When Loved Ones Are In Chronic Pain

We tend to think that pain only affects the individual feeling it, but it can be a difficult thing for the people around them to cope with as well. Educating and helping family or friends of someone with pain is incredibly important, however, as family support is shown to greatly increase the outcomes of pain patients.

If you have someone close to you in pain, this is likely going to be a very important resource for you. By managing your own energy and emotions, you can significantly help someone else manage their pain.

Understand That It's Not In Their Head

It needs to be remembered that chronic pain is neurally driven and not not necessarily require a structural cause. Some individuals may be told that their body's are not "worn down" enough or have anything wrong with them, despite being in pain, leading them to scrutiny for continuing to struggle.

Having anyone not believe that they're in pain can be a traumatizing thing, and the depression, anxiety, and stress are likely to cascade the situation and increase the discomfort they are in. Acknowledging your loved one's situation is the first step in helping them to get through it.

They Do Not Want To Be In Pain

Sometimes, a person might seemingly demonstrate a lack of desire to pursue recovery, leading to more accusations of, "You don't even want to get better!" But would you tell someone who's overweight or struggling with depression that they simply don't want to get healthy as well, though?

After living with chronic pain for an extended period of time, it's natural for individuals to begin to identify with it in order to help cope. When this happens, it becomes an inadvertent act to normalize how they feel and have trouble visualizing and looking ahead toward any type of recovery anymore. This does not mean that they have stopped caring about their health, though!

In these cases, support through motivation and reassurance that there is a positive outcome for them is vital. These individuals need to be reminded that there is still a possibility that they won't be in pain (or as much of it) again and that it is an attainable goal.

Communicate

Whether it be illness, pain, or any other crisis, frustrations are bound to go through the roof at some point. Even when understanding someone's situation, there will be times when enough just seems to be enough.

Remember the importance of communication when it comes to supporting someone in pain. Verbalize your own feelings before they boil over and encourage them to do the same. By doing so, you can help to make sure that the support be given and received does not diminish or become depreciated.

Keep Them Involved

Pain can be incredibly isolating, with removal from work and activities creating the feeling of one's life being shut down. Without finding a way to keep your loved one involved in the world around them, their ability to motivate themselves back toward recovery can quickly plummet.

I've mentioned before how I like to keep my rehab fun and applicable, not necessarily revolved around weights and reps. Even when not prescribed by a healthcare professional, if you can encourage someone to join you for walks, go to the park, spend time with the family, and more, then you're propelling both their physical and mental health recovery.

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4 Reads For Acute Injury Management

Summer time always has us more active, whether it's sport, play, or even just yardwork. This increase in activity comes with some inherent risks, as you know, such as rolled ankles, wrenched backs, and pulled hamstrings.

One thing asked of me quite often is advice regarding acute injury management. In the hours and days following a fresh injury, what can be done? Rest, ice, compress, and elevate, as we are classically taught? Well...maybe. We're starting to refine a little bit since the 80's, however. Below are four pointers and quick reads on the topic.

1) Understand How Pain And Spasm Work

Even when true tissue damage doesn't occur, pain and muscular guarding in response are possible to still happen in the event of sudden trauma. This pain, itself, is enough to freeze many of us in our tracks, and every time we feel that pain, our bodies are likely to start guarding even more in order to protect itself.

Understanding how the cycle of pain and spasm works is helpful in helping us to get past it, because it gives us assurance that not all pain is necessarily indicative of increasing tissue damage; it's simply our body's reactionary mechanism to the experience. By breaking this cycle - or minimizing it in the first place - we can rapidly improve our rate of recovery. Which brings us to...

2) Ice It, But Not Too Much

The jury on the topic is still out, but more and more, professionals are starting to agree that ice is useful, but only to an extent in the event of injury.

Icing can definitely help to minimize the onset of the pain-spasm cycle. Decrease the pain at its earliest onset and decrease the body's guarding response to it! In addition, preventing excessive inflammation and swelling is important to ensure that fresh circulation and nutrients are able to enter the damaged tissue to promote healing.

However, new schools of thought are now starting to look at the fact that too much ice can, understandably, prevent that healthy circulation that the injured area needs. Restricting bloodflow, as you can imagine, isn't the most productive toward healing. With that being said, opinions are leaning toward using ice in the newest acute stage to prevent that excess of inflammation, but then allowing more minor amounts of inflammation to continue - and only icing as needed for pain management - in order to recover more quickly.

3) Rest, But Only As Much As Needed

Obviously, a decrease or modification of physical activity is going to be needed, as it's important to not further the injury more. The thing to realize, though, is that too much prolonged rest is not the most beneficial prescription for injury, despite what many walk-in clinics will suggest.

When we rest for too long throughout the body's very, very metabolically-active healing process, we are depriving it of one of the ingredients that it needs to create healthy, new tissue. The lack of movement means a lack of muscular pump and blood flow, which is needed for an optimal recovery time. Muscle tone, thus, can be lost as well, deconditioning the body and even increasing the potential for reinjury. Finally, as scar tissue develops to bridge the gap where the damage occurred, immobilization can deprive the area of the motion it needs for that tissue to align along the needed directions of stress. This decreases the end-result durability of that scar and can increase long-term levels of discomfort. And so finally...

4) Get That Body Moving!

The sooner you can start mobilizing the injured area, the better. Complete absence of pain is not a requirement to starting to move, with minor amounts of discomfort being expected and perfectly fine. Early range of motion and proprioceptive work is vital to prevent restrictions from developing, and gradual return of resistance for maintenance of strength, endurance, and power.

If one exercise hurts too much, then modify and regress it. If absolutely every single movement to the area is agonizing, then continue to exercise above and below. The body craves for continued use as closely resembling full function as possible, as that's how we retrain it to get back there.

And that's where Athletic Therapy comes in. Excuse the plug.

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Cannabis Research - Things To Consider

I generally don't discuss cannabis use too heavily, as a professional. Partially as to not begin a debate with anyone who disagrees with my views, but also because it's not my place to be recommending pharmaceuticals to clients anyway. However, objectively, there's a lot of stock to be placed in cannabis' use for health and medicinal purposes, and with October 17 quickly approaching, I expect to be receiving many questions on the topic in my practice.

You may have heard, though, the recent story about the major Australian study that found no beneficial use of marijuana for the treatment of chronic pain. This study is making headlines and many are considering this to be a big blow to the validity of cannabis.

However, if we read further than the first paragraph, the study is admitted as being inconclusive. Rather than being a controlled experiment, this study was purely observational. True, the findings were that chronic pain patients who used marijuana in addition to opioids  (as opposed to those who used opioids alone), the marijuana users reported higher pain rates. But, what this study did not control for was the possibility that those cannabis users may have been in higher pain to begin with and could have simply been self-medicating with marijuana due to that fact.

Nor did this study look at the variety of cannabis strains that these individuals were using and the vast number of others that are out there. For those who aren't in the know, this number is closing in on a thousand, with the effects of each type having it's own unique set of effects on the human body.

Let's also remember that opioids, themselves, can have a pain-sensitizing effect in the long-term, and so the dosage of their medications, other treatments they were receiving, and overall lifestyle need to be taken into account.

In fact, there are still many more studies supporting cannibinoids and pain relief, and even some findings that opioids and cannabis together are an even more effective combination. This seems contradictory to the recent story, though, doesn't it?

Overall, we need to keep in mind how restricted cannabis research has been up until this point. Studies and experimentation using marijuana was so difficult to attain approval for that virtually ANY research on the topic is severely lacking. So while, yes, a lot of research is supporting cannabis for medical use, our overall knowledge is FAR from complete.

This being said, there were definitely limitations on the study that seemed to quash cannabis as a pain treatment. At the same time, the research that DOES support marijuana for medicinal use is still in the early stages. No matter which way you lean on the subject, we need to take any findings with a grain of salt for the next foreseeable future. I have no doubt of many of the benefits being reported, but at the same time, I'm sure there are HEAVY placebo effects regarding the creams and ointments hitting the market.

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Growth Spurts and Injury

School is out for the summer! Kids are done classes as well as (most) sports. Time for them to relax before things start all over again in September! And if you're the parent of a child starting to hit adolescence, the fall will likely bring comments with how much they've shot up like a beanstalk. Great, they're taller than you now, aren't they?

As a thing to keep in mind, if your child is active or athletic, sometimes weird things with young people's physical ability can happen as they start to reach their growth spurts.

Imagine if your limbs were suddenly a foot longer than they were yesterday. It would certainly be weird. All that extra length on both your arms and legs and no idea how to handle it! It would probably be awkward, wouldn't it? Well, if you're finding yourself harping on your child's clumsiness, keep in mind that this is probably happening to them.

This. I think.

This being said, with drastic changes in body composition comes a challenge for a person's brain to maintain proper body awareness. While not being an area that is heavily studied, it is being found that adolescence is a time where proprioceptive ability and postural control fall behind in development due to the obvious reasons touched on above. And, as we know, with a lack of proprioception and inability to adjust joint control as needed, injury rates become much more common.

The risk here doesn't stop at the fact that your teenager has a tendency to trip (a lot!) or roll their ankles. Chronic back pain is even a rampant - and often under-reported - problem in young people!

And we haven't even touched on the high rate of tendon injuries that happen as a young person's muscles suddenly find themselves on new, permanent lengthening.

Let me be clear, however. This is not an attempt at fear-mongering to cause parents to either remove their children from sport or to feel like they now need weekly preventative trips to the therapist's office to stop injury from occurring! The majority of young people are going to grow up into healthy adults with minimal injury just fine!

The important thing, though, is to be mindful that there are these massive changes occurring with their bodies and that we should be attentive to any warning signs. Long-term aches and pains or even a new and noticeable struggle with coordination may warrant seeking help. Or, as an alternative, perhaps just look at diversifying that child's physical activity to allow them to get comfortable using their body in a variety of ways again. Also, appropriate rest.

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Your Immune System and Pain

I came across some reading regarding the immune system's role in chronic pain. It's a very neat viewpoint, as we typically think of the nervous system and immune system to be independent of one another. However, when it comes to both acute and chronic pain, it seems that there is a much larger role of our immune response in the sensations we feel.

To put in brief, the body has immune reactions to acute, inflammatory injuries as well as to long-term neural pain and damage. White blood cells, inflammatory mediators, and other structures travel to those sites and interact with the tissue and nerve cells in the area and attempt to repair.

The study shows that many of the white blood cells that go to work at an area of pain have a positive effect, often going as far as to release pain-dampening opioid chemicals. However, there is also a line to be crossed with the immune response. In acute injuries, prolonged inflammation and the inflammatory cells that act in the area can further potentiate pain signals. In chronic, neural pain, immune cells can completely change the way that both our peripheral nerves (through the body and tissue) and central nerves (in the brain and spinal cord) respond to stimuli, heightening sensitivity to pain in many situations.

The specific processes and variety of cells involved in this phenomenon is exceedingly complex and well out of the scope of any manual therapist to thoroughly understand or attempt to address. However, it's important to be aware of the mechanisms in place, as it's suggested that any activation of the immune system, such as general illness and disease, might play a role in pain propagation.

While we certainly do not want to be shutting down and suppressing our immune systems in order to try and control pain, researchers are working on ways to isolate the individual immune mechanisms to alter pain sensations. Although no solutions are hitting the applied practices of medicine yet, this information certainly has major implications when it comes to factoring in general health, chronic disease, and even diet into the reasons why complex pain occurs.

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