<![CDATA[Chronic Pain]]> en daily 1 <![CDATA[Expert Answers on Complementary Therapies for Chronic Pain]]>
Robert Bonakdar, MD, is the director of pain management at the Scripps Center for Integrative Medicine in San Diego.

Q: How many people with chronic pain use complementary remedies?

A: Surveys show that 40% or more of chronic pain patients use some level of complementary therapies. The number is high because pain is becoming epidemic. More people are experiencing pain, so you are going to have people who don’t get immediate relief and start searching for other options. According to several large surveys done by the National Institutes of Health, the needs of the pain patient aren’t always being met. So it makes sense that pain patients will ask, "What else is out there?"

The most common treatments are manual therapies, such as massage or chiropractic, as well as herbal medicine, dietary supplements, acupuncture, and mind/body therapies (a catchall phrase for techniques like biofeedback, guided imagery, and meditation).

Q: Should anyone with chronic pain consider adding complementary approaches to their treatment?

A: Yes, within reason. There are obviously many approaches that fall under that umbrella. Most of them are benign treatments—you aren’t going to necessarily mess anything up by doing them. My advice is always to use a health-care advocate like a doctor who can give you unbiased treatment advice. If you are getting to a point where other things aren’t working, most rational health-care providers will bring up other options. But we need a larger knowledge base—84% of doctors feel uncomfortable discussing complementary and alternative medicine (CAM). When probed, they say that they don’t know enough about it.

Q: How do the mind and body interact when you're in pain?

A: We know pain can create very significant emotional and physical stress in the body. The stress component can cause a large cascade of stress hormones that go on to damage other parts of the body and place a huge burden on the brain. The brain literally changes from pain; the brain actually will lose part of the gray matter so you have a less functional brain. You also have more depression, more insomnia, and more anxiety—the nervous system becomes its own enemy. Mind/body therapies are an elegant avenue to retrain the brain, and one is not necessarily better than another. They are all shifting the mind to a better place. It might not take your back pain away tomorrow, but it can give you excellent coping strategies and increase awareness of what modifies the pain.


Next Page: Which complementary treatments should I try?
Q: Which complementary treatments should I try?

A: It's not a one-size-fits-all approach. It depends on what you are looking for and what you are open to. If you are stressed out and want something relaxing, you might try guided imagery or hypnosis for pain. If you are very data-driven or analytical, you can try biofeedback. Yoga is great for back pain, but one has to be open to the concept and the level of investment that may be required to see results. CAM is much like medication; you have to try different things until you find something that works.

Q: How can I tell the difference between valid, effective treatments and miracle cures that could be dangerous?

A: Anytime that someone is in a bad state of health, they may become desperate for relief. In some cases, people will try to take advantage of that scenario. So you need to have a health-care advocate to help you filter out all of the information. The best person to do that is a health-care provider or someone you trust, in the context of that experience. You can find a lot of information about valid treatments at the National Center for Complementary and Alternative Medicine.

Q: What is the most important new research on CAM therapies?

A: There is a lot of interest in research using functional MRI to show how acupuncture changes the brain. This is proving what they knew 3,000 years ago, that a needle between the first and second finger can help decrease pain; now we know it may be because it makes the limbic system less sensitive. There is also research on the effects of biofeedback and chronic pain, particularly fibromyalgia, irritable bowel syndrome, and recurrent abdominal pain. Another type of biofeedback being studied is heart-rate variability, a noninvasive way to look at how stressed someone is; low heart rate variability—when the heart is slow to adjust its rate in response to changing situations—is linked to high pain, high anxiety, and increased rate of heart disease.

Q: Do you think complementary approaches will soon be part of mainstream pain treatment?

A: In most of the world, people have some sort of CAM integrated into their treatment. Unfortunately, the United States is behind. We need more education and more basic efficacy research to show, for example, that a chronic pain patient feels better after 12 weeks of acupuncture. We are getting there, but it’s slow.

Q: What can I do if my doctor is resistant to incorporating complementary approaches?

A: Each patient owes it to herself to create the optimal health-care environment, which includes the doctor, the clinic, and the staff. Sometimes you have to find a different provider. You have to find someone you can work with, in terms of personality and the dialogue, and teasing that out is important.

Q: How can I find a good CAM practitioner?

A: Start by asking your doctor if he can recommend someone who works with CAM. If that doesn’t work, then go to a national or state licensing organization for whatever you are interested in, acupuncture or massage, for example. Pick a few names, call the providers, and make sure that everyone is on the same page. But again, make sure that you have a pain advocate who can advise you. They might tell you that a particular treatment isn’t good for you if you just started a new medication. There are ways now that providers can communicate, such as with electronic medical records, to make it a little bit easier. Remember, you shouldn’t be your own quarterback. You shouldn’t be riding the bike while you are trying to fix it.

]]> (ROBERT BONAKDAR) <![CDATA[A Biologic Drug Helped Me Conquer Rheumatoid Arthritis]]>
rheumatoid arthritis for more than 20 years. For 15 of those years, she experienced crippling pain, even setting up an office in her bedroom because moving was unbearable. She finally received a new treatment, which changed her life, and she's now strong enough to work out, travel, and even walk marathons.]]>
When I moved to North Carolina 18 months later and talked to my new doctor about my lupus, he said, “Honey, you don’t have lupus, you have rheumatoid arthritis.” I was thrilled! While painful, RA is an easier disease to deal with on a day-to-day basis.

I was initially treated with anti-inflammatory drugs. At one point, I was taking up to 12 aspirin a day, but my ears were ringing. My doctors said, “Oops! That’s a problem.” They took me off aspirin and I embarked on a 15-year cycle of experimentation with different anti-inflammatories and disease-modifying antirheumatic drugs (DMARDs).

The ups and downs of treatment
I hated taking the drugs and didn’t appreciate the importance of trying to impact the progression of the disease and the joint deformity that can happen with RA. My doctor would put me on a path of medication and I wouldn’t follow it. He and I had a love-hate relationship. I wouldn’t go in to see him because I didn’t want to take the drugs. I can be stubborn, but I was also in denial that I had a chronic disease that I needed to manage.

The drugs were helping me control my pain—but barely. I owned a coffee-roasting business, and work was physically demanding. But quitting wasn’t an option. I was terrified of having a 9-to-5 job where I would have to get up, wear panty hose and high heels, and arrive early in the day.

My husband had to help me brush my teeth and dye my hair. My hair was short because I couldn’t wash it very much. For a year, I could only wear tennis shoes—anything else was too painful.

Living in my bedroom because moving was unbearable
Eight years ago, I became the president and CEO of Gingrich Communications. Because I had the flexibility, my desk was in my bedroom—two steps from my bed. Some days that was too far. I would work from bed and take naps. I never got out of my pajamas and traveled as little as possible.

My ability to function was decreasing every day.


Next Page: A biologic changed my life
A biologic changed my life
God bless my rheumatologist. He tried for more than a year and a half to get me started on a biological DMARD. I resisted until one of my ankles was freezing up and it was likely I would lose my mobility. I went back to my doctor and said, “I give up; I’m done; I’m willing to try it.” So, five years ago, he put me on a biologic, and within a very short period, my pain level decreased substantially and my mobility and energy improved.

If you were to look at the revenue stream at Gingrich Communications, you would see a tremendous spike at that time due to the variety of work I was able to take on and the amount of energy I could exert.

Now my office is in the next room, but we also have an office in Miami that I visit two to three times a month and a D.C. office I visit frequently. I don’t have to take an hour-and-a-half nap each day. Instead, I use that time to work out with a personal trainer.

Last year, my sister and I fund-raised and participated in the Arthritis Foundation’s (AF) marathon in Athens, Greece. Just a few weeks ago, I completed the Dublin Marathon. Having the opportunity to train and accomplish that was a joy and, as a board member for the AF, I am a huge advocate for the prevention, control, and care of arthritis.

Now I'm blessed with almost no pain. The pain I do have is from muscular overuse, not my joints. X-rays have confirmed that the disease is not progressing or deteriorating my joints.

When you are living with chronic pain, it saps your energy—psychologically, emotionally, and physically. Without that disease on my shoulders, I've been transformed. I can do a lot more and I'm physically able to carry out the dreams I have for my future.
]]> Kathy Lubbers's energy and mobility improved with a biologic. She’s recently walked two marathons. KATHY LUBBERS <![CDATA[What Is Rheumatoid Arthritis?]]>
]]> (GETTY IMAGES) <![CDATA[Living With Rheumatoid Arthritis]]>
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