Sunday, April 21, 2013
Saturday, December 15, 2012
Friday, December 14, 2012
Deep breathing is also a relaxation technique
- Find a quiet place, a comfortable position for your body, and block out distracting thoughts
- Imagine a spot just below your navel
- Breathe into that spot
- Fill your abdomen with air
- Let the air fill you from the abdomen up
- Let it out, like a balloon deflating
12 Tips for Living With Chronic Pain
1. Stop Smoking
3. Reduce stress in your life
- There is plenty of evidence that smoking worsens chronic pain
- Smoking also decreases your ability to use other pain relief techniques
- Mindful meditation has been used for thousands of years to reduce chronic pain
- Helps your body relax
- Stress intensifies chronic pain.
- Negative feelings like depression, anxiety, stress, and anger can increase your sensitivity to pain
- Listening to soothing, calming music can lift your mood
- Endorphins are brain chemicals that help improve your mood while also blocking pain signals
- Exercise also strengthens muscles, helping prevent re-injury and further pain
- It can also keep your weight down, which may relieve stress on your spine.
- 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.
- 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.
- Meet 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
- 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
- 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.
- 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.
- 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.
- 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.
- 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
- Red peppers - they contain a chemical which acts on pain in a way similar to acetaminophen
- Red Grapes, Blueberries, Cranberries
- Contains resveratrol
- blocks enzymes that contribute to tissue degeneration
- protects against cartilage damage that causes back pain
Monday, November 5, 2012
Meditate for Pain Relief
- Eases pain by taking out the tension and tightness from muscles
- Helps your body relax
- Eases stress, which causes tension and aggrevates pain
- Focusing on your breath
- Ignoring your thoughts
- Concentrate on your breath or repeat a word or phrase, a mantra, chant: this causes your body to relax
Tuesday, October 16, 2012
Smoking and Chronic Pain
Recently, it has been discovered that smoking is a risk factor for chronic pain.
Evidence is showing that smokers not only have higher rates of chronic pain but also rate their pain as more intense than nonsmokers
Here is what recent discoveries have been made in the link between smoking and chornic pain:
The Many Interactions between Smoking and Chronic Pain
Findings from recent prospective studies suggest a causal relationship between smoking and chronic pain. For example, one study found that Finnish adolescents who smoke at age 16 were more likely to develop pain symptoms by age 18.4 Another one found that adolescent smokers were at increased risk for hospitalization for low-back pain later in life and that male smokers were at increased risk for lumbar discectomy.3 A longitudinal study of 9,600 twins found a dose-response relationship between the number of cigarettes smoked and the development of back pain.1
Smokers with chronic pain are more adversely affected by their pain than nonsmokers with chronic pain. Studies of patients presenting to the Mayo Clinic Pain Rehabilitation Center, Outpatient Pain Clinic, Orofacial Pain Clinic, and Fibromyalgia and Chronic Fatigue Clinic consistently show that smokers report greater pain intensity and greater functional impairment than nonsmokers.7-10In addition, their scores on measures of life interference were worse. For example, smokers with fibromyalgia missed more days of work; reported worse sleep, greater anxiety, and depression; and had more pain, stiffness, and fatigue than nonsmokers with fibromyalgia.9
Because nicotine has analgesic properties and smoking a cigarette can blunt pain perception,11 the higher prevalence and increased severity of chronic pain in smokers as compared with nonsmokers may seem surprising. Researchers are exploring this apparent paradox. They have found that nicotine-habituated animals undergoing nicotine withdrawal demonstrate increased sensitivity to pain stimuli.12 They have also found that when human smokers are deprived of nicotine, they perceive pain stimuli earlier and have reduced tolerance for pain.13,14 Thus, some postulate that nicotine withdrawal could increase a smoker’s perception of pain and even the intensity of chronic pain.
Heightened awareness of pain in response to nicotine withdrawal could, in turn, further encourage smoking because it reduces a person’s perception of pain and/or helps them cope with the pain or mitigates anxiety associated with increased pain. For example, in at least one study, smokers reported that feeling pain made them want to smoke.15 Current research at Mayo Clinic is examining if and how pain motivates female smokers with fibromyalgia to smoke.
Researchers are also attempting to identify the mechanisms that might lead to increased pain in smokers. Some point to the changes that occur in the neuroendocrine system in response to long-term smoking. In the nonsmoker, the physiologic stress that results from pain activates the sympathetic nervous system and the hypothalamic-pituitary-adrenal (HPA) axis. The increased sympathetic output blunts pain perception. However, the HPA system is down-regulated in smokers, which may increase their perception of pain.
Another potential explanation may be that smoking accelerates degenerative changes such as those from osteoporosis and lumbar disc disease, and impairs bone healing. Such changes could predispose smokers to injury, impede healing, and subsequently increase their risk for future chronic pain.
Psychosocial factors also may have an effect. Current scientific understanding of biological processes and neural pathways suggests a link between depression and pain. It is known that smokers have higher rates of mood disorders such as depression and anxiety than nonsmokers and that patients with these mood disorders have more chronic pain. We also know that patients with chronic pain have higher rates of mood disorders. We recently reviewed a national data set and found that smoking increased the likelihood of pain in older adults but only in those who were also depressed.16 However, in a recent analysis of patients treated at our Pain Rehabilitation Center, we found that pain severity was independently associated with depression severity but not smoking status.17 Obviously, the interactions between smoking, depression, and chronic pain are not completely understood and are complex. However, the clinician who encounters a smoker with chronic pain should strongly consider that mood disorders also may be present.
Research is also examining how income and marital status play into this issue. Smokers tend to be less educated, poorer, and more likely to be unemployed and divorced than nonsmokers. In addition, as smoking rates decline, smokers are becoming increasingly marginalized in society. Weingarten et al. reported that 50% of smokers presenting to our outpatient tertiary pain clinic were unemployed or disabled, compared with 18% of nonsmokers.8 These differences suggest smokers are more isolated and lacking in social support than nonsmokers. It is thought that these factors could contribute to functional impairment from chronic pain.
Another consideration is that current and former heavy smokers are more likely to use prescription analgesics.18 We observed that more smokers than nonsmokers admitted to our Pain Rehabilitation Center used opioid analgesics and used them at higher doses.18 In addition, we discovered that male smokers consumed the greatest quantities of opioid analgesics.19 Smokers are known to have higher rates of drug abuse, and smoking is almost ubiquitous among opioid abusers. We also know that smoking alters the pharmacokinetics of opioids. A study comparing the effects of hydrocodone on both smokers and nonsmokers with back pain found that the smokers used more hydrocodone tablets yet continued to report greater pain. Interestingly, despite taking higher doses of hydrocodone, they had lower serum hydrocodone levels.20 An explanation for this may be that the polycyclic aromatic hydrocarbons, substances in cigarette smoke, induce P450 enzymes involved in morphine metabolism. This could account for the higher consumption of opioids in male smokers with chronic pain.
Tobacco Cessation in Chronic Pain Patients
Current guidelines recommend that clinicians advise tobacco users to quit and provide them with the assistance to do so at every encounter. Certainly chronic pain patients would benefit from stopping smoking. However, given the imperfectly understood relationship between pain and smoking, it is not clear how tobacco abstinence affects chronic pain. In the short term, nicotine abstinence has the potential to make it worse, and stopping smoking would remove a mechanism that smokers perceive as useful in coping with anxiety. Yet, in the long term, recovery from the effects of smoking might improve chronic pain.
Smokers who suffer from chronic pain have the same motivation to quit as smokers who do not have pain.21 However, we found that very few patients enrolled in our Pain Rehabilitation Center who smoked could successfully quit despite receiving tobacco-intervention services.10We need to find ways to help smokers with chronic pain quit successfully. One approach might be to help them adopt coping strategies other than smoking such as relaxation techniques and behavior modifications. Clearly, we need additional research to better understand the effects of nicotine abstinence on chronic pain in order to develop effective interventions that can be readily applied in the clinical setting.
Conclusion
Chronic pain is among the many health problems associated with smoking. When smokers develop chronic pain, their symptoms and disability are often worse than those of nonsmokers with chronic pain. The reasons for these observations are likely multifactorial; but as yet they are not clear. Clinicians should provide tobacco-cessation interventions to their patients with chronic pain who use tobacco even though more research is needed regarding how smoking cessation might affect their pain and how best to help them quit
Evidence is showing that smokers not only have higher rates of chronic pain but also rate their pain as more intense than nonsmokers
Here is what recent discoveries have been made in the link between smoking and chornic pain:
- Smokers are more likely than nonsmokers to experience chronic pain
- Chronic pain is even more prevalent among former smokers than it is among those who have never smoked
- Smokers with chronic pain indicate that their pain is more intense than that of nonsmokers
- Although it is not fully understood, research is beginning to shed light on how smoking and pain interact.
The Many Interactions between Smoking and Chronic Pain
Findings from recent prospective studies suggest a causal relationship between smoking and chronic pain. For example, one study found that Finnish adolescents who smoke at age 16 were more likely to develop pain symptoms by age 18.4 Another one found that adolescent smokers were at increased risk for hospitalization for low-back pain later in life and that male smokers were at increased risk for lumbar discectomy.3 A longitudinal study of 9,600 twins found a dose-response relationship between the number of cigarettes smoked and the development of back pain.1
Smokers with chronic pain are more adversely affected by their pain than nonsmokers with chronic pain. Studies of patients presenting to the Mayo Clinic Pain Rehabilitation Center, Outpatient Pain Clinic, Orofacial Pain Clinic, and Fibromyalgia and Chronic Fatigue Clinic consistently show that smokers report greater pain intensity and greater functional impairment than nonsmokers.7-10In addition, their scores on measures of life interference were worse. For example, smokers with fibromyalgia missed more days of work; reported worse sleep, greater anxiety, and depression; and had more pain, stiffness, and fatigue than nonsmokers with fibromyalgia.9
Because nicotine has analgesic properties and smoking a cigarette can blunt pain perception,11 the higher prevalence and increased severity of chronic pain in smokers as compared with nonsmokers may seem surprising. Researchers are exploring this apparent paradox. They have found that nicotine-habituated animals undergoing nicotine withdrawal demonstrate increased sensitivity to pain stimuli.12 They have also found that when human smokers are deprived of nicotine, they perceive pain stimuli earlier and have reduced tolerance for pain.13,14 Thus, some postulate that nicotine withdrawal could increase a smoker’s perception of pain and even the intensity of chronic pain.
Heightened awareness of pain in response to nicotine withdrawal could, in turn, further encourage smoking because it reduces a person’s perception of pain and/or helps them cope with the pain or mitigates anxiety associated with increased pain. For example, in at least one study, smokers reported that feeling pain made them want to smoke.15 Current research at Mayo Clinic is examining if and how pain motivates female smokers with fibromyalgia to smoke.
Researchers are also attempting to identify the mechanisms that might lead to increased pain in smokers. Some point to the changes that occur in the neuroendocrine system in response to long-term smoking. In the nonsmoker, the physiologic stress that results from pain activates the sympathetic nervous system and the hypothalamic-pituitary-adrenal (HPA) axis. The increased sympathetic output blunts pain perception. However, the HPA system is down-regulated in smokers, which may increase their perception of pain.
Another potential explanation may be that smoking accelerates degenerative changes such as those from osteoporosis and lumbar disc disease, and impairs bone healing. Such changes could predispose smokers to injury, impede healing, and subsequently increase their risk for future chronic pain.
Psychosocial factors also may have an effect. Current scientific understanding of biological processes and neural pathways suggests a link between depression and pain. It is known that smokers have higher rates of mood disorders such as depression and anxiety than nonsmokers and that patients with these mood disorders have more chronic pain. We also know that patients with chronic pain have higher rates of mood disorders. We recently reviewed a national data set and found that smoking increased the likelihood of pain in older adults but only in those who were also depressed.16 However, in a recent analysis of patients treated at our Pain Rehabilitation Center, we found that pain severity was independently associated with depression severity but not smoking status.17 Obviously, the interactions between smoking, depression, and chronic pain are not completely understood and are complex. However, the clinician who encounters a smoker with chronic pain should strongly consider that mood disorders also may be present.
Research is also examining how income and marital status play into this issue. Smokers tend to be less educated, poorer, and more likely to be unemployed and divorced than nonsmokers. In addition, as smoking rates decline, smokers are becoming increasingly marginalized in society. Weingarten et al. reported that 50% of smokers presenting to our outpatient tertiary pain clinic were unemployed or disabled, compared with 18% of nonsmokers.8 These differences suggest smokers are more isolated and lacking in social support than nonsmokers. It is thought that these factors could contribute to functional impairment from chronic pain.
Another consideration is that current and former heavy smokers are more likely to use prescription analgesics.18 We observed that more smokers than nonsmokers admitted to our Pain Rehabilitation Center used opioid analgesics and used them at higher doses.18 In addition, we discovered that male smokers consumed the greatest quantities of opioid analgesics.19 Smokers are known to have higher rates of drug abuse, and smoking is almost ubiquitous among opioid abusers. We also know that smoking alters the pharmacokinetics of opioids. A study comparing the effects of hydrocodone on both smokers and nonsmokers with back pain found that the smokers used more hydrocodone tablets yet continued to report greater pain. Interestingly, despite taking higher doses of hydrocodone, they had lower serum hydrocodone levels.20 An explanation for this may be that the polycyclic aromatic hydrocarbons, substances in cigarette smoke, induce P450 enzymes involved in morphine metabolism. This could account for the higher consumption of opioids in male smokers with chronic pain.
Tobacco Cessation in Chronic Pain Patients
Current guidelines recommend that clinicians advise tobacco users to quit and provide them with the assistance to do so at every encounter. Certainly chronic pain patients would benefit from stopping smoking. However, given the imperfectly understood relationship between pain and smoking, it is not clear how tobacco abstinence affects chronic pain. In the short term, nicotine abstinence has the potential to make it worse, and stopping smoking would remove a mechanism that smokers perceive as useful in coping with anxiety. Yet, in the long term, recovery from the effects of smoking might improve chronic pain.
Smokers who suffer from chronic pain have the same motivation to quit as smokers who do not have pain.21 However, we found that very few patients enrolled in our Pain Rehabilitation Center who smoked could successfully quit despite receiving tobacco-intervention services.10We need to find ways to help smokers with chronic pain quit successfully. One approach might be to help them adopt coping strategies other than smoking such as relaxation techniques and behavior modifications. Clearly, we need additional research to better understand the effects of nicotine abstinence on chronic pain in order to develop effective interventions that can be readily applied in the clinical setting.
Conclusion
Chronic pain is among the many health problems associated with smoking. When smokers develop chronic pain, their symptoms and disability are often worse than those of nonsmokers with chronic pain. The reasons for these observations are likely multifactorial; but as yet they are not clear. Clinicians should provide tobacco-cessation interventions to their patients with chronic pain who use tobacco even though more research is needed regarding how smoking cessation might affect their pain and how best to help them quit
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