5 Tips For Dealing With Chronic Pain During The Holidays

Chronic Pain HolidaysChronic pain is never fun to deal with, but it can be especially difficult to manage during the holidays. Your diet, sleep schedule and travel plans can get your body out of whack, so today I’m sharing some tips to help you control your chronic pain during the holidays.

1. Travel Tips – If you’re dealing with chronic back or neck pain, being crammed on a plane or in a car for hours on end can be painful. That said, there’s still some ways to make yourself more comfort while traveling. If you’re traveling on a plane, see if you can get an aisle seat. That way you can stand up and stretch if needed without waking up any sleeping patrons in your aisle. If you’re in a car, leave earlier so you have time to stop at a rest stop and move around if your joints start to get stiff.

2. Eat Right – The holidays are a time when our waistbands can expand to Santa’s size, so be cognizant of what you eat. Eating junk food can aid to your chronic pain, make you more lethargic, and as a result, keep you from exercising, which is beneficial in chronic pain management. If you have to travel, pack a healthy option so you’re not gorging on fast food during your travels.

3. Keep Exercising - As I’ve said in earlier posts, regular exercise is crucial in controlling and preventing chronic pain symptoms. Getting your regular workout in during the holidays is no easy task, but don’t use the company party or a family visit as a reason to skip your exercise. Wake up early or carve out some time – even if it’s only 15 minutes – to exercise. Getting out of a routine makes it easier to stay out of your exercise routine, so don’t let the holidays slow you down.

4. Medication Management - Most people who take medications to help with their chronic pain have a pretty set schedule for managing their meds, but as this post suggests, the holidays can throw your routine out of whack. Double check to make sure you have all your medications for a long stay, but also be aware of where you store them so young nieces and nephews can’t accidentally access your medications. If you’re going to run out of a prescription while out of town, contact your doctor before you leave instead of having to jump through hoops from afar.

5. Rest Up - Sleep is a restorative process where your mind and body relax and rejuvenate, so try not to skimp on sleep this holiday season. It may be easier said than done, but it’s important nonetheless. That means no staying up in the wee hours of the night trying to catch Santa Claus!

Follow these tips to have a pain free (or at least a little less painful) holiday break! If you have any tips on how you manage chronic pain during the holidays, please share in the comments section.

Nutrition, Diet and Pain

DietPain is a complex experience with multiple components, including those from the physical interpretation of sensory signals to the brains perceptions of the signals. Sensory signals are transmitted electrically and chemically throughout the body. The chemical nature of the body is significantly affected by our activities, including exercise, nutrition and diet. What we put into our bodies affects how we feel, including our perception of pain. Diet and nutrition can certainly impact pain.

In the most basic sense, obesity and being overweight can contribute to pain. Recent studies have shown that the extra fat of obesity is pro-inflammatory, causing the body to feel more pain. Extra weight also mechanically stresses all components of the body. The extra forces placed across them stresses the joints. The muscles, ligaments and tendons are forced to use extra power to move normal amounts. Often people in pain find that eating is one of few pleasurable activities, and then they eat more and move less.

Inflammatory Foods

Food can be broken down into two general categories: pro-inflammatory and anti-inflammatory groups. The pro-inflammatory foods and nutrients have the effect of promoting inflammation in the body directly or by how they are metabolized and broken down. The anti-inflammatory foods do the opposite and reduce inflammation in the body either directly or indirectly. Not surprisingly, eating a healthy diet tends to be high in anti-inflammatory compounds. Diets rich in pro-inflammatory compounds tend to be rich in things that are considered not so healthy.

Diets that are pro-inflammatory are very common in our culture. The foods typically have a high glycemic load, raise blood sugars, contain “empty” calories, are highly processed and contain red meat, fat and oils that are not healthy. The American diet is rich in refined grains, sweets, and sugar. Pasta, white rice, bread and potatoes are all mostly carbohydrates and just add to our glycemic load and produce inflammation. Topping it off, many processed foods contain sugar or corn syrup, which are just empty calories. Animal fat (and human fat) are high in omega-6 essential fatty acids, and these are broken down into pro-inflammatory compounds including arachidonic acid thromboxane and leukotrienes. Vegetable oils including sunflower, peanut and corn oil also are high in omega-6 fatty acid and tend to be pro-inflammatory.

Diets that tend to be healthier are rich in compounds that are anti-inflammatory in nature. Foods that are high in omega-3 fatty acids, anti-oxidants and phytochemicals are anti-inflammatory. These include a variety of fruits and vegetables, spices and cold water fish. Omega-3 fatty acids are found in walnuts, flaxseeds, chia seeds, olive and canola oils and are anti-inflammatory. Healthy fish to eat include tuna, herring, salmon, cod and bluefish. Beans and lentils also provide high quality protein without bad fats. Some intake of omega-6 is necessary in the body, but controlling the amount and thus the amount of fatty red meat is essential.

Diets that have more fresh vegetables and fruits also tend to provide good sources for vitamins and minerals that act as antioxidants. Compounds that are antioxidants rid the body of free radicals that can lead to inflammation and breakdown of many structures like vessels and joints in the body. Vegetables and fruits also provide the body with phytochemicals, nutrients that protect cells, fight bacteria and help regulate the body’s hormones. Many spices and herbs also provide essential antioxidants and phytochemicals, and some even tend to mimic the actions of compounds like Ibuprofen.

Improving diet and nutrition can be a healthier way to control pain. What we eat can have a direct effect on our pain in many different ways. The typical American diet is rich in the compounds that promote obesity and inflammation. A dietitian can be extremely helpful in changing a person’s intake to change your health. It will take a bit of work, but eating better will help you lose weight and may decrease pain and inflammation in the body.

Chronic Pain in the Military

Army painA recent study published in JAMA Internal Medicine suggests that chronic pain in active and former military members is a significant problem.

The study surveyed 2,597 soldiers who served in either Iraq or Afghanistan in 2011 in order to understand how chronic pain affects their everyday lives. According to the survey results:

  • 45.4 percent reported suffering combat injuries.
  • 44 percent reported experiencing chronic pain.
  • 48.3 percent reported pain lasting at least a year.
  • 55.6 percent said they suffer from “constant” pain.
  • 51.2 percent said their pain was moderate to severe.

Those tasked with helping military members reintegrate back into society after a deployment know the management of physical and emotional pain is crucial. The study also attempted to uncover how military members use opioids to aid in pain management.

“I had conducted a similar study at [the] CDC because we felt that it was important to understand [the] use of opioids to get a greater context for misuse and abuse,” said lead author Dr. Robin L. Toblin, a clinical research psychologist at the Walter Reed Army Institute. “When I began my current position, we sought to look at the same constructs within a military population, who seemed to be that much more likely to be in pain due to the combat deployments over the last decade.”

Dr. Toblin noted that providing opioid therapy and management to combat veterans is key. Opioids can certainly ease pain after a combat injury, but problems can arise if veterans try to self-medicate or are uninformed about proper dosages. According to Dr. Toblin, 15.1 percent of soldiers say they have received opioid-based therapy to control their chronic pain.

“[Based on these findings], we hope that the military services will be more aware of the unmet needs for the assessment, management and treatment of pain and will broaden the services and availability of those services for servicemembers,” Dr. Toblin said.

The findings have touched off some debate over whether military members should be taking opioids. Obviously we want returning service members to be pain free, while others claim the drugs could affect their physical and mental performance. In the end, I think it really comes down to taking a strong, hands-on approach to ensure our veterans and returning servicemembers get the care they deserve and a treatment strategy that suits their individual situation.

Is The Web A Useful Resource for Medical Information?

Medical websitesThe web can be a very good place for information, but one has to be careful at which places they look for info. There are many commercial based sites that try to sell products based on your search criteria. Other sites are the equivalent of an infomercial for a medical practice or institution, while some may simply be a personal blog. Various organizations also sponsor sites, and some are very good, while others are pushing their philosophy toward a certain problem as the only true solution. The best sites seem to try to explain the science behind a problem and explain the variety of solutions available.

The sites that I have found the best are sponsored by the government or large medical organizations. For instance, the Mayo Clinic has a huge amount of information on a variety of topics. They write informational pages on various topics, like medical problems, the typical history, diagnostic studies that may be needed and treatment options. Other good places to look for factual information include insurance companies, health organizations, medical groups, and large universities. Many of these places have fact sheets available on topics of interest that are good reference material. The U.S. government also sponsors information, often from the National Institutes of Health, on a variety of issues.

Then there’s the gray area source of Wikipedia. Generally this source can is an excellent place for information and entries are written by top notch experts on a disease, however, it can be also written by someone who actually has no medical background and just decided to write an article for the site. The information found on this site should be verified with other sites and not be taken as a sole source of data.

The Internet and Chronic Pain

The internet can provide an excellent resource of information for the self motivated person. I have found it useful for baseline information about various pain conditions. I also use it as a resource for patients who want more information on certain topics, like exercises for low back pain. Youtube also has videos that demonstrate a variety of things from exercises to surgical procedures.

Cellphones have brought the internet to the palm of the hand. For a quick definition or piece of information it can be wonderful. Medical providers can find a variety of references for free that help make diagnoses, identify medications and there uses, and for dosing information. That said, reliable and free information in app form is hard to find. iPhone apps are a huge business, but I’ve found no beneficial free exercise apps for patients with chronic pain. There are some inexpensive apps for exercise, but read the reviews first to see if they are going to be helpful for your situation.

The internet is like the Wild West from long ago. There are many very good sites and areas to find educational information about a variety of conditions. The better sites are free and often sponsored by large medical institutions, such as the Mayo Clinic, Johns Hopkins University, other not-for-profit organizations or the U.S. government. Some doctors are also prolific writers and work at trying to educate their patients through the web. Unfortunately, in the pain world, there are also some terrible sites that are forums to gripe about a condition, and the doctors who “know nothing.” The internet can often be a very good starting place for information. It is also a good place to develop questions such that you can have a good discussion with your doctor about what to do next in your management.

Texting May Be Causing Your Neck Pain

Text NeckAs more and more people are becoming glued to their smartphones, medical professionals are warning people about a new condition called “text neck.”

If you’re at school or the breakroom at work it probably doesn’t take long to see more than a few individuals hunched over their cellphone. Responding to texts and sending that work email are important tasks, but you may be jeopardizing your neck health if you hunch your head down while typing away.

“It isn’t the best for our posture,” said Linda Scholl, a University of Utah physical therapist. “It’s not correct posture, but kind of leaning forward.”

Dr. Kenneth Hansraj, a spine surgeon in New York, coined the condition “text neck.” He says the condition is caused by tilting a your head down while staring at your smartphone. According to Dr. Hansraj, teens are especially at risk, as some teens have spent an additional 5,000 hours on their phone compared to older adults.

Scholl agrees, saying teens and colleges students are spending more time than ever buried in their smartphones.

“People are spending more time leaning forward, paying attention to what’s in front of them, instead of having their posture upright and looking at the world around them,” Scholl said.

Scholl noted that people have hunched their heads in the past – be it by reading books or working at their desks – but these activities rarely cause a person’s neck to be in a poor position for such a long duration.

Text Neck Pain

Scholl went on to discuss just how much pressure you can put on your neck by tilting it forward. According to her, the human head weights about 12 pounds, and the farther forward you lean, the more weight is placed on the cervical spine. Once your tilt reaches 60 degrees, “you have about 60 pounds worth of pressure going through your spine. So that soft tissue has to hold the weight of the head in this forward position.”

In addition to neck issues, poor head position can lead to other side effects like reduced lung capacity, neurological problems and heart disease.

Preventing Text Neck

Text neck is a serious problem, but it can be prevented pretty easily. Follow these tips to avoid neck problems while texting.

  • Mentally note where your neck location is every time you use your phone. When using your phone, try to keep it out in front of you. If it’s in your lap, you’re going to need to lean forward to use it.
  • Regularly stretch and exercise your neck. Rotate your shoulders and neck at regular intervals.
  • Don’t be glued to your cell phone. Sure, sometimes it’s very necessary to be on your phone, but the more you’re on it, the more likely you are to subconsciously slip into a poor posture.

If you suffer from neck pain, take a close look at your cell phone use. You may be doing harm without even realizing it!

Related source: Deseret News

Smoking Increases Risk of Chronic Back Pain

Smoking and Back PainA new study conducted at Northwestern University found further evidence that smokers are at an increased risk for developing chronic back pain.

While medical experts have known for a while that smoking increases a person’s risk of chronic back pain, this study examines why that’s the case. Researchers were keen to learn more about the link between back pain and smoking as back pain affects more than 80 percent of the population at some point in their life. According to the folks at the American Chiropractic Association, back pain is the number one reason for missed work and the second most common reason for doctor’s visits.

Smoking Study

For their study, researchers examined 160 individuals who had developed subacute back pain, which is defined as back pain lasting between  1-3 months. In addition, researchers analyzed 32 participants with chronic back pain – back pain for more than five years – and 35 people with no symptoms of back pain. Patients were asked to complete a health and wellness questionnaire once a year for a period of five years, and they also underwent MRI brain scans to analyze brain activity in the nucleus accumbens and the medial prefrontal cortex. These areas play a role in a person’s addictive behavior and motivated learning.

Without getting too technical, researchers say there is a crucial connection between these two areas of the brain. The stronger the connection between the too, the less resilient a person is to chronic pain. According to researchers, smokers had a stronger connection between these two areas of the brain compared to non-smokers, meaning smokers were more likely to develop chronic pain. In fact, researchers suggest that a smoker is three times more likely to develop chronic back pain than a non-smoker.

But there is good news. Dr. Bogdan Petre said the connection between the nucleus accumbens and the medial prefrontal cortex can be decreased by kicking the habit.

“We saw a dramatic drop in this circuit’s activity in smokers who – of their own will – quit smoking during the study,” said Petre. “So when they stopped smoking, their vulnerability to chronic pain also decreased.”

Petre concluded that his team’s findings are only further evidence that smokers are putting themselves at risk for chronic back pain.

“We conclude that smoking increases risk of transitioning to chronic back pain, an effect mediated by corticostriatal circuitry involved in addictive behavior and motivated learning.”


Insurance Coverage and Pain Management

Medical InsuranceEvery time someone goes to the doctor, they want to know if the visit and treatment is covered by insurance. Unfortunately, there is no simple answer to that question. In the distant past, care was much simpler and each visit with your family doctor had a small set cost that covered everything preformed.

Today it is a complex financial industry with thousands of players each getting paid, from the insurance industry, to the medical suppliers, to the manufacturers of every widget and needle to lastly, the physician.

The cost of everything gets itemized and factored into the cost of each visit and treatment. The insurance industry and Medicare have complex formulas to figure out how much every service is worth and what can be charged. Unlike going to an auto mechanic who tells you the cost of the parts and labor, the medical industry is very different. A physician can determine how much it will cost in order to provide a service, but each insurance company decides how much they are willing to pay on their end, and the doctor is stuck with that amount. Rarely is a medical service fully reimbursed to the provider; often it is at 30-40 cents on the dollar.

Am I Covered?

The first question on coverage is whether you have medical insurance. Every person now can qualify for insurance and there are a variety of plans available. Total cost and coverage are the remaining issues. The benefit of the Affordable Care Act (nicknamed Obamacare) is now everyone can get medical insurance and no one can be denied. Unfortunately, that means everyone needs to understand the insurance they have purchased, and realize every service provided is set by the coverage that you bought. Most physicians try to work with the patient and insurance to determine the best option in management of any medical problem. To stay in business, most physicians must have specialists in their offices to make sure they have the necessary prior authorizations in order to see and treat an individual.

The insurance industry has set a guideline that a service should be covered if it is deemed medically necessary. The amount of coverage depends on the individual plan, deductibles and co-payments required. Furthermore, the service may need to be approved by a primary physician in addition to the ordering physician, and it may need special approval by an insurance company’s medical expert.

Wait, What?

At this point, most people are totally confused and are concerned about the cost of seeing a doctor. If you have a problem that is not going away, then you should always start with your primary physician. A good history and physical exam should tell most physicians what is wrong and the treatment that will solve 90 percent or more of the problems without expensive intervention. If the problem does not resolve, then involving the next level of experts, tests and treatments may be necessary. Obtaining referrals, checking for authorizations and determining your copays and deductibles are now issues. Both your referring doctor and specialists can help explain the particular costs that may occur if you contact their business offices.

If you have insurance, the cost of your medical care is dependent on the insurance coverage, especially the amount each visit costs due to the deductible amount and copay required. Each insurance company sets a reimbursement rate for every conceivable medical service provided. The answer to how much anything will cost you can only come from a physician’s billing office and your insurance company. Unfortunately this is not a simple answer. If you ask a physician how much it will cost you, they will have no idea since they get paid at the whim of each and every insurance payer at different rates for the same services.