National Pain Awareness Month

This year's National Pain Awareness Month is coming to an end, and yet I'm continually reminded that my pain is not.

It pains me to know that there are so many people in chronic pain; and that they, too, often feel misunderstood. It can be difficult for others to comprehend / believe that anyone could really hurt so much all the time, which is the reality for those that live with a chronic illness. Regardless of the intensity of the pain, when it's unrelenting, it reduces a person's ability to function (concentrate, perform day-to-day tasks, work, socialize, exercise, sleep); and it can lead to depression, isolation, and loss of self-esteem.

While it can be very difficult for others to imagine what it must be like to live with constant pain, it's important for friends and family members of someone in chronic pain to be understanding, and to show support and encouragement. Listen without judgment, and let them know you care. Just because someone with a chronic illness is doing something that seems "normal" doesn't mean that they are suddenly better / cured... it's not all or nothing. It's extremely painful to have loved ones question the validity of your pain or accuse you of being lazy or just wanting drugs / pain meds... sometimes more painful than the physical pain itself.

The caregivers of those in chronic pain also face misunderstanding, isolation, and frustration. I'm so grateful that my husband has taken such a difficult situation and helped make it something to bring us closer together. He takes care of me, cheers me on, etc... all without making me feel guilty for my illness changing the trajectory of his life. He is such a blessing!

My hope is that EVERYONE will try to be more compassionate and understanding with each other. One of the groups of people that desperately needs this is the chronic pain community.

NHF Regional Conference - Part IV

Dr. Tim Clark

Dr. Tim Clark is the program director for interdisciplinary services for the Baylor Center for Pain Management in Dallas.


Migraine is a Chronic Disease

• Examples of other chronic diseases: diabetes, high blood pressure, high cholesterol, fibromyalgia, arthritis, asthma
• It's there even when you're not having a headache

Knowledge is power

• What you think (your perception) matters
• Identify, manage, avoid triggers
• Take medications as directed
• Talk with your doctor (it's important to establish empathy and trust between patient and healthcare provider)

Triggers - Being exposed to more at one time makes you more vulnerable for a "perfect storm" / migraine attack


Pain is the 5th vital sign

• There's no way to objectively measure pain
• You have to record it and communicate it with your doctor

Ways to Improve Chances for Successful Headache Management:

• Diaries
• Managing pain is the primary goal
• Discuss goals/expectations with doctor
• Find support
• Doing several positive things at a time often leads to greater effects
• 3 P's of long-term success -

• Persistence
• Patience
• Positive attitude

Physical Therapies

• Acupuncture
• Have to give it a fair chance - 2 x's per week for 10 sessions, 1 week off, then 10 more sessions (sessions ~30 minutes each)
• Exercise
• Massage
• Chiropractic

Cognitive-Behavioral Therapies

• Biofeedback
• Training body in relaxation techniques (must practice regularly)

Relaxation Therapies

• Progressive muscle relaxation
• Autogenics
• Meditation or passive relaxation
• Hypnosis
• Abdominal breathing
• Mindfulness meditation

Treat Comorbidities

• Anxiety
• Depression
• Sleep disorders
• Chronic dysfunctional coping skills
• etc...

NHF Regional Conference - Part III

Dr. Steven Linder

Dr. Linder has a private practice in Dallas, TX, where he treats children and adolescents with migraine. He discussed neurostimulators (occipital and supra-orbital nerves) in adolescents. He was very knowledgeable, and answered audience questions.

Dr. John Claude Krusz

Dr. Krusz has a private practice in North Texas (Anodyne Headache and PainCare), where he treats pain, headache disorders, sleep, mood and neuropsychiatry/neurobehavioral disorders. He spoke primarily about treatment options for migraine.

* The goal of medication is to improve function *


Acute Medication Treatment:

• Not more than 2 days per week
• Treat early (don't wait until severe)
• Use adequate dose, combine meds
• Keep headache diary
• Goal is to get you back to 'normal' within 2-4 hours
• Can repeat meds, if not getting relief
• Go to sleep (sometimes, no matter what you do, some headaches get out of control)
• Some examples:
• NSAIDs - Aspirin, Ibuprofin, Naproxen, Diclofenac, Indocin
• Anti-Nausea - Reglan, Compazine, Zofran, Phenergan
• Others - Excedrin, Tramadol
• Triptans - Amerge, Axert, Frova, Imitrex, Maxalt, Relpax, Zomig
• Ergots - DHE, Migranal, Ergotamine

Rescue Medication Treatment (when acute treatments don't work):

• Sedatives - get to sleep
• IV or IM injections (often requires office or ER visit)
• Avoid narcotic pain meds
• Examples: Corticosteroids, Depacon, Magnesium, Toradol

Medication Overuse Headache:

• Rebound (use acute/rescue meds too often)
• Acute meds become less effective
• Headache frequency increases, eventually becoming daily
• Narcotics (opioids)/barbituates - high rebound
• No preventative works well

Preventive Therapy:

• Control other medical problems
• Diet
• Exercise
• Sleep
• Medication
• Anti-depressants (SNRIs)
• Anti-hypertensives
• Anti-epilepsy (neurostabilizers)
• Anti-inflammatory
• Muscle relaxants
• Sleep aids

Supplements:

• 5-HTP
• Magnesium
• Riboflavin (Vitamin B-2)
• CoQ-10
• Butterbur
• Feverfew

NHF Regional Conference - Part II

Migraine Triggers

Dr. Frederick Freitag

Dr. Freitag recently stepped down as co-director of the Diamond Headache Clinic in Chicago, IL. His new position is at Baylor University Medical Center in Dallas, TX. He is very active in headache initiatives (including clinical research, lecturing, etc...).

Migraine Facts:

• 1 in 4 households has a migraine sufferer
• Migraine affects women more than men (3:1)
• ~30 million people in the U.S. have migraine
• 12-18% of the population have migraine (more than asthma and diabetes combined)
• If one parent has migraine, his/her child has ~50% chance of also having migraine
• 75% of migraine sufferers have neck pain/tenderness

Migraine is...

• Genetic - brain programmed to be sensitive
• Hyperexcitability / hypersensitivity of the brain
• Neurologic process
• Whole-body disorder
• Chronic systemic disease
• Attacks vary (between migraineurs and migraine attacks)
• May be progressive
• SULTANS --
  
  • (moderate to) Severe pain
  • Uni-Lateral
  • Throbbing
  • Aggravated by activity
  • Nausea or vomiting
  • Sensitivity to light and sound (environmental)

Premonitory Phase (can include any combination of the following symptoms):

• Fatigue
• Thirst
• Yawning
• Dizziness
• Increased energy
• Food cravings
• Frequent urination
• Poor concentration
• Hypersensitivity to sound
• Neck pain/tightness
• Blurred vision
• Irritability/emotional

Aura - builds gradually 5-60 minutes (usually visual)

Prodrome Phase ("Migraine Hangover") can include any combination of the symptoms from the Premonitory Phase

Comorbidities (more prevalent in people with migraines than the normal population):

• Depression
• Anxiety
• Bipolar
• Obsessive-compulsive disorder (OCD)
• Panic
• Sleep disorders
• Heart disease
• Irritable bowel syndrome (IBS)
• Fibromyalgia
• Stroke
• Obesity
• Migral valve prolapse
• Back/neck pain
• Patent foramen ovale (PFO)

Risk Factors (Triggers):

• Stress (or let down)
• Hormonal changes
• Diet (skipping meals; specific foods)
• Sleep disruptions
• Weather
• Head trauma

Food Triggers (not an exhaustive list):

• Additives - aspartame, MSG
• Vasoactive amines - aged cheddar, fava beans, soy products, left overs, lunch meats
• Other foods - long list of possible food triggers
• Alcohol - red wine, other wines/beers
• Caffeine

Protective Factors:

• Eat regular meals
• Standardized sleep pattern
• Exercise
• Stress management (biofeedback, recreation/have fun, massage)
• Post-menopause

Just Keep Swimming...

Patients For A Moment (PFAM) is a patient-centered blog carnival to build connections within the community of people who blog about illness, disease, and disability. Brittney, at The Road I'm On, is hosting the next edition of the PFAM blog carnival:  "What do you do when something you thought you conquered comes back? How do you deal with the change, accept that what you thought was gone for good isn't, and get back to the positive side of life?"

This topic couldn't have come at a better time because I'm currently dealing with this in my life.

I know that I'm going to struggle, at least to some extent, with my illness for the rest of my life (I'm not sure I've fully accepted and embraced this, but I know it). I'm hoping to be able to get things under as much control as possible, so that I can live as close to a 'normal' life as possible.

Now, I can't say that my life was in any way 'normal.' But, I felt like I was on the right track. My husband and I had moved back to Texas (near our families... and doctors). I was starting to be able to do a little bit more around the apartment, and spend a bit more time with my family (though still definitely much less than 'normal'). And, then, everything tumbled down...

Things have been really rough for me over the last few weeks. It's been a pretty big set-back, but I'm really trying to just remember that things will get better. I've kinda gotten used to the 'one step forward, two steps backward' process that tends to be prevalent in chronic illness. It's difficult, but I have to be very deliberate in my thinking, in order to remind myself that things will get better.

I think that part of the challenge is that a false sense of stability forms, when someone that is chronically ill experiences even a short amount of time functioning at a higher level (even if it's only minimally higher). Having even the smallest taste of 'normal' can trick your mind into thinking that things have changed permanently. But, having a chronic illness doesn't work like that. There will continually be ups and downs. You just have to learn to cherish and savor the ups, and trudge through and survive the downs. Much easier said than done... but it's an important thing to work towards. So, when life gets you down...  just keep swimming...

by midnightheartache

NHF Regional Conference - Part I

"The National Headache Foundation (NHF) exists to enhance the healthcare of headache sufferers. It is a source of help to sufferers' families, physicians who treat headache sufferers, allied healthcare professionals and to the public. The NHF accomplishes its mission by providing educational and informational resources, supporting headache research and advocating for the understanding of headache as a legitimate neurobiological disease" (NHF Mission Statement)

"The National Headache Foundation will be the premier educational and informational resource for headache sufferers, their families, physicians, allied healthcare professionals and health policy decision makers. The NHF will advocate for the headache sufferers. The organization will employ the most effective means to disseminate information and knowledge to headache sufferers and non-sufferers" (NHF Vision Statement)

My husband and I attended the NHF Regional Conference, Bridging the Gap Between Patient & Clinician, yesterday in Dallas, TX. So, I'd like to pass along some of the things we learned at the conference.

Serene Branson was the keynote speaker. She shared about her on-air migraine attack that happened in February. She has partnered with the NHF to help educate others about migraine.

There were several doctors there that spoke about related topics. Please join me over the next few days, as I share some of what each of them covered (it may not be new information, but it's always good to refresh and return to the basics).