Notes from the pain management workshop, week 5

Oops, I forgot to post these earlier while the session was fresh in my mind. I’m going to have to work a lot harder to decipher my handwriting this time around.

This was the 5th week. Next week is the last one. I’m kind of glad to see it ending. Sigh.

Topics covered this week:

• Medications
• Depression management
• Physical activity
• Mind management

Medicaton and chronic pain

Pain medication absolutely should be taken on an as-needed basis; if you’re starting to feel pain, don’t delay taking it. It’s easier to manage a small amount of pain than a lot of pain.

Purposes of pain medication:

• Keep pain and inflammation under control
• Increase basic comfort
• Improve your ability to function
• Improve other related symptoms (depression, fatigue, etc.)

Major types of pain medication:

• Anti-inflammatories such as acetaminophin or NSAIDs; these are generally available over-the-counter in pull, gel, cream, and linament forms
• Muscle relaxants; these are usually prescription-only and are intended for short-term action on muscle spasms, to prevent pain from increasing (but do not treat pain itself)
• Antidepressants; at low doses, many antidepressants will also prevent neuropathic pain from cascading on itself
• Anti-convulsants; same reason for antidepressants
• Opioids; prescribed for severe chronic pain, highly addictive, etc.etc.
• Cannabinoids (CBD); not particularly well-studied at this point but information is becoming way more readily available, and even mainstream pharmacies are starting to carry OTC CBD products

Reasons people might stop taking them:

• No noticeable effect (the reduction in pain isn’t enough to be noticed compared to the amount that remains)
• But it might be holding the pain at bay and at least it isn’t getting worse
• could also be a delayed onset
• or it might actually be ineffective, but don’t stop just because you aren’t sure
• Allergies - must be immediately reported and stop taking the medication
• Side effects
• Usually annoying and unwanted
• Can be dangerous (drowsiness, severe constipation, etc.)
• Most of these improve with time or can be managed
• Especially look out for:
• stomach bleeding
• liver failure
• reduced concentration
• excess sleepiness
• Physical dependence
• This is not the same thing as addiction
• Withdrawal symptoms can be a problem
• Work with doctor to taper down on such medications
• Tolerance
• Needing increased amounts for the same effect
• This happens especially with opioids
• Addiction – Refers to a psychological craving independent of pain relief effects. Signs of addiction:
• Impaired control over dosing
• Drug-seeking behavior
• Compulsive use (even if it’s not effective or if another medication is more suitable at the moment)
• Craving the medication itself

Responsibilities to the patient:

1. Inform all health providers of all of their meds
• health providers includes dentists, massage therapists, etc.
• medications includes OTC meds, supplements, etc.
2. Make and carry a medication list for easy access
• Vital for emergency care etc.
3. Know why you take every medication you take
4. Report effects of the medications
• also report off-label usage of it
• also report if you’ve opted to stop taking it
5. Use as prescribed
6. Use your mind
• think about what you’re doing with the medication and if anything seems off

Common problems that prevent people from taking as prescribed: (brainstorm)

• forgetting to take a dose
• reminder goes off at a bad time
• run out, unable to refill
• forgot to bring it with you
• need to take it with food but food isn’t available
• don’t feel like it
• don’t want the side effects
• government interference (esp. with opioids or CBD)
• expensive

• use reminder apps such as Medisafe; incientally, if you would like to get Medisafe Premium for free, use promo code TH2W9
• look into time-release versions or alternate delivery methods (such as patches)
• keep a pill container with you
• keep snacks with you
• use a whiteboard to track/log medications/meals/etc.
• visual cues (such as turning a pill bottle over after you’ve taken it)
• tie it to other routine activities (coffee, exercise, meal, toothbrush)

Depression

Often just another symptom that comes from chronic pain, like fatigue or other emotions. It is a normal part of the symptom cycle, and chronic pain generally leads to acute depression, rather than chronic/clinical depression.

Symptoms of depression:

• grouchy/irritable
• fatigue
• anhedonia
• suicidal thoughts
• staying in bed
• under/overeating
• social isolation
• sleep disruption
• alcohol/drug abuse
• not tending to personal needs or hygiene
• weight loss/gain
• frequent accidents
• low self-image
• arguments/temper/anger
• confusion/inability to concentrate

Mitigation strategies: (brainstorm)

• exercise
• get outside, take a walk
• get sufficient sunlight (or use a therapy lamp)
• take care of animals
• watch a comedy or other favorite movie
• medication
• check your hunger levels, and eat as appropriate
• seek support from friends/family/therapist
• music
• make social plans (and hold yourself to them)
• treat yo'self
• help others/volunteer
• limit alcohol consumption
• ✨positive thinking✨

Not all depression is self-manageable. Here are some warning signs to look out for:

• Lasting more than a few weeks
• Suicidal thoughts
• A desire to commit acts of self-harm or harm to others

✨positive thinking✨

Pessimists have worse chronic pain than optimists.

Negative thoughts can often be rephrased as positive thoughts, and as an exercise that can be beneficial.

For example: “I would liek to exercise but I can’t” → “I can try a simple exercise and enjoy the flowers while I rest.”

(then we brainstormed on positive affirmations and maybe this is my pessimism speaking but I just wanted to barf at most of it)

Steps towards positive thinking:

1. Write down your self-defeating, irrational thoughts
2. Change the phrasing to positive ones
3. Rehearse the positive ones
4. Practice following the above
5. Be patient

Also, when thinking something self-hating, think of whether you’d say that to your friend; try to be your own best friend.

Guided imagery

This was just a basic overview of mindfulness meditation, and guided imagery in particular is a directed daydream. The session runners talked us through imaginging we were walking through a forest. Personally I’m a fan of Michael Sealey and there are plenty of other guided meditation folks on YouTube (see also my anciety resources list).

Next week’s action plan

Do 20 minutes of lightbox therapy every other day at 11 AM.

Homework

1. Keep a food diary for one weekday and one weekend day including portion sizes (per week four)
2. Write what you feel you’ve accomplished in this workshop
3. Write a letter to your healthcare provider about how you feel about the program as well as to the people who prepared the course materials for this
• You don’t have to actually send it
4. Pay attention to negative thoughts, rephrase them as positive