Therapy

Chronic Pain: What We Know And How To Manage It!

Chronic Pain

It’s important to note that all pain is real! Chronic pain is not “all in your head.” It is pain that persists beyond the acute stage (greater than two months). It often occurs independent of actual tissue damage, meaning that there is no damage to muscle, tendon, ligament, bone, etc that is causing the pain.

Chronic pain involves changes that occur within the brain in response to pain that lasts for long periods of time. Areas in the brain that are not associated with perceiving pain begin to perceive signals as pain – meaning that activities that should not cause pain are now painful! This can significantly affect the quality of one’s life.

Chronic pain affects almost 1 in 3 people worldwide! The cost in the US is about $600 billion annually for medical treatment, lost wages, and lost work time. Chronic pain is the most common reason to seek treatment and the most common reason for disability and addiction. The cost of treatment for chronic pain in the US is even greater than those for cancer, heart disease, dementia, and diabetes care.

Currently, chronic pain is not managed well by healthcare providers. A common treatment is the use of opioids. Opioids (e.g. codeine, morphine, hydrocodone (Norco), oxycodone, fentanyl) are meant for short term management of acute pain. They are not meant for long term management of chronic pain. Medication alone cannot treat chronic pain. When other treatments are added in addition to medication, outcomes are shown to be better. Some people on long term opioid treatment actually experience the side effect of hyperalgesia (or hypersensitivity) which increases pain!

How to Manage

There are several other ways to manage chronic pain in addition to medication.

Exercise – start with light, painfree activities and increase as you are able

Reduce stress as stress causes increased inflammation which can lead to increased pain

Learn more about your condition – learn how others manage to control their pain and maintain their function

Keep up with normal activities as much as possible

Improve your overall health

Avoid bed rest and inactivity – Bed rest will not improve your pain and may make it worse, as it leads to other problems such as weakness, weight gain, and poor circulation.

Consume an anti-inflammatory diet
– Emphasizes plant-based foods and anti-inflammatory spices: turmeric, ginger
– Nutrient deficiency is common in chronic pain and can be worsened by long term use of analgesics (common deficiencies include vitamin D and magnesium)
– Make sure you have the correct intake of omega 3 fatty acids

Make sure you are hydrated
– Dehydration can amplify chronic pain symptoms such as headaches, muscle aches, joint stiffness, and fatigue
– Proper hydration is key in managing pain and improving our body’s function
– Caffeine intake to address loss of sleep, fatigue, and headaches can contribute to dehydration
– The recommendation for appropriate amount of water varies but 64 oz is a great place to start

Make sure you are getting enough sleep
– Position modification
– Stretching before bed
– See if there are other factors other than pain that are contributing to loss of sleep
– Caffeine intake
– Stimulants such as light or noise
– Use of cell phones or other electronics prior to bed

Physical therapy or occupational therapy to increase strength, increase mobility, and improve function as well as to address pain

Be your own advocate when seeking treatment. Only you know what you are feeling and how it affects you. Work to find the treatment that is best for you!

This blog was specially written by our friend and guest writer Rachel Zimmerman, DPT.

Rachel is clinic director at ATI Physical Therapy in Green Bay, WI. You can find out more about her clinic or find a location near you at ATIpt.com!

CBD Benefits and Breakdown!

Marijuana has been in the news quite a bit as it has become legal recreationally in almost a dozen states and legalized for medicinal use in 33 states. All the talk of marijuana has brought CBD more into the spotlight.

Hemp-based CBD is legal to purchase in all 50 states. Derived from hemp, a plant has less than .3% THC (tetrahydrocannabinol – the intoxicant in marijuana). CBD made from “marijuana” with higher than .3% THC is only legal where laws have been passed indicating so.

Although Amazon is still shying away, some big box retailers including Barney’s, CVS, Walgreens, and Rite Aid have already rolled out the red carpet to some CBD products and mall kiosks will be popping up soon. It is necessary to point out that CBD is still very new and still being studied. Only a few human trials have been conducted so far. This week we will break down some of the claims or proposed benefits!

Potential Benefits/Uses

• Anti-Seizure – the FDA has approved Epidiolex, a drug derived from hemp CBD for that use.

• Anti-Anxiety

• Anti-Inflammatory and chronic (no pun intended!) pain relief

• Reduced Stress Response – CBD may help in keeping cortisol levels lower during stressful times. High cortisol levels are well-known to negatively affect sleep and muscular recovery to name a couple of things.

• Improved Immune System Functioning

• Improved Heart Functioning

• Pre-Workout Boost – by elevating your mood and helping to prep your muscles for intense activity through its’ anti-inflammatory properties. Allowing you to get in the right frame of mind to push yourself past that point of exhaustion.

• Improved Sugar Metabolism

How Does It Work?

CB1 & CB2 are the two naturally occurring cannabinoid receptors within the body that CBD interacts with to produce the physiological benefits mentioned previously.

• CB1 is located primarily in brain and nervous system and is responsible for relief from pain, nausea, depression, and more.

• CB2 is located primarily in the immune system and helps regulate our appetite, immune system functions and pain management.

How Do You Use It?

CBD can be inhaled, taken via softgel, ingested orally via tinctures, or consumed in edibles (edibles are still murky as far as legality).

For localized relief after an injury/strain, CBD lotion has been used as an effective alternative to traditional topical pain relief creams. CBD lotions can be applied directly to sore muscles.

Lotions work well to combat the surface level pain where softgels or vaping work from inside to ease internal inflammation.

*If you consider using a CBD product, be sure to check with your doctor and/or pharmacist to discuss if there may be any contra-indications with current medications or conditions you may have.

**If you are going to be taking a urine test, there is a possibility that CBD products can cause it to turn up positive.

Pets and Health: Bigger Than You Thought!

According to the 2017-2018 National Pet Owners Survey (yes that is a real thing!), 68% of US households – about 85 million families – own a pet.

Studies have shown that dog owners particularly decrease their risk of death in general by 33 percent compared with those without a pet!!

This week we’ll talk about how pets can have a positive impact on your health from stress to fitness! Don’t have a pet? Go check out the local humane society and/or pet sanctuaries!

Pets and Stress Response:

Now this may depend on the person – and on the pet – but numerous studies have shown that pets can help lower blood pressure and regulate the heart rate during stressful conditions. Even when they are not with you at the time! Pretty amazing. Outside of casual health benefits, therapy animals can be used for more extensive needs, such as equine therapy for conditions from depression, to anxiety and post-traumatic stress!
Check out this link for info on therapy dogs!

Pets and Staying Active:

Pets can help you stay active, particularly if you have a pet that requires outside time. Walking the dog for instance is an activity that will force you to get outside in even the harsh winter conditions instead of loafing around when the weather is poor! Going for a short walk can have tremendous health benefits when compared with hours of sitting uninterrupted.

Pets and Mental Health:

On the same idea as licensed therapy pets, pets love you for who you are without judgement, which can lead to feelings of acceptance that one may not always get from family or society! Dog parks can be a great way to get active with your pet as well as have a social outlet with others that share a common interest.

Find local parks, and establishments, where you can bring your dog along at www.bringfido.com. Check out the activities area for local dog parks and outdoor options.

Pets and Allergies:

The National Institute of Health has suggested “children exposed to high indoor levels of pet or pest allergens during infancy have a lower risk of developing asthma by 7 years old.” (Source) A similar earlier study found homes with cats had a protective effect, having made allergy-related antibodies, against asthma symptoms in young children. Some scientists believe pets carry microbes that stimulate the immune system so that children don’t become allergic. (Source)

A Pet a Day Keeps the Doctor Away:

Two studies involving the same participants 5 years apart showed that people who had a pet both at the first and second touchpoint had the fewest doctors visits of the group, followed by the group who had no pet the first round and had then acquired one within the 5 years preceding the next.

Take a moment to think about that!

Dog, Cat, Horse, Fish, Bird – any pet counts!

More Resources:
http://www.center4research.org/benefits-pets-human-health/
https://www.webmd.com/hypertension-high-blood-pressure/features/6-ways-pets-improve-your-health#2

Dry Needling for Joint and Muscle Pain Relief

What is Dry Needling?

The name “dry needling” comes from studies that were done to determine the effectiveness of injections. The studies showed that just putting a needle into a trigger point (a small, tight, tender area in a muscle) was just as effective as injecting a pain relieving or anti-inflammatory medication into the trigger point. Since nothing is injected with dry needling, we refer to it as “dry.”

Is Dry Needling the Same as Acupuncture?

While the two are often confused, they are actually different treatments. Dry needling is performed in the dysfunctional area, whereas acupuncture may be performed in the hand to address a headache, for example. Dry needling also focuses mainly on the treatment of musculoskeletal conditions.

How is Dry Needling Done?

First, the area of pain or tension will be assessed in order to locate trigger points. Then a needle will be placed into the muscle, and then the needle will be moved around in small movements that cause the muscle to activate – seen or felt as a twitch in the muscle. Once the twitching ceases, the needle is removed from the muscle.

What is the Purpose of Dry Needling?

Dry needling helps to relieve pain, help muscles relax, and improve function. Usually dry needling is used on tense muscles that are causing pain and affecting a person’s function. It is a very effective method and the results can be seen quicker than other treatments such as massage. The effects of dry needling can be felt after just one session but may take more than one to fully resolve the issue. It is used in conjunction with other treatments such as manual therapy and exercise.

Is Dry Needling Safe?

The risks associated with dry needling are minimal which makes it a safe procedure when performed by a trained practitioner. Physical therapists are regulated by each state in the training they must receive for dry needling before they can use the treatment on patients. Physical therapists also use clean technique, meaning they wear gloves and make sure that they use hand sanitizer and alcohol to sanitize the area being needled. Also, needles are kept in sealed packaging until use so that they are sanitary and safe for use. After a single use they are disposed of in a sharps container and are never reused.

Does Dry Needling Hurt?

Every person is different, and each muscle responds differently to dry needling. The process can be uncomfortable, but is usually not painful. The needle used for dry needling is a very thin needle similar to those used for acupuncture, so there is usually no pain associated with the needle being inserted into the skin. The muscle twitches associated with dry needling can be uncomfortable but typically are not painful. There may be some lingering soreness afterwards but this usually lasts less than 24 hours. Drinking plenty of water after having dry needling done can help to lessen this soreness.

Is Everyone Appropriate for Dry Needling?

While dry needling is a very effective and safe procedure for most people, not everyone is a candidate for it. There are certain precautions that can affect someone’s ability to have dry needling done (for example, over the area of a pacemaker). There is also a timeline of when dry needling is appropriate after surgery so that there is no increased risk for infection. Talk to your physical therapist to see if you’re appropriate for dry needling.

This blog was specially written by our friend and guest writer Rachel Zimmerman, DPT.

Rachel is clinic director at ATI Physical Therapy right here in Green Bay, WI. You can find out more about her clinic or find a location near you at ATIpt.com!