Pain Management

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Silverlining
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Pain Management

Postby Silverlining » Wed Apr 20, 2016 6:20 am

There is a thread recently resurrected that is morphing into pain relief so I thought a dedicated post might be worthwhile. I have structural pain (connective tissue disorder/osteoarthritis); I do not believe diet is the cause. I do think that the pain levels are exacerbated by activity, but I MUST move/exercise! I'm fighting off several genetic disease predispositions that are ameliorated by exercise; also exercise is so beneficial for my mental/emotional outlook. I'm a big believer in the "use it or lose it" mentality. If I rest and do very little for several days, my pain does lessen, but obviously muscles will atrophy from disuse over time. Unfortunately over the past year or so, I've had to continually scale back on my exercise and it is SO frustrating. Trust me, I'm not talking about aggressive activity here, just power walking, extremely limited racquetball (doubles/4 players), gardening, household chores, etc. The balance between pain and activity level is a constant challenge for me. I take at least 1-2 doses of a pain reliever most days. I juggle Tylenol, Advil and occasionally something stronger. I have a toolbox of other pain relieving modalities (heat, microcurrent "zapper", massage, foam rolling, stretching, physical therapy, etc.). Currently, I've been relying more on Advil than Tylenol. I feel certain others here must have the same concerns/questions I do about the best pharmaceutical pain relief?

Stavia posted the following on the thread I mentioned in the opening:

Stavia wrote:Bulldog, very good question

Here is an excerpt from UpToDate, the online medical textbook I subscribe to - short version is that is is not recommended to take an anti-inflammatory drug to reduce the risk of dementia at this stage. When we talk about inflammation we mean a broad sense of inflammation, which is caused by many different factors including diverse issues such as high blood sugars, micronutrient deficiency, poor diet, possibly gut barrier issues, obesity and many other subtle and interacting factors.

NSAID therapy — Some epidemiologic studies, but not others, have suggested that nonsteroidal antiinflammatory drugs (NSAIDs) protect against the development of AD and cognitive decline [101-113], possibly by lowering levels of amyloidogenic Abeta42 protein [114-117]. Conflicting results regarding their efficacy may be due in part to the timing and duration of NSAID use, to differences in tracking NSAID use, and to the ApoE genotype status of the participants. Their use is not currently supported by randomized clinical trials.

The duration, dose, and timing of NSAID use may be important factors:

●A meta-analysis of cohort and case-control studies found a pooled relative risk (RR) of AD among NSAID users of 0.72 (95% CI 0.56-0.94); the RR among short, intermediate, and long-term users was 0.95 (CI 0.70-1.29), 0.83 (CI 0.65-1.06), and 0.27 (0.13-0.58) respectively [108]. The RR among aspirin users was 0.87 (CI 0.70-1.07). In one of the larger observational studies, computerized pharmacy records of 6989 people aged >55 years found that long-term NASID use protected against the development of AD [107]. With relative risk of AD of 0.95 in patients who had used NSAIDs for one month or less, 0.83 in patients who had used NSAIDs for more than one but less than 24 months, and 0.20 in patients who had used NSAIDs for 24 months or more.

●In the latter study, most of the NSAID effect in the long-term users was attributed to therapy two or more years before the onset of dementia, suggesting that there may be a critical period during which NSAID use is protective [107]. This was also the finding of the Cache County, UT study in which NSAID use in midlife rather than late life was associated with less severe cognitive decline over eight years of follow-up [110].

●Another population-based cohort study found that heavy NSAID use in late life may be associated with an increased rather than decreased risk of AD (HR = 1.7) [118]. In a subset of this cohort with autopsy data, the burden of neuritic plaque was associated a higher cumulative use of NSAIDs [119].

●No preferential benefit was found for those NSAIDS which are reported to selectively reduce Abeta42 (eg, ibuprofen, indomethacin, sulindac) compared with those which do not (eg, naproxen, etodolac), according to one large cohort study and the pooled results of six other cohort studies [111,120].

A large randomized trial studied the efficacy of naproxen, celecoxib, and placebo in the prevention of AD in 2528 individuals >70 years with a history of at least one family member with AD-like dementia [121]. Imperfect screening had led to the enrollment of 53 persons with premorbid dementia or mild cognitive impairment. Analysis of the study population with these individuals excluded, after two years of follow-up, demonstrated that AD risk was actually increased in both active treatment groups (HR=4.1, 3.6). Other measures of cognition were not improved and were possibly worse in the treated groups [122]. The trial was stopped early because of an increased risk of myocardial infarction in patients treated with naproxen [121]. Long-term use of certain COX-2 inhibitor inhibitors has also been associated with an increased risk of cardiovascular events. (See "COX-2 selective inhibitors: Adverse cardiovascular effects".)

Another large, randomized study of 6377 participants found that older women randomly assigned to low dose aspirin had similar rates of cognitive decline compared to the placebo-treated group after more than 5 years of follow-up [123]. Similarly, a 5-year study of low dose aspirin in 3350 individuals over 50 years found no effective of treatment on cognitive test scores [124].

Cyclooxygenase-2 (COX-2) inhibitors and NSAIDs should not be used for the treatment or prevention of dementia or cognitive impairment at this time.


Here is a fairly recent paper on acetaminophen:

http://www.medscape.com/viewarticle/704809_1

Acetaminophen Inhibits Neuronal Inflammation and Protects Neurons from Oxidative Stress

"Background: Recent studies have demonstrated a link between the inflammatory response, increased cytokine formation, and neurodegeneration in the brain. The beneficial effects of anti-inflammatory drugs in neurodegenerative diseases, such as Alzheimer's disease (AD), have been documented. Increasing evidence suggests that acetaminophen has unappreciated anti-oxidant and anti-inflammatory properties. The objectives of this study are to determine the effects of acetaminophen on cultured brain neuronal survival and inflammatory factor expression when exposed to oxidative stress."

Any advice would be much appreciated!

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Stavia
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Re: Pain Management

Postby Stavia » Wed Apr 20, 2016 12:23 pm

Silver honey, treat your pain. Untreated pain will raise your cortisol and affect your mood which are both not good for you.
Either the nsaids or the acetaminophen or whatever version of codeine or whatever you have in the US. I personally feel with the current murky evidence around the first two, you may as well chose the one that works the best for you.
Your situation isn't one of taking the meds for AD prevention. You have pain.
Treat your pain.

PS its naughty of the study authors in the study you found to state so confidently that nsaids prevent AD. They're cherry picking to support their premise. It's not as simple as that.

hill dweller
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Re: Pain Management

Postby hill dweller » Wed Apr 20, 2016 1:01 pm

Silverlining,
Do you have access to a Finnish sauna or hot tub? Do heating pads help? Heat can stimulate cell repair.

circular
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Re: Pain Management

Postby circular » Wed Apr 20, 2016 1:03 pm

(((Silver))) as another connective tissue disorder patient (hypermobile EDS) I completely understand the conundrum. Throw in mast cell activation syndrome and I find it very hard to get the exercise I want, enjoy and need anymore. One thing I don't do are any of my former hobbies, no matter how enjoyable, that physically would just be too painful and exacerbate my unstable joints. Had they been my hobbies, racquetball, gardening, household chores would be off my list, but I understand these may be okay for you. We're all different. My lower back and hips are big problems so I couldn't do those. Well I do have to do some household chores since I can't afford a house cleaner since the dumb condition rendered me disabled, but my house is no longer ever completely clean (big frown!). I just don't do it that often and my husband helps as much as he's capable but also has issues with it. I get out of gardening by having a yard without even minimal landscaping! Hate it but that's that.

Instead, for activity I focus on things that cause the least adverse reactions for me while making me more functional: walking (very flat surfaces, no hills/slants, a soft track best), PT exercises (I have a good two hours or so worth but never get all that done in one day), and when I can (lately every afternoon) some brief elliptical bouts. In other words I try to limit my physical activities to things that will support rather than exacerbate my condition. While very limiting, these have become my new hobbies. PT has expanded the things I can do that are safe and help me to have less pain and better functionality, but gone is recreation as I used to enjoy it. The PT for stabilization and 'strength' is too time consuming to leave any time to try to move back into light recreational activities.

The elliptical seems to be the best 'machine' type thing for me these days - no resistance while strengthening the major leg muscles, which in turn help stabilize my loosy goosey hips and give me some higher aerobics than I get walking. For the last 10 'sick' years I haven't gotten past 10 minutes on it, but it helps. My podiatrist told me no more treadmill. He doesn't like the walking mechanics of treadmills, especially if you have ankle/foot issues. (Also told me no more long beach walks when I'm at one! … Fist on table) Oh, and a warm, saltwater rehab pool is devine and very good for us. The water actually helps compress our joints while exercising. Unfortunately we moved and where I now live there is no such pool available. My gym's pool water is too cool so causes me too many toe cramps to get much done in it, but I still get in it on occasion for a few minutes of variety.

Not sure any of this helps. I have a slight migraine this morning and my mind is wandering here. The gist is that for me I've adjusted to giving up old hobbies in favor of, mostly, EDS-specific PT, walking and elliptical. I don't have the stamina I'd like, but more frequent, shorter spells are also good. I try to move frequently all day rather than try to have the focused workouts others enjoy. My living room floor is covered with PT toys.

I'm hoping you have better luck keeping your favored activities and that I might gradually get back to some over time.

For anti-inflammatories, I use Longvida curcumin (Susan also says that helps her RA pain) and SAM-e. For years OTC SAM-e was wondrous, 400 3x/day (enteric coated, individually sealed). Then one day I missed a dose and wasn't in pain. I realized that having switched curcumin brands to Longvida was working. I dropped the SAM-e about five months ago. If I exacerbate the pain I go on it again for a short spell to calm the inflammation down again.
Last edited by circular on Wed Apr 20, 2016 3:14 pm, edited 1 time in total.
ApoE 3/4 > Thanks in advance for any responses made to my posts.

hill dweller
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Re: Pain Management

Postby hill dweller » Wed Apr 20, 2016 1:36 pm

circular wrote:
warm, saltwater rehab pool is devine and very good for us


We talked for years about getting a hot tub but accepted the fact that our steep lot just won't support one (we dwell on a hill). So, after watching and reading about heat and beneficial hormesis, we decided on an indoor Finnish sauna, to go in the garage. It hasn't arrived, yet, but I'm looking forward to it. The initial expense is far less than a hot tub, and the maintenance will be less, too -- no chemicals, easy cleaning. And it's in the garage, for the ultimate in privacy.

If you're interested, Costco.com has a good sale price for the next few days.

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Re: Pain Management

Postby marthaNH » Wed Apr 20, 2016 2:53 pm

Sympathies and good luck. You gave me a reason to count my blessings today.

circular
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Re: Pain Management

Postby circular » Wed Apr 20, 2016 3:22 pm

I occasionally go on about such things not to be self obsessed, but because I hope it's useful in educating people who don't deal with such problems about just how deranged daily life can become.

Actually I may not be in any worse shape or pain than you (?), hard to say. It's just that I made the decision that maintenance and preventive physical activity was more important than keeping up old hobbies that might make me worse off in the long run. Hopefully this isn't something you need to consider.
ApoE 3/4 > Thanks in advance for any responses made to my posts.

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Re: Pain Management

Postby KatieS » Wed Apr 20, 2016 3:44 pm

Silver, I was saddened to read what a challenge it is for you to manage chronic pain. Although I only have a chronic knee OA, I have really enjoyed being mostly pain-free with continuous salsalate, rather than intermittent Aleve, as now I can enjoy daily brief afternoon walks. My husband (widespread OA) seem to have significantly less pain after CPAP, so be sure that your set-up for full efficacy.

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Re: Pain Management

Postby adventure » Wed Apr 20, 2016 4:41 pm

I have osteoarthritis in both hips, my left having bone-on-bone contact. I got the diagnosis after going to the doctor because I was having pain when walking. Well, I figured if there was bone-on-bone contact, then I was going to imagine making the bone as smooth as a skipping stone.

I would find a position that was uncomfortable and then I would "jiggle" my hip in that position until it was sore. I did this twice a day. I also drank tart cherry juice twice a day. I noticed slow but continuous progress in how far I could move the hip before it hurt. Anyway....one year later, my hip is now free of pain when I walk.

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SusanJ
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Re: Pain Management

Postby SusanJ » Wed Apr 20, 2016 5:38 pm

Silver, hugs. Any of us managing chronic conditions with pain know the struggle.

But, yes, what Stavia said. Treat it and work on the other stuff to see if you can wean yourself later.

When my RA started, I couldn't even pull on my socks without finger pain. Yep, that bad. I did prednisone to start. Of course, that has it's downsides, too, but at least it helped my joints to settle a bit. I also took methotrexate for a while, but I didn't feel good on that (and now that I know I have MTHFR C677T, that makes sense.)

But managing the pain allowed me to experiment with diet (dropping the gluten was huge for me) and supplements. Longvida curcumin (1000mg/day, split dose) works best for me - think I've tried all the major curcumin brands. And fish oil (2 x Nordic Naturals Ultimate Omega, split dose). Fish oil has been another anti-inflammatory for me, no doubt about it - if I cut back I will hurt.

I, too, have cut back all the physical activities (example, I only ski for a couple hours a few times per year - geez, I used to teach!!!) Very little biking due to pressure on my hands. So, like you, it's all about the walking or light hiking, and like circ, some ellipitical time. I also do a few weights and yoga at least once per week. I don't know how to swim, but am thinking about learning since we have a local pool fed by hot springs (Circ, really, you need to come visit - we'll just sit in the hot springs!!!)

And some days, well, I just have flares and take Alleve. Nothing wrong with that in my book.


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