To ‘cure’ your pain a patient must learn patience. Your chronic pain is a complex web that developed through a course of misfortunate events and set up an engrained neurological pathway signal of pain to your brain. We give the example of a girl walking across a dewy meadow. A girl walks across the meadow in the morning, you would not see her path later in the day. However, if that same girl walks across the meadow everyday for the next 6 months, even if she then misses one day you will be able to see the path she has walked. This is the same as chronic pain patterns.
It took a long time to get to the point of your chronic pain and your ‘cure’ will also take a period of time and be a process to heal. Don’t expect any magical healthcare provider to be able to solve all your ills in one visit. Instead, understand that a patient with patience and understanding will have the best results. Patience also helps to curb anxiety that intensifies pain and hinders the healing process.
We recommend mindful meditation, prayer, exercise or relaxation techniques to help patients practice patience. These techniques will help decrease stress cortisol levels, boost natural endorphins and will help patients become more in tune with their body and help the healing process.
To ‘cure’ your pain you will need to actively seek a health care team dedicated to achieving your goals. Although our practice is only one example, you will want to seek providers that take a multidimensional approach. Ideally you will have a healthcare provider who can manage any approach medication options needed. Find a provider that doesn’t treat you like cattle. Find a provider that takes the time to know their patients and not someone who kicks you out the door after 10 minutes. Avoid the ‘pill mill’ clinics! If you suffer with underlying anxiety and depression, which is almost every patient, you will want to also work with a pain psychologist or psychiatrist to help with coping skills.
Some alternative add-ons that we recommend would involve joining a pain support group, either one specifically for your pain condition or one for chronic pain. Having a support group to vent at, share ideas, share victories or frustrations is a critical component. I like to call it the “Oprah effect” as Oprah has done wonders with addressing issues and bringing them into the viewer’s living room. So can these support groups be your “Oprah effect”.
As you become a more active participant, we then encourage our patients to actively seek an exercise instructor with experience in pain patients. Yoga, Tai Chi, Pilates, aquatic Therapy are all wonderful examples of improving strength and flexibility while decreasing pain.
The goal is finding the right members to fill out your pain fighting team!
Chronic pain and depression are so closely linked that a viscous cycle can easily set in if one does not honestly address and treat any underlying depression. Studies show that patients with chronic pain have lower levels of the hormones serotonin and norepinephrine compared to patients not in pain. Lower levels of these hormones are known to lead to depression and anxiety. Combine these physiological lower levels of hormones with the frustration patient’s feel regarding their lower quality of life and limitations from their pain and you have a set up for patients to fall into a feeling of hopelessness.
The first step toward finding your ‘cure’ and treating pain is to work to attack depression directly. Depression is a medical condition that should be treated with a multimodality approach. We work with our patients on setting up successful coping skills and techniques to improve their outlook on pain and depression. For a good amount of patients, working with a clinical psychologist or psychiatrist will also be a valuable member of a patient’s pain fighting team. There are prescription medications that not only treat depression related issues but also have FDA indications for pain. Cymbalta is one example, it has FDA indications for Fibromyalgia, Diabetic peripheral neuropathy, chronic low back pain as well as anxiety and depression.
For patients that want to avoid traditional pharmacological medications, supplements like Magnesium have been used to treat stress and are an excellent smooth muscle relaxant. If you want to avoid pills all together, meditation and exercise are two successful strategies that every patient would benefit from. Both meditation and exercise boost endorphin levels, decrease stress hormone levels and give patients an improved outlook on life.
Finally, anyone with depression issues need to find someone to talk with, whether that be a support group, licensed professional, or a close friend. Releasing stress through the power of conversation is vital in helping patients gain both insight and learn tools to better cope with pain and depression.
Chronic pain is a misunderstood and complex condition to treat. Research on the biology and neurobiology of pain has shown a relationship between spirituality and pain. Using a number of cognitive and behavioral strategies to cope with pain, including religious/spiritual factors, such as prayer or seeking spiritual support to manage pain is an essential component to finding a ‘cure’ for your pain.
Many patients confuse spirituality with religion. Although the two can overlap there is a difference between the religion and spirituality. Religion is an organized faith system grounded in institutional practices while spirituality is grounded in personal beliefs and practices that can be expresses with or without a specific formal religious belief.
The role of spirituality in treating chronic pain is vital as it helps patients to create a meaning and purpose that is essential in fighting chronic pain. Spirituality can help patients cope with the physical as well as the psychological component to chronic pain. The psychological meaning that patients assign to their pain impacts how they process their pain long term.
Spirituality lies in the sense of connection and inner strength and peace that individuals derive from the relationship with themselves, others, nature and possibly a connection to a specific religion. The role of a more spiritual patient is vital to improving a patient’s overall well-being and quality of life. This improved well being takes time and training to accomplish but works through visualization, meditation, positive thinking and possibly even prayer.
A sense of connection to one’s environment, nature and a higher power helps to give patient’s an improved outlook on their treatment and significantly improved outcomes in treating their pain. Patients that find the ability to improve their inner strength will have an improved outlook, a sense of purpose and will lead them to their ‘cure’.
This is an absolutely huge topic, I can’t state that enough! In fact, this article is only a primer to an entire book we are writing that will help to attack and treat Fibromyalgia. I will give a few of the highlights on our ‘cure’ for Fibromyalgia.
Before we can treat Fibromyalgia, let’s try to put to the side the past stigmas associated with Fibromyalgia. For many years a majority of physicians did not believe in Fibromyalgia and there are still a few physicians who refuse to recognize or treat Fibro. While rounding on patients in the hospital, I overhead a colleague label Fibromyalgia as the “depressed, overweight, middle age, housewife syndrome”. On the other spectrum, you had the theory that Fibromyalgia was a warning of things to come. This group looked at Fibromyalgia patients similar to the theory of the canary in the coal mine.
Luckily, the medical community is finally coming around to recognizing this chronic pain condition. Current Fibromyalgia research and philosophy is a mixed component of a central nervous system dysfunction with a chronic myofascial component. Below is a list of recommendations we make to all of our Fibromyalgia patients on there first visit.
- Fibromyalgia is a diagnosis of exclusion, make sure to have labs to rule our other connective tissues diseases first, like Rheumatoid Arthritis, before accepting the Fibro diagnosis.
- Every Fibro patients needs a sleep study to treat any underlying sleep disorders that will directly complicate pain.
- Treat any underlying depression.
- Check underlying vitamin deficiencies that can complicate pain, including Vitamin D, Vitamin B12, Vitamin B1
- Start a daily home exercise/stretching program, Fibro will worsens with inactivity.
- Eliminate all soda’s immediately, totally toxic and can increase inflammatory levels in the body complicating pain.
- Restrict the ‘nightshade plants’ from the diet to limit their inflammatory related issues
- Limit yeast foods, so many of my patients struggle with this one but it will dramatically improve your energy.
- Work with a local physician and consider one of the FDA approved medications for Fibromyalgia: Cymbalta, Lyrica or Savella.
- Consider a workup for gluten allergy.
So much more to cover in future blogs, but this will give you a good starting point and as always consult your local healthcare provider before starting any new health lifestyle modification.
An often overlooked part of any patient’s find for a ‘cure’ is a friend to offer support. A friend, or some form of a supportive social network, is key to any recovery. This can range from a family member, understanding neighbor, friend or online support group.
It’s seems that for some of our pain patients we act as much a counselor rather than a traditional medical provider. Sometimes patients just simply need someone to vent their frustrations and aggravations to, someon who will take the time to listen and empathize with their situation. For some of our patients, a trip to the office is the highlight of their social calendar for the month.
We encourage all patients to find someone who they can spend quality time with in a supportive and caring manner. This social bond has an psychological impact on a patient’s recovery. Having social support helps to motivate patients to be more active and involved. For some patients, their social network is severely limited due to their disability or lack of proximity to family and friends. Even patients with severe isolation issues can find some form of social network. We encourage home bound patients to join an online therapy or support group that is tailored to patients with their similar condition. This can be an effective tool to use as a sounding board for advice or support. Of course, always discuss any information gathered on theses message boards with your local provider before implementing.
Find a friend who will listen and get involved.
A very successful and overlooked tool in the treatment and eventual ‘cure’ of your pain is laughter. Laughter holds many known benefits for the body from a both psychological and physiological perspective.
Laughter is known to lower blood pressure and reduce stress hormone levels. Laughter, the actual act of laughing, can also improve cardiac health. Laughter is known to improve immune function which is a vital factor in your recovery. Laughing also triggers the release of endorphins which are your body’s natural pain killers. Laughing also improves a patient’s general well being. Laughter improves circulation and smooth muscle relaxation, of vital importance to patient’s suffering from chronic muscular pain conditions and ailments.
Beyond these physical responses to laughter, we have found that patients who regularly incorporate laughter have an improved outlook to their pain. Patient’s who have the insight to laugh at their circumstances have improved quality of life and improved overall function. The old theory of the glass half full really does seem to apply to pain patients and helps to set realistic expectations.
So find a few moments every day to add some laughter back into your life.