More About Migraines

January 4, 2010

As identified in yesterday’s article titled, What Do You Know About Migraines?, the Mayo Clinic Staff provided a great definition of Migraines as painful headaches of unknown origin. Now you know that no one really knows where these headaches come from. The staff also went through symptoms, causes, risk factors, and complications. Today’s article begins with preparing for the appointment with your provider.

Preparing for your appointment

By Mayo Clinic staff

You’re likely to start by seeing your primary care provider first. If appropriate you may be referred to a neurologist or other physician who specializes in headache medicine.

Because appointments can be brief, and because there’s often a lot of ground to cover, it’s a good idea to be well-prepared for your appointment. Here’s some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

  • Write down symptoms you’re experiencing, even if they seem unrelated to your migraines.
  • Write down key personal information, including any major stresses or recent life changes.
  • Make a list of all medications, as well as any vitamins or supplements, that you’re taking. It is particularly important to list all medications that you have used to treat your headaches. Include the doses of the medications.
  • Take a family member or friend along, if possible. Sometimes it can be difficult to soak up all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
  • Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. For migraines, some basic questions to ask your doctor include:

  • What is likely triggering my migraines?
  • Are there other possible causes for my symptoms?
  • What kinds of tests do I need?
  • Is my condition likely temporary or chronic?
  • What is the best course of action?
  • What are the alternatives to the primary approach that you’re suggesting?
  • What changes to my lifestyle or diet do you suggest I make?
  • I have these other health conditions. How can I best manage them together?
  • Is there a generic alternative to the medicine you’re prescribing me?
  • Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend?

In addition to the questions that you’ve prepared to ask your doctor, don’t hesitate to ask questions during your appointment at any time that you don’t understand something.

What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

  • When did you first begin experiencing symptoms?
  • Have your symptoms been continuous or occasional?
  • How severe are your symptoms?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?

What you can do in the meantime

  • Keep a headache diary. A diary can help you and your doctor determine what triggers your migraines. Note when your headaches start, how long they last and what, if anything, provides relief. Be sure to record your response to any headache medications you take. Also note the foods you ate in the 24 hours preceding attacks, any unusual stress, and how you feel and what you’re doing when headaches strike.
  • Reduce stress. Because stress triggers migraines for many people, try to avoid overly stressful situations, or use stress-reduction techniques like meditation.
  • Get enough sleep but don’t oversleep. Aim for six to eight hours of sleep a night.

Tests and diagnosis

If you have typical migraines or a family history of migraines, your doctor will likely diagnose the condition on the basis of your medical history and a physical exam. But if your headaches are unusual, severe or sudden, your doctor may recommend a variety of tests to rule out other possible causes for your pain.

  • Computerized tomography (CT). This imaging procedure uses a series of computer-directed X-rays that provides a cross-sectional view of your brain. This helps doctors diagnose tumors, infections and other possible medical problems that may be causing your headaches.
  • Magnetic resonance imaging (MRI). MRIs use radio waves and a powerful magnet to produce very detailed cross-sectional views of your brain. MRI scans help doctors diagnose tumors, strokes, aneurysms, neurological diseases and other brain abnormalities. An MRI can also be used to examine the blood vessels that supply the brain.
  • Spinal tap (lumbar puncture). If your doctor suspects an underlying condition, such as meningitis — an inflammation of the membranes (meninges) and cerebrospinal fluid surrounding your brain and spinal cord — he or she may recommend a spinal tap (lumbar puncture). In this procedure, a thin needle is inserted between two vertebrae in your lower back to extract a sample of cerebrospinal fluid (CSF) for laboratory analysis.

Treatments and drugs

A variety of drugs have been specifically designed to treat migraines. In addition, some drugs commonly used to treat other conditions also may help relieve or prevent migraines. Medications used to combat migraines fall into two broad categories:

  • Pain-relieving medications. Also known as acute or abortive treatment, these types of drugs are taken during migraine attacks and are designed to stop symptoms that have already begun.
  • Preventive medications. These types of drugs are taken regularly, often on a daily basis, to reduce the severity or frequency of migraines.

Choosing a strategy to manage your migraines depends on the frequency and severity of your headaches, the degree of disability your headaches cause, and your other medical conditions.

Some medications aren’t recommended if you’re pregnant or breast-feeding. Some aren’t used for children. Your doctor can help find the right medication for you.

Pain-relieving medications
For best results, take pain-relieving drugs as soon as you experience signs or symptoms of a migraine. It may help if you rest or sleep in a dark room after taking them:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs). These medications, such as ibuprofen (Advil, Motrin, others) or aspirin, may help relieve mild migraines. Drugs marketed specifically for migraine, such as the combination of acetaminophen, aspirin and caffeine (Excedrin Migraine), also may ease moderate migraines but aren’t effective alone for severe migraines. If taken too often or for long periods of time, NSAIDs can lead to ulcers, gastrointestinal bleeding and rebound headaches.
  • Triptans. For many people with severe migraine attacks, triptans are the drug of choice. They are effective in relieving the pain, nausea and sensitivity to light and sound that are associated with migraines. Medications include sumatriptan (Imitrex), rizatriptan (Maxalt), naratriptan (Amerge), zolmitriptan (Zomig), almotriptan (Axert), frovatriptan (Frova) and eletriptan (Relpax). Side effects of triptans include nausea, dizziness and muscle weakness. They aren’t recommended for people at risk for strokes and heart attacks. A new, single-tablet combination of sumatriptan and naproxen sodium (Treximet) became available in 2008. It’s more effective in relieving migraine symptoms than either medication on its own.
  • Ergot. Ergotamine (Migergot, Cafergot) is much less expensive, but also less effective, than triptans. It seems most effective in those whose pain lasts for more than 48 hours. Dihydroergotamine (Migranal) is an ergot derivative that is more effective and has fewer side effects than ergotamine.
  • Anti-nausea medications. Because migraine attacks are often accompanied by nausea with or without vomiting, medication for nausea is appropriate and is usually combined with other medications. Frequently prescribed medications are metoclopramide (oral) or prochlorperazine (oral or suppository).
  • Butalbital combinations. Medications that combine the sedative butalbital with aspirin or acetaminophen (Butapap, Phrenlin Forte) are sometimes used to treat migraine attacks. Some combinations also include caffeine or codeine (Esgic-Plus, Fioricet). These medications, however, have a high risk of rebound headaches and withdrawal symptoms so should be used infrequently.
  • Opiates. Medications containing narcotics, particularly codeine, are sometimes used to treat migraine pain when people can’t take triptans or ergot. Narcotics are habit-forming and are usually used only as a last resort.

Preventive medications
Nearly half of those who get migraines could benefit from preventative medication, yet only about 1 in 10 people take it. You may be a candidate for preventive therapy if you have two or more debilitating attacks a month, if pain-relieving medications aren’t helping, or if your migraine signs and symptoms include a prolonged aura or numbness and weakness.

Preventive medications can reduce the frequency, severity and length of migraines and may increase the effectiveness of symptom-relieving medicines used during migraine attacks. Your doctor may recommend that you take preventive medications daily, or only when a predictable trigger, such as menstruation, is approaching.

In most cases, preventive medications don’t eliminate headaches completely, and some cause serious side effects. If you have had good results from preventative medicine and have been migraine-free for six months to a year, your doctor may recommend tapering off the medication to see if your migraines return without it.

For best results, take these medications as your doctor recommends:

  • Cardiovascular drugs. Beta blockers — commonly used to treat high blood pressure and coronary artery disease — can reduce the frequency and severity of migraines. These drugs are considered among first-line treatment agents. Calcium channel blockers, another class of cardiovascular drugs, especially verapamil (Calan, Isoptin), also may be helpful in preventing migraines and relieving symptoms from aura. In addition, the antihypertensive medications lisinopril (Prinivil, Zestril) and candesartan (Atacand) are useful in reducing the length and severity of migraines. Researchers don’t understand exactly why all of these cardiovascular drugs prevent migraines. Side effects can include dizziness, drowsiness or lightheadedness.
  • Antidepressants. Certain antidepressants are good at helping to prevent some types of headaches, including migraines. Most effective are tricyclic antidepressants, such as amitriptyline, nortriptyline (Pamelor) and protriptyline (Vivactil). These medications are considered among first-line treatment agents and may reduce migraines by affecting the level of serotonin and other brain chemicals. You don’t have to have depression to benefit from these drugs. Other classes of antidepressants called selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs), haven’t been proven as effective for migraine prevention. However, preliminary research suggests that one SNRI, venlafaxine (Effexor), may be helpful in preventing migraines.
  • Anti-seizure drugs. Some anti-seizure drugs, such as divalproex (Depakote) and topiramate (Topamax), and gabapentin (Neurontin), seem to reduce the frequency of migraines. In high doses, however, these anti-seizure drugs may cause side effects, such as nausea and vomiting, diarrhea, cramps, hair loss, and dizziness.
  • Cyproheptadine. This antihistamine specifically affects serotonin activity. Doctors sometimes give it to children as a preventive measure.
  • Botulinum toxin type A (Botox). Botulinum toxin type A is sometimes used for treatment of chronic migraines. Studies have had mixed results with respect to effectiveness. However, some headache specialists believe that it can be helpful for some people. Injections are made in muscles of the forehead and neck. When this is effective, the treatment typically needs to be repeated every three months.

Lifestyle and home remedies

Self-care measures can help ease the pain of a migraine.

  • Try muscle relaxation exercises. Progressive muscle relaxation, meditation and yoga don’t require any equipment. You can learn them in classes or at home using books or tapes. Or spend at least a half-hour each day doing something you find relaxing — listening to music, gardening, taking a hot bath or reading.
  • Get enough sleep but don’t oversleep. The average adult needs six to eight hours of sleep a night. It’s best to go to bed and wake up at regular times, as well.
  • Rest and relax. If possible, rest in a dark, quiet room when you feel a headache coming on. Place an ice pack wrapped in a cloth on the back of your neck and apply gentle pressure to painful areas on your scalp.
  • Keep a headache diary. Continue keeping your headache diary even after you see your doctor. It will help you learn more about what triggers your migraines and what treatment is most effective.

Alternative medicine

Nontraditional therapies may be helpful if you have chronic headache pain:

  • Acupuncture. In this treatment, a practitioner inserts many thin, disposable needles into several areas of your skin at defined points. A number of clinical trials have found that acupuncture may be helpful for headache pain.
  • Biofeedback. Biofeedback appears to be especially effective in relieving migraine pain. This relaxation technique uses special equipment to teach you how to monitor and control certain physical responses related to stress, such as muscle tension.
  • Massage. Massage may help reduce the frequency of migraines. And it can improve the quality of your sleep, which can, in turn, help prevent migraines.
  • Herbs, vitamins and minerals. There is some evidence that the herbs feverfew and butterbur may prevent migraines or reduce their severity. A high dose of riboflavin (vitamin B-2) also may prevent migraines by correcting tiny deficiencies in the brain cells. Coenzyme Q10 supplements may be helpful in some individuals. Oral magnesium sulfate supplements may reduce the frequency of headaches in some people, although studies don’t all agree on this issue. Magnesium taken intravenously seems to help some people during an acute headache, particularly people with magnesium deficiencies. Ask your doctor if these treatments are right for you. Don’t use feverfew or butterbur if you’re pregnant.

Prevention

By Mayo Clinic staff

Whether or not you take preventive medications, you may benefit from lifestyle changes that can help reduce the number and severity of migraines. One or more of these suggestions may be helpful for you:

  • Avoid triggers. If certain foods seem to have triggered your headaches in the past, avoid those foods. If certain scents are a problem, try to avoid them. In general, establish a daily routine with regular sleep patterns and regular meals. In addition, try to control stress.
  • Exercise regularly. Regular aerobic exercise reduces tension and can help prevent migraines. If your doctor agrees, choose any aerobic exercise you enjoy, including walking, swimming and cycling. Warm up slowly, however, because sudden, intense exercise can cause headaches. Obesity is also thought to be a factor in migraines, and regular exercise can help you keep your weight down.
  • Reduce the effects of estrogen. If you’re a woman with migraines and estrogen seems to trigger or make your headaches worse, you may want to avoid or reduce the amount of medications you take that contain estrogen. These medications include birth control pills and hormone replacement therapy. Talk with your doctor about the best alternatives or dosages for you.

I hope that some or all of this information will be helpful to you. If you have any questions or would like to look up other symptoms or problems, just go to The Mayo Clinic website. You can find out about any problem you may have in addition to a treatment, possibly an alternative treatment, what you can do at home for your problem, and how to prevent it. Please comment on the article if the information was useful to you.

By Diane | Posted in Chronic Pain, Chronic Pain Support, Educational Opportunity, Medication Information, Self Help Information, The Power of Education | Tagged , | Comments (2)

What Do You Know About Migraines?

January 3, 2010

The only thing I know about migraines is they hurt like “you know what.” I’ve only had a few of these headaches in my life (thank the Lord), but I have friends that have them and they cause their lives to come to a screeching halt. What can you do when your head hurts so bad you want to crawl into a dark room and pull the covers over your head?

Are you interested in the experts views on what migraine headaches are? OK! Back we go to my favorite experts, the medical staff at Mayo Clinic. I’m sure we will find some excellent information that will be helpful in understanding what migraines are, other than the obvious painful headache, and what to do about them.

Definition

By Mayo Clinic staff

Migraines are chronic headaches that can cause significant pain for hours or even days. Symptoms can be so severe that all you can think about is finding a dark, quiet place to lie down.

Some migraines are preceded or accompanied by sensory warning symptoms or signs (auras), such as flashes of light, blind spots or tingling in your arm or leg. A migraine is often accompanied by nausea, vomiting, and extreme sensitivity to light and sound.

Although there’s no cure, medications can help reduce the frequency and severity of migraines. If treatment hasn’t worked for you in the past, it’s worth talking to your doctor about trying a different migraine medication. The right medicines combined with self-help remedies and lifestyle changes may make a tremendous difference.

Symptoms

Migraines usually begin in childhood, adolescence or early adulthood. A typical migraine attack produces some or all of these signs and symptoms:

  • Moderate to severe pain, which may be confined to one side of the head or may affect both sides
  • Head pain with a pulsating or throbbing quality
  • Pain that worsens with physical activity
  • Pain that interferes with your regular activities
  • Nausea with or without vomiting
  • Sensitivity to light and sound

When untreated, a migraine typically lasts from four to 72 hours, but the frequency with which headaches occur varies from person to person. You may have migraines several times a month or much less frequently.

Not all migraines are the same. Most people experience migraines without auras, which were previously called common migraines. Some people have migraines with auras, which were previously called classic migraines. Auras can include changes to your vision, such as seeing flashes of light, and feeling pins and needles in an arm or leg.

Whether or not you have auras, you may have one or more sensations of premonition (prodrome) several hours or a day or so before your headache actually strikes, including:

  • Feelings of elation or intense energy
  • Cravings for sweets
  • Thirst
  • Drowsiness
  • Irritability or depression

When to see a doctor
Migraines are often undiagnosed and untreated. If you experience signs and symptoms of migraine, keep a record of your attacks and how you treated them. Then make an appointment with your doctor to discuss your headaches and decide on a treatment plan.

Even if you have a history of headaches, see your doctor if the pattern changes or your headaches suddenly feel different.

See your doctor immediately or go to the emergency room if you have any of the following signs and symptoms, which may indicate other, more serious medical problems:

  • An abrupt, severe headache like a thunderclap
  • Headache with fever, stiff neck, rash, mental confusion, seizures, double vision, weakness, numbness or trouble speaking
  • Headache after a head injury, especially if the headache gets worse
  • A chronic headache that is worse after coughing, exertion, straining or a sudden movement
  • New headache pain if you’re older than 50

Causes

Although much about the cause of migraines isn’t understood, genetics and environmental factors seem to both play a role.

Migraines may be caused by changes in the trigeminal nerve, a major pain pathway. Imbalances in brain chemicals, including serotonin — which helps regulate pain in your nervous system — also may be involved.

Serotonin levels drop during migraines. This may trigger your trigeminal system to release substances called neuropeptides, which travel to your brain’s outer covering (meninges). The result is headache pain.

Migraine triggers
Whatever the exact mechanism of the headaches, a number of things may trigger them. Common migraine triggers include:

  • Hormonal changes in women. Fluctuations in estrogen seem to trigger headaches in many women with known migraines. Women with a history of migraines often report headaches immediately before or during their periods, when they have a major drop in estrogen. Others have an increased tendency to develop migraines during pregnancy or menopause. Hormonal medications — such as oral contraceptives and hormone replacement therapy — also may worsen migraines, though some women find it’s beneficial to take them.
  • Foods. Some migraines appear to be triggered by certain foods. Common offenders include alcohol, especially beer and red wine; aged cheeses; chocolate; aspartame; overuse of caffeine; monosodium glutamate — a key ingredient in some Asian foods; salty foods; and processed foods. Skipping meals or fasting also can trigger migraines.
  • Stress. Stress at work or home can instigate migraines.
  • Sensory stimuli. Bright lights and sun glare can produce migraines, as can loud sounds. Unusual smells — including pleasant scents, such as perfume, and unpleasant odors, such as paint thinner and secondhand smoke, can also trigger migraines.
  • Changes in wake-sleep pattern. Either missing sleep or getting too much sleep may serve as a trigger for migraine attacks in some individuals, as can jet lag.
  • Physical factors. Intense physical exertion, including sexual activity, may provoke migraines.
  • Changes in the environment. A change of weather or barometric pressure can prompt a migraine.
  • Medications. Certain medications can aggravate migraines.

Risk factors

Several factors make you more prone to having migraines.

  • Having a family history. Many people with migraines have a family history of migraine. If one or both of your parents have migraines, there’s a good chance you will too.
  • Being younger than 40. Half the people who suffer from migraines started getting them before they were 20 and migraines are most common in people who are between 30 and 39 years old.
  • Being female. Women are three times as likely to have migraines as men are. Headaches tend to affect boys more than girls during childhood, but by the time of puberty, more girls are affected.
  • Experiencing hormonal changes. If you’re a woman with migraines, you may find that your headaches begin just before or shortly after onset of menstruation. They may also change during pregnancy or menopause. Some women report that their migraines got worse during the first trimester of a pregnancy. Though for many, the migraines improved during later stages in the pregnancy.

Complications

Sometimes your efforts to control your pain cause problems.

  • Abdominal problems. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin, others) and aspirin, may cause abdominal pain, bleeding and ulcers — especially if taken in large doses or for a long period of time.
  • Rebound headaches. In addition, if you take over-the-counter or prescription headache medications more than nine days per month or in high doses, you may be setting yourself up for a serious complication known as rebound headaches. Rebound headaches occur when medications not only stop relieving pain, but actually begin to cause headaches. You then use more pain medication, which traps you in a vicious cycle.
  • Serotonin syndrome. This potentially life-threatening drug interaction can occur if you take migraine medicines called triptans, such as sumatriptan (Imitrex) or zolmitriptan (Zomig), along with antidepressants known as selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs). Some common SSRIs include Zoloft, Prozac and Paxil. SNRIs include Cymbalta and Effexor. Fortunately, serotonin syndrome is rare.

The Mayo Clinic Staff does a great job of explaining the information they present, don’t they? You, too, can go online and type in whatever health topic you want to learn more about. I hope this information is beneficial, especially if you have migraine headaches. Tomorrow, we will see what the Staff has to say about preparing for your provider visit, tests and diagnosis, treatment and drugs, lifestyle and home remedies, alternative medicine, and prevention. Take care and have a pleasant Sunday afternoon and evening. See You Tomorrow!

By Diane | Posted in Chronic Pain, Chronic Pain Support, Educational Opportunity, Medication Information, Self Help Information, The Power of Education | Tagged , , | Comment (1)

I Have This Back Pain That Doesn’t Go Away

November 28, 2009

You wake up in the morning after sleeping only a few hours, again. The muscles in your back are burning as if on fire. That’s when you start thinking, “How am I going to get through the day like this?”

Believe me when I say that you are not the only one thinking like this daily. There are millions of people all around the world thinking the very same thing as they get up in the morning. Chronic back pain is a very prevalent problem. Both men and women suffer with this type of pain.

We are a society that doesn’t know how to deal with diseases that cannot be cut out or cured with medicine. What we don’t want to hear is that the pain will likely never go away. When a medical provider says, “You will have to learn to live with it,” we walk away not knowing what to do.

If a medical provider is in the know, he or she will send you to a pain clinic. The providers in a pain clinic specialize in helping people cope with chronic pain. If the medical provider is honest with you, he or she will tell you that the procedures are basically “bandaids.” If anything, the injections will give you a few months of relief before the pain comes back. Even though the injections do not take the pain away, the other treatments provided could possibly help you cope with the pain.

The other treatments that pain clinics offer could be physical therapy to include massage, physical therapy-exercise (which is very important to maintain muscle mass and movement), pharmacy-medicines, psychotherapy-coping strategies and medications, occupational therapy (retraining to other occupations), vocational rehabilitation (vocational training and job relocation), etc.

You see, a chronic pain condition affects your entire body not just your back. Coping with chronic pain requires the help of a wide range of specialty people working together to care for your every need.

When I hurt my back, I thought the pain would go away. That is what I expected, but it didn’t happen. Back in the 1970s, the neurologist put me in the hospital for 10 days in pelvic traction and physical therapy (water therapy). The medicine he gave me made me feel very drowsy and weak. One of the problems that developed in coping with this pain was the inability to sleep. Muscle relaxants made me drowsy and pain medicine helped me sleep a little bit, but for the most part, I was awake every 3 to 4 hours.

After a few years of conservative therapy, I was tired of dealing with daily pain with no end in site. Finally, I consulted a surgeon, a neurosurgeon. He warned me that the pain may not go away completely even if they found what was causing it. I was willing to take that chance. No more of this conservative stuff, I was tired of it. So, off to surgery I went.

Enough of this story for now! I will go on with my story tomorrow. Stay tuned, because what I learned in the years following my back surgery will be very revealing reading.

By Diane | Posted in Chronic Pain Support, The Power of Education | Tagged , , | Comments (0)

Fibromyalgia and Coping Strategies

November 15, 2009

Fibromyalgia is the new word that describes a condition that used to be called “rheumatism.” This condition like rheumatism  has similar symptoms, i.e., muscle pain, body aches,  fatigue, sleep disturbances, chronic facial muscles pain or aching, and reduced exercise tolerance, etc.. There are specific sites, called tender points, on the back of the neck, the lower back, sternum or breast bone, hip, shin, elbows, and kneResearchers believe repeated nerve stimulation causes the brains of people with fibromyalgia to change. This change involves an abnormal increase in levels of certain chemicals in the brain that signal pain (neurotransmitters). In addition, the brain’s pain receptors seem to develop a sort of memory of the pain and become more sensitive, meaning they can overreact to pain signals.es. For the most part, the incidence of fibromyalgia happens in women between the ages of 20 and 50. The prevalence of this chronic pain disorder is between 0.7% and 13% for women and 0.2% and 3.9% for men.

Researchers believe repeated nerve stimulation causes the brains of people with fibromyalgia to change. This change involves an abnormal increase in levels of certain chemicals in the brain that signal pain (neurotransmitters). In addition, the brain’s pain receptors seem to develop a sort of memory of the pain and become more sensitive, meaning they can overreact to pain signals.

According to an article on fibromyalgia on the Mayo Clinic website, doctors don’t know what causes fibromyalgia, but it most likely involves a variety of  factors working together. These may include:

  • Genetics. Because fibromyalgia tends to run in families, there may be certain genetic mutations that may make you more susceptible to developing the disorder.
  • Infections. Some illnesses appear to trigger or aggravate fibromyalgia.
  • Physical or emotional trauma. Post-traumatic stress disorder has been linked to fibromyalgia.

Why does it hurt?
Current thinking centers around a theory called central sensitization. This theory states that people with fibromyalgia have a lower threshold for pain because of increased sensitivity in the brain to pain signals.

Treatments and drugs

In general, treatments for fibromyalgia include both medication and self-care. The emphasis is on minimizing symptoms and improving general health.

Medications
Medications can help reduce the pain of fibromyalgia and improve sleep. Common choices include:

  • Analgesics. Acetaminophen (Tylenol, others) may ease the pain and stiffness caused by fibromyalgia. However, its effectiveness varies. Tramadol (Ultram) is a prescription pain reliever that may be taken with or without acetaminophen. Your doctor may recommend nonsteroidal anti-inflammatory drugs (NSAIDs) — such as aspirin, ibuprofen (Advil, Motrin, others) or naproxen sodium (Aleve, others) — in conjunction with other medications. NSAIDs haven’t proved to be as effective in managing the pain in fibromyalgia when taken by themselves.
  • Antidepressants. Your doctor may prescribe amitriptyline to help promote sleep. Fluoxetine (Prozac) in combination with amitriptyline is effective in some people. Duloxetine (Cymbalta) may help ease the pain and fatigue associated with fibromyalgia. And milnacipran (Savella) was recently approved by the Food and Drug Administration for the treatment of fibromyalgia symptoms.
  • Anti-seizure drugs. Medications designed to treat epilepsy are often useful in reducing certain types of pain. Gabapentin (Neurontin) is sometimes helpful in reducing fibromyalgia symptoms, while pregabalin (Lyrica) is the first drug approved by the Food and Drug Administration to treat fibromyalgia.

Therapy

  • Physical therapy. Specific exercises can help restore muscle balance and may reduce pain. Stretching techniques and the application of hot or cold also may help.
  • Counseling. Cognitive behavioral therapy seeks to strengthen your belief in your abilities and teaches you methods for dealing with stressful situations. Therapy is provided through individual counseling, classes, and with tapes, CDs or DVDs, and may help you manage your fibromyalgia.

Lifestyle and home remedies

Self-care is critical in the management of fibromyalgia.

  • Reduce stress. Develop a plan to avoid or limit overexertion and emotional stress. Allow yourself time each day to relax. That may mean learning how to say no without guilt. But try not to change your routine completely. People who quit work or drop all activity tend to do worse than those who remain active. Try stress management techniques, such as deep-breathing exercises or meditation.
  • Get enough sleep. Because fatigue is one of the main characteristics of fibromyalgia, getting sufficient sleep is essential. In addition to allotting enough time for sleep, practice good sleep habits, such as going to bed and getting up at the same time each day and limiting daytime napping.
  • Exercise regularly. At first, exercise may increase your pain. But doing it regularly often decreases symptoms. Appropriate exercises may include walking, swimming, biking and water aerobics. A physical therapist can help you develop a home exercise program. Stretching, good posture and relaxation exercises also are helpful.
  • Pace yourself. Keep your activity on an even level. If you do too much on your good days, you may have more bad days.
  • Maintain a healthy lifestyle. Eat healthy foods. Limit your caffeine intake. Do something that you find enjoyable and fulfilling every day.

Alternative medicine

Complementary and alternative therapies for pain and stress management aren’t new. Some, such as meditation and yoga, have been practiced for thousands of years. But their use has become more popular in recent years, especially with people who have chronic illnesses, such as fibromyalgia.

Several of these treatments do appear to safely relieve stress and reduce pain, and some are gaining acceptance in mainstream medicine. But many practices remain unproved because they haven’t been adequately studied. Some of the more common complementary and alternative treatments promoted for pain management include:

  • Acupuncture. Acupuncture is a Chinese medical system based on restoring normal balance of life forces by inserting very fine needles through the skin to various depths. According to Western theories of acupuncture, the needles cause changes in blood flow and levels of neurotransmitters in the brain and spinal cord. Some studies indicate that acupuncture helps relieve fibromyalgia symptoms, while others show no benefit.
  • Chiropractic care. This treatment is based on the philosophy that restricted movement in the spine may lead to pain and reduced function. Spinal adjustment (manipulation) is one form of therapy chiropractors use to treat restricted spinal mobility. The goal is to restore spinal movement and, as a result, improve function and decrease pain. Chiropractors manipulate the spine from different positions using varying degrees of force. Manipulation doesn’t need to be forceful to be effective. Chiropractors may also use massage and stretching to relax muscles that are shortened or in spasm. Because manipulation has risks, always go to properly trained and licensed practitioners.
  • Massage therapy. This is one of the oldest methods of health care still in practice. It involves use of different manipulative techniques to move your body’s muscles and soft tissues. The therapy aims to improve blood circulation in the muscle, increasing the flow of nutrients and eliminating waste products. Massage can reduce your heart rate, relax your muscles, improve range of motion in your joints and increase production of your body’s natural painkillers. It often helps relieve stress and anxiety. Although massage is almost always safe, avoid it if you have open sores, acute inflammation or circulatory problems.

Coping and support

Besides dealing with the pain and fatigue of fibromyalgia, you may also have to deal with the frustration of having a condition that’s often misunderstood. In addition to educating yourself about fibromyalgia, you may find it helpful to provide your family, friends and co-workers with information.

It’s also helpful to know that you’re not alone. Organizations such as the Arthritis Foundation and the American Chronic Pain Association provide educational classes and support groups. These groups can often provide a level of help and advice that you might not find anywhere else. They can also help put you in touch with others who have had similar experiences and can understand what you’re going through.

Most of the information above comes from an article written by staff of the Mayo Clinic. As a fibromyalgia sufferer myself, I have to tell you that the information written above is very helpful. Sleep is a very important treatment. Exercise will actually help decrease the pain you feel, contrary to what you are thinking as you read this. Another thing that will help you to live with your fibromyalgia is to decrease the amount of stress you take on. Relaxation and breathing exercises will help you decrease the stress and relax your muscles. Warm baths or a Jacuzzi will help you relax as well.

I’ve given you the medical information available on the Mayo Clinic website as well as my personal recommendations as to what worked for me. My fibromyalgia came about as the result of an accident in which I broke my neck, hurt my right shoulder, and suffered a closed head injury all at one time. I’m sure every fibromyalgia sufferer out there can tell a similar story. As stated above, if you are having difficulty coping with this painful condition, don’t hesitate to find a chronic pain support group in your area or go to the American Chronic Pain Association online. You will read a lot of great information that will help you cope with fibromyalgia. Whatever you do to help yourself will be the first step in coping with this condition. If you have questions or concerns about fibromyalgia, please leave a comment. I will get back with you as soon as possible.

By Diane | Posted in Chronic Pain Support | Tagged | Comments (4)

Stress and How it Affects Your Pain!

November 3, 2009

Oh my gosh! I’m so upset! Everything is so tense at work. My boss is constantly watching my work. I feel like I can’t make a mistake or I’ll lose my job!

Have you ever been under a lot of stress? If you have, your pain level probably goes from tolerable to off the charts in response to your stress level, doesn’t it? In my own experience, my back and neck pain seems twice as severe when I’m under a lot of stress. Do you have some coping mechanisms to decrease your stress levels or your increased pain levels, or do you just take a pill? Let me tell you about some coping mechanisms that have helped me deal with stress; which, in turn, has helped decrease my pain.

First of all, slow deep breathing or mindful deep breathing helps tremendously to decrease stress. Sitting quietly at your desk or in a comfortable chair, take in a very slow deep breath through your nose, counting to 10. Upon exhaling, blow the air out slowly counting to 10. Each time you take in a breath fill your lungs as completely as you can. When you exhale, blow the air out slowly through your mouth. Close your eyes and do this deep breathing technique for at least 10 to 15 minutes.

Another stress and pain relieving technique is progressive muscle relaxation. This type of relaxation begins at the toes. Tense your toes on both feet as hard as you can and then release them. Then, tense your calf muscles, on both legs, count to three and release. Tense your thigh muscles front and back on both legs, count to three and release. Tense your abdominal muscles, count to three, and release. Tense your back muscles, count to three and release. Tense your fingers or make a fist with both hands, count to three and release. Tense both arm muscles for three seconds and release. By the time you finish tensing and releasing all of your muscles, you should feel less tense and hopefully less pain. If you haven’t relieved your stress or your pain, do this technique again starting at the toes.

Imagery or visualization is another way of relieving stress and pain. Sit quietly in a comfortable chair, close your eyes, and think about a place you would like to be. As you are thinking, create a perfect place in your mind. Put yourself in the mountains in a cabin by a lake, in a sail boat on a beautiful sunny day, a cruise ship with your significant other, or wherever your favorite place is.

As long as you are in your favorite place,  your stress will be gone as well. As you are creating your favorite place, create a total scenario. Bring your significant other into your image. If you don’t have a significant other create the perfect person and bring him or her into your favorite place. You can sit quietly in your favorite place or you can create a dialogue between yourself and the person you are with. What is most important is that you use your imagination and create a beautiful place that you can take yourself whenever you want to relax, de-stress, or take your mind off your pain.

These are just a few of the techniques you can use to decrease your stress. Stress can hurt you psychologically as well as physically, especially if you have a chronic pain condition. Try any or all of these techniques to decrease your stress or to take your mind off your pain. You will be surprised how well they work. If you have any questions about these techniques or you would like additional information, please comment on this article. I will be happy to respond to your questions personally.

Take care and continue to read the articles. See you tomorrow!

By Diane | Posted in Chronic Pain Support | Tagged , | Comments (0)

Coping With Chronic Pain

November 2, 2009

If you have chronic back or neck pain, or any other chronic pain, there is only so much medicine your physician can prescribe without over-medicating you. At times, the medication may not help all of your pain. If that is the case, take heart, because there are other ways to cope with the pain that do not involve medication.

One way to cope with your pain is to visit the Health & Energy Center of Wisconsin or your local Migun Center. Using the Migun Infra-red Therapeutic Massage Bed 5 or 6 times a week when your pain is really severe, can help to decrease your pain to a tolerable level. The Massage Bed is noted to help people with sciatica, slipped discs, muscle pulls, osteoarthritis, and other difficulties by decreasing the pain and reducing inflammation. If you do not have a Health & Energy Center/Migun Center where you live, don’t worry!  There are other ways to take your mind off your pain.

One way to take your mind to another place is to focus on your breathing. Taking slow deep breaths in and out will not only take your mind off how much you are hurting, but it will also oxygenate your lungs and the rest of your body. Let’s get started.

First of all, sit upright in a comfortable chair. You can close your eyes while you are taking deep breaths. When you inhale, do so through your nose. As you inhale deeply, make sure you lift your chest cavity and count to 10 slowly. When you exhale, let your breath out slowly through your mouth, counting to 10. Repeat the inhale and exhale procedures slowly for at least 20 minutes. While you are doing these deep breathing exercises, put some relaxing music on the CD player or the radio. The music, in addition to the deep breathing exercises, will help you focus on other things besides your pain. You can also use the Deep Breathing Exercises and the relaxing music to help you fall asleep. Many individuals have utilized these techniques at bedtime and have slept for quite a few hours.

Another strategy that has helped people take their mind off their pain and to fall asleep at night is yoga meditation. Meditation can be accomplished during the day at a yoga class or one can purchase yoga meditation Compact Discs (CDs) and play them right before going to sleep. Meditating is a wonderful practice that totally puts the mind at rest and in a place other than with the pain.  Being able to focus on something other than pain can bring relief for quite a few hours. Meditation is done with mantras, which are sounds made to a specific rhythm. While meditating, one focuses on taking deep breaths while saying or singing the mantra sitting quietly or performing yoga movements. The yoga movements are excellent exercise for the painful areas of the body because they are slow and easy.

If getting to sleep is a problem, there are more ways besides the ones already explained above that can help. The most important prerequisite for getting to sleep is relaxation. Thinking about problems or situations that keep your brain active will not help you relax and go to sleep. Sometimes, a glass of warm milk will help you with relaxation. Everyone has heard their grandmother say that a glass of warm milk will help with sleep. Well, this is true. If you do not like  milk, then have a cup of Chamomile Tea. Chamomile is a herb known to promote relaxation. Having your neck or back rubbed will also promote relaxation. Sitting in a nice warm bath before going to bed will also help with sleep.

Once you are in bed, do not have the TV on. The TV will pique your interest, and your relaxation technique will be useless. After using the relaxation technique of choice, go to bed in a  dark quiet room. Close your eyes. If you don’t go to sleep in 15 minutes, listen to some relaxing music. Listening to relaxing music will help you drift off to sleep.

There are many coping strategies available out there. I’ve only touched on a few to get you started. Tomorrow, I will explain a few more strategies that will help you cope with pain without additional medication.

God Bless You! Keep reading my blog! I will be able to help you cope with your pain. Just to let you know, these are some of the many strategies I use to help me relax and go to sleep. I have chronic neck and back pain and fibromyalgia. If anyone reading this article has chronic pain, please comment so I can help you personally. See you all tomorrow.

By Diane | Posted in Chronic Pain Support | Tagged | Comments (0)

Do You Have Chronic Pain?

November 1, 2009

If you have pain as a result of an injury or surgery that has lasted six months or more, you have “Chronic Pain.” This is a diagnosis no one looks forward to hearing. We have been raised in a society that thinks every ache and pain we have can be taken care of with medicine or a shot. I worked in the “Western Medicine” venue. Doctors spend 10 minutes with a patient. If he or she cannot find anything on the MRI that can be fixed with surgery, you get pills or he or she tells you “…your pain is in your head.”

I’m sure everyone with any type of chronic pain has heard the adage “Your pain is in your head”. Do you think the doctor is making fun of you? Perhaps! For the most part, doctors have no idea how to deal with a person with chronic pain.

In the last few years, health care providers have begun to focus on the presence of pain in all of their patients. Why do you think that is? My opinion (and it is just an educated opinion) is that accrediting authorities are demanding that hospitals, doctors, nurses, nursing assistants, and emergency medical personnel focus on treating pain in patients or they face losing accreditation. What do you think of that? Finally, medical professionals have to help people that are suffering with pain every day. It seems like everyone I come in contact with seems to have a chronic condition whether it be arthritis, neuralgia, back pain, foot pain, etc., and now fibromyalgia.

Well, guess what! Doctors and nurses are finally realizing that people’s pain must be diagnosed and treated. Western medicine’s idea of pain treatment usually includes physical therapy, a trip to the psychiatrist, and a trip to the pharmacy for non-steroidal anti-inflammatory drugs to help decrease inflammation; muscle relaxants, to relax muscles all over your body; antidepressants, which definitely help a person cope with pain; and perhaps a narcotic, if nothing else works.

Are doctors thinking of alternative methods for pain relief like relaxation techniques, a lesson in biofeedback to learn total body relaxation, a lesson in guided imagery to take your mind away from your pain, lessons in self-hypnosis, acupressure with infra-red heated therapy, etc.? Most likely not! Believe me when I say that these methods can work miracles to control your pain and you don’t even need a prescription to use them.

I can teach you some relaxation exercises, deep breathing techniques, guided imagery, and biofeedback which will help you fall asleep. Sleep is another requirement to help reset the pain reducing cycle in your brain. If you don’t get any REM or dream sleep, you are NOT resetting the pain reducing cycle which adds insult to injury. The less you sleep, the more pain you feel.

If you have a lot of stress, you will feel more pain. High stress levels can adversely affect your body in more ways than having more back pain or arthritis, etc. If you live in the Milwaukee, WI area, the Health & Energy Center of Wisconsin has a technology that can help you get rid of back and hip pain, arthritis, shoulder and neck pain, migraines and headaches, and knee, ankle, and foot pain. This technology is infra-red acupressure therapy. Fifteen to thirty minutes per day on a massage bed with this technology will de-stress you and decrease your pain. If you have fibromyalgia, let the owner of the Center know. Nadine Retzlaff is very knowledgeable and knows how to use the beds to help people with “fibro.” There are also nutritional supplements available to help people with various chronic difficulties.

Please come by and talk to Nadine. The Center is located at 11931 West Bluemound Rd., Wauwatosa, WI 53226. If you just want to find out more about the Center, please call Nadine at 262-391-8409. You may even meet me there. I try to spend a few hours a day at the Center helping people who have any type chronic condition.

Tomorrow, I will talk about back pain and some great ideas that can help you cope with it on a daily basis. Read this article and let me know what you think.

By Diane | Posted in Chronic Pain Support | Tagged | Comments (3)