Tag: medications

How well do our pain medications work?

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!

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Spoonie Stress

It’s not really a surprise that Spoonies have more stress than healthy folks. Chronic illness and chronic pain warriors just have a lot more to deal with. Coming up with ways to relieve stress is important, and something I try to pay attention to. As stress accumulates it can lead to mental health problems, and quite often, especially with autoimmune diseases, flares. Today I thought we’d focus on some causes of stress and I’ll give some ideas (that work for me) for you to try out to see if they help at all.

Stress is an evolutionary response.

First, I thought we’d start off with a few definitions. The reason I want to give these is that often as a therapist-in-training, I see that people don’t really understand the meanings of the words they use, nor are they aware of the difference appropriate emotional responses and ones that don’t fit the situation.

  • stress – normal, physiological reaction caused by the fight-flight-freeze response in our brains, alerting us that something needs our attention. It’s neither good nor bad, but is a signal telling us that we need to act on something. podcast
  • anxiety – “an emotion characterized by feelings of tension, worried thoughts and physical changes like increased blood pressure” (American Psychological Association). Anxiety is also not inherently good or bad. It’s another natural response of the fight-flight-freeze part of our brain. It’s also normal and part of what makes us human. There is no way to be totally free of anxiety. Fear, on the other hand can be extremely protective and it can be easily confused with anxiety. podcast
    • Anxiety disorder: anxiety that is out of proportion with the situation, and is long-lasting and severe can indicate an anxiety disorder. Someone with an anxiety disorder has “recurring, intrusive thoughts or concerns” (APA)
  • depression: an emotional disorder that can include feelings of sadness, loss of interest in pleasurable activities, and low energy and motivation. Sadness is a common emotion that is important to our functioning. Depression occurs when sadness doesn’t just “go away” on its own. Both anxiety disorders and depression are helped with psychological treatments. blog, podcast
  • trauma – “an emotional response to a terrible event like an accident, rape or natural disaster. Immediately after the event, shock and denial are typical. Longer term reactions include unpredictable emotions, flashbacks, strained relationships and even physical symptoms like headaches or nausea” (APA). I’ve heard this one be misused often, so just be aware of whether you’re actually experiencing trauma. This can also be helped with psychological treatments.
Understanding mental health concepts can be helpful for managing it.

Okay, now that we’ve got that out of the way. What are some common causes of stress in Spoonies?

  • physical symptoms – flares, pain, and basically any other annoying and/or debilitating symptom that comes with your chronic illness. blog
  • medical gaslighting – when a doctor or healthcare professional dismisses your pain and/or symptoms. podcast
  • interpersonal relationships – difficulties with your partner, family, or friends often stemming from a lack of understanding of your illness. blog
  • finances/insurance – even with insurance there is a cost of medications and other treatments that may not be covered or give you as much coverage as you need. blog
Side effect from my hip arthroscopy that definitely caused me some stress.

These are of course, just a few, and you may experience a lot of other stressors depending on your illness and overall life situation. The point out reducing stressors like this is to improve your overall quality of life. So, here are some suggestions that I’ve found to be helpful for each of these (I’m going to link some of my other posts and podcast episodes in case you want more in-depth information).

  • Mindfulness, exercise, sleep, and diet. This means daily practice of whatever way you stay present. Getting whatever type of exercise is accessible during the day (even if it’s a short walk). Practicing good sleep hygiene. And eating as healthy a diet as you can. podcast, podcast, podcast, podcast (yes, one for each of these).
  • Being a self-advocate when it comes to your health and knowing your rights. The medical gaslighting podcast episode I mentioned earlier goes into being a self-advocate. For disability rights check out this podcast.
  • Effective communication and emotional regulation. We can’t control other people but we can definitely control ourselves, even if our emotions are high. podcast
  • Budgeting, budgeting, budgeting. I am without health insurance for the first time in many years. And yes, I live in Canada where healthcare is “Free” (with the exceptions of medications, dentistry, and adjunct care such as physio/chiro/naturopath/massage/etc). Yet I’ve seen the chiropractor twice in the past 3 months (with another appointment today) and gone for a massage. I’ve very meticulously budgeted these in because they are so helpful. The blog post mentioned for finances incorporates budgeting.
There are lots of ways to decrease stress. I enjoy some light exercise in nature.

On top of all this, practicing self-care (podcast) is very helpful. If you don’t like the term “self-care” because it’s been waaaay overused in the media than maybe think of it is as “ways to improve my overall health.” It includes domains of : physical, emotional, intellectual, social, spiritual, and work. It is also incredibly helpful in reducing stress levels. I’m going to be hosting a self-care challenge starting on April 24 on the premium blog. To sign up for the challenge it is only $5 and you get 4 weekly premium posts, motivation for the challenge, ideas and help with the challenge, and an opportunity to be featured on the blog and/or podcast! Stay tuned for more!

Until next week Spoonies, keep making the most of it!

Self-Development

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.

  1. 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).
  2. 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.
  3. 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!
  4. 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.
https://videopress.com/v/TR2aOFQL?preloadContent=metadata
Self-care can be anything you enjoy doing, that makes you feel good, and it is essential for mental health.

I’m going to link some podcast episodes for you to listen to when you get a chance in order to help you with these goals:

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.

Image from: https://corporatefinanceinstitute.com/resources/knowledge/other/smart-goal/

Take care of yourself this coming year, and keep on making the most of it.