Category Archives: Chronic Pain

Taking Charge of Chronic Pain

Chronic pain is often an annoying part of daily life. But there are ways to manage and reduce its intensity. I learned several useful techniques from physical therapist Sharlene Wing, PT. First, a little background about what contributes to chronic pain:

For some people, misaligned posture can cause imbalance in the back, hips, knees, or ankles.The result is often extra stress on the body structure, causing pain. This makes it hard to find a stable, neutral position that would naturally hold a person upright.If the positions of sitting, standing, or walking, are not well supported, or are out of alignment, this puts more wear and tear on the joint surfaces, as well as on their supporting structures, such as ligaments.

The Gravity of the situation

One big challenge is to deal with the constant pull of gravity, finding positions where we can exercise or do repetitive activities without causing harm.  Besides motion, gravity also causes problems when we are still, as sleeping in bed, or sitting for long periods. “Even when you are still, gravity is still a constant force,” says Sharlene, “causing joint creep, as joints succumb to gravitational pull and become misaligned.” This “joint creep” contributes to stiffness in the morning, or when we stand up after a two-hour movie.

Everyday strategies to reduce chronic pain

Sharlene has several easy and safe exercise suggestions to do at home. I have tried them and have noticed a significant reduction in back and joint pain.

  1. Before getting out of bed, spend about ten minutes stretching your legs out and doing ankle pumps and ankle circles. Gently move hips and knees to get the synovial fluid moving. (This fluid bathes the joints to reduce friction.) If the back feels stiff, one option is to create gentle traction while holding onto the headboard and pulling only as much as is comfortable. If you do this before your feet hit the floor, it gets all the joints ready for weight-bearing. (Sharlene advises caution here if your shoulders are bothersome).
  2. Practice posture on a wall. With the back against the wall, touch the backs of the hands against the wall, arms turned outward to open the shoulders. Try to have the head, buttocks, and calves also touching the wall as much as possible, but not the lower back. Even if you can’t do all of this, says Sharlene, it is a good alignment practice, to lengthen and straighten as much as possible. If anything hurts, cautions Sharlene, don’t do it without consulting with a physical therapist.
  3. Try to be conscious of good posture alignment during day, whether getting in and out of the car, carrying things sitting at a desk, using a computer, or even during a movie. If you slouch, it should only be for short spans of time!

Pain is a warning sign that something is being stressed and should be addressed 

Even though pain is annoying, says Sharlene, we can also think of it as a protective mechanism. “Your body is telling you that something is wrong and you should pay attention,” she says. “Often, for people with chronic pain, the symptom gets heightened, and can become a constant, dull ache,” she says. “it often helps to work with a physical therapist to ‘unlearn’ problematic positions or behavior, strengthen muscles to compensate for overstretched ligaments, and learn new ways of using the body to reduce pain.”

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Filed under Aging, Chronic Pain

Cold shower burst – the science behind the madness

Former Navy SEAL Clint Emerson, author of 100 Deadly Skills: The SEAL Operative’s Guide to Eluding Pursuers, Evading Capture, and Surviving Any Dangerous Situation, explains why it can be healthy for you to end a shower with cold water. Following is a transcript of his interview.
“Cold water will wake you up, without a doubt, and it will keep you awake. But it has more health benefits than anything else. In SEAL training you spend a lot of time in cold water and there’s actually some science to the madness of putting us in cold water. One, the reason professional athletes do it all the time after a workout is it increases recovery. It vasoconstricts the entire body, squeezing out all of that lactic acid so that you can feel good to go the next day and be ready for the next day training.
That cold water is therapy. Even though it was torture, it’s therapy so that it keeps you healthy, keeps your joints and inflammation down, vasoconstricts everything down and allows you to keep moving forward, hopefully without any more injury.”

My book with Alexa Fleckenstein, MD, explains more. So turn that shower dial to  cold for 20 seconds after your hot shower, and you’ll feel great!

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Filed under Chronic Pain, cold shower health benefits, Water

Are You Ready for Your Closeup? When health interferes with work

The good news about advances in the treatment of chronic illness and pain is that many of us are now living—and working— well into midlife and beyond. But this good news may be tempered with new challenges.  For some, the body’s responses to long-term wear and tear might create obstacles to going to work every day. Such obstacles might include problems with mobility or discomfort with sitting at a computer for long periods. It may even be difficult to find professional—and fashionable! shoes that we can walk comfortably in.

All the World’s a Stage

When we leave home in the morning to go to work, we are entering the world “stage” to perform as employees, says Martin R. Anderson, certified Trager® practitioner and former actor. “The more that we have prepared for our performance, the better we will be.” The gentle Trager Approach of mind/body integration and movement education helps free tight bodies for efficient and effortless function.

“As with any performance, we need ‘rehearsal time,’ says Martin, particularly when dealing with chronic musculoskeletal condition and pain.” Martin suggests incorporating movements such as as stretching, yoga, or tai chi—into your morning routine before leaving for work. This increases circulation of blood and fluids, reducing joint pain. “Focus fully on your bodily sensations, without distraction from radio or TV,” he cautions. “This can be a form of self-hypnosis, reminding yourself to be at ease during the day.” My addition: Try a ten-second cold shower burst to get some instant energy!

When You Need to Make a Change

Even with careful preparation, however, there may come a time when going to your workplace full-time becomes difficult, and you would like to find ways to work that accommodate to your physical constraints. Management consultant Barbara Kivowitz, co-author of In Sickness As In Health, points out that physical pain, mobility problems, or reduced energy can interfere with your confidence in your ability to do a good job. “Even though it is hard to accept the reality of your body and its limitations,” says Barbara, “if you do so early enough, you can work with your manager to make changes in the way you work. Thanks to the Internet, many jobs can be performed remotely.” As a first step, Barbara advises making sure your supervisor appreciates the value of your contributions. “Then, you can initiate conversations where you ask for the help of your supervisor to figure out how you can continue to contribute to the workplace, while accommodating to your physical limitations.” While the Americans With Disabilities Act prohibits discrimination and ensures equal opportunity for persons with disabilities in employment, says Barbara, it is best to approach your employer as a partner, solving this problem together. After the changes are put in place, says Barbara, “It is then important to continue the conversation by checking in every few weeks or months, to make sure the system is still working for both you and the workplace.”

Adds Martin: “Feel gratitude about all you are able to accomplish.”

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Filed under Aging, chronic illness, Chronic Pain, Work life

Healing Hands: Physical Therapy for function, mobility, and comfort

I  have discovered a unique, highly effective form of physical therapy that combines the best elements of personal training with muscular therapy. Valerie Ruccia Eagan has developed her own brand of physical therapy that uses hands-on techniques, core- strengthening, and flexibility-building exercises, as well as mind-body energetic work. Her method cuts to the root of physical pain and mobility problems to provide deep and lasting healing.

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Filed under Aging, chronic illness, Chronic Pain, Healing, Marfan Syndrome

Managing Chronic Pain

Despite the media hype of books that promise to “banish your pain,” the reality is that chronic pain is just about impossible to extinguish, whether in “five simple steps,” “four quick weeks,” or whatever the latest tantalizing promises are. The truth, as you probably know if you have been experiencing chronic pain, is that the goals of controlling, managing and living  a satisfying life with pain are much more realistic. As both a person who lives with chronic pain and a medical writer, I have come across a useful website with a realistic, helpful approach to  chronic pain. Full disclosure: I have written some articles for this site, in consultation with several reputable medical professionals. In so doing, I have come to respect both the source of the information and the approach of the site. I have also learned a great deal.

The site is painAction.com, and here are some of the articles I wrote, although I recommend reading any others on topics that are of interest! The site covers back pain, migraine pain and cancer pain, and includes articles, lessons and interactive tools. The focus is on developing skills in self-management, gathering knowledge, medication safety, working with  health care professionals, communication and  emotional coping. Given my interest in integrative medicine, I am also pleased to report that there is information on alternative/complementary modalities to manage chronic pain.

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Filed under Cancer, Chronic Pain, Headache

The Medical System Gave Up On Me

In 1995 I woke up from routine heart valve surgery with the left side of my body paralyzed from a stroke caused by the surgery itself: A tiny piece of tissue had broken away from the valve, traveled through blood vessels and lodged in my brain, blocking the flow of blood with its essential supply of oxygen to the neurons that controlled movement on my left side. I was 43 years old, married, with two young children.

If I had obediently followed the prescribed role of stroke patient in the world of conventional medicine, I would be an invalid in a wheelchair today. Instead, I am back at work as a medical journalist, paying taxes instead of collecting social security.

I recovered because “adapting” to my disability — which is what the insurance company doctor (who had never met me) told me to do after two months of occupational and physical therapy — was not an acceptable option for me. I didn’t want to buy shoes with Velcro, buttonhole fasteners or devices to hold a tomato steady so I could slice it. I didn’t want to walk with a cane or use a wheelchair in the airport. And I certainly didn’t want to spend valuable recovery time learning to use adaptive devices.

During my recovery, the health providers whom I found most helpful were those who recognized the devastation and despair that I felt as the result of this physical calamity. They saw me not just as a patient, but also as a wife, mother, writer and even amateur musician. In their understanding I found the encouragement, strength and hope that I needed to fight back to recovery.

The doctors I found least helpful were those who saw me not as a whole person, but rather as a “stroke patient:” These included the neurologists who shrugged and said “wait and see” when I told them that they must be wrong: I needed my left arm and I needed to be able to walk; and the heart surgeon who breezed into my hospital room just long enough to say, “Sorry you stroked, but heart-wise you’re fine.”

I quickly learned that while the advances of modern surgery can save your life, the conventional medical system — along with the insurers who pay for it — is not set up for full recovery.  The goal of the system was to get me out of the hospital or rehabilitation facility and send me home. What happened after that was up to me. The insurance company doctor (the one who never met me) told me that I had “plateaued,” which meant that while I had made progress in physical and occupational therapy, there would probably be no further improvement. I was at an impasse and additional intervention would be counterproductive (not to mention expensive).

As a patient, it feels as if the health insurers and many doctors want us to accept and “adapt” to our disabilities — whether we are recovering from a heart attack or stroke, suffering from chronic illness or pain or trying to manage the difficulties of growing older.  It is easier to prescribe pills and adaptive devices than to help us take responsibility for our bodies and our health.

I chose to fight my way back to recovery, and this is a tough thing to do for those of us who are accustomed to seeing our doctors as omniscient beings who control our health.  I learned about methods of healing outside of mainstream conventional medicine,including Traditional Chinese Medicine, chich has used acupuncture for thousands of years to treat stroke patients . Yoga, from the equally ancient Indian Ayurvedic system of medicine, gave me strength, balance and peace of mind. The Alexander Technique — a powerful system of movement education — taught me to use my body with less effort and reduced pain. Pilates exercise coaxed my weakened muscles back to work and craniosacral therapy restored my body’s natural rhythms.

I was fortunate: I had the will, the family support, the research skills and the financial means to pursue unconventional healing methods. Fighting the system is much harder for those who don’t have the money, the knowledge of alternative therapies or the emotional strength to keep up the lonely struggle for recovery.  Too often, such people live with pain, disability and despair.

Doctors must understand what illness means in the lives of their patients. They must use their positions, their authority and their words wisely. They have the power to heal, but they also have the potential to destroy hope and, along with it, the chance to recover.

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Filed under acupuncture, Alexander Technique, chronic illness, Chronic Pain, Doctors, Stories of Hope, stroke, Traditional Chinese Medicine

Story of Hope: “All I wanted to do was hug my children.”

One Sunday morning in February 1997, Jacqueline Miller was standing on a  stool hanging curtains in her son’s room.  The last thing she remembers before she found herself covered in blood on the floor is beginning to get down off the stool.  “We figured out later that I must have lost my balance, “ she says.  “I had apparently hit my face — hard — on the corner of my son’s desk.”  The impact had severely injured her spinal cord in the area of her neck and she would need 150 stitches for the lacerations in her face.

Jackie’s spinal cord injury had transformed her in an instant from an outdoor enthusiast, scientist and mother of two young boys to someone who could not walk, turn a page or feed herself.  The prognosis was grim: Doctors told her that she would be permanently paralyzed below her waist, with minimal movement in her arms and hands.  “One of my doctors told me that the best recovery I could hope for was to be able to eventually shuffle 10 feet down the aisle — with a walker — at my son’s wedding,” says Jackie, adding quickly, “They were wrong.” When the extent of the traumatic injury finally sank in, Jackie was in shock and disbelieving.  “All I wanted to be able to do was hug my children,” she says.  “And I couldn’t even do that.”
Those who know Jackie best describe her resilience and determination, and these two qualities, along with her sense of humor, have helped her reclaim her life. She is back at work “more than” full-time and recently got back from a trip to Rome and Morocco with her husband. Her son called the donkey “Mom’s Moroccan wheelchair.” Read more of Jackie’s inspirational recovery here

— Here are pictures of Jackie on her trip; She had been told she would be  quadriplegic:

donkey-and-me6a-stroll-through-the-forum-with-huw-and-max-rolling1

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Filed under Chronic Pain, Healing, Stories of Hope, Uncategorized

Walking from the Heart

This fall, I participated in the American Heart Association HeartWalk in Boston. This was significant for me on several levels: I did the walk with my two children, now 25 and 21. These are children  I was not supposed to have— according to the doctors I had seen when I was growing up—because the stress of pregnancy and childbirth was considered too much for a heart compromised by Marfan Syndrome. But thanks to the  skill and watchful care of a wonderful cardiologist, I was able to thrive through two pregnancies (with planned C-sections), and rejoice with my husband at the birth of our children, who are now well-launched in their own lives and continue to be two of the joys of ours.

The HeartWalk was also significant because I was actually able to complete two of the miles without pain—thanks to the benefits of “physical therapy boot camp” and my new program of regular gym workouts. Again, I feel as if I have “outwitted” some of the usual problems of Marfan Syndrome—joint pain— as long as I am faithful to the exercise routine. Walking that distance was meaningful for another reason: In 1995 I had mitral valve replacement surgery and woke up with half my body paralyzed by a stroke caused by a wayward piece of tissue that had lodged in my brain. I recovered by using integrative medicine (another story), so doing this walk without a cane or other assistance was particularly sweet!

Last—and certainly not least—my family and I walked on the HeartWalk team of the very cardiologist who, 30 years ago, heard and understood how important it was for my husband and me to have children, and who helped make our dream come true. Now, all these years later, here is the result. As I look back on the past 30 years, I realize even more how imporant it is not only to “own our health,” but also to find the right medical partners to help us.

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Filed under Boot camp, Chronic Pain, Health, heart arrhythmia, Marfan Syndrome, Pregnancy, stroke

Healing Arts for Marfan and Chronic Pain

I recently helped to organize a Healing Arts workshop for the National Marfan Foundation annual meeting, which was held in Boson this year. More than 30 participants heard and asked questions of a panel of complementary/alternative practitioners who discussed managing the symptoms of Marfan syndrome—particularly chronic joint pain—with Tai chi, the Alexander Technique, acupuncture, Traditional Chinese Medicine (TCM), nutrition, and craniosacral therapy. Combining alternative treatments with conventional care is called “integrative medicine,” and putting together your own personal healing combination is an excellent way to take responsibility for your health. These healing modalities have applications for anyone suffering from chronic pain.

The workshop began with Tai chi and Alexander teacher Jamee Culbertson leading us in the opening movements and breathwork of a Tai chi form that is thousands of years old. Research has found that these ancient, graceful, meditative movements improve balance and reduce falls. As we breathed deeply and moved slowly in unison, the room seemed to transform into a kind of “sacred space,” as the group united with a shared purpose and energy. With two volunteers, Jamee then demonstrated how the Alexander Technique reduces pain and eases body movement through simple awareness of habitual actions that may be restricting activities. Both Tai chi and the Alexander Technique are gentle, non-invasive practices, and do not stress joints or ligaments.

Eurydice Hirsey, a trained chiropractor and craniosacral therapist, then talked about the use of craniosacral therapy to ease pain and improve movement by enhancing the circulation of cerebrospinal fluid. This is done through gentle touches on the head and sacrum, following the body’s own natural rhythms and movements, without force or pressure. While chiroporactic may not be indicated for most people with Marfan syndrome, the light touch of craniosacral therapy can ease tight muscles and reduce pain, even in those who have had spinal fusions, by focusing on other areas of the body where movement is possible.

Acupuncturist and researcher Stephen Cina shared his orthopedic investigations into the nature of connective tissue and its possible relationship to the meridians (energy pathways) used in Traditional Chinese Medicine. A practitioner either inserts tiny needles into “points” on the skin that correspond to the energy meridians (the needles are usually painless), or applies pressure with the hands (acupressure) on these same spots, in order to reduce pain. And naturopathic intern Amanda Daeges–who has Marfan syndrome, talked about maintaining integrity of connective tissue through what we eat and drink: specifically whole foods and whole grains that include nutrients and trace minerals. She also stressed the importance of drinking enough water. (Divide your body weight in half to find out how many ounces of water you should drink each day.)

All of these complementary modalities (and many more) are described in detail here, has well as profiles of practitioners and personal experience stories.

VERY important: Before you try any complementary/alternative practices, always check with your doctor.

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Filed under acupuncture, Alexander Technique, Chronic Pain, Health, Marfan Syndrome, Tai Chi, Traditional Chinese Medicine

Cold Showers: What’s the Evidence?

Some people have questioned the evidence behind hydrotherapy, especially the cold water treatments that are described in the book that Alexa Fleckenstein and I co-authored. German research supports the effects of cold water used on the skin as therapy. Unfortunately, the studies are in German, and they are small. (1) Because Pharma firms have no interest in inexpensive water cures, there probably won’t be big studies any time soon. Fact is, the German insurance system pays all or part of physician-prescribed treatments, including hydrotherapy and herbs. The importance and therapeutic potential of water, and especially cold water, are now simply taken for granted in Germany.(2) Here are some specific research studies supporting the health benefits of cold water treatments. Citations are listed at the end. (More cold water research details in Own Your Health (2003)

Boosting the immune system
A pilot study of immune effects from cold water therapy with a small number of breast cancer patients found significantly increased disease-fighting cell counts in every category examined, including neutrophils, lymphocytes, monocytes.(3)

Reducing the perception of pain
In a study in Japan, cooling by ice water was one of the “competitive stimuli” that reduced the perception of the pain of a laser beam on the skin. (4)

Improved circulation and function in the legs
A Swedish group administered three weeks of alternating cold and hot hydrotherapy to the legs of patients suffering from intermittent claudication (reduced blood flow) and found that improved systolic blood pressure in ankles and toes, reduced pain, and markedly better walking ability went beyond the results of standard treatment and persisted for at least a year after treatment.(5)

Swimming in the winter?
Ten healthy subjects who regularly swim during the winter were evaluated at Berlin’s Institute of Biochemistry at Humboldt University Medical School. Their blood and urine showed increased levels of anti-oxidants, which prevent cell damage, indicating their bodies’ increased tolerance to stress.(6)

(1)Summarized in Bühring, M., Naturheilkunde: Grundlagen, Anwendungen, Ziele (Natural Medicine: Basic Application and Goals), Munich, Verlag CH Beck, 1997.
(2)Haas, S.S., Hydrotherapy and more: Adapting Kneipp’s Natural Medicine to the U.S., Complementary Medicine for the Physician, 2000; 5(8):57,61-64.
(3)Kuehn, G., Sequential hydrotherapy improves the immune response of cancer patients. In: Mizrahi A, et al., (eds.) Potentiating Health and the Crisis of the Immune System: Integrative Approaches in the Prevention and Treatment of Modern Diseases. New York: Plenum, 1997.
(4)Kakigi R., et al. Pain relief by various kinds of interference stimulation applied to the peripheral skin in humans: pain-related brain potentials following CO2 laser stimulation. J peripher Nerv Syst 1996;1:189-198.
(5)Elmstahl, S. et al., Hydrotherapy of patients with intermittent cluadication: a novel approach to improve systolic ankle pressure and reduce symptoms. Int Angiol. 1995;14:389-394.
(6) Siems, W.G., et al., Uric acid and glutatione levels during short-term whole body cold exposure. Free Radic Biol Med. 1994;16:299-305.

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Filed under Chronic Pain, cold shower health benefits, Healing, Health, Water