1. Learn deep breathing or meditation to help with chronic pain.
Deep breathing and meditation are techniques that help your body relax, which eases pain. Tension and tightness seep from muscles as they receive a quiet message to relax.
Although there are many to meditate, the soothing power of repetition is at the heart of some forms of meditation. Focusing on the breath, ignoring thoughts, and repeating a word or phrase -- a mantra -- causes the body to relax. While you can learn meditation on your own, it helps to take a class.
Recommended Related to Pain Management
Chronic Pain: Does Vitamin D Help?
Not getting enough vitamin D in your system may be linked to chronic pain. Over the past 10 years, several researchers have found an association between extremely low vitamin D levels and chronic, general pain that doesn’t respond to treatment. Many Americans are running low on vitamin D. A study published in the Archives of Internal Medicine in 2009 showed that vitamin D levels have plummeted among all U.S. ages, races, and ethnic groups over the past two decades. But does not having enough vitamin...
Deep breathing is also a relaxation technique. Find a quiet location, a comfortable body position, and block out distracting thoughts. Then, imagine a spot just below your navel. Breathe into that spot, filling your abdomen with air. Let the air fill you from the abdomen up, then let it out, like deflating a balloon.
2. Reduce stress in your life. Stress intensifies chronic pain.
Negative feelings like depression, anxiety, stress, and anger can increase the body's sensitivity to pain. By learning to take control of stress, you may find some relief from chronic pain.
Several techniques can help reduce stress and promote relaxation. Listening to soothing, calming music can lift your mood -- and make living with chronic pain more bearable. There are even specially designed relaxation tapes or CDs for this. Mental imagery relaxation (also called guided imagery) is a form of mental escape that can help you feel peaceful. It involves creating calming, peaceful images in your mind. Progressive muscle relaxation is another technique that promotes relaxation.
3. Boost chronic pain relief with the natural endorphins from exercise.
Endorphins are brain chemicals that help improve your mood while also blocking pain signals. Exercise has another pain-reducing effect -- it strengthens muscles, helping prevent re-injury and further pain. Plus, exercise can help keep your weight down, reduce heart disease risk, and control blood sugar levels -- especially important if you have diabetes. Ask your doctor for an exercise routine that is right for you. If you have certain health conditions, like diabetic neuropathy, you will need to be careful about the types of activities you engage in; your doctor can advise you on the best physical activities for you.
4. Cut back on alcohol, which can worsen sleep problems.
Pain makes sleep difficult, and alcohol can make sleep problems worse. If you're living with chronic pain, drinking less or no alcohol can improve your quality of life.
5. Join a support group. Meet others living with chronic pain.
When you're with people who have chronic pain and understand what you're going through, you feel less alone. You also benefit from their wisdom in coping with the pain.
Also, consider meeting with a mental health professional. Anyone can develop depression if they're living with chronic pain. Getting counseling can help you learn to cope better and help you avoid negative thoughts that make pain worse -- so you have a healthier attitude. Asking for help is a sign of strength, not weakness.
6. Don't smoke. It can worsen chronic pain.
Smoking can worsen painful circulation problems and increase risk of heart disease and cancer.
7. Track your pain level and activities every day.
To effectively treat your pain, your doctor needs to know how you've been feeling between visits. Keeping a log or journal of your daily "pain score" will help you track your pain. At the end of each day, note your pain level on the 1 to 10 pain scale. Also, note what activities you did that day. Take this log book to every doctor visit -- to give your doctor a good understanding of how you're living with chronic pain and your physical functioning level.
My link to free pain diary:
http://www.docstoc.com/docs/30680755/Pain-Diary-Worksheet
And a second one:
http://www.painknowledge.org/physiciantools/PALogB698/PainandActivityLog_B698_FINAL.pdf
8. Learn biofeedback to decrease pain severity.
Through biofeedback, it's possible to consciously control various body functions. It may sound like science fiction, but there is good evidence that biofeedback works -- and that it's not hard to master.
Here's how it works: You wear sensors that let you "hear" or "see" certain bodily functions like pulse, digestion, body temperature, and muscle tension. The squiggly lines and/or beeps on the attached monitors reflect what's going on inside your body. Then you learn to control those squiggles and beeps. After a few sessions, your mind has trained your biological system to learn the skills.
9. Get a massage for chronic pain relief.
Massage can help reduce stress and relieve tension -- and is being used by people living with all sorts of chronic pain, including back and neck pain.
10. Eat a healthy diet if you're living with chronic pain.
A well-balanced diet is important in many ways -- aiding your digestive process, reducing heart disease risk, keeping weight under control, and improving blood sugar levels. To eat a low-fat, low-sodium diet, choose from these: fresh fruits and vegetables; cooked dried beans and peas; whole-grain breads and cereals; low-fat cheese, milk, and yogurt; and lean meats.
11. Find ways to distract yourself from pain so you enjoy life more.
When you focus on pain, it makes it worse rather than better. Instead, find something you like doing -- an activity that keeps you busy and thinking about things besides your pain. You might not be able to avoid pain, but you can take control of your life.
http://www.webmd.com/pain-management/11-tips-for-living-with-chronic-pain
Showing posts with label info. Show all posts
Showing posts with label info. Show all posts
Monday, January 23, 2012
Monday, August 23, 2010
Fibromyalgia Syndrome An Informational Guide for FM Patients, Their Families, Friends and Employers
Fibromyalgia syndrome (FM) is a complex, chronic condition of widespread muscular pain and fatigue. Research shows that about 2 percent of all adults in the US have fibromyalgia (3.5 percent of women, 0.5 percent of men). In total numbers, that means that more than 6 million, and possibly as many as 11 million Americans meet the criteria for fibromyalgia. It affects women more than men in an approximate ratio of 9:1. It is seen in all age groups from young children through old age, although for most patients the problem begins between their 20s and 50s. Studies have shown that FMS occurs worldwide and has no specific ethnic predisposition.
Symptoms and Diagnosis
Patients with FM report widespread musculoskeletal pain (100 percent), fatigue (96 to 100 percent) and disturbed sleep (86 to 98 percent). In 1990, the American College of Rheumatology accepted a research diagnosis of fibromyalgia that includes chronic, widespread pain and tenderness in 11 of 18 specific points on the body. Fatigue, sleep disturbances, restless legs and leg cramps, impaired memory and concentration, nervousness, depression, disorientation, headaches, irritable bowel and bladder, premenstrual syndrome, and cold intolerance are some of the symptoms associated with fibromyalgia. Other conditions which may overlap with fibromyalgia include: chronic fatigue syndrome, depression, Lupus erythematosus, rheumatoid arthritis, Lyme disease, and neurological conditions such as cervical myelopathy, small posterior fossa and Chiari I Malformation. These conditions are termed co-morbidities and may also have been the trigger for fibromyalgia. Fibromyalgia is not life threatening, but there are a number of other conditions that are associated which can be life threatening.
There is no definitive blood test or x-ray to determine the diagnosis of fibromyalgia. This initially led doctors to believe that fibromyalgia is “all in the patients’ head.” Extensive studies now show that fibromyalgia has a physiologic basis most likely mediated by the central nervous system. Tender points are sensitive to touch and pressure. Fibromyalgia patients report allodynia (a condition when normally non-painful stimuli is painful) and hyperalgesia (extreme sensitivity to painful stimuli). Functional MRI testing shows that fibromyalgia patients’ brains do in fact respond differently to painful stimuli. Musculoskeletal pain and fatigue is a chronic problem and can wax and wan in the patient. There is no generally accepted cure for fibromyalgia and most patients can expect to have this problem lifelong. Treatment can reduce the severity of symptoms and help patients to lead a more normal life.
Treatment
Each person with fibromyalgia has come to the diagnosis through a different path and has a different set of symptoms. The best treatment program for each patient will include many components. For that reason, a multidisciplinary approach has been shown to be the most effective. There are also many things a person with fibromyalgia can do to improve the quality of their lives. Becoming educated about fibromyalgia is a first step. Education by both the physician and patient will decrease the frustration felt by both parties and help improve the odds of successful treatment.
Sleep
It is important for the physician to determine if the patient has problems with sleep. Some of these disturbances include sleep apnea, restless legs syndrome, periodic limb movements and teeth grinding, among other disorders that affect specific stages of sleep. Physicians may request a full sleep study to determine if a patient has a specific sleep problem, and to help determine the best medication for the patient’s condition. Patients need to be sure they are doing everything they can to improve their sleep. Learning about good sleep hygiene, and the actions they can take to improve their sleep, is one of the most important ways a patient can take control of their chronic illness.
Exercise
People with fibromyalgia frequently become deconditioned and lose muscle tone because even normal activities seem painful. Increasing appropriate daily activities can be beneficial for the person with fibromyalgia. Research has shown that eccentric exercises (using muscles that are both contracted and lengthening like in vacuuming) are especially hard on people with FM. However, most activities can be modified. Patients can take smaller steps when walking down hill and walk forward with the vacuum cleaner instead of pushing it out and in all with arm movements. One way to think about how to modify activities is for the person with FM to imagine they have a hoop skirt around their neck. All their arm motions should stay within the confines of the imaginary skirt. As the person with FM increases daily activities, efforts should be made to add a regular exercise and stretching routine. Regular walking, the use of a stationary bicycle, and swimming or other low impact type of activity can be beneficial to FM patients. Supervision by a physical therapist or an exercise physiologist can be of benefit. The researchers at the Oregon Health and Science University have made wonderful materials on exercise available at the Fibromyalgia Information Foundation website, www.myalgia.com. It is okay to start slow—even one or two minutes a couple of times a day can begin to improve the conditioning of a person with FM.
Medications
Over the counter drugs like Advil and Tylenol are not particularly effective in fibromyalgia. Their greatest help may come in decreasing the pain of co-morbid conditions like arthritis. In June 2007, Lyrica (pregabalin) was the first medication to receive a listing for fibromyalgia from the FDA. Other medications may be listed by the FDA in the coming months. However, no medication works for all patients or for all symptoms. Caring physicians will use Lyrica and other medications that have been researched in fibromyalgia to improve livability for people with fibromyalgia. Tricyclic antidepressants such as Desyrel, Elavil, Flexeril, Pamelor, and Sinequan can help with both pain and sleep because depression and pain share similar pathways in the brain. Generally, in people with fibromyalgia these medications are prescribed at levels below where they are indicated for depression. Medications that affect the neurotransmitters serotonin, norepinephrine and dopamine are Paxil, Prozac, Zoloft, Effexor, Mirapex, and Cymbalta are frequently effective. Some patients find relief of fibromyalgia symptoms and co-morbidities with anti-anxiety medications such as Xanax and Klonopin or muscle relaxant medications such as Norflex, Flexeril and Zanaflex. Anti-convulsant medications such as Neurontin and Topomax also provide relief for many patients. Narcotic painkillers are used effectively by many physicians for the pain of fibromyalgia. However, other physicians have avoided narcotics for fear of addiction. Recent research shows that addiction seldom occurs when these medications are used in chronic pain states. It is important to understand the difference between addiction and dependence.
There is no single medication that will relieve all of the symptoms associated with fibromyalgia. Physicians must work closely with their patients to find the right combination of medications that most improve the patient’s symptoms while minimizing the negative side effects that come with each medication.
Myofascial Trigger Points
Research studies indicate that up to 68% of persons with fibromyalgia also have myofasical trigger points. It is unclear if these are co-morbid conditions or triggers to the pain of fibromyalgia. Trigger points are different from tender points in that they are taut muscle bands that feel like a knot or lump underneath the skin. There is pain when they are pressed on that can radiate to other areas of the body. Tender points are sensitive to pressure and are part of a diffuse body wide condition. Treating the trigger points can help to reduce fibromyalgia pain. Treatment may include injecting the trigger point with Procaine and then stretching the affected area in a technique called spray and stretch. The injection can be quite painful and there is typically a two to four day period before the effects are noticed. Dry needling has also been effective when utilizing an acupuncture needle and inserting it into the trigger point which allows the muscle to relax and lengthen. Other techniques that may be helpful are heat, massage, and gentle stretching.
Depression
About 20 percent of people with fibromyalgia have a co-existing depression or anxiety state which needs to be appropriately treated with therapeutic doses of anti-depressants or anti-anxiety medications, often in conjunction with the help of a clinical psychologist or psychiatrist. Patients who have a concomitant psychiatric problem have a double burden to bear. They will find it easier to cope with their fibromyalgia symptoms if their psychiatric condition is appropriately treated. It is important to understand FM itself is not a psychogenic pain problem and that treatment of any underlying psychological problem will not cure the fibromyalgia.
Balancing Daily Activities
Most FM patients quickly learn there are certain things they do on a daily basis that seem to make their pain worse. These actions usually involve the repetitive use of muscles or prolonged tensing of a muscle, such as the muscles of the upper back while looking at a computer screen. Careful detective work is required by the patient to note these associations and where possible to modify or eliminate them. Pacing of activities is important; we recommend patients use a stopwatch that beeps every 20 minutes. Whatever they are doing at that time should be stopped and a minute taken to do something else—possibly stretching. Patients who are involved in fairly vigorous manual occupations often need to have their work environment modified and may need to be retrained in a completely different job. Certain people are so severely affected that consideration must be given to some form of monetary disability assistance. This decision requires careful consideration, as disability can cause adverse financial consequences as well as loss of self-esteem. In general, doctors are reluctant to declare FM patients disabled and most FM applicants are automatically turned down by the Social Security Administration. Each patient needs to be evaluated on an individual basis before any recommendation for or against disability is made.
Complementary and Alternative Therapies
There are many therapies that fall in this general category that may prove to be effective for people with fibromyalgia. Postural training, occupational therapy and relaxation therapy can help in improving body mechanics and decreasing pain instigators. Acupuncture, hypnosis and cognitive/behavioral therapy have been studied in chronic pain states such as fibromyalgia. Research is still limited, but it appears promising and these treatments may be helpful when included in a comprehensive pain management program. Nutritional therapy such as vitamin and mineral supplements can help with stress and supporting the immune system. While there is no specific fibromyalgia diet, people who suffer with fibromyalgia should work to improve the nutritional quality of the foods they eat and work with their physicians to ensure they are not suffering from conditions such as celiac disease or other treatable conditions that impact the digestive system.
Symptoms and Diagnosis
Patients with FM report widespread musculoskeletal pain (100 percent), fatigue (96 to 100 percent) and disturbed sleep (86 to 98 percent). In 1990, the American College of Rheumatology accepted a research diagnosis of fibromyalgia that includes chronic, widespread pain and tenderness in 11 of 18 specific points on the body. Fatigue, sleep disturbances, restless legs and leg cramps, impaired memory and concentration, nervousness, depression, disorientation, headaches, irritable bowel and bladder, premenstrual syndrome, and cold intolerance are some of the symptoms associated with fibromyalgia. Other conditions which may overlap with fibromyalgia include: chronic fatigue syndrome, depression, Lupus erythematosus, rheumatoid arthritis, Lyme disease, and neurological conditions such as cervical myelopathy, small posterior fossa and Chiari I Malformation. These conditions are termed co-morbidities and may also have been the trigger for fibromyalgia. Fibromyalgia is not life threatening, but there are a number of other conditions that are associated which can be life threatening.
There is no definitive blood test or x-ray to determine the diagnosis of fibromyalgia. This initially led doctors to believe that fibromyalgia is “all in the patients’ head.” Extensive studies now show that fibromyalgia has a physiologic basis most likely mediated by the central nervous system. Tender points are sensitive to touch and pressure. Fibromyalgia patients report allodynia (a condition when normally non-painful stimuli is painful) and hyperalgesia (extreme sensitivity to painful stimuli). Functional MRI testing shows that fibromyalgia patients’ brains do in fact respond differently to painful stimuli. Musculoskeletal pain and fatigue is a chronic problem and can wax and wan in the patient. There is no generally accepted cure for fibromyalgia and most patients can expect to have this problem lifelong. Treatment can reduce the severity of symptoms and help patients to lead a more normal life.
Treatment
Each person with fibromyalgia has come to the diagnosis through a different path and has a different set of symptoms. The best treatment program for each patient will include many components. For that reason, a multidisciplinary approach has been shown to be the most effective. There are also many things a person with fibromyalgia can do to improve the quality of their lives. Becoming educated about fibromyalgia is a first step. Education by both the physician and patient will decrease the frustration felt by both parties and help improve the odds of successful treatment.
Sleep
It is important for the physician to determine if the patient has problems with sleep. Some of these disturbances include sleep apnea, restless legs syndrome, periodic limb movements and teeth grinding, among other disorders that affect specific stages of sleep. Physicians may request a full sleep study to determine if a patient has a specific sleep problem, and to help determine the best medication for the patient’s condition. Patients need to be sure they are doing everything they can to improve their sleep. Learning about good sleep hygiene, and the actions they can take to improve their sleep, is one of the most important ways a patient can take control of their chronic illness.
Exercise
People with fibromyalgia frequently become deconditioned and lose muscle tone because even normal activities seem painful. Increasing appropriate daily activities can be beneficial for the person with fibromyalgia. Research has shown that eccentric exercises (using muscles that are both contracted and lengthening like in vacuuming) are especially hard on people with FM. However, most activities can be modified. Patients can take smaller steps when walking down hill and walk forward with the vacuum cleaner instead of pushing it out and in all with arm movements. One way to think about how to modify activities is for the person with FM to imagine they have a hoop skirt around their neck. All their arm motions should stay within the confines of the imaginary skirt. As the person with FM increases daily activities, efforts should be made to add a regular exercise and stretching routine. Regular walking, the use of a stationary bicycle, and swimming or other low impact type of activity can be beneficial to FM patients. Supervision by a physical therapist or an exercise physiologist can be of benefit. The researchers at the Oregon Health and Science University have made wonderful materials on exercise available at the Fibromyalgia Information Foundation website, www.myalgia.com. It is okay to start slow—even one or two minutes a couple of times a day can begin to improve the conditioning of a person with FM.
Medications
Over the counter drugs like Advil and Tylenol are not particularly effective in fibromyalgia. Their greatest help may come in decreasing the pain of co-morbid conditions like arthritis. In June 2007, Lyrica (pregabalin) was the first medication to receive a listing for fibromyalgia from the FDA. Other medications may be listed by the FDA in the coming months. However, no medication works for all patients or for all symptoms. Caring physicians will use Lyrica and other medications that have been researched in fibromyalgia to improve livability for people with fibromyalgia. Tricyclic antidepressants such as Desyrel, Elavil, Flexeril, Pamelor, and Sinequan can help with both pain and sleep because depression and pain share similar pathways in the brain. Generally, in people with fibromyalgia these medications are prescribed at levels below where they are indicated for depression. Medications that affect the neurotransmitters serotonin, norepinephrine and dopamine are Paxil, Prozac, Zoloft, Effexor, Mirapex, and Cymbalta are frequently effective. Some patients find relief of fibromyalgia symptoms and co-morbidities with anti-anxiety medications such as Xanax and Klonopin or muscle relaxant medications such as Norflex, Flexeril and Zanaflex. Anti-convulsant medications such as Neurontin and Topomax also provide relief for many patients. Narcotic painkillers are used effectively by many physicians for the pain of fibromyalgia. However, other physicians have avoided narcotics for fear of addiction. Recent research shows that addiction seldom occurs when these medications are used in chronic pain states. It is important to understand the difference between addiction and dependence.
There is no single medication that will relieve all of the symptoms associated with fibromyalgia. Physicians must work closely with their patients to find the right combination of medications that most improve the patient’s symptoms while minimizing the negative side effects that come with each medication.
Myofascial Trigger Points
Research studies indicate that up to 68% of persons with fibromyalgia also have myofasical trigger points. It is unclear if these are co-morbid conditions or triggers to the pain of fibromyalgia. Trigger points are different from tender points in that they are taut muscle bands that feel like a knot or lump underneath the skin. There is pain when they are pressed on that can radiate to other areas of the body. Tender points are sensitive to pressure and are part of a diffuse body wide condition. Treating the trigger points can help to reduce fibromyalgia pain. Treatment may include injecting the trigger point with Procaine and then stretching the affected area in a technique called spray and stretch. The injection can be quite painful and there is typically a two to four day period before the effects are noticed. Dry needling has also been effective when utilizing an acupuncture needle and inserting it into the trigger point which allows the muscle to relax and lengthen. Other techniques that may be helpful are heat, massage, and gentle stretching.
Depression
About 20 percent of people with fibromyalgia have a co-existing depression or anxiety state which needs to be appropriately treated with therapeutic doses of anti-depressants or anti-anxiety medications, often in conjunction with the help of a clinical psychologist or psychiatrist. Patients who have a concomitant psychiatric problem have a double burden to bear. They will find it easier to cope with their fibromyalgia symptoms if their psychiatric condition is appropriately treated. It is important to understand FM itself is not a psychogenic pain problem and that treatment of any underlying psychological problem will not cure the fibromyalgia.
Balancing Daily Activities
Most FM patients quickly learn there are certain things they do on a daily basis that seem to make their pain worse. These actions usually involve the repetitive use of muscles or prolonged tensing of a muscle, such as the muscles of the upper back while looking at a computer screen. Careful detective work is required by the patient to note these associations and where possible to modify or eliminate them. Pacing of activities is important; we recommend patients use a stopwatch that beeps every 20 minutes. Whatever they are doing at that time should be stopped and a minute taken to do something else—possibly stretching. Patients who are involved in fairly vigorous manual occupations often need to have their work environment modified and may need to be retrained in a completely different job. Certain people are so severely affected that consideration must be given to some form of monetary disability assistance. This decision requires careful consideration, as disability can cause adverse financial consequences as well as loss of self-esteem. In general, doctors are reluctant to declare FM patients disabled and most FM applicants are automatically turned down by the Social Security Administration. Each patient needs to be evaluated on an individual basis before any recommendation for or against disability is made.
Complementary and Alternative Therapies
There are many therapies that fall in this general category that may prove to be effective for people with fibromyalgia. Postural training, occupational therapy and relaxation therapy can help in improving body mechanics and decreasing pain instigators. Acupuncture, hypnosis and cognitive/behavioral therapy have been studied in chronic pain states such as fibromyalgia. Research is still limited, but it appears promising and these treatments may be helpful when included in a comprehensive pain management program. Nutritional therapy such as vitamin and mineral supplements can help with stress and supporting the immune system. While there is no specific fibromyalgia diet, people who suffer with fibromyalgia should work to improve the nutritional quality of the foods they eat and work with their physicians to ensure they are not suffering from conditions such as celiac disease or other treatable conditions that impact the digestive system.
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