Yoga has been one of the ways that has helped me a lot with my well-being in the past year or so. These are two versions of one of my favourite poses for the back – seated and laying twists. Yoga not only has a lot of physical health benefits (such as improving flexibility) and mindfulness benefits (such as mindful movement) but also mental health benefits as therapeutic yoga is used as an embodiment approach to mental health. As always, talk to your doctor or other healthcare professionals before changing your exercise routine.
For more ways to improve your well-being, check out the podcast. And for more mindfulness practices check out the meditation channel. Keep making the most of it everyone!
If you’re anything like me, you may have wondered why pain medications aren’t working well. Aren’t giving the relief we’re told they should. I’ve been taken off NSAIDs because they hurt my stomach – has this happened to you to? I’ve been offered opioids after surgery but decided against it for fear of addiction even though I’ve been in a lot of pain – do you relate? I’ve also tried lowering doses of medications and found they’ve been as effective on a lower dose as they were on a higher one, because I’ve added holistic approaches to pain control – what about you?
Some medications and supplements I’ve been on (and this isn’t even all of them).
There were some interesting recommendations out of the National Institute of Health and Care Excellence (NICE) in the UK that came out of a meta-analysis (review of scientific studies) on treatments for pain/pain management. The part of the study and recommendations that really blew my mind what was that not a single pain medication was said to have enough evidence to support its effectiveness for treating chronic primary pain. Now, I will say that they reviewed about 22 studies per type of pain management – each medication and each holistic approach – that they looked at, so not super extensive but definitely enough to be a good indicator. I’m going to do a podcast episode on the 5 suggested treatments (exercise, acupuncture, 2 types of psychotherapy, and anti-depressants) for pain so stay tuned to the podcast for that episode in a few weeks. On the blog this week, I thought we’d talk about what they said about all these pain meds that we take!
NICE didn’t comment on CBD/Medical Marijuana, other than to say they didn’t really review the research in this area.
Opioids – I know that these are commonly prescribed, and as a mental health professional, I also know that there is an opioid crisis in North America (that being said, just because you take opioids does not mean you’ll become addicted as we need to look at other biopsychosocial factors). NICE states that there is not enough evidence that shows long-term opioid use actually helps with chronic pain, plus they note the risk of addiction (for some people) in the short- and long-term. Conclusion: Maybe not a good idea.
Benzodiazapines and NSAIDs – also commonly prescribed, and as I said, I used to be on strong NSAIDs that hurt my stomach, now I have a less strong one that I’m to take “as needed.” Benzos were cautioned as not being effective for chronic pain, AND leading to poorer functioning. And NSAIDs, these were said to also not improve pain, distress, or quality of life and increase the risk of gastrointestinal bleeding. Conclusion: Maybe not a good idea either.
Antiepileptics (Gabapentinoids) and Pregablin – these are only shown to be effective for neuropathic pain and CRPS. However, NICE cautions that they can be highly dependent and are known to be addictive. Again, one needs to consider biopsychosocial factors, but if you have other risk factors for addiction, possibly not a good choice. Conclusion: Depends on your condition and your risk factors for substance misuse.
Local anaethetics – Short-term use indicates they may actually make things worse, except for CRPS. So again, this might come down to your specific diagnosis. Luckily there was nothing mentioned about them becoming addiction. Conclusion: A go for CRPS but not anything else.
Paracetamol, ketamine, corticosteroids, anaesthetic/corticosteroid combinations and antipsychotics – again there is insufficient evidence for all of these, and NICE cautions that harm could actually come from taking these, though they don’t specify what the harm is. Conclusion: Maybe not a good idea.
I find it best when I combine holistic approaches, like exercise, with Western medicine, like pain meds.
So, what have I done to supplement lowering my pain medications (which may not be that effective anyway) so that I can continue to have better quality of life and well-being? A lot of the recommendations made by NICE and some others. I exercise daily (any movement is good movement if you’re starting out), I eat healthy, I use approaches such as acupuncture, chiropractor, physiotherapy, mindfulness, etc., and I have been to psychotherapy (and I currently use psychotherapy to help others). You can check out NICE’s study here. ALWAYS, check with your physician and healthcare team before changing medications or doses or adding holistic care to your plan. I started by adding holistic approaches first, and then cut back on meds. We are each unique individuals and this information is for psychoeducation/health education purposes only.
This week’s podcast episode is on nutrition for chronic illness – check it out: Apple, Spotify, Web. Everyone, keep making the most of it!
If you like my content, I would love the support on Patreon so I can keep bringing it to you (plus you get some bonuses by signing up).
Processing…
Success! You're on the list.
Whoops! There was an error and we couldn't process your subscription. Please reload the page and try again.
When I was first diagnosed with a chronic illness, my mental health started to suffer. I actually tried to hide that, even from myself, but my anxiety increased over the first 7 or 8 months until I started seeing a therapist (and thus my journey to becoming a therapist began). The thing is, I’m not alone as far as my story with my chronic illness taking a toll on my mental health. Many, many chronic illness warriors have been through the same thing. So, if you’re reading this and you’re struggling, know that it is normal and it is okay to struggle. Also note that change is slow. I can give you these 10 ways to improve you mental health (as I did a few weeks ago with physical health) but you aren’t going to feel better overnight, or after the first time you do these. It takes repeated practice and effort on your part (I still practice all of these!). If you’re ready for that commitment then let’s get into it!
How’s your mental health right now?
Support and Connection – this is pretty much the opposite of isolation, which is common with chronic illness, and mental health issues such as depression and anxiety. Support and connection can come in the form of joining formal support groups (which are likely still mostly online due to the pandemic, but may be in person depending on where you live), or informally by talking with your family and friends, or connecting with others in the Spoonie community via social media. As we’ve seen from the pandemic, isolation is not good for our mental health so do what you can to stay connected. Check out this podcast episode.
2. Mindfulness – I know this comes up a lot but there are many, many studies showing that this has powerful effects on both physical and mental health. It can be formal meditations, but it doesn’t have to be. Mindfulness can be fully engaging in an activity, such as mindful eating or mindful walking. If you’re present you’re unlikely to be ruminating about the past (depression) or worrying about the future (anxiety). Take a listen to this podcast.
Being mindful take practice.
3. Assemble your healthcare team – that includes someone to help you with your mental health. If you can’t afford to see someone in private practice, check out community settings. I’m currently doing my internship in a community setting, where our services are free. There is a bit of a longer wait time, and is usually brief/short-term service, but it is definitely a good option for many people. Check out this podcast on depression and this one on anxiety.
4. Use holistic approaches – what I’m talking about here are approaches that utilize the body-mind connection. If you’re lucky you can find several practitioners that do so. For me, my physiotherapist has a BA in psychology so she always takes a body-mind approach (podcast with her here), and I also saw a naturopath before I moved, which is all about the body-mind connection. They can give you more ideas for how to take care of your mental health and understand it interacts with your illness. This podcast is with my naturopath.
Make sure your healthcare team is able to help you with all aspects of your health.
5. Get moving – movement, of any type, is helpful not just for your physical health but for your mental health to. There have been studies to show that exercise decreases depression. Even if you’re not super mobile, going for a walk, doing some yin yoga, or taking up Tai Chi (podcast here) are good options to increase those endorphins and other neurotransmitters in your brain.
6. Connect with your values – who and what is important to you? If you can figure that out, then try to brainstorm some ways you can continue to live by your values, even with chronic illness. I’ll give you an example from my life. It is important to me to have adventures. Obviously travel is harder with a chronic illness, but it’s not impossible. So my friend and I (pre-pandemic) went on an “adventure vacation” to Costa Rica and for every “adventure day” we did a “rest day.” Honestly, it worked out super well, and we both felt more mentally and physically healthy that trip then we had in a long time. Check out this podcast.
Connecting with my values and doing what matters to me.
7. Do what matters – this ties into this above, connecting with your values. Once you have done the brainstorming, it’s important to do the things that matter to you. So for me, it was travel. It might also be spending more time with family and friends, or being creative. Doing the things (what therapists call behavioural activation) actually decreases depression (lots of evidence here). Check out this podcast for more.
8. Find an outlet – this might tie in to doing what matters for you. My main outlet is writing (probably no surprises here), but I have other ones too, such as playing the piano and colouring. I know a lot of people use art or photography or music or dance. It doesn’t necessarily have to be a creative outlet, but creativity can be useful, because a lot like exercise, it gets those helpful brain chemicals to increase.
Being in nature also matters to me and is an outlet as well.
9. Distance yourself from thoughts, feelings, sensations, etc. that are “hooking” you – what I mean by hooking, is the ones that pull you away from your values, the ones you can’t stop thinking about and make your anxiety/depression/etc worse. If you think of it like fishing, when you cast, and then hook a fish, you immediately start to reel it in, and the fish struggles, flopping around. This is what some thoughts, etc. can to do us – make us struggle and flop around, doing things that are unhelpful. By putting some distance between ourselves and them can help decrease their power (this includes physical sensations of chronic pain).
10. Acceptance – whoa I know this is a big one because no one really wants to accept that they have a chronic illness. And yet this might be the most powerful part of the list for Spoonies. Not just accepting that you have a chronic illness, but allowing your to sit in the physical sensations of pain (without getting “hooked” by them), and allowing yourself to sit in feelings of sadness and anxiousness, etc. These are all adaptive for us. They are part of our evolutionary history. They are here for a reason, and we can learn to allow them to be without it stopping us from doing what matters.
Acceptance can feel peaceful.
I’m sure I’ve given you a lot to think about, so that’s all from me for this week. Keep on making the most of it!
And don’t forget, the self-care challenge starts for premium members on April 24. If you haven’t signed up yet, it’s just $5 CDN for 4 weeks of posts and check-in around self-care!
Recently I read an article in a psychotherapy magazine put out by the BCACC (British Columbia Association of Accredited Counsellors) about how therapists can and perhaps should integrate health promotion into their clinical practice. Being interested in health psychology anyway, and wanting to work with people with chronic illness as well as mental health problems, I devoured the article. Then I did a quick google search to see what others are saying. And while there are not a ton of journal articles on the subject, there are a few, all pointing to the same thought – this is something therapists should do. What makes it difficult is that psychotherapists, whether they hold a Masters or PhD (or not, depending on where you live they may not need either), typically don’t have a lot of training in health outside of mental health (always a little bit as it relates but rarely a large amount). This makes me curious as to what everything thinks about therapists encouraging health promotion, in some way, during counselling.
Article from Insights magazine (Spring 2017 issue)
What this article really looks at is not just physical health or mental health but all components of health. A holistic approach. Sometimes people go to therapy for things like weight loss, which in that case, health promotion and education seems necessary. Other times someone might bring it up as a secondary concern. There’s also, of course, the interrelation between things like exercise and nutrition and mental health. As well as sleep and mental health. See where I’m going with this? It actually might be almost impossible for therapists to not integrate health into counselling. So, while I usually save this kind of stuff for my premium blog, I thought I would share some health behaviours I’m going to put extra effort into this week, and I hope everyone reading thinks about some that they can as well! Body-mind connection week indeed!
nutrition: I’m going to go with making sure I eat fruit everyday (which I typically do but sometimes stumble on the weekends)
exercise: putting yoga back back into my routine at least 2x/week
sleep: ensuring I don’t have anything to drink after 8pm (part of sleep hygiene!)
other (social, hobbies, gratitude, mindfulness): playing the piano daily (I haven’t been playing as much as I would like)
As you can see, integrating health is rather inclusive and definitely extends beyond just physical aspects. Medication adherence can be another really important one for chronic illness warriors. The article I read speaks about Maslow’s hierarchy of needs, which I’ve mentioned in previous posts. We need to take care of our basic needs in order to take care of our higher needs. The three basic components of physical health I mentioned above are so important. So here’s my question (and I’d love answers in the comments), would you want your therapist to help you with aspects of health promotion that you are neglecting? Why or why not?
I will admit that I haven’t had too many issues dealing with ableism. However, it’s an experience that everyone dealing with a chronic illness (visible or invisible) or a disability has had to deal with at some point. Emotions can range from moderate annoyance to incredibly frustrating depending on the situation. At work in the past I’ve been up front about my health, which also acted as a preventative measure against ableism. But ableism (like sexism, racism, ageism, and for forth) can happen anytime and anywhere. So how can we deal with it?
I wonder if Spike ever had this issue.
My recent experience actually happened at my apartment building. I was carrying three grocery bags and waiting for the one elevator in the building. Because of Covid it’s just one person in the elevator at a time (unless you live together) which totally makes sense. Now, I’m young and obviously my health issues are invisible, but also I was carrying three very full grocery bags and had walked ten minutes with them already. I live only two floors up so I do often take the stairs when I’m able. And the building is only four floors total. Well, this young guy comes in from outside, sees me waiting for the elevator and then says, “even if it weren’t Covid, I would take the stairs.” And then he proceeded to take the stairs. Now, there is a chance he wasn’t making a comment about me taking the elevator, but I certainly took it that way. I would say I was moderately annoyed, because again, even if I was totally okay I was holding groceries!
Abilities can sometimes change from day to day.
I feel like there are two approaches to take with this kind of scenario and it really depends on the specifics of the situation.
I can let it go: This means realizing that while this guy should not have commented, he probably didn’t know any better. Does that make it okay? No, but sometimes there isn’t a chance to do #2. Part two of this answer is that I can regulate my emotions well enough to not be upset by one simple interaction. If I was running into this guy every day and he kept saying similar things, that might be different. I can choose to take this one incident to heart or not.
It’s time to educate the other person: Again, this depends on the situation. Is there going to be enough time? Will the person be open to listening? Is the setting appropriate? And so on. However, I think this is an important thing to do when possible. “Sometimes people who look healthy have invisible illnesses or disabilities. How familiar are you with that?” I’m sure this is not the best worded example of what to say (feel free to comment better ones!) but you get the picture. Take back the power in a respectful way!
The truth is, any time of “-ism” will not disappear unless the community (both those directly effected and those not effected/allies) stand up to it!
Check this out!
I also, want to take a moment to let everyone know that I was recently a guest on a podcast called BeFun BeKind. Check out my appearance here, where I talk about self-acceptance. Until next week, keep making the most of it!
Literally my least favourite question when I go into any doctor or specialist appointment is, “what is your pain like today?” or “on a scale of 1 to 10, 10 being the worst ever, how’s your pain right now?” To someone with chronic pain, these are the most useless, arbitrary questions. Here’s the thing, I understand why doctors and other healthcare professionals ask the question. They want to get a gauge on if your pain is better or worse than it has been in the past. It totally makes sense. However, there are a few things about chronic pain (and pain in general) that aren’t taken into account with this questions.
My perception of what a “10” is may be higher or lower than your perception of what that is.
I’m not always entirely sure what number I should give. Like really, what is the difference between a “6” and a “7”?
Often pain changes throughout the day, so just because I give it a “4” right now, doesn’t mean that it won’t be an “8” in half an hour.
Hm… I’m smiling and happy in both pictures and yet my pain is a “0” on the left, and a “7-8” on the right.
And yet, this is always the first question asked at any appointment. Sometimes I literally just want to say “I don’t know.!” How many of you feel this way to? Plus, sometimes there is this need to want to give a higher number so that the pain is taken more seriously and not just dismissed. Here’s the thing that healthcare professionals often miss – there are better ways to describe pain than using a 1-10 scale. For example, “what type of pain are you experiencing/do you experience?” “What times of day are worst for pain?” “What activities or circumstances do you notice more pain or less pain?” “Are there any points in the day when you feel little to no pain?” And so on. These questions are easier to answer, and honestly, give a more realistic perspective of my pain than me guessing at a number to give my doctor.
Just gonna throw in the random deer visiting a retirement home across the street from me.
The main model used in medicine (and psychology) right now is the biopsychosocial model (except sometimes doctors forget to use it when talking about chronic pain it seems). For those of you not familiar with this, it is the interplay between biological and psychosocial causes (or maintenance) of a medical (or psychological condition). When applying this model to chronic pain, we look at the biological causes of an illness or injury, and how psychosocial factors maintain or increase the physical sensations of pain. It’s that mind-body connection. Here’s an example: the hypothalamic-pituitary-adrenocortical (HPA) system in your brain has been associated with several chronic pain syndromes including fibromyalgia, chronic fatigue syndrome, rheumatoid arthritis, and MS. It is one of the biological causes of pain (though not necessarily the only). Psychological factors that can maintain or increase this pain include feelings of helplessness and hopelessness. Social factors and behaviours that maintain and increase pain include door diet and nutrition, lack of exercise, and substance use (including smoking). Stress is another major psychosocial factor associated with chronic pain. So, rather than asking what are pain is on a scale from 1-10, looking at these factors is likely more productive in both understanding and managing pain!
Let’s talk about pain management. Whether you do this on your own, or with the help of your healthcare team, here are some ways to improve your pain management (because let’s face it, chronic pain is unlikely to magically go away):
medication compliance – taking all medication as prescribed!
addressing psychological factors – such as anxiety – this could be through relaxation and meditative techniques or even exercise, or going to see a psychotherapist
utilizing interdisciplinary healthcare teams – do you have a family doctor? A specialist for your illness or injury? A psychotherapist? A physical and/or occupational therapist? Anyone else who can help you with your pain? (I also have a naturopath and chiropractor for example).
Make a therapist part of your healthcare team! We’re here to help! (just noting that I’m a therapist-in-training right now)
For anyone reading this who is not a chronic pain warrior, please remember that pain isn’t in our heads, and telling us to just deal with it isn’t helpful. In fact it can be stigmatizing, and people with chronic pain always face stigma because of a lack of understanding. We may laugh, smile and have fun, and yet be in pain at the same time. The things are not mutually exclusive. I’m going to link a few episodes of my podcast that complement this post below. For now, keep making the most of it everyone!
Normally at this time of year I do a yearly recap and/or setting goals for the new year, but seeing as 2020 did not turn out how anyone expected, it seems unnecessary to recap and hard to want to set goals since we have no idea what’s coming (not that we’ve ever had an idea but there was more optimism in the past). By the way, if you want to watch an extremely funny take on the past year check out “Death to 2020” on Netflix – satire at its finest. Here’s the thing though, I don’t think personal development has to stop because things aren’t going well in the world. At least it doesn’t stop for me. Sure, some things were completely derailed because of the pandemic, and some more so for some people than others but I don’t want to stop living to the best of my abilities, do you?
I read an article on Global News this morning, indicating that 40% of Canadians have been struggling with mental health and/or substance abuse issues since the beginning of the pandemic (and about 30% with weight gain). Interestingly the normal yearly prevalence rates for mental illness in Canada is about 20%, but the lifetime prevalence is 50% (Canadian Mental Health Association, 2020). Our yearly rate is definitely up, and only time will tell how the lifetime prevalence will be affected. I think it is safe to say that this year we all should focus on our mental health. Whether that means going to therapy (check your area for free counselling options or therapists will sliding scales), utilizing crisis intervention services, or just enhancing our self-care practices to try and keep ourselves as feeling as good as possible, we all need to do something. In terms of substance abuse, it’s important to monitor how much you’re drinking and do the occasional detox/cleanse is probably a good idea. Finally, if you’re concerned about your weight, try to come up with ways to exercise at home (I’ve done a lot of this and post a workout video every 3 weeks on this blog).
At home exercise can be as effective as at the gym exercise.
So, in a sense, we kind of do have some goals for this year that are totally realistic, regardless of what the year has in store for us. For chronic illness warriors, I’m adding one additional, totally realistic goal as well. And trust me, I’m going to do these with you as well.
Prioritizing our mental health: therapy and/or crisis intervention services AND self-care (if you can subscribe to my premium posts, they are all about improving self-care).
Watch how much we are drinking: go a week here-and-there without drinking at all; monitor what you do drink; and try not to drink too much. I find tea in the evening is a good substitute for a drink.
Keep in as good of shape as we can: my chiropractor told me he thinks my recovery from surgery has gone so well because I was in good shape before my surgery. Eat healthy and find creative ways to exercise at home!
Continue to monitor and prioritize your illness: go to your doctor appointment (virtually if necessary), take your medications, utilize any other health services you have, and rest as needed.
The best goals are SMART – specific, measurable, attainable, relevant and time bound – so remember that when actually making your goals for the year. For example, my goal for mental health is: Do one self-care activity every day for at least 5 minutes, 7 days a week for the whole year. If you need help creating some of these goals, feel free to reach out.
It’s no secret I’m a huge fan of yin yoga. I was introduced to it a few years ago but actually didn’t start regular practice until last spring. It has huge health and mental health benefits and has been used to treat symptoms of chronic pain, depression and anxiety. But don’t take my word (or the research I’ve done) for it (because you should always do your own research and consult your own healthcare professionals!) – try it out for yourself! I utilize YouTube for classes and my favourites are by SarahBeth Yoga because she has a variety of classes in different lengths and that target different parts of the body.
For more on the benefits of yin yoga and stretching, check out my podcast episode with Dr. Alex Triendl, “How Stress and Anxiety Manifest in the Body,” and my episode with Danielle Potvin, “Massage Therapy for Chronic Pain.”
Chronically Living 