, she’s spent over a decade working in communications and freelance journalism, where she has been published in outlets like Maxim, Vice Motherboard, and Popular Science. She is involved in advocacy work, volunteering and her local chronic pain community, and has far more first-hand experience finding doctors than she wishes she did.

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How pain impacts sleep

By Lisa Ann Smalls

Pain and sleep are two vital functions our bodies need to work effectively. Pain lets us know something is wrong somewhere in our system. Sleep gives or bodies the chance to restore and revitalize itself. The problem when pain impacts sleep is that it can become a vicious cycle – chronic pain can lead to a sleep debt, and not enough sleep can make pain worse.

The problem with pain and sleep

People with pain experience disruptions to sleep that are 80 percent worse than the rest of the population. Unsurprisingly, pain can make it difficult to fall asleep as well as stay asleep. According to a poll conducted by the National Sleep Foundation, people suffering from chronic pain have a sleep debt of 42 minutes each night due to their pain, and people with acute pain have a sleep debt of 14 minutes per night. Over time, this sleep debt accrues. It can exacerbate a person’s pain, wreak havoc with their immune system, and even increase their risk of other chronic conditions, like obesity, heart disease, and diabetes.

Why does pain increase at night?

For starters, at night, there are fewer distractions from pain. A person with pain who may be able to distract themselves with activities during the day—as they try to quiet down their mind and body at night—may suddenly be more aware of the painful symptoms they’ve been avoiding all day.

Hormones may play a role as well. Our bodies run on a 24-hour cycle called the circadian rhythm. This rhythm dictates the fluctuations in our bodies’ chemicals and hormones. One of the hormones that drop at night is cortisol. Made by our adrenal glands, cortisol regulates blood pressure, reduces inflammation, and helps us manage stress. As cortisol drops, our white blood cells get to work fighting infections in our body, which can cause symptoms of infection or painful conditions to surface.

Research is ongoing into the link between sleep and pain and their impact on each other, with some showing a greater connection between cognitive arousal and sleep than pain and sleep – even for chronic pain sufferers.

How to promote better sleep

Making sleep a priority is the first step to improving your night’s rest. Even among those with pain, a greater motivation to get sleep was linked with longer sleep periods and better quality sleeping.

Making sure your mattress is supportive and comfortable is key. There is no “one size fits all”when it comes to the best mattress for pain. However, it is worth noting that a study done in 2003 looked at the firmness of mattresses for non-specific, low-back pain with results showing a medium-firm mattresses to be better than something that was extra-firm.

Stress reduction techniques such as mindfulness or meditation, can help prepare both the mind and body for sleep, triggering a relaxation response that help us to fall asleep and stay asleep for longer.

Just as exercise can help you manage pain, it can also aid sleep at night by decreasing arousal, anxiety and positively supporting circadian rhythms. Try to keep exercise to two or more hours before bed however, as if less, it can disrupt sleep.

Other “sleep hygiene” tips include creating a dark, quiet space using eye masks or earplugs; setting the temperature to the optimal 60-67* for sleeping; and setting a regular bedtime and wake up time to create a more standard routine.

Remember—sleep is vital to pain control! Prioritize your rest.

Lisa Smalls is a freelance writer from North Carolina who regularly covers the topic of sleep health. After seeing her mother, who was diagnosed with fibromyalgia in 2014, struggle to get adequate sleep due to the chronic pain she experienced as a result of her condition, Lisa became passionate about understanding the relationship between pain and sleep health. Now she loves educating others on the topic through her writing.

 

 

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Clearing up 12 common myths about medical cannabis for pain

Ellen Lenox Smith is Co-Director of Medical Cannabis for U.S. Pain and a U.S. Pain Board Member. She lives with two rare conditions: Ehlers-Danlos Syndrome and sarcoidosis. After years of struggling to find pain relief without side effects or adverse reactions, she discovered medical cannabis.

A retired school teacher, Ellen is now a renowned patient advocate and works tirelessly to encourage safe, fair access to all treatment options, particularly medical cannabis. She has spoken at numerous conferences on cannabis access and been featured widely in the media on the topic. She is also the author of two books: It Hurts Like Hell!: I Live With Pain—And Have A Good Life Anyway and My Life as a Service Dog.

Below, she clears up common myths surrounding medical cannabis for pain.

Myth #1: All  people who use cannabis must be “stoned” or “high.”

Truth: this only happens if you use too much medication. People living with pain get pain relief; people using it socially and not in pain, get high! In addition, medical cannabis is made of two components: THC, which causes the mental effects associated with feeling high, and CBD, which produces bodily effects. Various strains of cannabis have different ratios of THC and CBD, which means that not all strains create as much of a “high” feeling.

Myth #2: Everyone who uses the same strain experiences the same result to using it.

Truth: Each body can have a different reaction to each strain, even if you have the same medical condition. Patience is needed. Don’t give up on your first try–each person must find the strain that best works for their bodies.

Myth #3: All types of cannabis have a lot of THC in them and will make me feel stoned.

Truth: There are many strains of the plants to choose from. Some have a higher ratio of THC than others and others have much lower THC and higher CBD. So take time to do your research before deciding which strain might be best for you! The professionals at your local medical dispensary are also a good resource.

Myth #4: There are no risks with using medical cannabis.

Truth: While medical cannabis is widely considered to be much safer than many medications, it does come with risks. Be especially careful for when you ingest cannabis, as it will not activate immediately and can take up to even hours before you feel the effect. So if you take a bite of that cookie and think you feel nothing, don’t eat the rest or you risk ingesting too much and being very high, which can cause a bad reaction, like anxiety.

Myth #5: When I ingest cannabis, it will leave my system quickly.

Truth: ingesting your medication means it not only takes longer to activate but also takes longer before it leaves your system. This is a good reason to take it in small doses to get to your right dose for pain relief and not cause yourself to feel high. If you take too much, don’t panic. It will wear off. but it can take hours.

Myth #6: Using medical cannabis will just make me feel tired.

Truth: There are two main categories of medical cannabis strains. The indica strains have higher CBD and lower THC counts. They can help with increased mental and muscle relaxation; decreased nausea and acute pain; and increased appetite and dopamine. Indica is typically preferred for night-time use. Meanwhile, the sativa strains have lower CBD and higher THC counts. They can help with anxiety and depression; chronic pain, and increased focus and serotonin, Sativa is usually preferred for daytime use.

Myth #7: I would have to smoke medical cannabis if I used it for pain.

Truth: Many do not smoke cannabis for their medicine. You can, for example choose to vaporize, take pills, tinctures, topicals, patches, oil, edibles and even use drinks.

Myth #8: My doctor will write me a prescription to use medical cannabis.

Truth: In most states, a doctor would need, in most states,  to sign a from identifying and confirming you have a qualifying condition, not a prescription. Typically, you would then use this documentation to apply for a medical cannabis card from your state.

Myth #9: No matter what state I travel to, all laws are equal for medical cannabis use.

Truth: Each state presently has their own laws, some only allowing CBD from the hemp plant, three with no laws at all, and the rest with some form of a medical cannabis program established. Educate yourself on your state’s specific laws and be cautious when traveling between states.

Myth #10: I will need to go to the pharmacy and order my medical cannabis.

Truth: In some states, you are allowed to grow your own or have a caregiver grow for you. For others, you go to the dispensary to purchase your medication.

Myth #11: I will have my medical cannabis covered by insurance.

Truth: Only the country of Germany presently covers the cost of cannabis. For the rest of us, it is not covered–yet. Only once the federal government gets cannabis out of Schedule I and all states allow a medical cannabis program,  will insurance coverage for medical cannabis be possible.

Myth #12: I am sure I will be able to qualify since I live with pain.

Truth: Many states have very specific lists of conditions that qualify for medical cannabis use. If your specific condition is not listed as a “qualifying condition” and your state does not include the wording of “chronic pain,” you may have difficulty being allowed into the program. However, some states are beginning to allow the doctor to decide what patient should be using cannabis, which helps many get into the program.

To learn more about medical cannabis for pain and start advocating for access in your state, visit https://uspainfoundation.org/medicalcannabis/. To learn more about Ellen and her work, visit http://ellenandstuartsmith.squarespace.com/.  

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A Q&A about opioid-induced constipation

A Q&A with Jeffrey Fudin, BS, PharmD, FCCP, FASHP, FFSMB

Opioid medications are rarely the first choice of individuals with chronic pain. But for people with severe pain who have not found relief from other therapies, opioids may be necessary. Unfortunately, opioids can have a number of side effects, including opioid-induced constipation or OIC.

Below, Dr. Jeffrey Fudin talks about OIC, how it differs from regular constipation, and treatment options.

1. Why is OIC important to treat?

“Most patients that experience opioid-induced constipation (OIC) try and treat it themselves first. They’re embarrassed to bring it up with their doctors, so they take over-the-counter (OTC) medications, which often leads to frustration because they don’t treat the underlying cause of their constipation.

Properly diagnosing and treating OIC is important for several reasons. First, OIC can cause distress and discomfort for patients, leading to more doctor’s visits, more absences from work and decreased productivity. Worse yet, serious complications such as aspiration, possibly leading to painful reflux, difficulty breathing, or aspiration pneumonia, and/or bowel perforation, fecal impaction and hemorrhoid formation can occur if left untreated. When uncontrolled, OIC can lead to longer hospital stays, increased emergency department (ED) visits and increased readmissions. Ultimately, treating OIC can help the patient return to their normal quality of life, as well as reduce the burden on the health care system.”

2. How common is OIC among chronic pain patients on long-term opioid therapy?

“OIC affects between 40 to 80 percent of chronic pain patients on long-term opioid therapy. Of which, 77 percent report suffering from OIC for at least one year and 43 percent for more than three years.”

3. Is OIC managed and treated the same as other types of constipation?

“While patients and health care providers might try to treat OIC the same way as other types of constipation, such as using laxatives or making lifestyle changes (e.g., increasing fluid and exercise), it is often ineffective. Because OIC occurs as a direct result of the way opioids work in the gut, it must be managed differently. Targeted OIC treatments such as PAMORAs (peripherally-acting mu-opioid receptor antagonists), may be the most effective option for treating the root cause of OIC and providing relief to patients. PAMORAs are not laxatives; instead they actually block the problem that causes constipation.”

4. Why don’t patients with OIC generally respond to laxatives?

“Laxatives do not effectively target the underlying cause of OIC – which is the binding of opioids to receptors in the gut. Therefore, a medication that targets this may prove more effective in providing relief by prevention. Also, according to data from a national survey, one of the biggest challenges for chronic pain patients suffering from OIC is that medications to relieve this problem often don’t work quickly enough to relieve their constipation symptoms, cause undesirable side effects like cramping, and are unpredictable in terms of when or how drastically they will work after leaving their home. As a pharmacist, I’ve noticed that the benefits of flexible dosing and predictability are important to many patients.”

5. What types of medications are most effective in helping to treat OIC?

“PAMORAs (peripherally-acting mu-opioid receptor antagonists), are typically most effective for treating OIC. These medications are designed to target the action that decreases opioid-induced constipating effects without decreasing the effectiveness of opioids to treat pain. However, it is important for patients to speak with their physician or pharmacist about OIC and find a treatment plan option that works best for them.”

6. What should patients know about medications for OIC?

“It is important for patients to know that they have options when it comes to treating their OIC. Medications used to treat OIC are different from over-the-counter (OTC) laxative medications. There are several PAMORAs available to treat OIC; however, it’s important to speak with your doctor or pharmacist about which option is right for you. Consider other medications you may be taking, and how quickly you want to experience a bowel movement. There are some PAMORAs available that vary in dosage, oral absorption, and the way they are metabolized within the body. For example, methylnaltrexone does not have any known drug-to-drug interactions, can be taken orally or by injection, and offers quick and predictable relief.

It is always important for patients to keep an open-line of communication with their HCP regarding symptoms and medication use and effectiveness.”

Dr. Fudin is the owner and managing editor for www.paindr.com and founder and CEO of Remitigate LLC, which offers software to doctors looking to more safely prescribe opioids. He has participated in developing practice guidelines for use of opioids in chronic noncancer pain (American Pain Society, American Academy of Pain Management collaborative) and participated in national (U.S. Department of Health and Human Services) and international guideline development for various pain types, including but not limited to, arthritis, fibromyalgia, and palliative care. He has also participated in the development and co-authored consensus guidelines for the treatment of opioid-induced constipation (OIC) and for urine drug monitoring.

Dr. Fudin practices as a Clinical Pharmacy Specialist and Director, PGY-2 Pharmacy Pain Residency Programs at the Stratton Veterans Administration Medical Center in Albany, NY.

 

 

 

This post was created through a collaboration with Salix Pharmaceuticals.
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Voices from the Hill

By Jorie Logan-Morris and Jeannette Rotondi

Every year in February, advocates for migraine and headache disease come together in Washington, D.C., for an event known as Headache on the Hill (HOH). HOH is organized by the Alliance for Headache Disorders Advocacy (AHDA) and has been running now for 12 years.

During HOH, advocates of all kinds — migraine and headache patients, caregivers, doctors and specialists, and more — work together to lobby and meet with Congress, presenting important legislation and “asks” related to migraine and headache disease in hopes that lawmakers will support our requests. This in turn helps bring more national awareness to migraine and headache disease and ultimately further supports the millions who suffer all across the country.

HOH 2019 just recently passed, and we all had an amazing experience together. We also had a record number of advocates attending this year: 160 people turned out to advocate from 46 different states.
Our “asks” that we presented to Congress and staffers were two-fold this year:

  1. Our first ask requested an allocation of National Institutes of Health (NIH) pain funding specifically for migraine and headache disorders. We asked NIH Director Francis Collins and Congress for the HEAL Initiative to create comparable RFA (Resource Family Approval) programs focused on migraine and headache disorders research in the same way they have non-opioid pain therapy programs specifically for back pain and hemodialysis pain. This does not require more funding, but instead asks for the existing budget to be reallocated in proportion to the disease burden.
  2. Our second ask was to create a blue book listing specifically for migraine and headache disorders in order to make Social Security Disability Insurance (SSDI)more accessible to people with migraine or headache disease. Per the current standards, a patient with one of those diagnoses applying for SSDI has to apply under the unfair pretense of epilepsy, a very different neurological disorder that is incomparable to migraine.

Since HOH 2019 has passed, we asked several attendees and members of the U.S. Pain Foundation what made the HOH experience so special and memorable for them, and here’s what they had to say:

“Something especially meaningful to me about HOH, is that I walk away each time with new found friendship(s)… It is special to be a part of such an incredible family of pain warriors. I couldn’t help but feel somewhat on top of the world… The gravity of how many lives we have the potential to impact by showing up and having our voices heard began to hit me as I ventured the hallways at the Hill… Through this experience, I fell in love with advocacy and to it made a life-long commitment.”

– WI Advocate Mia Maysack (third from left) with fellow advocates

“It was empowering to connect with others who understand the unique challenges of living with migraine disease, to join our voices and share our stories with lawmakers. I hope telling my story will help bring policy change. It has already brought change within me. I now know that I am not alone and that my pain does not define me.”

– GA Advocate Peggy Stumhofer, pictured with Rep. Joe Wilson from SC

“This was my second year attending HOH. This population of people are some of the most genuine, caring people I have ever met. Everyone at this event that is dealing with migraine and cluster headaches are warriors. We stood together, supporting one another, and collectively used our voice to not only represent ourselves, but also the millions of people around the world with migraine and cluster that are unable to use their voice. Being part of the U.S. Pain family makes this experience even more enriching, as these people become part of your tribe. It’s comforting to know that none of us are alone in dealing with this disease. Together we are stronger.”

– Dr. Melissa Geraghty, pictured left at the office of Rep. Lauren Underwood (IL) with fellow Advocate Chloe Vruno

“For a long time, I wanted to hide behind my illness. Having chronic migraine makes me different. But now that I am much older, I see migraine is a part of me now — but not all of me. If I could help just one person out in the world by sharing my story and advocating for migraine and research, then it’s worth it to me. And that’s what Headache on the Hill represented to me….For the first time in a long time, I felt “normal” I wasn’t the odd person out. I was with people like me from all over the world who had come together to with such a deep fire and passion and pain for something they believed to the core in. It took my breath away and I was honored to be a part of it.”

– AL Advocate Ashley Greene (right) pictured with Congressman Gary Palmer & fellow advocate Tracy Karnes St. John (left)

“HOH to me was being able to put myself in charge, instead of my invisible illness being in control. To know I have that power and I can advocate for myself is life changing. Getting to share this experience with people who live with the same disease as you and do not have to explain how you are feeling is a relief. These people will become amazing friends and support to you. The entire HOH experience is extremely tiring and completely worth every single second. I am honored to have played a small part.”

– AL Advocate Tracy Karnes St. John

“I’m glad I was able to attend Headache on the Hill 2019.  It was very inspiring seeing all the other advocates and it was a great experience going to the capital and  meeting with my senator and representative. I hope to have the opportunity to do it again next year, if I am able healthwise.”

– ME Advocate Ernest Merritt at the office of Rep. Chellie Pingree

“For me HOH means empowerment. Empowerment through supporting one another, identifying important needs for our community, being armed with education and the facts to achieve these goals, and continued motivation to ask for what we need with other like-minded individuals. By participating in this event we are taking a lead in our personal care and how the migraine and headache disorder community will receive care. We are utilizing our voice for those unable to participate.”

– U.S. Pain Outreach and Events Specialist and NJ Advocate Jeannette Rotondi at Advocacy Training with fellow VA Advocate Jorie Logan-Morris

“Headache on the Hill is such a rewarding experience during which I am proud to call myself an advocate and migraine warrior. It’s amazing to meet up with friends I’ve made over the years participating in online advocacy, as well as making new friends during the HOH event itself. Knowing I’m a part of something bigger in an effort to help the millions of other migraine and headache disease patients out there is an incredible honor. I was heartbroken this year that I had to bow out of HOH events early due to bronchitis, but being surrounded by so many people who understand the health battles we all face and offer their authentic compassion makes up for it. This is truly a time when I can come together with my “tribe” to exercise one of my mantras: “turn your pain into your purpose!”

– VA Advocate Jorie Logan-Morris

This article was reprinted courtesy of Migraine Mantras, a blog dedicated to living mindfully and holistically with migraines, mental illness, and other chronic illnesses. Jorie Logan-Morris is founder and owner of Migraine Mantras and a U.S. Pain Advocate. Jeannette Rotondi is a blogger for Migraine Mantras and serves on staff at U.S. Pain as its Outreach and Events Specialist.

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Understanding paroxysmal extreme pain disorder

By Reese Jones

Rare Disease Day was last month, but it’s always a good time to raise awareness about unique disorders.

Paroxysmal extreme pain disorder, or PEPD, is a little-known and discussed illness — even among people that are affected by chronic pain. Characterized by skin redness, flushing, and severe pain attacks in various parts of the body, this debilitating condition has been documented by scientific literature and only currently affects 80 individuals, according to a report by the National Library of Medicine. Like many other rare diseases, PEPD is generally thought to be caused by a genetic mutation. This condition often manifests from infancy all throughout a patient’s life, while other studies have pointed to the likely possibility of it being felt even in utero.

Let’s take a closer look at this exceptionally unusual pain disorder and shed further light on PEPD’s history, symptoms, causes, and treatments.

A brief history

PEPD was first described in 1959 by medical researchers who noted their subjects’ severe moments of intense burning pain in the rectum, eye, and jaw. It was only in 1972, when Dr. R.E. Dugan conducted his own research into the disease, that the disease was named—as familial rectal pain syndrome.

This label remained in tact in journals and medical practice for 33 years. Clinicians then resolved to rename it as PEPD in 2005, following patients’ disapproval of the original name and how it ignores the other components of the disease’s symptoms.

“Worse than labor”

As mentioned above, PEPD is characterized by sudden, episodic attacks of burning pain in the rectum, ocular, and mandibular areas of the body. Sometimes, the location of these attacks can relocate as a person suffering from PEPD ages. As most patients experience the disease’s onset in the neonatal period of their lives, it begins to manifest through flushing on one side of the face – often accompanied by a glazed expression and irregular heartbeats. Soon, pain will begin to be felt in lower parts of the body. These attacks are often triggered by bowel movement, which is why many children diagnosed with PEPD also develop constipation in fear of the pain.
Most patients begin with pain in the lower body, and many will move on to experience the same aches in their head and face, most often near their eyes or jaw. Flushing and redness accompany these attacks, which usually correspond with the center of the pain attack. These attacks typically last between a few seconds to several minutes, but more extreme cases have been known to last for hours. Triggers can include sudden changes in temperature, spicy food, cold drinks, and even emotional distress, along with taking medicine and bowel movements. The pain experienced during these attacks is significant: as a study published in the Journal of Neurology explains that patients who have given birth rank PEPD pain as even more severe than labor pain.

In addition to the pain and flushing, non-epileptic seizures and a slow heart rate are also common among PEPD patients.

But what exactly is the cause of these symptoms? Research into the disease have pointed to a mutation in the SCN9A, wherein the voltage-gated sodium channel NaV1.7 experiences an inability to activate. This causes prolonged action potentials and repetitive firing, which then dramatically increases the sensation of pain as well as activity in the sympathetic nervous system. The same gene, when mutated differently, has also been found to cause the opposite phenomenon — the total lack of pain.

Diagnosis, treatment, and management

Like many rare and genetic diseases, diagnosis for PEPD heavily relies on a patient’s medical history, physical exams, and laboratory test results.

Once diagnosed by a healthcare professional, treatment is typically administered through carbamazepine, a drug that has been found to be at least partially effective in lowering the severity and number of pain attacks. Other anti-epileptic drugs, such as gabapentin and topimarate, have only had limited effects.

In terms of managing this disease, as with many rare diseases, close and detailed counseling is crucial in receiving proper treatment. For more information about PEPD, click here.

Reese Jones does freelance data analysis for various health institutions and insurance companies. Her spare time is spent contributing to blogs, tending to her small garden, and caring for her grandmother who has looked after her since she was young. 

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 Holistic approaches to chronic pain

By Deborah Ellis, ND, CTN

If you’re like me, and millions of others, you’ve probably suffered with chronic pain for a year or longer. Chronic pain affects 50 million Americans, 20 million of whom have high-impact chronic pain. It has been linked to increased risk of major mental conditions including depression, anxiety, and post-traumatic stress disorder. Science understands a body in chronic pain continually sends stress signals to the brain, leading to a heightened perception of not only the pain itself but also the perceived level of threat. It’s a vicious cycle that’s hard to break or control.

When a person is diagnosed with pain, the first line of treatment is typically pain medication. But while these medications may work for some people, in others, the side effects—ranging from nausea to heart complications—may outweigh the relief.

For patients looking to explore a holistic pain management program, whether alone or in tandem with traditional medicine, there are a number of options to consider.

Let’s review a few of the more common holistic strategies available today.

  • Acupuncture
  • Chiropractic
  • Exercise
  • Massage
  • Stress-reduction techniques like mindfulness and meditation training
  • Vitamin or herbal supplements
  • Aloe vera

Acupuncture

Acupuncture, common in Chinese medicine, involves inserting thin, tiny needles into certain points of the body. Traditional Chinese practitioners believe acupuncture balances the flow of energy or life force — known as qi or chi. Western practitioners see it as a way to stimulate nerves and muscles in a way that promotes pain relief and healing. Many  practitioners are now beginning to recognize the potential benefits of acupuncture.

Chiropractic care

A chiropractor’s main objective is to realign and manipulate the spine and neck in a way that relieves pain, promotes healing, and improves overall function. There are many different styles of chiropractic care, and chiropractors use a wide range of strategies, techniques, and products as part of treatment. It’s important to find a reputable, experienced practitioner and to be sure to understand the risks and benefits in advance of treatment.

Exercise

Exercise is one of the most important ways you can improve your overall health and, often, even manage pain. No matter how much pain you are in, there is almost always some type of exercise you can do–even if it’s just gentle ankle movements or hand squeezes. If you have limited mobility, consider finding small exercises you can do while seat or lying down. Remember to start small and go so slowly. Some good examples of exercise for those with chronic pain include: walking, swimming, Pilates, Tai Chi, Yoga, and strength training. Talk to your doctor, a physical therapist, an occupational therapist, and/or a personal trainer about what is best for you. 

Massage

Therapeutic massage has proven to be beneficial for a number of chronic pain conditions. In addition to relieving pain by relaxing painful muscles, tendons, and joints, massage can also help decrease stress and anxiety, which can increase pain. There are a wide range of massage styles, including Swedish, deep tissue, sports, Shiatsu, trigger point, and reflexology.

Stress-reduction techniques, like mindfulness and meditation training

Mindfulness and meditation help quiet the nervous system and lower stress, which decreases muscle tension and can lead to lower pain levels. There are many styles of meditation and mindfulness training, such as techniques that focus on breathing, progressive relaxation, or engaging in guided imagery.

Vitamin or herbal supplements 

There is an incredible array of vitamin, herbal or plant-based supplements to explore for pain relief. In some cases, these supplements may support overall well-being, which can, in turn, help reduce pain. In some instances, supplements may provide more direct relief by reducing inflammation or improving joint health. Examples of vitamin supplements include B vitamins, which are thought to support nerve health and vitamin C and D for bone health. An herbal or plant-based example would include turmeric or aloe vera.

Aloe vera

Natural aloe vera gel contains more than 200 biologically active constituents, including calcium, chromium, copper, iron, magnesium, manganese, potassium, selenium and zinc—that provide essential nutrients and help boost metabolic function.  It contains 20 of the 22 essential amino acids and the vitamins A, C, E, choline, folic acid, B1, B2, B3, and B6. It even contains B12, a vitamin that typically is only found in animal foods.

Aloe vera’s nutrients, as well as its anti-inflammatory and analgesic qualities, may be helpful in relieving muscle and tendon pain. The gel is sometimes used topically in sports medicine to soothe achy muscles, but taken orally, the anti-inflammatory ingredients may also help with pain.

It’s important to note that if you’re using aloe vera to reduce inflammation, you should also rebalance your diet. By eliminating unhealthy foods, aloe vera has a better chance of working. To learn more about aloe vera products, including topical and drinkable versions, visit  https://painsmarts.org/?u=4everaloe.

There is no one-size-fits-all

Whatever therapy you choose, it’s vital to remember that there is no one-size-fits-all approach to pain management. Because they are less invasive and come with fewer risks, complementary therapy options can be a good place to start. Keep an open mind and talk with your provider about the different options available to you.

This post was created through a collaboration with AloeVeritas. Please remember to talk with your healthcare provider before starting or stopping any treatment.

Deborah Ellis is an independent lifestyle coach with AloeVeritas and a certified traditional naturopath by the American Naturopathic Certification Board. She lives with late-stage Lyme disease, chronic fatigue, chronic pain, and fibromyalgia.

AloeVeritas is a global health and wellness company that first launched in Europe, then the United States in March 2018. They have partnered with PainSmarts to conduct the largest and most comprehensive natural pain relief study in the world. If you would like to participate or would like more information about the study or AloeMD, please go to: https://painsmarts.org/?u=4everaloe or contact Deborah Ellis, ND, CTN, at Delyn.Ellis@gmail.com. 

 

 

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Managing fibromyalgia in children

By Brent Wells, DC, a chiropractor and founder of Better Health Chiropractic in Anchorage

If your child feels tired and achy, you may not worry initially. After all, there’s nothing urgent about what seems to be mild, general discomfort. However, if your child is constantly in pain, exhausted, having trouble sleeping, and experiencing intense moods, he/she may have fibromyalgia.

This condition is fairly common in adults, but parents and clinicians may overlook the possibility of juvenile primary fibromyalgia syndrome — that is, fibromyalgia in children.

Juvenile fibromyalgia symptoms to watch out for

Fibromyalgia is a chronic condition characterized by pain and fatigue. According to experts, children will often describe this pain as “stiffness, tightness, tenderness, burning or aching.” This pain can last for months and is often accompanied by other sympt

oms that affect a child’s overall well-being, energy level, and emotional health, including:

  • Tender spots on muscles
  • Difficulty sleeping and fatigue
  • Aches, including stomachaches and headaches
  • Lack of focus or memory
  • Anxiety and depression

If your child is experiencing these symptoms, you should see a doctor. There’s not one test to confirm it, so he/she will go through a range of tests to rule out other conditions.

Unfortunately, there is no one “cure” for fibromyalgia, which can be frustrating for patients, especially children. If left untreated, symptoms can lead to issues at school or making friends. Many parents describe this as a “vicious cycle” where symptoms continue to feed the condition.

Experts still aren’t sure what causes fibromyalgia or how it develops in the body. Some believe that mixed-up pain signals in the brain cause greater pain chemicals and/or overactive pain receptors. Others think it might be triggered, in part, by an emotional event like an illness, injury or psychological stress. But even if the cause involves emotions, the pain is still real.

How children can cope with fibromyalgia

It’s important to create a support team and get your child’s primary care doctor, pain specialist, psychologist, physical therapist, and teachers on board. The more people are aware of your child’s condition, the more they can help him/her cope with symptoms at home and school. You may also want to look for pain support groups near you, for both your child and you as a parent.

Your doctor can help you decide whether medication, such as anti-inflammatories, antidepressants, or nerve pain medications, may be right for your child. He or she also may recommend therapies like injections or topical creams. In conjunction with these interventions, your doctor will probably prescribe treatments like physical therapy and behavioral changes, which are crucial to long-term management of fibromyalgia.

Let’s go over some nonpharmacological strategies for coping with fibromyalgia.

Five strategies for improved symptoms

Although fibromyalgia may disrupt your child’s life, affecting school and friendships, you may be able to improve your child’s quality of life with these natural therapies and changes. Of course, there’s no cure for fibromyalgia, but by managing symptoms, you can help your child get back to some sense of normalcy.

  1. Get moving!

Exercise can be incredibly valuable for managing your child’s fibromyalgia symptoms. Exercise can relieve muscle stiffness and tire out the body physically so that your child can fall asleep more easily. In particular, pool exercises have been shown to help patients because the warm water can have a soothing effect on pain and also promote blood circulation.

Consider signing up your child for swim class to get regular exercise that is both fun and good for symptoms. Start with limited intervals of exercise at first, and slowly increase them as symptoms allow. Aquatic physical therapy can be extremely beneficial for patients whose fibromyalgia is too severe for regular pool activities.

  1. Incorporate meditation methods

While your child may not be interested in meditation, try to incorporate some of the practices in your child’s daily life. After playtime, encourage your child to take a moment to relax and reset. In addition, teach your child how to use relaxing breathing exercises when he/she feels overwhelmed during school or before bed.

Studies show that meditation can help reduce fibromyalgia patients’ stiffness, anxiety and depression. In the least, promoting a stress-free environment and creating a sense of relaxation will help your child feel less anxious.

  1. Say goodnight to fibromyalgia

Your child’s sleep routine is essential for improving fibromyalgia symptoms. Chart out the best routine for your child together. Make sure he/she goes to bed at the same time every day and start “sleep-ready” habits an hour before bed. This routine could include a break from screen time, reading a story together, listening to a relaxing song and/or taking a hot bath. Promoting a relaxing environment will help your child get to sleep.

Make sure you’re not giving your child food late at night, especially items with any caffeine or sugar. Also, be sure take away tablets and cell phones. The blue light can wake up your child instead of helping him/her get sleepy. Sufficient sleep is essential to managing pain.

  1. Change your child’s diet for success

Some experts recommend following an anti-inflammatory diet to prevent aches and pains. In general, an anti-inflammatory diet is based on the Mediterranean diet, which emphasizes fish, fish, vegetables, whole grains, and olive oil.

Update your child’s lunch to include a handful of nuts, or add an apple for a snack. Anytime you can add fruits and vegetables to his/her diet, do it! This boost of nutrients will fuel your child for success. Try to limit junk food as well, which has no value and could actually inflame your child’s pains.

  1. Schedule your child for a physical therapy session

Your child could benefit from seeing a physical therapist or chiropractor near you. Recent studies show how physical therapy or chiropractic can have a positive impact on fibromyalgia patients. Finding the right physical therapist is important. Call in advance to ensure they have experience with fibromyalgia and/or with children. Specific exercises in physical therapy can help to improve your child’s core strength and incorporate techniques to soothe muscle aches and pain.

Similarly, regular massage therapy sessions with an experienced masseuse can improve your child’s exercise, sleep and mood.

Talk to your doctor

A fibromyalgia diagnosis can be challenging, but doesn’t have to take over your child’s life. It’s a good idea to talk to an expert to come up with the most effective care plan for your child, one that ideally includes a diverse range of strategies, like those listed above. Together, you can talk about your child’s specific issues and needs, and figure out the best way to improve symptoms.

 

About Dr. Brent Wells

Dr. Brent Wells is a graduate of the University of Nevada where he earned his bachelor of science degree before moving on to complete his doctorate from Western States Chiropractic College. He founded Better Health Chiropractic in Anchorage in 1998. He became passionate about being in the chiropractic field after his own experiences with hurried, unprofessional healthcare providers. The goal for Dr. Wells is to treat his patients with care and compassion while providing them with a better quality of life through his professional treatment.

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Understanding constipation with pain medications

U.S. Pain Foundation collaborated with Salix on a survey of 441 adults to better understand the challenges of constipation due to opioid therapy. Here are some of the findings from that survey.

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How I refused to allow pain to stop me from traveling

Smith aboard a cruise ship.

By Anne M. Smith, owner of Travel & Events Extraordinaire and a U.S. Pain ambassador

When I was first bombarded with multiple pain conditions nine years ago, I was completely overwhelmed, and there are still days when it tries to overtake me. As a travel agency owner and event manager, I have had to completely restructure my life, my business and, more importantly, the way I travel.

To understand the difficulties I face, you can think of my nervous system wiring as being totally rerouted. It is akin to a highway construction manager putting up detour signs for my nerves all throughout my body—they are confused with which exit to take. So, they have gone haywire, leaving central nervous sensitization in its path and my pain receptors are all on high alert. Couple that with referring pain and we have a map of tangled highways, streets, and roads going around in an endless cloverleaf exit ramp.

Just the other night, I asked my husband to calculate my average pain level from nine different sources of pain. It was determined that I constantly stay at a 6.9, all triggered by the simplest of things like writing, typing, sitting, standing, walking, rolling over, and sleeping.

With that in mind, when I travel, whether for work or pleasure, every decision from beginning to end is factored around my pain. I have to think about how I am going to get there, where I am going to stay, how will I get around, how far can I walk, how long can I stand, how long can I sit, and will I be a disruption to anyone around me if I need to get up and walk, etc.

If I am traveling by car, the immediately impacted body parts include my hands (carpal tunnel), elbows (cubital tunnel), shoulders (bilateral scoping surgeries), neck (anterior cervical disc fusion C3/C4), lumbar spine (L4/L5/S1 for degenerative disc disease), and bilateral knees from both being replaced (right one most recently in May of 2018). Earlier this month, I re-learned that about one hour is my maximum for gripping the steering wheel. Unfortunately, the drive to Philadelphia for a recent trip was two hours! The last hour was filled with electrical shooting pains from my hands to elbows and up to my arms. This triggered my neck, so that was also hurting.

Because I was driving, I was only able to take 800 mg of Tylenol. Upon entering my hotel room, I took my stronger pain meds and allowed the hot water of the shower to soothe my wrist, arms, shoulders and neck. I concluded with massaging the impacted areas until I had some relief.

It’s crucial when driving to known your limits. You should also be sure to have plenty of self-care and treatment options for once you arrive at your destination.

When I travel by air, I always request wheelchair service at the ticket counter. This saves my spinal column, knees and feet from having to stand in long lines at the ticket counter, security, and the boarding gate. I always sit in the front of the plane, close to the bathroom, also due to pain. As soon as I deplane, there is a wheelchair and attendant awaiting my arrival to be wheeled through oftentimes very huge airports in between gates or just to get to baggage claim. He or she earns my biggest tips! And I often use the baggage carts once my luggage is retrieved. Some airport terminals and gates are as far as the east is from the west. So whenever possible, I research in advance if they have the motorized transport vehicles and where to request them.

Even when you plan ahead, things can still go wrong.

Earlier this month, aboard the Harmony of the Seas cruise ship, where I was a guest speaker conducting training to 40 travel professionals, my ankles had swollen due to a new medication being introduced to my system right before I traveled.

(Note to self – “Self, wait until after you return from travel to try new medications!”)

This medication was supposed to help with the aforementioned electrical shooting pains. But then I felt like my second passion as a voice-over actress kicked in and I starred in my own medication commercial where I read aloud very fast that “this medication will help patients alleviate the zapping of misfiring nerves, but it could cause lower body extremity edema such as the swelling of your ankles the size of softball appendages, turn your calves into logs, and prevent you from wearing shoes. So much for sexy summer logs, I mean legs!!!” And cut…

(I write with a lot of humor otherwise the gravity of the amount of pain I deal with daily would be more overwhelming than most people could deal with.)

Suffice it to say, it was not the business trip I had envisioned. I had no water pills with me to remedy the edema. I had planned to stand and walk around the training room, but I was kind to my body and chose to sit and teach. I made it work.

Meanwhile, walking aboard the ship was actually quite painful because of its size. It significantly hindered my ability to be a travel agency owner scouting out activities and excursions for my clients to experience in the cruise port destinations we visited. I could only wear two pairs of the shoes out of the several pairs I brought with me.

Every trip I take, I feel like I learn new lessons about how to prepare.  I learned three crucial things on this business trip: 1) never start new medications before I travel, 2) always bring comfortable shoes, and 3) always have water pills on hand in case of swelling.

I truly wish I could travel as much as my free-spirited soul would love to travel, but my body limits me. That said, it does not force me to stay at home and if I can only travel a couple of times a year, I will take that over never traveling again. I have one small suitcase for my pain needs and as long as my pain remedies are portable, I am always ready for an adventure…pain and all!

Anne Smith is a pain warrior, a term she learned during her training with U.S. Pain’s support group program, Pain Connection. From Pain Connection, she also learned perseverance and determination in overcoming the multiple pain conditions that she has. After a few years of restructuring her life to cope with pain, she found the strength to restart her travel and events planning business, Travel & Events Extraordinaire. Since then, with the help of family, friends, and organizations like the U.S. Pain Foundation, she has adapted her business to embrace her pain conditions, but also equipped herself to learn about accessible and medical travel to better assist her client’s unique travel needs.

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Clinical research shows cannabis relieves pain…so why is access so limited?

By Jahan Marcu, Ph.D., Chief Science Officer for Americans for Safe Access

With over 100,000 active members in all 50 states, Americans for Safe Access (ASA) is the largest national member-based organization of patients, medical professionals, scientists, and concerned citizens promoting safe and legal access to cannabis for therapeutic use and research.

ASA works to overcome political and legal barriers by creating policies that improve access to medical cannabis. One method is to share the facts when it comes to research.

Clinical research analysis on cannabis and pain studies

Chronic pain conditions are the most prevalent form of disease in many countries. With few alternatives and a lack of safe and effective treatments for disabling pain, millions will continue struggling to function in their daily lives. Given the public health issues surrounding long-term use of opioid medications, researchers have been analyzing the clinical trials that have investigated the effects of cannabis across more than 15 years of study.

Since 2001, at least nine other clinical reviews have been published by various groups on randomized controlled trials (RCTs) involving cannabis and pain. In recent years, several new clinical papers have been published, which have investigated the ability of cannabis and cannabinoids to treat pain caused by a variety of conditions.

The clinical trials administered cannabis in different forms (smoked, extracts, oral THC, synthetic analogues). Three recent reviews of the clinical trials on cannabinoids and pain demonstrate that researchers agree with the published data: cannabis and its preparations are effective for treating certain types of chronic pain with acceptable side effects.

After review of 43 RCTs (a total of 2,437 patients) involving various types of cannabis-based medicines (CBMs) and various pain conditions, researchers from Israel concluded that:

“In comparison to other indications, CBMs have most extensively been investigated on NP (neuropathic pain) and evidence suggests a moderate to good treatment effect. Furthermore, NP patients should be advised that the inhalation of cannabinoids showed relatively better pain reduction effects than other routes of administration.” (Aviram & Samuelly-Leichtag, 2017)

A study published this year also examined the role of cannabis in helping to alleviate pain:

“Collectively, this research indicates that although the results of experimental studies with healthy adults are mixed, there is converging evidence to support the notion that cannabis can produce acute pain-inhibitory effects among individuals with chronic pain.” (Hill, Palastro, Johnson, & Ditre, 2017)

Another pain research group published a similar review, years earlier, that stated:

“This systematic review of 18 recent good quality randomized trials demonstrates that cannabinoids are a modestly effective and safe treatment option for chronic non-cancer (predominantly neuropathic) pain. Given the prevalence of chronic pain, its impact on function and the paucity of effective therapeutic interventions, additional treatment options are urgently needed.” (Lynch & Campbell, 2011)

These observations, from three different groups of researchers, agree with determinations made by authors of the recent National Academies report on cannabis that there is ‘‘conclusive or substantial evidence’’ of benefit from cannabis or cannabinoids for chronic pain.

An impressive body of literature supports the use of cannabis in pain conditions, and recently, this has been supplemented by an increasing number of phase I–III clinical trials. Cannabis-based medicines are currently available in various countries for pain treatment, and cannabinoids of botanical origin may be approvable by the FDA. We will continue to track this research. For more information, visit: safeaccessnow.org/reports.

About Jahan Marcu, Ph.D.

Jahan Marcu, Ph.D. is the Chief Science Officer for Americans for Safe Access and Director of Patient Focused Certification. He is also a contributing author and editor of several scientific and regulatory publications, and is a court-qualified cannabis and synthetic cannabinoid expert.

This story was originally published in the INvisible Project: Medical Cannabis edition.

 

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Pain Awareness Month: Always aware of my chronic pain

By Kerry L. Wong

When most people think of sarcoidosis, what usually comes to mind is … OK, let’s start by correcting that – most people don’t ever think of sarcoidosis at all (in fact, most have never even heard of it). Once they learn of this disease, usually because someone they know has been diagnosed, they most likely think about breathing problems. That makes sense, since 90% of people with sarcoidosis have it in their lungs. This can lead to severe bouts of pneumonia, pulmonary fibrosis (scarring), and more.

I do have sarcoidosis in my lungs – that’s actually what helped lead to my diagnosis, after nearly 8 years of trying to figure out what was wrong with me. But (knock on wood) my breathing issues are relatively minor.  The most severe symptom I have, the one that dozens of doctors and dozens of treatments have been unable to adequately contain, is chronic pain. Because sarcoidosis can affect nearly any organ in the body and is frequently accompanied by a number of comorbidities and/or complications, sarcoidosis patients often live with pain in a variety of forms, severities, and parts of the body.

For me, that literally means pain from head to toe. I have been living with a few different types of headaches for most of my life: these include tension headaches since high school, migraines since college, within the past decade, sinus headaches from chronic sinusitis, and even more headaches that come as a side effect of medication.  I also have fibromyalgia, which is “characterized by widespread, debilitating pain,” among other symptoms, and have suffered with painful endometriosis since college, and irritable bowel syndrome since long before they even called it IBS.

Since sarcoidosis is an inflammatory disease, the chronic inflammation causes painful arthritis, most often in my ankles, knees, hips, and hands, as well as muscle aches most often in my neck, back, and arms. As sarcoidosis affects my nerves, the neuropathy causes a painful pins and needles feeling in my hands, feet, and lower legs, a sharper pain that shoots down from my hips, and back pain that can be completely incapacitating. Even cutaneous (skin) sarcoidosis causes erythema nodosum, painful bumps that develop on my legs. I am in pain every minute of every day; it just varies in location and severity.

The pain can be debilitating. There are days when I can’t get out of bed for an hour after I wake up, and moments when I am literally stopped in my tracks from a sudden burst of pain while I’m out. But the pain itself isn’t always the worst part. Because pain is invisible, sarcoidosis patients like me are often told that we don’t look sick.

This is actually a double-edged sword, though. While I’m glad I don’t typically go around looking like an extra from The Walking Dead, people often have difficulty believing what they cannot see. Since we look fine, people assume that we are fine – and often do not fully understand or believe how much we are truly suffering. This can lead to all sorts of problems – with friends, when we have to cancel plans; with family, when we have to miss special occasions; with employers, when we have to call in sick so often; with Social Security, when we have to apply for Disability Insurance; even with (some) doctors, when we try to get some much-needed relief.

That’s why Pain Awareness Month is so important. First and foremost, it is an opportunity for chronic pain patients to share our experiences, to help educate not only those closest to us, but anyone who is willing to listen (or read). The more we share each other’s stories and raise awareness, the better we can support the next person who is suffering from chronic pain and its societal consequences.

Speaking of the next person … that’s the other great thing about Pain Awareness Month – sharing these stories helps to connect us with the next person who is suffering. Living with chronic pain that affects every aspect of our lives can be incredibly isolating.  It’s easy to feel like we’re all alone, that no one else understands what we’re going through. But when we raise awareness, each of us gets to see that we are not alone.  In fact, a recent study from the National Institutes of Health reports that 11% of Americans (that’s around 25 million people) suffer from chronic pain.

Through blogs, social media, patient-centered organizations and support groups (both in person and online), we find people we can turn to with questions, ideas, joys, and sorrows. We are no longer alone, or just one of 25 million suffering in silence.

We are in this together; we are the chronic pain community.

About Kerry Wong

Kerry Wong is an active U.S. Pain ambassador who shares her experience in order to support fellow patients, guide newer advocates, and help educate those around us. She suffers with chronic pain due to a number of conditions, but does her best to remain positive and empowered. Though managing her health has become Kerry’s full time job, she continues to write for her blog, Float Like a Buttahfly, to organize fundraising and support events, and to lead advocacy activities at the federal, state, and local level.

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Self-care is not selfish

Originally appeared on HealthCentral.com, by Marianna Paulson

Self-care is an important strategy for everyone. If you live with a chronic illness, please don’t negate or neglect this vital part of your treatment plan.

Self-care can help propel you to better emotional, mental, and physical health. At the very least, it can help you maintain the quality of health you currently have. That’s not a bad thing. Far too often, the road of chronic illness is riddled with potholes, which can cause serious breakdowns.

What Is Self-Care, and Why Practice It?

Here is the World Health Organization’s 1998 definition: “Self-Care is what people do for themselves to establish and maintain health, and to prevent and deal with illness. It is a broad concept encompassing hygiene (general and personal), nutrition (type and quality of food eaten), lifestyle (sporting activities, leisure, etc.), environmental factors (living conditions, social habits, etc.), socio-economic factors (income level, cultural beliefs, etc.), and self-medication.”

Do you feel selfish when you practice self-care? I could tell you to stop it, but that’s not enough, especially if you’ve held this as a lifelong belief. Rather than slapping a negative adjective such as “selfish” on self-care, leave off the judging word. Just make it something you do. Period.

Thoughts that you think over and over again become beliefs. Make self-care a new belief.

Finding Strength Through RA

Self-care is one of the least selfish things you can do, especially when you take the long view. When you practice self-care, you not only function better, but you also feel better. This ripples outward, anointing the people and things in your life with your given best.

If self-care seems like a foreign word to you, create your own definition. Instead, substitute the word “generous” for self-care. During the 17th century, generosity was identified as a nobility of spirit, which was thought to be associated with people from noble lines, who were presumed to possess traits such as courage, fairness, gallantry, gentleness, and strength. If you live with a chronic condition, you probably possess many of those traits already.

Currently, the Science of Generosity defines it as the virtue of giving good things to others freely and abundantly. Be generous with yourself.

I hope to convince you to regularly implement self-care techniques by releasing negative feelings, such as guilt and selfishness. Immersing yourself in those negative feelings also contributes to stress—something you don’t need, considering its connection to the inflammatory response.

Elements of a Self-Care Practice

Think T.O.T.O.M. I could say, “Da plane, da plane,” if you’re old enough to remember the TV show “Fantasy Island.” If not, think T.O.T.O.M.—Theory of the Oxygen Mask. There’s a reason the flight attendant tells you that, in case of emergency, you should put on your own oxygen mask before you deal with the masks of those under your care. When you practice self-care, you not only model good behavior for your children, but you also cultivate your own well-being so that you can effectively look after the people and things in your life.

2-4-6-8! Who (what) do we appreciate? This exercise, done over time, can change your half-empty glass to one that is filled with effervescent bubbles of optimism. A 2015 University of Illinois study found a connection between a more positive outlook on life and better cardiovascular health.

Be selective about who you tell. When you make a behavior change, keep it close to your heart. Only tell those you can trust. It’s hard enough to make the change without the voice of the naysayer.

Your life depends upon it. I recently heard a woman complain, “I wish I could get paid to exercise.” Her partner worked in emergency services, and because of the dangerous nature of his work, his job description included regular fitness sessions, so in essence, he does get paid to exercise. But even if we don’t, our well-being still depends on us being as healthy as possible.

Know your “window.” When you live with a chronic illness, you have a threshold of “too much.” It might mean too much work, too much activity, too much stress. Cross the threshold and you feel exhausted, have a flare-up—emotionally or physically—or get sick.

Never mind “Fill the bus!”  Instead, fill your toolbox with a number of different self-care strategies. Your brain may get bored with the same old ones. It’s good to experience something new, even though you may have your favorites. Keep in mind that your self-care may be different from mine.

Learn the value of yes and no. This is pretty much self-explanatory, but you might try this little experiment: Say “yes” to the things you usually say “no” to, and vice versa.

Schedule it. If you’re new to self-care, put it on your calendar. I find that regardless of what task I want to do, if I write it down the night before, I usually accomplish it the next day.

Can you overdo self-care? Maybe. If your quest for self-care becomes an obsession, where the quest is more important than the actual practice, you might be overdoing it. Ralph Waldo Emerson reminds us to have moderation in all things. Or as my mom once said to me when I asked why we couldn’t have her special dessert every Sunday: “Because then it wouldn’t be special, would it?”

Don’t wait until International Self-Care Day on July 24, a day selected for its 24/7, or round-the-clock symbolism. The International Self-Care Foundation was formed to promote self-care around the world. See how you’re doing with their “7 Pillars of Self-Care.”

To get started, ditch the perfectionism and self-flagellation. In other words, be as kind to yourself as you are to those you care about. Be generous about self-care!

Reprinted with permission from HealthCentral.com

About Marianna Paulson

Marianna Paulson, aka Auntie Stress, has had rheumatoid arthritis for 40 years, but RA hasn’t had her. It has taken her on a journey of many career and health changes. Along the way, she has learned to adapt to and adopt a better way of living, much of which she shares on her two blogs, AuntieStress.com/Auntie-Stress-Cafe (Healthline’s Best Stress Relief Blogs of 2017), and rheumfuloftips.wordpress.com. When she is not helping clients (and herself) address stress, she keeps active by swimming, dog walking and taking frequent dance breaks when she is working on her computer.

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To be their advocate: A personal letter from one parent to another

Psychologist Jenna Krook, MS, offers advice on how to become your child’s best advocate.

Dear fellow parents,

Our journey started seven years ago when our son was diagnosed at 10 years old with reflex sympathetic dystrophy (RSD). This mysterious and debilitating condition was overwhelming—it became the center of our lives.

Being an advocate for a sick child is a difficult role. When you face a condition as misunderstood and overwhelming as RSD, finding the time and resources to discover and advocate for treatment and intervention is a challenge. Learning what will work for your child takes time, and there is no quick answer.

Sources of strength

We have been blessed to share our journey with a family that provides us with support and guidance. Parents to an extraordinary young woman who faced RSD, survived, and ultimately thrived, they shared their experience and knowledge—which makes an enormous difference. What follows here is a summary of our collective experience that we hope will help you.

The diagnosis process

The process of getting an RSD diagnosis, or any diagnosis, requires advocacy. I know it’s disheartening to see a number of doctors who often misunderstand the condition. It takes time—which is a quandary, because a fast diagnosis is critical to recovery.

It is helpful to bring a document to all appointments that lists your child’s symptoms, doctors/specialists, descriptions of injuries, overview of previous treatments, and your questions and concerns. You may need to go to several appointments and see several specialists before you feel like you have found your “team”—the group of specialists who will help your child heal.

Become an investigator

It is essential to investigate and become knowledgeable about your child’s condition. You may find it helpful to access resources like books and articles related to pain conditions; interview specialists/doctors knowledgeable in the area of chronic pain conditions; and join organizations or foundations related to pain disorders.

Reaching out to support groups and getting connected with families that are facing the same challenge is also valuable. You will not only gain the support of others who understand your situation, but you will also gain knowledge regarding treatment options.

Because no single treatment works for everyone, you will need to continue investigating and trying new treatments. Often, the only way to find out about these options is to connect with those who have taken this journey before you.

The importance of education

One area of advocacy we found critical was educating the child in pain, as well as their siblings.

Our goal is to help our children with chronic pain learn to advocate for themselves. They can’t do this without understanding the science behind the condition. Consider providing the information in a written form along with visuals (like photos and diagrams) so your child can always return to the information when questions arise.

When we educate children, we empower them. Knowledge gives them the strength to advocate and educate others. Even more important, when children understand what is happening in their body, they can begin to understand how each treatment creates change in the body. This knowledge assists in the healing process.

Shifting the focus away from mental health

Most of us have been to doctors who look for mental health-related explanations for pain. You may find yourself educating doctors and advocating for treatments that address the pain condition rather than focus on mental health.

There is a need to provide emotional support for a child facing a chronic illness, but beware the doctor who believes that a mental health condition is the cause of the pain. Be vigilant in directing care in a manner that provides emotional support/therapeutic intervention for a child who is suffering from a pain condition, versus directing care at a mental health condition as a reason for the pain.

Seek specialists

Keeping an open mind about treatment options is essential. Investigating alternative/naturopathic methods of treatment can be useful in developing your “team” of specialists. Be willing to advocate for these less-conventional, often less-understood treatment modalities, because they may help provide pain relief for your child.

Advocate at school

You will also have to advocate in a complicated school system. Sharing your knowledge with school staff is a fundamental step toward securing services/accommodations.

Request a meeting with school staff and support personnel. In this meeting, provide a document that educates them on the unique medical needs of your child. Offer a signed release of information so school staff can access the expertise of your specialists.

The school staff may consider developing a 504 plan, a legal document that can ensure accommodations like modified homework, extended time on assignments/tests, schedule changes, timing of classes, access to tutoring, study halls, counseling, restricted physical education, and more.

Make time for fun

Be an advocate for laughter and play. This staggering, potentially disabling condition has the ability to strip our children and our families of joy. As we search our souls to find gratitude and hope for a better tomorrow, we must keep a sense of humor, laughter, and play in the lives of our children.

On days that feel hopeless, we must find ways to be together and infuse play into our day. Including your child’s friends in these activities—finding ways to keep our children included in their circle of friends—maintains joy. Finding the strength to create joy can be one of our greatest works of advocacy.

About Jenna Krook, MS

Jenna Krook holds a Master of Science in Counseling and a School Psychology Credential. Jenna has 23 years of experience as a psychologist, both as a school psychologist and in private practice. Her efforts are focused on helping children learn social skills, increase self-esteem, manage anger, and achieve healthy emotional development—even in the face of challenges. She works hard every day to never take for granted her health and well-being as well as that of her children. Jenna lives in Walnut Creek, California with her husband, 17-year-old-son, and 13-year-old daughter.

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I can see a little more clearly now

By Edward Bilsky, PhD

Having experienced little pain, myself, it is impossible to fully comprehend what it is like to live with severe chronic pain. My work as a research scientist studying the basic biology of pain and opioids for almost three decades has not shed much light on the challenges faced by people in pain.

I have read plenty of clinical papers and spoken with countless physicians and other health care practitioners about this topic, but to be honest these efforts barely scratch the surface. It has taken self-realization, reflection, and a willingness to come out of my own comfort zone to peel back a layered and nuanced veil and peek inside.

Beginning to see pain

It was a little over three years ago that I received the first of many emails and calls from people affected by chronic pain. The award of our new pain grant was well-publicized, resulting in a number of inquiries from people desperate for pain relief. They wanted to enroll in our clinical trial of a new pain medication that did not yet exist (our work was focused at the pre-clinical level).

I had a choice. The simple option was to ignore the queries or politely respond that we were not conducting clinical trials. But, realizing that in almost 30 years of education and research, I had yet to have a meaningful conversation with a person in chronic pain, I made a commitment to respond to each person who reached out to me, asking them if I could meet in person and learn about their pain and its impact on their lives.

What could I offer to help?

The anticipation of meeting these individuals in person was nerve-racking. What would they be like? What would they ask for? How would the conversation go? What could I actually offer in terms of help?

The answers came quick enough. Some walked through the door with canes, walkers, and limps, while others were the epitome of “invisible” pain, with powerful strides, firm handshakes, and no apparent distress on the outside. Each had a unique story, but they also shared many commonalities in their narratives. And with each new introduction and listening session, I became more convinced that meeting them all was one of the best decisions I had ever made.

 “The INvisible Project provides another example of how working with people who face adversity to tell their stories helps to better educate future health care professionals.” – Edward Bilsky, PhD
A profound impact

These initial encounters have had a profound impact on my life, and on many others at the University of New England. We have formed deep and meaningful partnerships with the Chronic Pain Support Group of Southern Maine and the U.S. Pain Foundation. I have learned about the INvisible Project and the important work it is doing by bringing the faces and voices of pain into discussions with policy makers, health care providers, and scientists.

Through advocacy efforts, people in our communities who experience significant chronic pain are candidly sharing their experiences with our students—the next generation of health care providers and researchers. We are collecting stories and creating video narratives of complex pain states, examining each case from numerous angles to get a more complete picture.

This work is being disseminated well past our own communities in an effort to de-stigmatize and de-mystify chronic pain. A group of us are also working with  pain warriors (policy advocates who themselves have chronic pain) to be more effective advocates for improving prevention and management options for chronic pain. We are using photography, videography, narrative medicine, art, music, and other techniques and disciplines to complement our efforts in the laboratory and clinic.

Professional meets personal

The greatest irony in all this effort is that the impact of chronic pain was staring me in the face for the past 40 years. My mother fractured her hip when I was a young boy and had several complications that led to decades of severe chronic pain. The stoicism she displayed, in part due to the stigma of chronic pain and the callousness of our society, led to a tangled downward spiral of isolation, anxiety, depression, and silent suffering.

As a child, I was not sensitive enough to pick up on the signs; I sometimes ignored them as life got busier and more complex. I learned much more about my mother’s story when she and my father (who now also has chronic pain) spoke to 175 first-year medical students. Their first-hand accounts of the effect of pain on themselves and their family were revealing.

They’ve experienced moments when the health care system failed them, and moments when a single individual acted to make their situation better. Their stories and countless others drive my newfound passion to make the invisible visible.

About Edward Bilsky, PhD

Dr. Edward Bilsky is Vice President for Research and Scholarship at the University of New England. He received a PhD in Pharmacology and Toxicology from the University of Arizona Colleges of Medicine and Pharmacy in 1996. Dr. Bilsky’s laboratory conducts translational research in the areas of pain and addiction. He has received more than $6 million in extramural funding to his laboratory and has published more than 75 peer-reviewed publications in leading journals, presenting nationally and internationally in a variety of different venues. He was awarded the 2011 American Osteopathic Association Research Mentor of the Year Award, is a recipient of the Faculty for Undergraduate Neuroscience Lifetime Achievement Award, and the 2014 Patient Advocacy Award from the American Academy of Pain Medicine. 

 

 

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Words Matter: A patient weighs in on the importance of clear language when discussing RA/RD

By Kelly O’Neill Young

When I was diagnosed with rheumatoid arthritis (RA), I had no idea what it meant. Not only was I unaware of what symptoms to expect, I did not know exactly what the disease was. My grandfather had lived with the disease, and died with it. But the only things I remembered were his bent fingers and watching him push with the back of his hands to stand up. Why did he do that and what was wrong with his hands?

I asked more questions when Granddad died suddenly from a heart attack (first event myocardial infarction). People don’t just die in their sleep out of the blue—at least they hadn’t in my 19 years. Family members answered my questions with clichés about death that left me quiet but still curious.

In Pain, and Unsuspecting of More

As mysterious joint symptoms pestered me occasionally over the next two decades, I asked my doctors a few times whether I might have RA. Each one insisted it was impossible. How did they know? I had no idea how they judged.

It haunted me that my frozen shoulders, dislocated hips, painful feet, and neck degeneration might be that mysterious disease of Granddad’s that I knew nothing about.

Eventually, I experienced onset of full-blown RA, with multiple joints swelling intermittently. I lost strength and range of motion overnight. It only took a couple more doctors before one finally ran a blood test that indicated RA.

This new pain in my joints was comparable to the pain of childbirth without medication, which I had experienced five times. Now, I thought about Granddad a lot. Why hadn’t I asked him more questions? How could I know absolutely nothing about this disease?

Unexpected Bonuses With RA

Unfortunately, my joint pain and stiffness were not my only symptoms. There were bright red rashes that covered my arms, daily fevers of 101 degrees, black circles on my toes, and severe reddening of my face several times a day.

Because the harsh joint symptoms interfered with doing most normal activities like washing my hair or dressing my baby, they eclipsed my systemic symptoms at first. So, I took many surprising symptoms in stride. Even my kind rheumatologist essentially shrugged at my systemic symptoms, at one point saying, “But those aren’t joints.”

In addition to weird skin symptoms and daily fevers that continued for years:

  • No one warned me my eyes might dry out. When I got to the point of wearing sunglasses at night in my living room, I went to the ophthalmologist who said the surface of my eyes “was rough like asphalt.” Sjögren’s syndrome, he said, from your RA.
  • No one warned me I could lose my voice entirely. By the time I went to a throat doctor, I knew. Cricoarytenoid arthritis, inflammation, and spasms, from the RA.
  • No one told me RA could inflame my blood vessels, but it did. It caused painful blood blisters from just folding clothes or taking a step. I was also diagnosed with livedo reticularis, a permanent condition on my skin caused by rheumatoid vasculitis, courtesy of RA.
  • No one believed RA would affect my heart, least of all me. But the erratic blood pressure and atrial fibrillation I experience are some of the many heart symptoms investigated by rheumatology experts at Mayo Clinic.
  • No one seemed to know inflammation from RA could cause platelet levels to rise to over 700,000. But mine do, along with frequent bleeding under the skin and numerous abnormal blood lab results.
  • Could RA lead to autoimmune hepatitis? It seems to have done so in my case and that of other patients I know.
  • No one ever suggested vitiligo was a possibility either, but here we are, with skin on my arms that doesn’t make pigment any longer.
  • No one warned me about shortness of breath. But whatever I can feel going on in my heart, lungs, or blood vessels has caused this frequent symptom as well.

Rheumatoid Symptoms or Coincidental Comorbidities?

“But Kelly, you are an unusual case,” I’ve heard. Am I? Being part of a patient community for several years has convinced me that I am not unusual. It is not unusual to have close relatives who died from RA-related causes. And extra-articular disease (meaning disease not located in a joint) is not uncommon.

It becomes hard to imagine these are coincidences.

While I learned firsthand the harsh pain and limitations RA’s effects impose on a person’s joints, the following also contributed to my understanding:

  • Hundreds of thousands of interactions with other people with RA
  • Hundreds of academic articles from medical journals and historical publications
  • Large surveys and polls of our patient community

I also had two advantages as this data informed my understanding of this disease: A sincere curiosity to know the truth, and an abiding trust in the stories patients tell.

Research and Listening Persuaded Me that RA is RD

One common thread connected all these data points and my experience. It was that RA is not a type of arthritis. Arthritis is only one symptom of what we call “rheumatoid disease.”

When I started interacting with other people with rheumatoid disease (RD) in 2008, I heard the same refrains often heard today: “No one understands. People think this is the same as osteoarthritis, but it’s so much more.” I avoided discussions and arguments about the name of the disease. I wasn’t afraid to confront the error of the disease name; I was worried about wasting time debating the name when there was so much work to be done to provide information and encouragement to people fighting the disease.

Meanwhile, I read many academic articles that refer to RA as rheumatoid disease, especially non-American publications, older articles, and those published in non-rheumatological journals. If you think about it, it might sound silly in a thoracic or cardiac journal investigating ways RD affects the lungs to use the word “arthritis” because there are no joints in the lungs or heart.

The bigger picture came into focus.

The picture I saw was undeniable. People I heard from were living with the complex disease that is documented in medical literature. Arthritis is a painful and significant symptom of that disease. However, arthritis is not necessarily the first nor most life-impacting symptom. Neither is joint inflammation (arthritis) the reason for the persistent mortality gap in RD.

Most of the problems faced by people with RD are closely related to the misnomer of RD as “a type of arthritis:”

  • Medical problems that contribute to the mortality gap are not appropriately treated in RD because of the false impression that the disease only affects joints, and only certain joints.
  • Problems with lack of empathy or obtaining accommodations in both personal relationships and employment have a common cause: the lack of awareness of the nature of the disease.
  • Better treatments and a cure have been stalled by confusion about how the disease affects the body. For example, many researchers are unaware of specific ways in which RD inflammation affects certain organs and systems.

The Experiences of Patients Pointed to a Simple Solution

Rheumatoid disease is actually a historical term. So I often say, “I did not invent the ball; I just picked it up and ran with it.”

I wrote my book, Rheumatoid Arthritis Unmasked, to help patients and medical professionals know the medical dangers of rheumatoid disease that need to be addressed in people living with RD.

The term “RD” has been readily adopted by many patients and is used interchangeably on some health websites because they know patients appreciate it. It has been a natural change for the patient community because most of us know someone who died from an RD-related cause.

Correcting the label of RA to RD is the most simple and productive action that could be taken to help people living with the disease. It is time to update the label and acknowledge that research confirms what our experiences with the disease have already taught us: that arthritis is only one symptom of a complex disease.

About Kelly O’Neill Young

Kelly is the creator of the award-winning website RAwarrior.com, which she launched in 2009. Her non-profit organization, the Rheumatoid Patient Foundation, works to improve the lives of people living with RA/RD through research, education, and advocacy. She also works as a consultant and patient advocate with various organizations and agencies including the Food and Drug Administration (FDA), the Patient-Centered Outcomes Research Institute (PCORI), and the Department of Health and Human Services. 

 

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Complementary and Alternative Medicines for Migraine

By Katie Golden

In Dr. Robert Cowan’s paper “CAM in the Real World: You May Practice Evidence-Based Medicine, But Your Patients Don’t,” he explores the notion that patients with migraine disease often incorporate complementary and alternative medicine (CAM) into their treatment regime, although it is a topic often left out of the discussion between physician and patient.

Some examples of CAM are yoga, meditation, acupuncture, massage therapy, homeopathy, biofeedback, and natural supplements.

Dr. Cowan believes most physicians lean on evidence-based medications that have been proven in FDA-approved clinical trials, while dismissing alternative methods that are harder to study under standard scientific procedures. He reports that less than 20 percent of headache specialists surveyed incorporate any type of CAM into treatment plans.

On the flip side, over 80 percent of patients report they use some form of CAM, and only half tell their doctor about it because they are afraid of being judged.

My CAM Journey

I strive to manage my migraine disease through a mix of medication and complementary and alternative medicines. I’m very open with my headache specialist about what I want to try, and she’s always been supportive.

Throughout my journey, I’ve tried massage therapy, dry needling, natural supplements, biofeedback, chiropractic, meditation, and more. Yoga is the one self-healing measure I have found the most comfort in. It gives me the greatest relief, energizes my soul, and challenges me the most.

Taking the Yoga Practice with You

At the end of my favorite yoga class on Sunday nights, my yogi says, “Take the support from this group into the rest of your evening and take this practice with you throughout your week.” Yoga doesn’t just live on the mat in a class; it can guide you through your day. It’s taken years of diligent practice to find what “taking your practice with you” means to me.

I practiced Bikram yoga, or hot yoga, for years. It helped me during a difficult time in my life. When my migraine disease became chronic, any form of yoga seemed impossible. Actually walking down the street seemed impossible.

Looking back, it made perfect sense to get out of bed and get on my mat. My muscles were always in a constant state of fatigue, which only contributed to my pain. I needed to open up my body and my heart center. Yet all I could focus on was working and sleeping. I was in survival mode.

When my doctor suggested I go on short-term disability, I decided to make exercise a priority. I felt weak. I had no control over my body. It was something my athletic boyfriend had been urging me to do as well. I enlisted the help of a trainer, who had no knowledge of my condition, but who researched workouts and modifications that would help me succeed and not incite a migraine.

Baby Steps Are Worth It

Some days, I felt I was making progress … baby steps towards endurance. Then I would have a setback, losing weeks of work to being confined to bed. When I returned to the gym, I felt like I was starting all over again. Frustration does not even begin to explain the defeat I felt.

After a year of weekly training sessions, I felt brave enough to step onto my mat in a classroom. I told the yogi about my health issues and limitations; I wasn’t sure I could endure an hour-long class. She told me she would give me modifications, but the most important thing was just to stay in the room for the entirety of the class, which I did!

I had put so much pressure on myself to be able to gracefully transition between poses or hold my gaze steady while balancing on one foot. But that wasn’t where I was yet, and I had to learn to give myself some slack. No one was looking at me, no one was judging me … except myself.

Each class was a crapshoot, never knowing if stretching out my body would be healing or hurtful. With each session, I learned something new about the practice and about my body. Eventually, I felt more in tune with what my body was trying to tell me—I had just never stopped to listen before. I could no longer ignore the signals that screamed for me to eat more regularly, drink more water, or stretch out my body.

Taking Yoga Off the Mat and Into Your Life

Over time, I learned that returning to the fundamentals of yoga could help me daily.

In yoga, your breath is connected to every move you make. For example, breathe in while you bring your arms up, touching the palms above your head. Breathe out while releasing the arms and moving them down to the sides of your body. This connection of breath and movement takes practice, but I found it helped me in my daily life. When giving myself a shot of Toradol, I breathe in and insert the needle and breathe out when I inject the medicine.

It might sound silly, but focusing on the breath can help me to ignore the pain of receiving the injection. That is just one way that I take my yoga practice off my mat and into my week.

When I notice that my balance is off, I’ll work on certain poses that challenge my balance, such as tree pose. To just gain a quick boost of energy, I will do an easy sun salutation. I have no shame in doing yoga wherever I am and whenever I need it. The airport is definitely a place where my weary body yells at me to pay attention to it. These are other ways in which I integrate yoga into my daily life.

Consistency Brings Results

A 2014 study assigned migraine participants to either a conventional care group, or a yoga group that practiced five days a weeks for six weeks, along with their conventional care.

At the end of the study, the yoga group reported greater improvement in the intensity and frequency of their migraine attacks compared to the conventional care group.

Movement, even in the most basic form, can become difficult for those with chronic pain. I encourage everyone to explore yoga. That could mean learning simple stretching techniques, finding a way to connect your breath with movement, or letting go of your inhibitions and attending a class.

Don’t have money for a class? No problem. There are many free classes available online. I personally use “Yoga with Adriene” on YouTube. From the fundamentals to upper level poses, her style is easy to follow.

Yoga may not be a cure, but the fundamentals could help you feel more in control of your body.

Other CAM options:

  • Massage Therapy: Massage therapy can include multiple techniques like Swedish, deep tissue, Shiatsu, Thai, myofascial trigger point, and hot or cold stone. One study showed that those who received 12 myofascial trigger point massages during a six-week period, instead of ultrasound, reported the highest positive change in headache frequency, perceived headache pain, and greater improvement in their pressure-pain threshold.
  • Acupuncture: Acupuncture is likely the oldest form of CAM. Thin needles are placed strategically along one or more of the five meridian lines believed to be necessary in balancing a person’s energy or chi. Needles are inserted into the top layer of skin to increase blood flow and stimulate nerves, muscles and tissues. A 2015 study found that a group of patients who received 16 sessions of acupuncture within a 20-week period reported a positive change in the frequency and intensity of their migraine attacks, as well as an increased pain threshold. At a three-month follow-up, the results were the same, but at 12 months post-treatment, the effects had worn off.
  • Natural Supplements: The following list of over-the-counter supplements or vitamins have been used to treat migraine, either in conjunction with preventative medications or alone. Due to the potential for side effects, your doctor should always be included in decisions to use any of these supplements:
    • Butterbur
    • Vitamins B2, B6, C, D, and E
    • Magnesium
    • Potassium
    • Fish Oil
    • Coenzyme Q10
    • Petadolex
    • Peppermint oil
    • Flax seed
    • Feverfew

Please note: The U.S. Pain Foundation and the INvisible Project do not recommend any specific modalities to treat cluster headache or any other chronic pain condition. Your doctor should be informed of any decisions that vary from your treatment plan.  

 

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Medical Cannabis in a Balkanized Legal Landscape

By Jerry S. Goldman and Ethan W. Middlebrooks

As a result of the conflicting laws and policies of the federal government and the various states, users of medical cannabis are faced with a host of practical challenges.

The Federal Controlled Substances Act places cannabis (including CBD, a constituent chemical) in Schedule I, the most tightly restricted category, with substantial criminal penalties for its sale and distribution and adverse implications for banking, taxation, intellectual property, and litigation.  State law is subject to the primacy of federal law. For most of the 20th century, states mirrored the federal policy. Over the past two decades, however, a large majority of states have permitted the regulated distribution and possession of cannabis for medical and/or adult-use purposes. Some states permit such uses only for CBD; 21 other states (along with D.C., Guam and Puerto Rico) have comprehensive medical cannabis programs; and 8 states have authorized adult-use cannabis programs.

There are currently limited exceptions to the federal ban that help states maintain cannabis programs. Through the Cole Memoranda, a series of Department of Justice guidances, the federal government, in an exercise of its discretion, has advised that it will not prosecute cannabis offenses under the CSA if (i) the offense relates to medical cannabis; (ii) it takes place in a state which has a robust medical cannabis regulatory regime in accord with certain DOJ requirements; and (iii) the alleged offender operates in accordance with state law. If a distributor violates state law, e.g., by shipping cannabis out of state, it loses this protection.

Further, Congress has enacted a series of amendments to the federal budget authorization acts for fiscal years 2015, 2016, and 2017 that prohibit the use of congressionally allocated funds by the DOJ to prosecute alleged violators of the CSA, if they acted in compliance with the laws of certain enumerated states.

The Impact on the Medical Cannabis Patients

These administrative and Congressional actions have minimized the possibility of federal prosecution of operators of medical cannabis programs who comply with the varying regulatory requirements. Risks nonetheless remain to state programs and persons who use medical cannabis.  The Cole Memoranda are subject to being rescinded, and each budget act has an end date with no guarantee that a similar amendment will be enacted. The real remedy is a structural amendment to the CSA—an action Congress has not yet been able to achieve.

The federal government’s nominal “hands off” approach leaves states free to develop a patchwork of laws regarding cannabis. Each state’s program is limited to its own borders and differs—often radically—from other states. And cannabis cannot be transported across state lines.

Each state has different conditions for lawfully obtaining a prescription for cannabis. The legal means of ingestion may also differ. In New Jersey, one may only ingest cannabis by smoking ‘flower’; in New York, that means of consumption is prohibited—as are edibles in both states, in contrast to Colorado. States differ significantly in the amount of excise or sales taxes charged, who can ‘write’ prescriptions, whether THC-based cannabis (as opposed to CBD) is available, and the frequency and quantities that one may purchase at a dispensary. Some states permit consumers to grow their own cannabis; others do not. There are differing regulations as to where one may consume cannabis (although, generally, one may not consume it while walking around in public, and all states sensibly prohibit the use of cannabis if one is operating a motor vehicle). Laws differ as to who may own a dispensary, how many dispensaries are permitted in a state and where they may be located. These varying requirements create seemingly unnecessary difficulties for both medical cannabis businesses and consumers. However, given that this is a new legal industry, this legislative experimentation hopefully will ultimately lead to the implementation of best practices legislation.

One of the greatest present obstacles to medical cannabis patients is the restriction on interstate activity and access to legal cannabis. Even with the Cole Memoranda and federal budget act amendments, the federal government strictly prohibits any interstate transportation of cannabis.  This prohibits those in the medical cannabis business from shipping the product, which can impair product quality and uniformity, and can result in product shortages, higher prices, and adverse environmental impacts (e.g., in a northern state in the winter, where cannabis must be grown indoors using artificial lighting and supplemental heating).

A patient cannot travel across state lines possessing medical cannabis; the patient will not be able to fill an out-of-state prescription in another state (with the exception of Nevada which has a reciprocity program), and the patient will generally be ineligible to register in order to obtain an in-state prescription. Thus, because of residency requirements, a patient will be deprived of her or his cannabis when travelling. The “work-around” for a patient who cannot easily forgo the treatment is to restrict travel to states which have adult-use programs.

Since California’s initial attempts at reform, the industry and the ability of patients to obtain help has radically changed. We can reasonably expect to see additional changes in the coming years as the industry matures, state governments see what works best, and public (and political) attitudes develop. Ultimately, in order for medical cannabis to work best for those who need it, at least modest federal legislative relief is needed. Until then, patients and cannabis providers should learn how to adapt to these challenges and opportunities.

Disclaimer: The views expressed herein are those of the author and do not necessarily reflect the views or positions of Anderson Kill PC, any of its affiliates or other attorneys, or any of its clients. This article is for general information purposes only, in a changing legal environment. It is not intended to be, nor should it be construed as legal advice to any person or entity for any particular factual content.

 

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