This site provides resources for support group facilitator and others with chronic pain, as well as an area for communications and support. This site is not approved by ACPA management.
~It’s shortly after 4:00a.m. as I start this week’s Group message. Outside, the 58 degree temps under mostly cloudy/still dark skies blankets the sleeping neighborhood with a promise of pending rain. Barometric pressure is building.
For some of us, that building pressure can be felt in our bones/joints. For others, it’s the low pressures that trigger pain. Mystery, eh?
Remember Kewpie Dolls? Little plastic figurines on a pedestal, constructed of dozens of pieces of plastic held together by an elastic sting. Press the bottom of the pedestal, and the elastic string loses tension, making the figurine slump. With a bit of clever maneuvering of the base, you could make that figurine dance, contorting into a myriad number of poses.
Barometric pressure works in similar ways. High pressure maintains maximum tension on the body. No movement possible; all joints are locked into place. For some people, the extra bit of rigidity helps maintain just enough support for the body to maintain a feeling of being altogether together. Movement is easier, because all the bits-n-pieces are not knocking about, crashing into one another, pinching nerves.
For others, low pressure allows all the bits a greater range of motion. Bits-n-pieces of the body that had been tensed by high pressure can relax. The relief feels very similar to floating on a placid lake — no restrictions, nothing binding or squeezing against sensitive nerves.
I am a low-pressure lover. I love the rain that releases my body from tension. It’s the closest I ever get to pain-free living. As you can imagine, I pay attention to the weather forecasts and plan ahead as much as possible. I know that, when the barometric pressure starts rising, I need to get as much physical/mental work done in advance as possible, for when it peaks, I’ll be incapacitated. Likewise, when rain is in the forecast, I can make a list of things to do when I’ll feel at my best performance level, during the downfall.
Environment does indeed determine our behavior! Knowing what conditions will enhance as well as impinge upon physical performance is a worthy ‘tool’ to have in our Tool Box for pain management. When others better understand our fluctuations, they are better able to gauge expectations.
Having grown up on a farm in the foothills of N.C., weather conditions were important factors in determining what we needed to do. Gathering fresh bedding for the livestock, for instance, required knowledge of when leaves/pine straw would be at peak dryness. Knowing when sustained freezing temperatures would arrive set the calendar for slaughtering time. Planting and harvesting were not determined by the social calendar or our inner willingness, but by weather conditions, phases of moon, timing of seasons. All played a role in our daily chores, and in how well we did them.
In our modern climate-controlled, mostly-indoor lifestyles, we are too often removed from the natural elements to remember our intimate connection with them. Thus, we have almost lost our ability to connect how we physically feel with the natural changes taking place in the greater outdoors. We can, if we are willing, get better acquainted with our kewpie-doll self simply by paying greater attention to what conditions in the environment help and hinder our physical well-being.
I have heard people state that rainy weather makes them feel “so depressed”. Hmmmm ~ as if that elastic tension that had held them up-right/up-beat had suddenly been released? All the bits-n-pieces … slumping, sliding, coming unglued? That’s a high-pressure lover!
We may not be able to cure or prevent what ails us. We’ll surely never be able to manipulate weather conditions that result in everyone being content/feeling great. But we can learn more about how to deal with our fluctuating pain levels by knowing our own connection to the environment. Pay attention; and, plan accordingly!
Similarly, our mental/emotional pain management is affected by external environmental factors. As we move forward into our third year of this pandemic, let’s continue to pay attention to what we can do as well as what we should not do within whatever environment we find ourselves in. Sometimes, the best we can do may not feel good. Sometimes, our best is not recognized by others as “good enough”. It will always be the best we can do.
kbarbow Design
We cannot control the weather. We cannot please everyone. Doing the right thing won’t always result in feeling good or gaining public accolades. No magic potions or wizard-wands or happily-ever-after. No one lives continually pain-free. We can, however, know more about our connection with environmental conditions and plan accordingly. Don’t like the weather? Wait a while — it’ll change!
How quickly the days melt from the calendar! And yet, how slowly we seem to be moving through this pandemic! The mirror of Time has two ‘faces’ … each with a muddled mind. I begin to speak/write/think in that language I once considered the
voice of “old folks”; the one that remembers how “I used to ___________ and not feel tired.” The mirror-mind of my Past is shocked by the mirror-mind of my Present.
Yes, I once worked 10 hours a day, 5 days a week, in constant motion/activity. That was me at 65. At 45, I could work alongside my husband in his field research projects, from sunrise to sunset, for 6 to 10 days at a time. At 25, I could work full time, take care of home chores and mother two young children.
My Present is alien. So too is this Present world; yet, even as I type the words, I realize that the Present is becoming “Past” more quickly than I could have imagined. The mirror of Time is blending perceptions, and I realize something that artists learn early on: Unless we are alert, aware, care-filled, that blending will result in “mud” … a dull, colorless, useless goop.
Emotional pain tends to ‘muddy’ our senses as it captures our full attention/energy, trapping perception in Time’s mirror of loss/grief/heartache or simply the grey-mud of endless waiting.
Only self can rescue self from that realm, for only self can remember … re-member: to put together again and again ad infinitum … . Re-member your own personal Path through brain-files where colors of Life thrive. We remember by way of telling our stories, and in that sharing we recreate Life’s colors of Joy, Laughter, Hope, Love.
My “color-therapy story” of re-membering for this week:
My sister Joyce babysat my older son (5 weeks short of his second birthday) during the time of giving birth to my younger son. The day newborn Orion and I arrived home, Joyce brought toddler Scott to meet his wee baby brother. Joyce had given Scott a doll-baby, using it as a method of introducing his young mind to the notion that a real baby would soon be part of his family. Scott stood by the bassinet, doll-baby in hand, gazing at his real-baby brother. At one point, he laid the doll-baby in the bassinet next to the real-baby.
“It’s time to go,” Joyce announced. Scott would stay with her for a few more days, giving me time to heal/regain energy. He turned toward her, reaching for her hand. “Get your baby,” she reminded him, meaning he doll-baby but he reached for the real-baby instead. In his mind, the doll-baby had served its purpose … a stand-in until the real thing arrived. What shared Joy we sisters felt as we witnessed Love blossoming into colorful bloom, as older brother accepted younger into his Life!
This week holds the date of Scott’s birthday. March 4th will mark the date of his death. Of all the pain I have endured in my lifetime, the loss of him remains my personal 10 on the “scale from 1 to 10” we often recite to our health-care personnel. It is emotional pain as well as physical/mental/spiritual. Only “color therapy” works to stop the gray-mud of loss from engulfing me.
And so, I highly recommend that you too try your own “color therapy” as you deal with whatever muddies your mind when you look into Time’s mirror. You have the resources (brain-files), and you have the means by which to share them (our Tribe!). Let’s start a “color therapy” campaign to stop this pandemic of emotional pain! We all could use a bit more color in our world, eh?
Mental illnesses are medical conditions involving changes in behavior, thinking or emotions that interfere with a person’s ability to do daily tasks or care for themselves. Common mental health disorders include anxiety disorders and mood disorders such as depression, schizophrenia and ADHD. Other disorders include autism, borderline personality disorder, disassociate disorders, eating disorders and obsessive compulsive disorder, also known as OCD.
People diagnosed with serious mental illness typically need a combination of medication and talk therapy to get better.FACTMore than 46 million Americans live with mental illness.
Mental illness isn’t the fault of the person diagnosed. It’s a medical problem, just like diabetes or heart disease, and it’s also common in the United States.
For some people, symptoms of poor mental health such as feeling lonely, being overwhelmed or worrying become more serious mental illnesses.
More than 46 million Americans live with mental illness, according to the National Institute of Mental Health. That’s about 1 in 5 Americans, and 1 in 24 has a serious illness.
The good news is that mental illness is highly treatable. For example, more than 80 percent of people with depression get better after treatment. As many as 90 percent of people with panic disorders get better, according to Mental Health America.
Anxiety Disorders
These disorders are marked by severe fear or dread associated with certain situations or objects. Patients have physical reactions to these objects and situations, including rapid heartbeat and sweating. They cannot control their responses. With anxiety disorders, these feelings do not go away and can get worse. They can interfere with things like job performance, school and relationships. These disorders include panic disorder, generalized anxiety disorder, phobias, obsessive-compulsive disorder and post-traumatic stress disorder, or PTSD.
Panic Disorder
Panic disorder is an anxiety disorder marked by panic attacks. Symptoms include fast heartbeat, chest pain, trouble breathing and dizziness. Patients with panic disorder often report intense feelings of terror or impending doom associated with attacks. These attacks can happen without warning. Fear of these attacks can control a person’s life, even making it difficult to leave the home.
Phobias
Phobias are irrational fears. For example, acrophobia is fear of heights and agoraphobia is fear of public places. Some people have social phobia or phobias involving tunnels, highway driving, water, animals or flying. Phobias can be treated with medication and therapy.
Post-Traumatic Stress Disorder
This happens to some people who experience or witness a terrifying or traumatic event, such as a war, a bad accident or rape. PTSD is marked by flashbacks, feeling alone, sleep disturbances and angry outbursts. People with PTSD may have uncontrollable thoughts and intrusive memories about the event, and may avoid specific places, objects or events that bring about memories of the trauma. PTSD is treated with medications and psychotherapy. The therapist may pursue various treatment techniques.
Mood Disorders
These disorders involve changes in mood or disturbances. These typically involve depression or elation, also known as mania. These disorders are highly treatable. They include major depression and bipolar disorder.
Depression
More than 17 million Americans had at least one major depressive episode in 2018, according to the Substance Abuse and Mental Health Services Administration (SAMHSA). Symptoms persist and interfere with normal life.Symptoms include:
Sadness
Loss of interest or pleasure in things the patient used to enjoy
Weight loss or gain
Sleeping troubles
Loss of energy
Feelings of worthlessness
Thoughts of death or suicide
Causes can be genetic, environmental or biochemical. Treatment options include antidepressant medications and talk therapy.
Bipolar Disorder
Formerly known as manic depression, bipolar disorder causes extreme emotional lows and highs in known as depression and mania. According to an article in JAMA, about 10 million adults and children in the U.S. have this condition.
While depression has symptoms of extreme sadness or worthlessness, mania manifests as extreme elation, jumpiness and overblown feelings of self-esteem.
A person will cycle back and forth between these moods. This cycling affects their ability to perform daily tasks. The length and severity of symptoms determines whether a person has bipolar I, bipolar II or cyclothymia.
People with bipolar I have severe symptoms of mania and depression. Those with bipolar II have more serious bouts of depression, but a lesser form of mania. People with cyclothymia have less severe symptoms of depression and mania, but symptoms are more chronic in nature.
Treating bipolar disorder can be tricky because traditional treatments for depression such as antidepressants can worsen symptoms of mania. The most effective treatment plans include atypical antipsychotics, mood stabilizers and psychotherapy.
Schizophrenia
Schizophrenia is a mental illness that affects a person’s emotions, behaviors, concentration and perception of reality. This disorder is rarer than depression or anxiety, but it can be crippling.
Symptoms of this disorder fall into three categories: positive, negative and cognitive.
Positive symptoms include movement disorders, hallucinations and delusions, or fixed false beliefs. Negative symptoms include reduced feelings of pleasure in life, reduced speaking and difficulty beginning activities. Cognitive symptoms include trouble paying attention, problems processing information and difficulty understanding information and using it.
The main treatments for schizophrenia are antipsychotics and psychotherapy. Coordinated specialty care combines psychotherapy, medication, case management education, family involvement and employment services to help people live better lives.
ADHD
People with ADHD, or attention-deficit/hyperactivity disorder, have symptoms of inattention, hyperactivity and impulsivity. ADHD is usually diagnosed in children, but adults can also have the disorder.
Symptoms of ADHD include trouble staying organized, trouble focusing on tasks, restlessness, forgetfulness, excessive talking or difficulty paying attention to instructions and conversations.
People with ADHD may also have co-occurring disorders such as anxiety, depression or autism spectrum disorder.
For younger children, the first line of therapy should be behavior therapy, according to the American Academy of Pediatrics. This therapy teaches children how to control symptoms by changing behaviors. It focuses on positive reinforcement of “good” behaviors and improves social skills. Other types of therapy for ADHD are cognitive behavior therapy and parental skills training.
The typical medications for ADHD are called stimulants. These include drugs such as Adderall (amphetamine) and Ritalin (methylphenidate). But these should be used with caution because they are controlled substances and can be habit-forming.
Warning Signs of Mental Health Disorders
Major mental illness rarely appears without warning. In the early stages before a disorder is recognized, friends and family members may start to notice small changes. They may feel something is not right about their loved one’s thinking, feelings or behavior.According to the American Psychiatric Association, warning signs may include:
Social withdrawal or loss of interest in others
Drop in functioning at school, work or social activities
Thinking problems, which can involve concentration, memory or logical thought and speech
Increased sensitivity to sights, sounds, smells or touch
Lack of initiative or interest for involvement in activities
Feeling disconnected from oneself or one’s surroundings
Illogical thinking, including exaggerated beliefs about personal abilities to understand meanings or influence events
Nervousness or fear or suspicion of others
Unusual or peculiar behavior
Sleep, appetite or mood changes
If a person displays several of these symptoms at once, and if the symptoms are interfering with the person’s life, he or she should visit a mental health professional.
Risks and Causes
A person’s character flaws are not causes of mental illness, and being “weak” or “lazy” has nothing to do with them, according to the U.S. National Library of Medicine. Researchers don’t know exactly what causes mental illness, but they think it is a combination of factors.Risk factors and causes of mental illness include:
Alcohol or substance abuse
Chemical imbalances in the brain and other biological issues
Exposure to toxic chemicals or viruses in the womb
Genes and family history
Having cancer or other serious medical condition
Injury to the brain
Social isolation
Stress or a history of abuse and other negative life experiences, especially if they happen in childhood
Can Medication Cause Mental Illness?
While medications don’t typically cause mental illness, some drugs may cause psychiatric symptoms. This is especially true if a person suddenly develops psychiatric symptoms without a prior history.
Always tell your health care provider about all prescription, over-the-counter and illicit drugs you are taking.Psychiatric Symptoms Potentially Caused by MedicationsAgitation and PsychosisAnabolic androgenic steroids, Benadryl and other antihistamines, prednisone and other corticosteroids, agitation decongestants, Zantac (ranitidine) and other H2 blockers, NSAIDs, opioids, proton pump inhibitors, fluoroquinolones, skeletal muscle relaxantsAnxietyAnabolic androgenic steroids, prednisone and other corticosteroids, decongestants, ondansetron, penicillin, muscle relaxers, cyclosporine, acyclovir, didanosine, sumatriptanDepressionAnabolic androgenic steroids, beta blockers, prednisone and other corticosteroids, Zantac (ranitidine) and other H2 blockers, statins, tetracyclines, digoxin, efavirenz, isotretinoin, NSAIDs, fluoroquinolonesDelirumAntibiotics, NSAIDs, anabolic androgenic steroids, ACE inhibitors, beta blockers, opioids, prednisone and other corticosteroids, Zantac (ranitidine) and other H2 blockers, centrally acting blood pressure medications such as methyldopa and reserpine, lidocaineZANTAC SIDE EFFECTSRare cases of mental confusion, depression, agitation and hallucinations have been reported by patients taking Zantac. Read more about this drug’s serious side effects.VIEW SIDE EFFECTS
Treating Mental Illness
Most mental illness can be treated in an effective way, especially with early diagnosis. Treatment options include psychotherapy, medication and learning skills to manage symptoms.
With effective treatment, people with mental illness can live better, productive lives. Treatment plans are tailored to the individual patient, because people react to therapy and medication differently.
Psychotherapy
Also called talk therapy, psychotherapy is the best option for some patients. There are a number of psychotherapy techniques to help patients identify and modify thoughts, behavior and emotions with the help of a trained and licensed professional.
The two most popular forms of psychotherapy are psychodynamic therapy and cognitive behavioral therapy, according to Harvard Medical School.
PSYCHODYNAMIC THERAPY
Psychodynamic therapy focuses on how current and past relationships, life events and desires affect the choices you make and how you feel. The theory is that people create thought patterns and behaviors to protect themselves from traumatic experiences or external threats. A therapist can help people identify these thought patterns and behaviors and help develop strategies to cope with and overcome them.
For example, someone with overbearing parents may have difficulty developing intimate relationships because they are afraid of being controlled.
This type of therapy can also help improve social interaction. A type of psychodynamic therapy called interpersonal therapy blends psychodynamic and cognitive behavior therapy to help people deal with relationships and teach better ways to communicate with others.
COGNITIVE BEHAVIOR THERAPY (CBT)
In contrast to psychodynamic therapy, cognitive behavior therapy (CBT) focuses less on feelings. Instead, it teaches people how to recognize behavior and thought patterns that are causing problems. Then, it teaches techniques to change these patterns. The theory is that people can change feelings by changing thoughts and actions.
People have used CBT to treat smoking, phobias, procrastination and help symptoms of depression and anxiety.
For example, people may have distorted thinking patterns such as always thinking the worst, excessive guilt or self-criticism or thinking people view them negatively. CBT therapists help people recognize these patterns and change them.
CBT helps people develop more positive and productive responses to distress such as breathing deeply to relax instead of hyperventilating during stressful situations.NEED HELP FINDING A THERAPIST?The National Alliance on Mental Illness has information on different types of therapists and how to find one. Call the NAMI helpline at 800-950-NAMI or text “NAMI” to 741741 for help in a crisis.
Prescription Drugs
There are a number of prescription drugs to treat mental illness. According to a 2017 research letter published in the journal JAMA Internal Medicine, one in six Americans took a psychiatric medicine in 2013.
Often, health care providers will use medication as the first line of therapy for mental illness. But people should ask their health care providers if psychotherapy might be effective enough without medication.
Depending on the type of mental illness, health care providers may prescribe a specific type of drug. Because people respond to medications differently, finding the proper medication and dosage is often a trial-and-error process. Sometimes a health care provider may prescribe more than one medication.
It’s important for people to be patient and communicate their feelings and if they have experience side effects to their health care provider. Each drug has its own side effects and the patient and health care provider need to weight the risks and benefits of each medication.
Some medications for mental illness can be habit-forming. These include stimulants and benzodiazepines. Benzodiazepines are considered problematic for long-term use and are no longer recommended as the first line of treatment for anxiety.
MEDICATIONS FOR DEPRESSION AND ANXIETY
Medications for anxiety and depression are similar. These drugs are designed to balance some of the natural chemicals in the brain. Classes of antidepressants include selective serotonin reuptake inhibitors, monoamine oxidase inhibitors, atypical antidepressants and tricyclic antidepressants. SSRIs are the most popular type. They work by increasing the level of serotonin in the brain. Serotonin plays a role in mood.Common Medications for Depression and Anxiety
MEDICATIONS FOR BIPOLAR DISORDER AND SCHIZOPHRENIA
Medications for bipolar and schizophrenia are called antipsychotics. Antipsychotics are used to treat conditions that involve psychosis. Psychosis involves a disconnection with reality. These drugs relieve symptoms but are not cures.
Older antipsychotics are referred to as typical antipsychotics or neuroleptics. Newer antipsychotics are called atypical antipsychotics.
Both types of antipsychotics work to treat symptoms of schizophrenia and mania. Long-term use of older antipsychotics may cause a potentially incurable nerve condition called tardive dyskinesia. This condition involves uncontrolled muscle movements, often around the mouth.
Drugs called mood stabilizers are used to treat bipolar disorders and mood swings. Lithium is a well-known mood stabilizer. The U.S. Food and Drug Administration has approved it for treatment of mania and bipolar disorder. Mood stabilizers work by decreasing abnormal activity in the brain.Atypical Antipsychotics for Bipolar Disorder or Schizophrenia
RISPERDAL SIDE EFFECT INFORMATIONRisperdal caused a host of common side effects in clinical trials, including increased appetite, upper respiratory tract infection, vomiting and rash. Learn more about Risperdal’s side effects.VIEW SIDE EFFECTSTypical Antipsychotics for Schizophrenia
Experts advise that doctors should prescribe these medications at the lowest effective dose. They should continue to monitor their patients to determine whether the drugs are still needed. Researchers have found many patients are given long-term prescriptions for drugs that are recommended only for short-term use. Doctors and patients should work together on safely discontinuing drugs. Suddenly halting a psychiatric drug can be dangerous.FACTPrescription psychiatric drugs should be given at the lowest dose that will be effective.
Patients should also discuss possible interactions with other medications and supplements, as well as food. They should avoid mixing prescription drugs with alcohol and other substances.
Sometimes, a doctor may prescribe a medication for a use other than what is approved by the FDA. This is known as off-label prescribing. Patients should inquire if their drugs are being given for approved uses. If not, the doctor and patient should be clear about the limits of the research supporting the prescription in the patient’s circumstances.
Also, when patients take generic medications, they should realize they are not exactly the same as the name-brand drug. They may have different inactive ingredients, such as fillers and binders. However, generic drugs are required to have the same active ingredient, strength, route of administration and dosage form as name-brand drugs, and must be manufactured under the same strict standards.
Side Effects from Drugs to Treat Mental Illness
Medications used to treat mental illness are linked to a number of unpleasant side effects. They can make it difficult for patients to maintain employment or stay in school. Expected side effects vary depending on the class of medication used.Common side effects include:
Sleepiness
Nightmares
Dizziness
Drowsiness
Dry mouth
Nervousness
Headaches
Shakiness
Confusion
Weight gain
Nausea, diarrhea or stomach upset
Sexual problems
Other Treatments
In addition to prescription drugs, patients have the option of exploring other kinds of treatments. These include brain stimulation and complementary or alternative medicine.
Examples of complementary treatments suggested by the National Alliance on Mental Illness include herbs and supplements and exercise, including yoga. These treatments may be helpful, but NAMI stresses that the FDA does not review or approve many of these treatments.
The government agency that oversees these therapies is the National Center for Complementary and Integrative Health. People can visit this website to see what the current science says about the effectiveness for a particular complementary therapy.
Brain Stimulation
Brain stimulation involves using electricity to directly activate or inhibit brain activity. This can involve electrodes implanted in the brain or placed on the scalp. Magnetic fields can also be applied to the head.
These therapies can be helpful for patients who have mental disorders that don’t respond to other kinds of treatment. The most commonly used of these is electroconvulsive therapy or ECT — once called electroshock therapy. ECT is used to treat severe depression that has not responded to other therapy. It also may be useful in cases of bipolar disorder or schizophrenia. ECT involves the use of electrodes placed on the head of a patient under anesthesia. They pass electric current through the brain.
Research has found that ECT shows results more quickly than other forms of treatment.
Herbs and Supplements
Various herbs and supplements are used to treat different mental health conditions. For example, omega-3 fatty acids may help decrease the risk of developing chronic schizophrenia in young people who have had a psychotic episode. Folic acid or vitamin B9 may be useful in the treatment of depression and schizophrenia.
Exercise, Yoga and Meditation
FACTExercise can relieve mental illness and reduce some side effects from psychiatric medications.
Mind and body treatment options include yoga, exercise, meditation and Tai chi. These activities can improve mood and relieve anxiety and other symptoms of mental illness.
Exercise can also reduce side effects of many conventional psychiatric medicines, such as weight gain and fatigue. Research has found evidence that these activities may reduce symptoms of depression and anxiety.
Experts theorize that yoga, for example, may affect brain chemicals called neurotransmitters, boosting levels of chemicals like serotonin that make people feel good. The exercise may also reduce inflammation and have a positive effect on lipids in the body.
Meditation involves sitting in a quiet place, focusing on breathing or a specially chosen word, and letting distractions come and go without judgment. According to the National Center for Complementary and Integrative Medicine, some research suggests that meditation may reduce symptoms of anxiety, depression and insomnia. Please seek the advice of a medical professional before making health care decisions.SHARE THIS PAGE:
Wow! Sixty-five degrees at 2:25a.m. on the 17th day of December! or ? Or is this just another “is” in a long list of things we need to adjust to?
Speaking of adjustments, the process of adjusting to changes/challenges can be made a little easier by developing a flow chart — either starting with the challenge and working forward to the present, or starting with the present and working backwards to the source. For example: Working backwards to the source of my current back-pain challenge, my flow chart looks something like this —
Age-related mild osteoporosis. Thus, bones shift, pulling muscles/tendons/ligaments into abnormal alignment; which pinches a wide range of nerves, producing pain. NOTE: this is a normal reaction to the abnormal development (yet, osteoporosis is a natural and normal part of aging; more so for some than others.
A normal reaction to a normal condition.
Congenital cardiomyopathy. The condition has been well-tolerated up until recently. Throughout life, it has impeded my ability to do strenuous exercises/sports, and has on rare occasion caused spontaneous fainting. My inheritance of this condition is biologically normal. Just as is the inheritance of eye color and other traits passed along the DNA chain of command.
All of which is NORMAL. My lab tests/physical exams/etc. show that I am within normal limits of organ functions — normal, despite the age-related decrease in bone density/muscle placement/nerve compression … and those three areas are reacting in a NORMAL fashion to the challenges being put upon them by the NORMAL progression of living day-to-day.
What we often fail to realize is that seemingly convoluted meaning of “normal”. If you get cut/scratched, it is NORMAL for your body to bleed. If you suffer with a congenital condition of hemophilia, the NORMAL reaction to the injury would be that you don’t stop bleeding. What is normal for each of us depends on that flow chart of how our DNA expresses itself/makes “me” ME. With all the myriad things that others label as “wrong; defect; flaw; problem…”.
My “normal” is not your “normal”. Nor should it be; otherwise, we might as well be cloned or be robots.
Where we fail ourselves and others, and where the medical community has been hijacked by the Business Model lies in the misinterpretation of words/terms/phrases/diagnoses.
What we want NORMAL to be is “perfect; no flaws; no challenges; no mistakes; no degeneration or restriction”. When did NORMAL life ever unfold without challenges/adjustments/individuality/uniqueness?
It is NORMAL for me (and only me, because no one else is exactly like me) to avoid strenuous exercise, due to the limited ability of my heart to work perfectly all the time. Challenge me to a foot-race and you’ve wasted both your and my time/energy. If a bear starts chasing us, you have my permission to leave me at the “bait”. Save yourself! You have my permission to run forth-n-prosper!
It is NORMAL for me to faint if I try to push my body beyond its ability. It is NORMAL for my muscles to change position as osteoporosis decreases my ability to maintain proper posture. It is NORMAL for nerves to be pinched by muscles that shift/cramp/spasm.
This is my normal life, folks! I’m in the process of adjusting to all the challenges that my Life Path has brought me to. I have not conquered nor fully resolved any of them, for that is an end-of-life achievement. Growing old is a privilege. It’s not for sissies, and believe me when I say that I’m not now nor ever have been a “delicate flower” at any age. I cannot fight against the NORMALs that Life has given me to face. I can, however, learn how to better adjust to all the NORMALs that are inevitable.
After three months of dealing with back-pain on an almost continuous basis, I’m happy to report measurable progress in my recovery plan! Until this past week, I had been “living” primarily in my recliner, only venturing forth on the pain-filled journey to the bathroom and back again. Some of those journeys were merely taxing; some were horrors. “Down time” allows much opportunity for thinking (“cogitating” as my dad would say). Knowing that I have adverse reactions to manufactured steroids, I wondered if perhaps too I could be ultra-sensitive to my own adrenaline/stress hormones (natural steroids). To test my hypothesis, I took a single capsule of 25mg Benadryl, and paid attention to the results.
Yes! By reducing the allergic reaction to my natural (normal) steroids, inflammation decreased and my mood/internal dialogue improved. By charting my own flow-chart of how I got from There to Here, I could see more clearly how to better manage my physical/emotional/mental/spiritual pain. My recent blood-panel results are proof that my self-care regimen is working.
I am again able to sit upright at my desk with very little pain/discomfort, and only intermittent bouts of muscle spasm/cramping. (They are trying to remember their job, bless ’em!) Not for long periods, of course, for muscles have grown weaker from lack of exercise, and cannot adjust to their new positions/textures. Measurable progress, however, remains a blessing! Hallelujah!
Not yet able to pull those 10-hour days of steady work/activity. Those days may be and likely are behind me. If so, I will adjust. Just for now, it is “good enough” to sit at my desk sometimes … to sleep more often in my own bed and only sometimes in my recliner … to do some gentle Yoga stretches and carry on a conversation without being interrupted by yelps of spontaneous pain.
Thank you all for those continuous prayers and many offers of help/support! Better than Benadryl!
Let’s continue that brand of “good medicine” regimen for one another! Not just praying for one another but letting one another know that prayers are being said. Otherwise, it’s very LONE-n-lonely day-to-day we’re living.
Also, thank you for the prayers for my husband during this difficult time. Poor lamb, he has had his adjustments to make too.
Another bit of good news to share — we have a new member in our Group. Her name is Susan; she lives in Orlando; she suffers with chronic back pain and is recovering from a second surgery. She has asked that I share her email information with the Group in hope of generating a support network as she faces her personal list of “things to adjust to”. Being so far away, and being in chronic pain, it is nearly impossible for her to attend any of our in-person meetings. Emails know no borders or geographic boundaries and are a way of helping us feel NOT ALONE in the world. I have been in email contact with Susan and have enjoyed one phone session with her thus far. If you feel inclined to get acquainted, here is her contact info:
Which brings up another thing to ponder: “virtual Group sessions”. Who is in favor of this? I am a dinosaur when it involves anything electronic; however, I’m willing to get “baptized” into that congregation (only in the shallow part of the pool, LOL). I know nothing in this particular realm. If someone else is willing to be our i.t. coordinator, that would be fabulous! I do realize that with chronic pain, we can seldom plan in advance, never knowing what any day or hour will hold in store. Just let me know your thoughts/feelings on the matter. Thank you!
In regard to in-person meetings, after the New Year I hope we can resume those. Let me know, please-n-thanks, what is the best day/time for your personal schedule, in regard to a weekly small-group meeting. I will focus on the majority agreement for this. It may be that we hold two small-group meetings — one for the vaccinated and one for the non-vaccinated. (Regardless of personal beliefs/choices, persons in pain remain deserving of pain-management support-group meetings.) SenCen Programs Manager, Nick Hauser, has generously agreed to put our meetings back on the calendar whenever I am ready to do so. We could, for instance, offer a 2-hour session for the non-vaccinated, followed by the remainder of the afternoon being reserved for the vaccinated. I am open for suggestions/ideas about this.
I hope to be able to host small-group sessions here in my home as we have done in the past. Also, to resume private sessions after the New Year. There is no crystal ball that can guarantee anything, of course. Adjustment is like a river — you can never step into the same water twice; and, what is expected usually turns out to be a surprise. (How grateful I am that Life is full of surprises … never boring … flowing forward.)
Thus far, this week’s mass email has been about GRATITUDE. That adage from my younger (somewhat hippie) days remains a timeless truth: Attitude of Gratitude will get us through much! The word comes to us from the Greek, from the root word “grace”. It’s the “amen” we whisper at the end of our private list of gratitude for such things as food on the table, shoes on our feet, ability to survive some rather dire situations/painful consequences. It is the Spirit of our major holidays, minor celebrations, milestones and baby-steps. It is the secret of how we can step into our right-brain whenever the left-brain is overwhelmed by life’s challenges, brain-file cascade events, fresh shocks, compassion fatigue, simple or complex fears, pain on every level of our being.
We have gratitude. We can take it one step further: cultivate an attitude of gratitude. We just cannot live perpetually/indefinitely in that state of being. Not even the saints throughout history could do so; and there have been those who tried.
No growth without challenges! Our brains need multitudes of varied experiences. Our minds need growth that yields deeper compassion, increased understanding. We need a few challenges along the way! Some big, some small, some mysterious and others so simple we tend to overlook them. The past few years … well, that’s another “dead horse” that does not bear repeating nor beating; yet, even this depth of long-term challenge-of-challenges has taught us much!
The next time you look at yourself in a mirror, tell yourself: “Good job! Thank you!” Then, take note of what else your right-brain observes. We can step into our right-brain realm a thousand-thousand times a day. But, we also need to deal with the left-brain challenges, knowing that we will eventually have something else to tell our reflection, some other “good job” that increases our sense of grace/gratitude.
As the hours pass and bring a slowly rising level of unseasonal warmth into our shared Friday, may our personal/collective mantra for the week ahead be: “Love, Peace, Kindness”. These three attitudes, to increase our gratitude and to bless ourselves as well as others ~ ’tis the season, eh?
Migraine is the third most prevalent illness and sixth most disabling illness in the world – yet there’s still much misunderstanding and lack of information about this serious chronic pain condition that impacts one billion people across the globe.
Learn more about migraine – and see what you can do to manage this challenging condition, while finding better quality of life, by checking out these great educational tools and resources…
It’s CRPS Awareness Month! CRPS awareness month 2021 has finally started! Throughout November we will be sharing facts and information about CRPS across our social media channels, we also have our 7th annual national CRPS Conference on 21 November and don’t forget our Silent Auction in aid of Burning Nights CRPS Support. What’s Going On in November? Beril, are you a Formula 1 Racing fan?Fancy owning a framed signed cap by F1 2021 McLaren Team drivers Lando Norris and Daniel Ricciardo? Now’s your chance!
The signed cap has been expertly framed together with the images of both the drivers that were sent to us by McLaren Racing.
Between 1st to 20th November Burning Nights CRPS Support is holding an online silent charity auction where you can bid for this amazing prize. There is a reserve of £300.
All you have to do is to email your bid and your full contact details to fundraise@burningnightscrps.org
We will announce the highest bidder during our conference, it will be posted online, on our website & the winner will be contacted direct.
So what are you waiting for? Get bidding!Make A bid 7th Annual National CRPS ConferenceBeril, only a couple of weeks to go before our 7th annual CRPS conference on Sunday 21 November!
Our full 1 day annual CRPS conference will be a physical event & will be at DoubleTree Hilton Chester, United Kingdom. This is a FREE event and as usual we will have some fantastic speakers all who have working knowledge of Complex Regional Pain Syndrome.
Our annual conference is for CRPS patients, their families & caregivers as well as healthcare professionals & students and lawyers who have an interest in CRPS. There’ll be breaks throughout the day when you can chat with others attending the conference. Lunch & refreshments are provided free of charge during the conference.
Register now for your free ticket! There’s also a chance on the day to purchase any of our CRPS products including Christmas cards as well!
For those unable to attend the conference in person we are going to live streaming it on Zoom. If you are interested in the live stream option, please email us at support@burningnightscrps.org with your full contact details including full name, email and country you live in.Sign up for your FREE ticket Our 2021 CRPS Conference SpeakersMr Philip Cutts an Orthopaedic and Musculoskeletal Rehabilitation and Pain Management Specialist from Philip Cutts MSK talking about ‘Physiotherapy for CRPS’ Chris Edwards from Lewis Reed holding a Q & A on ‘Driving with a Disability’Mr Mohammed Akbar Hussain, Consultant Neurosurgeon talking on ‘Neuromodulation as a treatment option for CRPS’ Miriam Parkinson an Advanced Occupational Therapist is going to presenting on ‘Managing Your CRPS Flare-Ups’ Pankaj Madan – a Barrister who regularly deals with CRPS claims from Exchange Chambers talking about the Barrister’s Role in CRPS Legal ClaimsPCCA Ltd who are going to give us a very interesting talk on ‘An Introduction Personalised Medicines including for CRPS’ Ashleigh Stevens – a CRPS patient – sharing her lived experience of CRPS Register for your ticket Check Out Some Of Our Blog ArticlesHow To Get A Better Sleep With CRPS & Chronic Pain
Sleep can be extremely difficult when you live with CRPS or chronic pain. Check out our top tips for getting a better night’s sleep Learn More ›18 Tips Preparing For Your Pain Appointment
Attending a pain management appointment can be a daunting experience. Our 18 tips are to help you prepare for your appointment. Find Out More › Our Upcoming EventsCRPS Awareness Month
CRPS Awareness Month lasts the whole of November – if you’re interested in fundraising for Burning Nights CRPS Support please contact us & don’t forget to donate your money! Find Out ›Online CRPS Support Group
Join us for our monthly online CRPS Support group for CRPS patients on Wednesday 10 November at 2pm GMT. You’re not alone in this journey.
Are you a partner, parent or caregiver of a CRPS patient? Join our online support group on 16 November at 7pm GMT. Sign Up Today › Our Online ShopWinter Woodland Christmas Cards
This pack of 10 Christmas cards features a beautiful Winter Woodland scene will be loved by many but especially perfect for your nature loving friends & family Buy Yours Now ›Festive Red Bus Christmas Cards
This lovely pack of 10 cards with envelopes features a beautifully illustrated festive big red London Bus with the number 25 on the front as well as the charity name Get Your Pack Today ›Zipped Hoodie
Help spread awareness of CRPS with our Zipped Hoodie! The inside of the zipped hoodie is soft, making it a comfortable wear. Sizes Small to XXL. Colour Black with orange zip & toggles. Buy Yours Now ›CRPS Awareness Face Mask
Our reusable face masks a soft double layered polyester material and have black elastic straps for around the ears. Take a Look › FundraisingCRPS Awareness Charity Fundraiser
Maria Ayala from USA has set up a fundraiser for CRPS awareness and Burning Nights CRPS Support to run during November. November is the perfect time not only to fundraise but to also raise awareness of Complex Regional Pain Syndrome. Help us to help all those in need of our support. Make A Donation ›Corben Takes on Rock n Roll Liverpool Marathon
Corben Roberts made the decision to raise money for the UK’s best known CRPS charity & took on the Liverpool marathon (all 26 miles!). His wife Amy, has lived with CRPS since 2019 & is the primary reason for his fundraising efforts for the charity. Learn more about Corben or donate below
Donate Today › Thank You To Our Recent FundraisersOn behalf of all the people we support, we say a huge THANK YOU to our recent fundraisers! Most of the fundraisers below are still open to receive donations, please do consider donating if you can, as every penny and pound raised is important.
Fundraisers including:Daisy Roberts – who took on Lands End to John O’Groats cycle after learning to ride in just 1 month! Daisy raised just under £3,000 including matched funding from Abbott MedicalBen Ashworth– who bravely completed the Virtual London Marathon in October. Ben so far has raised £1,106.Corben Roberts – as mentioned earlier, Corben completed the Rock n Roll Liverpool Marathon & has raised £1,100 so farDan Ward – completed the gruelling Three Peaks challenge on crutches after having an accident in 2019 and developing CRPS. So far Dan has smashed his target and raised £2,660. Will you help him to reach £3,000?Lisa Jennings– completed a Triathlon after taking the summer to learn to swim with her knee injury. Lisa has so far raised £1,364.Elizabeth Marshall– has a number of ongoing events over several months. Please do donate if you can.Mark McKee (aka Sodden Gecko) – has been gaming live throughout 2021 and has raised £371 so far. We’re sure Mark has more gaming nights to go before the end of the year! Interested in Fundraising for Burning Nights CRPS?There are many ways you can fundraise for Burning Nights CRPS Support. Not sure why you should? Here’s what Corben had to say:
”I don’t think it matters how much you raise. I feel more committed, and that I need to share our story and tell people what is happening. For me and Amy, the awareness is really important.”
Find out more about fundraising for Burning Nights CRPS Support by clicking the button below.Get InvolvedFunds from Home Collection BoxesBeril, have you ordered one of our home collection boxes? If so don’t forget to donate your saved funds when your box is full! CRPS awareness month is the perfect time to donate that loose change you’ve been saving in the collection box!
There are a number of ways you can donate your saved change including:By bank transfer direct to our charity’s bank accountUsing our one-off donation form on our websiteBy PayPalBy cheque and post it to usSee the ways you can donate that saved up loose change on our website by clicking the button below, or contact us for our banking information. We will soon be in touch with all those who have ordered our boxes.
Don’t forget that if you are a U.K. tax payer you can also include Gift Aid if you’re eligible, as we can claim an extra 25% on top of your donation through the UK Government.Ways to Donate Your ChangeWe Support Anyone Affected By CRPSWithout the support of people like you Beril, Burning Nights CRPS Support couldn’t continue offering the services we do.Every week approximately 288 people in the UK are diagnosed with Complex Regional Pain Syndrome.
We want to give people with CRPS and their families and loved ones the knowledge they need to understand their condition and to offer a range of support services such as monthly online support groups, befriending scheme, counselling service and live chat, to name just a few.
If you find our information or our services useful, please consider making a small donation today or fundraising for us.Donate NowPS. Don’t forget to get your conference ticket today!Register Today
Depression can affect your body as well as your mind. Trouble falling or staying asleep is common in people who are depressed. But some may find that they get too much shut-eye.
Chest Pain
2/12
It can be a sign of heart, lung, or stomach problems, so see your doctor to rule out those causes. Sometimes, though, it’s a symptom of depression.
Depression can also raise your risk of heart disease. Plus, people who’ve had heart attacks are more likely to be depressed.
Fatigue and Exhaustion
3/12
If you feel so tired that you don’t have energy for everyday tasks — even when you sleep or rest a lot — it may be a sign that you’re depressed. Depression and fatigue together tend to make both conditions seem worse.
Aching Muscles and Joints
4/12
When you live with ongoing pain it can raise your risk of depression.
Depression may also lead to pain because the two conditions share chemical messengers in the brain. People who are depressed are three times as likely to get regular pain.
Digestive Problems
5/12
Our brains and digestive systems are strongly connected, which is why many of us get stomachaches or nausea when we’re stressed or worried.
Depression can get you in your gut too — causing nausea, indigestion, diarrhea, or constipation.
Headaches
6/12
One study shows that people with major depression are three times more likely to have migraines, and people with migraines are five times more likely to get depressed.
Changes in Appetite or Weight
7/12
Some people feel less hungry when they get depressed. Others can’t stop eating. The result can be weight gain or loss, along with lack of energy.
Depression has been linked to eating disorders like bulimia, anorexia, or binge eating.
Back Pain
8/12
When it hurts you there on a regular basis, it may contribute to depression. And people who are depressed may be four times more likely to get intense, disabling neck or back pain.
Agitated and Restless
9/12
Sleep problems or other depression symptoms can make you feel this way. Men are more likely than women to be irritable when they’re depressed.
Sexual Problems
10/12
If you’re depressed, you might lose your interest in sex. Some prescription drugs that treat depression can also take away your drive and affect performance. Talk to your doctor about your medicine options.
Exercise
11/12
Research suggests that if you do it regularly, it releases chemicals in your brain that make you feel good, improve your mood, and reduce your sensitivity to pain.
Although physical activity alone won’t cure depression, it can help ease it over the long term.
If you’re depressed, it can sometimes be hard to get the energy to exercise. But try to remember that it can ease fatigue and help you sleep better.
Note: Click here to submit your statement to your Congressional Representative.
On Friday, July 16, the National Center for Injury Prevention and Control (NCIPC)’s Board of Scientific Counselors (BSC) met to review a report on the new draft Guideline provided by the Opioid Working Group (OWG), a Centers for Disease Control and Prevention (CDC)-appointed outside group of stakeholders whose job was to review the new Guideline.
The new Guideline was authored by some of the same individuals involved in the drafting of the 2016 Guideline. Four out of the five authors are employees of the NCIPC who are injury prevention and addiction specialists, not pain management professionals, nor pain advocates, or pain patients. The fifth, a primary care physician, has for years publicly criticized opioid prescribing for pain in op-eds and interviews. Yet, pain patients and pain management providers will be the groups most affected by the new Guideline which describes how and when to prescribe opioid medication for pain.
The new draft Guideline came after the CDC held interviews with 100 stakeholders to get their views of how the 12 recommendations should be updated. It came after public listening sessions in which dozens of pain patients spoke about how they had been harmed by the 2016 Guideline. It came after FDA issued a report on a public meeting with 450 chronic pain patient-participants as well as a public docket that received 2450 comments held in July of 2018 in the aftermath of the release of the Guideline, in which patients uniformly described the burden of trying to access opioid medication that had long helped them detailing reduced dosing, forced tapering, medical abandonment, increased pain, withdrawal, disability, isolation, inability to work, inability to care for self or others, stigma and discrimination, anxiety and depression, self-harm and suicide as a result of loss of or reduced access to opioids.
It came after the Congressionally-mandated Pain Management Best Practices Inter-Agency Task Force (PMTF), of which the CDC was a member, heard public comment, patient testimonials and received over 9,000 e-mails and letters, 87% of which described loss of access to opioid pain medications that had caused all of the same harms described by the FDA report. And finally, it came after a review of the 2016 CDC Guideline conducted by the PMTF at the request of Congress, which pointed out a number of flaws in the Guideline, chief among them the arbitrary nature of the 90 MME/day maximum dose recommendation and the “3-days or less” and “more than 7 days will rarely be needed” duration of therapy limit following an acute, severely painful event. The PMTF review stressed the wide variability in patient, specific drug and disease or injury characteristics that determine the optimal dose for pain relief in each individual patient.
So, it is especially astounding that the Guideline authors made no significant changes in the Updated Guideline. (Click here to see a comparison of the 2016 vs the 2021 Guideline) The problematic and unscientific dose limits and duration of therapy recommendations are exactly the same as in the 2016 Guideline.
Even more astounding is the focus on reducing and eliminating the legitimate use of opioids for pain management while remaining silent on what patients living in high-impact, relentless severe pain should do for pain management beyond recommending “non-opioid therapies.”
The authors have long said the Guideline is intended for primary care physicians. This is exactly the group who have very little knowledge of current best practices in pain management and are generally not aware of the multitude of therapies including other medications, restorative therapies, interventional procedures, medical devices, behavioral approaches, and complementary therapies that could help patients manage their pain in addition to or in place of opioids. Furthermore, there are many pain patients whose pain is not helped by opioids, or cannot take them for one reason or another, who may be helped by therapies in the categories listed above.
By not discussing these options in the Guideline, the CDC has missed an important opportunity to educate physicians, patients and other healthcare providers about how best to manage pain. Unfortunately, there are barriers to accessing some of these alternate therapies such as lack of insurer coverage and cost. The CDC’s highlighting of these options could help to remove some of these barriers but not if they are not even discussed in the Guideline.
The CDC’s process going forward to arrive at a Final Guideline will be for the BSC to consider the OWG’s report and advise the CDC on the update. (Click here to see the OWG Report.) The CDC’s NCIPC authors will revise the Updated Guideline and post a new Draft Guideline for a 60-day public comment by the end of 2021. The CDC will then revise the Draft Guideline and release an official Final Guideline in late 2022.
What you can do
If you and your healthcare have been impacted by the CDC Guideline, then we urge you to write your Congressional Senators and House Representative.
Tell them your personal story in as concise a manner as possible. Explain how your pain care has been affected by the Guideline. Urge them to tell the CDC to add pain management healthcare providers, pain patients and pain advocates to the group authoring the new Guideline. Request that your representatives tell the CDC not to include daily dose and duration limits on opioid prescriptions for legitimate pain patients who use opioids appropriately to manage their daily chronic pain.
Dose and duration of treatment is not one size fits all. Many respected medical authorities, including the AMA, the FDA and the HHS Pain Management Best Practices Inter-Agency Task Force, have said there is wide variation in dose and duration of opioid therapy that is optimal for each individual patient.
Click the button below to visit our online Advocacy Center and compose your email which will automatically be sent to your Congressional representatives.Send Your Message
Comorbid Chronic Pain and PTSD: An Update on Research and Treatment
Chronic pain and PTSD often interact to negatively impact the course of either disorder, requiring thoughtful assessment and reflexive, tailored treatments.By David Cosio, PhD, ABPP and Amy Demyan, PhD, RYT
The prevalence rate of chronic pain in the general US population ranges between 10% to 20%.1 Chronic pain has been found to commonly coexist with post-traumatic stress disorder (PTSD) symptoms. In the veteran population, the prevalence of PTSD has been found to be between 10% to 47% among those referred to a pain clinic2,3 or attending a multidisciplinary chronic pain center.4 Patients with comorbid chronic pain and PTSD have been found to endorse more negative belief-based and behavioral symptoms compared to patients with chronic pain only.3,5 They have also been found to be at greater risk for negative coping, such as with substance use.5
Together, these findings support the need for tailored treatment interventions for patients with comorbid chronic pain and PTSD. Consequentially, theory-supported treatment programs have evolved overtime to meet the unique needs of patients who suffer from this type of comorbidity.
Theory-supported treatment programs have evolved overtime to meet the unique needs of patients who suffer from both chronic pain and PTSD (iStock).
Post-Traumatic Stress Disorder Defined
To understand the best treatment practices applied to comorbid chronic pain and PTSD, the utilization of the proper assessment of PTSD is crucial. The definition of PTSD has broadened since the release of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in 2013.6 The diagnosis now includes traumatic events that were experienced directly, indirectly, witnessed by the individual, or experienced by a family member or friend.6 In addition to these experiences, the individual must also exhibit symptoms from four different clusters of symptoms:
reexperiencing
arousal
avoidance
persistent negative alterations in cognitions and mood
PTSD can be diagnosed accurately by a trained mental health professional. The gold standard assessment is the Clinician Administered PTSD Scale for the DSM-5 (CAPS-5), which employs an interview with the patient about trauma and PTSD symptoms. PTSD has been found to affect 10% of women and 5% of men at some stage.7 However, the prevalence rates of PTSD in victims of trauma have been purported to approach 100%.8
Physical health problems (cardiovascular, headaches, diabetes, respiratory, gastrointestinal, and musculoskeletal) have been shown to be more common among individuals suffering from PTSD.9 Studies examining the prevalence of chronic pain in individuals with a primary diagnosis of PTSD have reported even higher co-prevalence rates. The rate of chronic pain in patients who suffer from PTSD is approximately double that of the general population.9 Pain is the most common physical complaint among patients who suffer from PTSD.10 Research has shown that anywhere from 60% to 80% of veterans with PTSD report that they have a chronic pain condition.11,12
Prevalence of Comorbid Pain and PTSD
When PTSD and chronic pain are considered together, the prevalence among returning veterans has been found to be 16.5%.13 Earlier studies reported a 1.7% prevalence of PTSD among chronic pain patients.14 However, in a more recent study, 47% of a sample of veterans with chronic pain met criteria for PTSD.3 Further, the prevalence of PTSD among injured workers referred to a rehabilitation program was found to be approximately 35%.15 Further, comorbid prevalence rates have been found to range between 30% to 50% among patients whose pain is secondary to a motor vehicle accident.16
Moreover, the prevalence of PTSD among hospitalized burn patients has been found to be approximately 45% at 12-months post injury.17 These comorbid conditions may interact in such a way as to negatively impact the course of either disorder,18 requiring thoughtful assessment and reflexive, tailored treatments.
Individuals with this comorbidity report health problems with increased functional impairment, greater frequency19 and higher pain ratings.5 Research indicates that patients with chronic pain related to trauma or PTSD experience more affective distress,20 higher levels of life interference,21 and greater disability22 than their counterparts without trauma or PTSD. They further report decreased occupational functioning, including more frequent absenteeism19 and greater loss of productivity.23 More importantly, they demonstrate higher rates of healthcare service utilization and increased healthcare costs.
Theories Behind Overlapping Chronic Pain and PTSD
Shared Vulnerability
There are several theories that may help explain the high rates of comorbid chronic pain and PTSD. For example, the theory ofshared vulnerability proposes that underlying mechanisms, such as anxiety sensitivity, are implicated in the comorbidity. Another theory, the mutual maintenance hypothesis, proposes that cognitive, affective, behavioral (eg, avoidance), and physiological symptoms of both disorders react in a synergistic way. Both chronic pain and PTSD share the clinical features of fear and avoidance, which may influence the development of each condition over time, may serve to maintain them, and may interact in ways that impact the outcome of either condition in a feedback loop.19
Fear Avoidance
The fear-avoidance modelis generally acknowledged for diagnosing and understanding how humans adaptively and maladaptively react to fear.24 In the realm of chronic pain, the model describes how individuals develop chronic, musculoskeletal pain as a result of avoidant behavior based on fear.25 The fear-avoidance model states that negative appraisals about pain and its consequences, including catastrophic thoughts, can result in feelings of pain-related fear, avoidance of daily activities, and hypervigilance or over-monitoring of bodily sensations.26 As a result of this misinterpretation, the individual repeatedly avoids the pain-inducing activity and will likely overestimate any future pain from such activity. In turn, the avoidance response ultimately results in physical deconditioning, depression, disability from work, inability to participate in recreation, and incapacity for family activities.27 This perpetuates the pain experience as opposed to moving toward wellness. Once the avoidant behavior is no longer reinforced, the individual exits the positive feedback loop.28
There is evidence that fear-avoidance is closely related to increased pain, physical disability, and long-term sick leave in chronic pain patients.29 This does not mean that the patient is “faking it” or that “it’s all in their head.” Rather, it demonstrates the importance of the mind/body connection in symptom expression and the power of formerly learned coping strategies that were once functionally adaptive. However in avoidance coping, patients miss the opportunity to examine the untested hypothesis: Does avoidance really keep me safe? With support and guidance, providers can gently encourage small, slow gains.
According to this model, treatment recovery is facilitated when pain acceptance is promoted. Pain acceptance increases when an individual uses adaptive coping mechanisms while minimizing or neutralizing negative thoughts or beliefs about pain, and/or pain catastrophizing. This approach can be expanded to include PTSD and can provide a comprehensive explanatory framework for the conceptual, symptomatic, and behavioral overlap of the two conditions.30
Treatment Modalities for PTSD and Chronic Pain
There are three primary approaches to treating patients who present with both chronic pain and PTSD31:
The parallel model
The sequential model
The combined or integrated multidisciplinary model
First, the parallel model treats each disorder at the same time but with separate medical teams who may or may not collaborate. As a result, the treatment teams may be operating from different philosophies of treatment without knowing it. Treatment using this model often leaves patients with little to no comprehensive help, as people are often not eligible for multiple services at the same time or there is not a provider who wants to take on the responsibility of both disorders.
Next, the sequential model is historically the most common framework of comorbid treatment. In this model of treatment, the patient is treated by two separate medical teams, with one treating one disorder and then the other team treating the other condition afterwards. This model may be problematic in that the untreated disorder may worsen the treated disorder. Also problematic is that treatment teams may disagree as to which disorder should be treated first. Furthermore, the patient may be left with an untreated disorder at times due to a lack of follow-through by providers and/or patients with the referral to the second medical team.
Lastly, the most promising framework is a combined, or integrated multidisciplinary model. The integrated model is relatively new, but it has been demonstrated as an effective method in many scientific studies. This treatment model helps patients recover by simultaneously offering treatment for comorbid disorders, treating both chronic pain and PTSD simultaneously in the same setting with providers working collaboratively and/or with providers who have expertise in both chronic pain and PTSD.
Multidisciplinary Approaches
A multidisciplinary treatment approach to pain has been found to be the most effective method for patients with comorbid chronic pain and PTSD.4 Several of the more common causes of chronic pain include traumatic events; thus, it is not unusual for patients presenting with chronic pain to also describe significant levels of distress including PTSD.32 The multidisciplinary treatment model should emphasize helping patients draw links between the traumatic event and subsequent chronic pain and PTSD.
Psychotherapy has been found to be the most effective therapy for patients with comorbid chronic pain and PTSD. Cognitive-Behavioral Therapy (CBT) is a structured, time-limited, present-focused approach to psychotherapy that helps patients engage in an active coping process. The aim of the treatment is to change maladaptive thoughts and behaviors that serve to maintain and exacerbate the experience of both chronic pain and PTSD. Patients have demonstrated benefits from CBT techniques (exposure therapy, pacing, and activity scheduling) to alleviate both conditions.32,33 CBT interventions have been associated with significantly greater improvements in maladaptive coping responses to pain than wait-list controls.34 The current literature also reveals robust evidence that CBT is effective for PTSD.35 Not only can CBT help restructure maladaptive thinking, it can also assist with making unhealthy behaviors become more adaptive.
CBT Treatment Protocol for PTSD
When chronic pain and PTSD symptoms co-occur, it is likely that providers will need to modify treatment protocols accordingly.36 One such integrated protocol was developed by Otis & Keane in 2009 at the VA Boston Healthcare System.37 This therapist’s manual combines traditional CBT with cognitive processing therapy used in PTSD treatment and is divided into 12 60-minute sessions.
As outlined in Table I, the CBT protocol for PTSD begins by helping patients become aware of the links between chronic pain and PTSD symptoms. In addition, cognitive therapy strategies address attentional biases, challenge overestimation of probability and cost, reinforce positive pain self-efficacy beliefs, and challenge catastrophizing.32
Furthermore, the manual includes strategies aimed specifically at reducing anxiety sensitivity using interoceptive exposure. The protocol then aims to increase activity levels through the use of activity pacing and then ends focuses on reducing cognitive and behavioral avoidance through the use of in vivo and imaginal exposure surrounding specific belief systems. Some scholars have argued that concurrent treatment of chronic pain and PTSD that is underway in the veteran population may also be beneficial to nonmilitary/nonveteran populations.30
Practical Takeaways for Providers
Rates of comorbid chronic pain and PTSD vary across populations and settings. Patients with comorbid chronic pain and PTSD have been found to experience more severe symptoms, greater functional impairment and disability, and higher rates of catastrophizing compared to patients with chronic pain only. As a result, patients who suffer from this comorbidity are often undertreated with traditional treatment modalities. Empirically supported, theory-driven advancements in treatment offer evidence for the effectiveness of multidisciplinary treatment approaches using a psychotherapeutic, CBT framework.
Overall, pain and behavioral specialists should remember:
Chronic pain and PTSD often co-occur in patients, requiring multidisciplinary treatment.
Assessment of PTSD is important when treating chronic pain patients. The gold standard PTSD assessment is the Clinician Administered PTSD Scale for the DSM-5 (CAPS-5).
The PTSD diagnosis in the DSM-5 expands on previous criteria and includes witnessing a traumatic event or learning that a family member or friend experienced a traumatic event in addition to experiencing it directly, and includes repeated exposures such as with first responders, law enforcement, and individuals exposed to repeated trauma based on minoritized identities.
Multidisciplinary treatment approaches, using a CBT framework, have been found to be effective for comorbid chronic pain and PTSD.
PCORI 2022 and Beyond: Opportunities for Funding and Involvement in Patient-Centered Research
Date:
Wednesday, February 2, 2022; 1:00 – 1:30pm EST
Location:Online
During this live webinar, PCORI Executive Director Nakela L. Cook, MD, MPH, and other PCORI leaders will share PCORI’s bold vision for 2022; initiatives and opportunities for funding and involvement in our work, including research, implementation, and Engagement Award funding opportunities; and ways to get involved with PCORI through advisory panels, the Ambassador program, and merit review program.
Please note that there will be live closed captioning during the webinar.
Chronic pain is pain that lasts for at least six months, though it may last for years. An injury, disease or infection may have originally caused the pain, but chronic pain continues long after the injury or illness has gone away. In some cases there is no known cause. Psychological and environmental factors may worsen the pain.
Chronic pain is sometimes called intractable pain or chronic pain syndrome, and it’s one of the most common reasons people visit their medical provider. About 50 million Americans suffer from chronic pain, according to the Centers for Disease Control and Prevention. Of those people, about 19.6 million have high-impact chronic pain.
The CDC defines chronic pain as pain that occurs every day or on most days for at least six months. High-impact chronic pain is chronic pain that limits a person’s work or life activities every day or on most days for at least six months.
Chronic pain can be disabling, but the Social Security Administration does not classify chronic pain itself as a disability. It does, however, recognize diseases and injuries that cause chronic pain as disabilities with potential compensation benefits. These include back injuries, neurological disease, lupus, cancers and inflammatory arthritis. If pain interferes with a person’s ability to work, it may also be considered as a factor.
Fortunately, patients and their medical providers can work together to treat and manage chronic pain. Treatment options include medications, non-drug treatments, psychological and behavioral treatments and mind-body treatments.
Chronic pain can affect all areas of the body and be caused by multiple conditions.
Types
Chronic pain is divided into two broad types: neuropathic pain and nociceptive pain. A person can experience both types of pain at the same time.
Neuropathic Pain
Neuropathic pain is pain that occurs after damage or dysfunction of the nervous system. This can happen because of a disease or injury. For example, about 30 percent of neuropathy cases result from diabetes, according to Cleveland Clinic.
Other diseases and injuries that may lead to neurologic pain include shingles, HIV infection, leprosy, stroke, broken bones, cancer and amputation.
Nociceptive Pain
Nociceptive pain comes from pain receptors in the body activated during injuries called nociceptors. Normally these receptors don’t activate unless there is an injury and then they stop when the injury is gone. Sometimes these receptors send pain signals even when the injury that triggered them is healed.
Nociceptive pain has two sub categories: visceral pain and somatic pain. Visceral pain comes from major internal organs. Most people describe this pain as achy. Even if it originates from an organ, it may affect other structures. For example, an organ in your abdomen may cause pain in the back.
Somatic pain comes from injuries to the outer body structures such as the skin, muscles, tendons, ligaments, joints and bones. Arthritis, bone pain and fibromyalgia are examples of somatic pain.
Causes
A disease or injury usually causes chronic pain. Sometimes, chronic pain occurs as a complication of a faulty medical device, such as a knee replacement, hip replacement or shoulder replacement. Some drugs may injure internal organs, ligaments or cause joint pain. Other times, doctors aren’t sure what the cause is.Potential causes of chronic pain include:
CHRONIC HERNIA MESH PAINSome people suffer chronic hernia mesh pain that interferes with their daily activities and can last from several months to years. Read about the ways to manage this pain.LEARN MORE
Risk Factors
Researchers don’t always know the exact cause of chronic pain, but people with certain risk factors have a higher chance of developing chronic pain. These factors include physical conditions, lifestyle habits and psychological factors.Factors that impact chronic pain development include:
Age – chronic pain typically affects older people
Alcohol
Being a veteran
Being overweight or obese
Employment status
Gender – women have a higher risk
Genetics
History of surgeries
History of violent injury or abuse
Lack of sunshine and vitamin D
Occupation
Physical activity
Poor mental health
Poor nutrition
Prior injuries
Sleep disorders
Smoking
Symptoms
Symptoms of chronic pain depend on what caused it and the body area affected. For example, rheumatoid arthritis pain usually attacks joints in the hands and feet on both sides of the body. A person with a bad hip replacement may feel pain in the affected hip.
Because chronic pain lasts for months or years, it takes a toll on a person’s mood and mental health.Symptoms include:
Pain that can feel like: burning, dull, stabbing, an electric shock, tingling, “pins and needles,” throbbing or stinging
Trouble sleeping
Depression
Anxiety
Low self-esteem
Anger
Fatigue
Mood changes
Loss of appetite
Weight loss
Decreased sex drive
Fear of injury
Acute Pain vs. Chronic Pain
While acute pain can be mild or severe and may last weeks or months, chronic pain lasts for more than six months and may last for years.
Acute pain is “sharp” and typically goes away after the injury or disease heals. For example, acute pain is the pain you may get from a cut or during childbirth. Once the body heals, the pain goes away.
Chronic pain continues even after an injury is healed. Certain chronic diseases with no cure such as arthritis and fibromyalgia cause chronic pain.
Can Chronic Pain Kill You?
Chronic pain itself isn’t fatal, but a person may die from complications of chronic pain — especially if the pain is poorly controlled.
For example, severe pain puts stress on the body. The body releases chemicals to contain the stress. These chemicals cause an increase in heart rate and blood pressure. The strain on the heart can lead to heart attacks.
Adrenal insufficiency is another cause of sudden death in chronic pain patients. Episodes of severe pain cause adrenal hormones to drop which may lead to cardiac arrhythmia and death.
People who have chronic pain may be treated with opioid painkillers. Sometimes, a person may die from an overdose.
Treatment
There is no one treatment or cure for chronic pain. If a disease or injury is causing pain, medical providers will first treat that problem. Most pain management doctors recommend a treatment plan that doesn’t rely solely on medications.
Learning ways to cope with pain, making lifestyle changes and improving mental health are non-pharmaceutical ways to treat chronic pain.
Medications
Medications are the most common way to treat pain. Depending on the type of pain, different medications may be more effective.Medications to treat pain include:
Acetaminophen
Anticonvulsants (anti-epileptics) such as gabapentin
Antidepressants such as the SNRI Cymbalta (duloxetine), tricyclic antidepressants and SSRIs
Antirheumatics/immunological agents
Botulinum toxins
Corticosteroids
Muscle relaxants
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Opioids
Sedatives for sleep problems
Topical pain relievers
Non-pharmaceutical Treatments
In addition to medication, medical providers may recommend lifestyle changes and other modalities to treat chronic pain.Non-drug treatments include:
Acupuncture
Cold and heat application
Deep brain stimulation
Exercise
Healthy diet with adequate nutrition
Massage
Spinal cord stimulation
Mind-Body Treatments
Emotions and the mind play a role in how a person experiences pain. For example stress, fear and depression can make the pain feel worse.
Likewise, people with chronic pain have a greater chance of developing mental health problems. People with chronic pain are four times more likely to have depression or anxiety than those without chronic pain, according to Mental Health America.
Mind-body treatments can be effective additions to a pain management plan.Mind-body therapies include:
Aromatherapy
Art therapy
Meditation
Mindfulness training
Music therapy
Pet therapy
Relaxation techniques
Behavioral and Psychological Treatments
Behavioral and psychological treatments focus on improving a person’s coping skills and teach them how to manage their pain. Therapy can help improve mental health which may improve pain.
GENERAL COUNSELING
General counseling sessions focus on helping people manage and reduce depression, stress and anxiety.
FEAR-AVOIDANCE TRAINING
People with chronic pain may develop a fear of activity and movement because they fear pain or getting hurt again. This therapy focuses on helping people do activities they stopped doing because of pain, and it teaches them techniques for managing pain.
COGNITIVE BEHAVIORAL THERAPY (CBT)
CBT teaches patients to rethink their thought process when it comes to pain. It also teaches relaxation techniques. CBT helps a person gain more control over feelings of pain. Please seek the advice of a medical professional before making health care decisions.
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