How to manage chronic pain?

Chronic pain is usually caused by chronic diseases like rheumatoid arthritis, end stage cancers or spinal injury which are not curable. The words "no cure" will itself bring pain to the heart. No pain can be compared with labor pain but most women come over it easily because they are going to receive a bundle of joy. It's not the same with chronic pain, you will have to bear them all your life for no good reason. Anyways, there are other alternate therapies to manage pain successfully.

Firstly, you must keep in mind that chronic pain is a part of your life and you are going to live with it. Secondly, understand that you cannot pass on the pain to somebody else, only you are going to bear it. It is the cross you are called to carry. Thirdly, you have to take optimal measures to keep yourself pain free which can be done with other's support. Fourthly, don't lose heart and carry on with your treatment until you succeed.

DIVERSION THERAPY: This is the best therapy I ever suggest for anybody with chronic pain. Don't think that you are going to get the pain soon, instead divert yourself in the activities you enjoy like reading books, watching television, calling a friend on the phone, bird watching, drawing, cooking or whatever. Just forget about the pain and concentrate on something else.

PSYCHO THERAPY: This is one way you ventilate your feeling to somebody you rely on so that all your burdens are lessened including your pain. Opening up the bottled up feelings can be done with anybody say your mother, daughter, nurse, friend or anybody on whom you put your trust. It need not be a psychotherapist all the time. Many patients say that a kind nurse who spares time to listen to their problems cures half their disease.

OCCUPATIONAL THERAPY: When you are stuck with pain, take your regular prescribed medication for pain and get back to work. If your health does not permit you to do office works try occupational therapy. Here, you'll be taught about various other works which you can perform inspite your deformity. Learn what all you can do and lead a productive life. Occupation will boost your self esteem, show independency and of course a good diversion.

PHYSIO THERAPY: Pain will usually impair your mobility and thereby unexercising your body will cause muscle wasting and weakness. Try out active and passive exercises. Get a good physiotherapist and work on it. Active exercise will relieve pain to a great extent.

RELAXATION THERAPY: This is one another therapy that makes you forget pain. Relax not only your body but also your mind. You can learn to relax each and every muscle of your body. Yoga relaxes your body and eventually relieves your pain. Deep breathing exercises have proved to relieve spasmodic pain. Keeping your mind relaxed and being stress free also relieves pain.

ACUPUNCTURE: Assessing the nerve which supplies the particular body part that causes pain and blocking them will allivate pain which is done by acupuncture. These needle pricks are painless and it can keep you pain free for quite a period of time.

SUPPORT THERAPY: You can identify groups who mirror your problem. Learn how they manage pain and their coping skills so that you can apply a few of them. They are practical and living examples. When you meet such people you will feel your pain is nothing compared to them. You can find such groups through your doctors who are supposed to leave you with those information and also from the internet.

FAMILY THERAPY: Family must be a good support to your sick relative who is in pain. Do talk kind words with them, visit them, take them for a walk. The sick person needs more attention than a normal person. Spend more time with them, listen to them and make them feel respected. And you too (sick person) have to take come out and not be withdrawn all the time.

SPIRITUAL THERAPY: Meditation also relieves pain. Make sure you go to church and involve in spiritual activities. If you are bed ridden, inform the church pastor so that he comes home and shares the good news with you and prays for you. You read Bible daily, give God His due and He definitely cares for you. Let this not be your last choice of treatment.

How to handle anxiety?

Anxiousness is common when we fear and worry about something. Each of us have a different defence mechanism to overcome our anxiousness. We are anxious about many things like impending surgery, forth coming examination and results or an oncoming presentation etc but this doesn't mean that we are having an anxiety attack. We call a condition 'anxiety attack' when the worries are persistent and unrelenting that one separates himself from the real world and not caring about himself. This is usually accompanied with other emotional and physical symptoms.

Anxiety attacks are easily treated with certain therapies, counselling, relaxation technique and medications. But before going for a treatment it is better to sort out there is no actual physical problem associated with it. Because there are some diseases which mimics anxiety attack and some problems that interferes with the treatment of anxiety attack.

WAYS TO COMBAT ANXIETY ATTACKS:
1.Good sleep: A good night rest of 8 hours at a regular time everyday keeps the mind calm and clear. This helps to start the day peacefully and take a wise decision. Do not ponder over anything lying in the bed. Let tomorrow worry about itself tomorrow.

2.Healthy diet: A healthy diet combats many diseases as well as stress and anxiety. A healthy diet basically corrects all imbalances and keeps the body hale and healthy. Take a well balanced diet and don't forget eat more fruits and vegetables.

3.Regular activity: Involve yourself in some kind of an activity which will divert you from anxiety. Don't keep your mind and body idle which will provoke fear and worries about future. Instead enjoy the day. Participate in some kind of sports, exercise programs, spa, yoga, aerobics etc.

4.Meditation: Let meditation be a part of daily routine. When you meditate or take time to pray all you worries will disappear miraculously. Meditation controls your body, mind and soul.

5.Relaxation: Learn relaxation techniques which is the best method to combat anxiety attacks. When your body alerts you that you are anxious about something start relaxing your muscle one by one, take deep breaths and start doing deep breathing exercises. Other relaxations like taking a break and going for a short vacation, having get together with family regularly and involving in some kind of a hobby is also helpful.

6.Acupuncture: It is believed even acupuncture can relax muscles and reduce anxiety. It has been successful in many cases.

7.Avoiding alcohol, caffeine and drugs: Some try to divert themselves from their worries by drinking alcohol, caffeine and using drugs. Though this causes a superficial excitement, the ill-effects are many. Studies have proved that alcohol, drugs and especially caffeine provokes anxiety but does not reduce them.

8.Biofeedback: These are sensors which will help you to identify when your body is going to throw an anxiety attack. It tracks the changes in heart rate and muscle tension, and you can be ready to use your defense mechanism to fight anxiety.

9.Natural remedies: There are certain herbal treatment or home remedies for anxiety attack but they have not proved it's magic. Valerian root and passion flower are famous herbal remedies.

10.Cognitive-Behavioral Therapy: This is considered as the best medical treatment for a diagnosed anxiety problems. Here you'll be exposed repeatedly to the situations that causes fear and anxiety under safe environment until you are numbed. This is otherwise called as flooding. You will gain a greater sense of control over your anxieties and learn new skills for dealing with stressful situations.

11.Anti anxiety drugs and anti depressants: These are two different classes of drugs which relieves anxiety by causing mild sedation. These drugs should be taken only for a shorter period with doctor's advice. Though it is effective in some ways, the side effects are said to be more.

12.Hypnosis and electro convulsive therapy: These two treatments were practiced till recently but has now proved to cause no positive effects for anxiety attacks. These treatments are no more treatment of choice now.

As anxiety attacks can come at any time, make sure you reach a safe place and even protect your head if possible. Always carry a tag or an identity card which will be helpful in case of emergency. If you feel that you are facing this problem, seek medical treatment as early as you can because they are completely curable and does not involve any invasive treatments. Don't worry be happy is the best way to combat anxiety attack!

Rheumatoid arthritis

Rheumatoid arthritis is an autoimmune disease that causes chronic inflammation of the joints.
Rheumatoid arthritis can also cause inflammation of the tissue around the joints such as the tendons, ligaments, and muscles, as well as other organs in the body.Rheumatoid arthritis is a chronic illness, meaning it can last for years, patients may experience long periods without symptoms. Typically, however, rheumatoid arthritis is a progressive illness that has the potential to cause joint destruction and functional disability.

The cause of rheumatoid arthritis is a very active area of worldwide research. The cause of rheumatoid arthritis is unknown. Some scientists believe that the tendency to develop rheumatoid arthritis may be genetically inherited.It is suspected that certain infections or factors in the environment might trigger the immune system to attack the body's own tissues.
Environmental factors also seem to play some role in causing rheumatoid arthritis. Recently, scientists have reported that smoking tobacco increases the risk of developing rheumatoid arthritis.

The goal of treatment in rheumatoid arthritis is
1.to reduce joint inflammation and pain,
2.to maximize joint function, and
3.to prevent joint destruction and deformity.
There is no known cure for rheumatoid arthritis.

Optimal treatment for the disease involves a combination of medications, rest, joint strengthening exercises, joint protection, and patient (and family) education. Treatment is most successful when there is close cooperation between the doctor, patient, and family members. Treatment is customized according to many factors such as disease activity, types of joints involved, general health, age, and patient occupation.

Two classes of medications are used in treating rheumatoid arthritis:

1. Fast-acting "first-line drugs" which includes NSAIDs (non steroidal anti-inflammatory drugs), COX-2 Inhibitors, Pain Medication (analgesics), Corticosteroids.
Acetylsalicylate (Aspirin), naproxen (Naprosyn), ibuprofen (Advil, Medipren, Motrin), and etodolac (Lodine) are examples of nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs are medications that can reduce tissue inflammation, pain and swelling. NSAIDs are not cortisone. Aspirin, in doses higher than that used in treating headaches and fever, is an effective antiinflammatory medication for rheumatoid arthritis. Aspirin has been used for joint problems since the ancient Egyptian era.NSAIDs are usually taken with food. Additional medications are frequently recommended to protect the stomach from the ulcer effects of NSAIDs.

Corticosteroid medications can be given orally or injected directly into tissues and joints. They are more potent than NSAIDs in reducing inflammation, and in restoring joint mobility and function. Corticosteroids are useful for short periods during severe flares of disease activity, or when the disease is not responding to NSAIDs. However, corticosteroids can have serious side effects, especially when given in high doses for long periods of time. These side effects can be partially avoided by gradually tapering the doses of corticosteroids as the patient achieves improvement of the disease. Abruptly discontinuing corticosteroids can lead to flares of the disease or other symptoms of corticosteroid withdrawal, and is discouraged.

2. Slow-acting "second-line drugs" (also referred to as Disease-Modifying Antirheumatic Drugs or DMARDs) which includes gold, methotrexate, hydroxychloroquine (Plaquenil),Sulfasalazine (Azulfidine) and D-penicillamine (Depen, Cuprimine) promote disease remission and prevent progressive joint destruction, but they are not anti-inflammatory agents.
Both classes are mixed for certain patients to obtain relief. Some patients are treated by injecting certain drugs directly and locally into the joints.

Newer "second-line" drugs for the treatment of rheumatoid arthritis include leflunomide (Arava), and the "biologic" medications etanercept (Enbrel), infliximab (Remicade), anakinra (Kineret), and adalimumab (Humira). Leflunomide (Arava) is available to relieve the symptoms and halt the progression of the disease. It seems to work by blocking the action of an important enzyme that has a role in immune activation.

Etanercept (Enbrel), infliximab (Remicade), and adalimumab (Humira) are biologic medications. These medications intercept a protein in the joints (tumor necrosis factor, or TNF) that causes inflammation before it can act on its natural receptor to "switch on " inflammation.

Anakinra (Kineret) is another biologic treatment that is used to treat moderate to severe rheumatoid arthritis. Anakinra (Kineret) works by binding to a cell messenger protein (IL-1, a proinflammation cytokine).

Rituxan can be effective in treating autoimmune diseases like rheumatoid arthritis because it depletes B-cells, which are important cells of inflammation and in producing abnormal antibodies that are common in these conditions. Rituxan is now available to treat moderate to severely active rheumatoid arthritis in patients who have failed the TNF-blocking biologics.

Orencia (abatacept) is a recently developed biologic medication that blocks T-cell activation. Orencia (abatacept) is now available to treat adult patients who have failed a traditional DMARD or TNF-blocking biologic medication.

The Prosorba column therapy involves pumping blood drawn from a vein in the arm into an apheresis machine, or cell separator. This machine separates the liquid part of the blood (the plasma) from the blood cells. The Prosorba column is a plastic cylinder about the size of a coffee mug that contains a sand-like substance coated with a special material called Protein A. Protein A is unique in that it binds unwanted antibodies from the blood that promote the arthritis. The Prosorba column works to counter the effect of these harmful antibodies. The Prosorba column is indicated to reduce the signs and symptoms of moderate to severe rheumatoid arthritis in adult patients with long standing disease who have failed or are intolerant to disease-modifying anti-rheumatic drugs (DMARDs). The exact role of this treatment is being evaluated by doctors and it is not commonly used currently.

In some patients with severe joint deformity, surgery may be necessary that may range from arthroscopy to partial and complete replacement of the joint.

Some go for natural treatment which include Acupuncture / Acupressure, Biofeedback, Chiropractic, Magnets, Massage, Meditation, Tai Chi, Yoga.
Supplements such as fish oil, glucosamine, chondroitin, MSM are also used. It is not confirmed if these are effective.

complimentary medicine includes regular exercise, eating a nutritious diet and the stress management.Heat and cold applications are modalities that can ease symptoms after exercises.

Future treatments: Scientists throughout the world are studying many promising areas of new treatment approaches for rheumatoid arthritis. These areas include treatments that block the action of the special inflammation factors, such as tumor necrosis factor (TNFalpha) and interleukin-1 (IL-1), as described above. Many other drugs are being developed that act against certain critical white blood cells involved in rheumatoid inflammation. Also, new NSAIDs with mechanisms of action that are different from current drugs are on the horizon.

Studies involving various types of the connective tissue collagen are in progress and show encouraging signs of reducing rheumatoid disease activity. Finally, genetic research and engineering is likely to bring forth many new avenues of earlier diagnosis and accurate treatment in the near future. Gene profiling, also known as gene array analysis, is being identified as a helpful method of defining which people will respond to which medications. Studies are underway that are using gene array analysis to determine which patients will be at more risk for more aggressive disease. This is all occurring because of technology improvements. We are at the threshold of tremendous improvements in the way rheumatoid arthritis is managed.

Supportive therapies:

Medical rehabilitation plays an important role in its treatment. Team of rehabilitation helps patients manage everyday activities and work and live with chronic conditions. This team includes physical therapists, occupational therapists, psychologists, social workers and relaxation specialists. Led by rheumatologists, the team initiates and monitors rehabilitative therapies, including all elements of managing the patient's condition that do not involve traditional medical, drug and surgical procedures.

Treatment may include:
Physical therapy
Occupational therapy
Individualized home strengthening and stretching programs to improve range of motion, function and independence while protecting joints and reducing flare-ups
Integrative medicine (e.g., acupressure and acupuncture)
Manual therapy (e.g., massage and stretching)
Nutrition counseling
Sleep counseling
Patient education
Vocational counseling

Physical therapy can help alleviate the pain, stiffness and weakness associated with rheumatic diseases and to restore function, improve mobility and independence and prevent or limit permanent physical disabilities. The goal of occupational therapy is to help people regain, develop and build skills that are essential for independent functioning, health and well-being.

Assistive device can help a person with a rheumatic disease move better, manage pain or avoid fatigue. Such devices include:

*Braces (e.g., back braces)

*Canes

*Grab bars in showers and tubs

*Shoe inserts

*Special tools or gadgets that can help maintain an active, independent life without straining the joints (e.g., reaching aids)

*Splints

*Using luggage or grocery carts

Aquatic therapy: Warm water helps to loosen tight joints and muscles while the resistance of the water improves muscle strength.

Diet: people with rheumatic diseases require no special diet. Some general guidelines to follow include:
*Limit alcohol consumption.

*Control your weight. Excess weight puts added stress on joints in your back, hips, knees and feet - places where arthritis pain is commonly felt. Excess weight also can make joint surgery more difficult and risky.

*Eat a healthy diet. Eating a diet high in vegetables, whole grains and fruits helps you maintain a proper weight and good health.

Lifestyle Modifications
While there is much about having a rheumatic disease that is not under your control, managing a variety of lifestyle issues can help make your condition easier. These include:

*Apply cold to joints or painful areas for occasional flare-ups. Cold may dull the sensation of pain in the first day or two. Cold also has a numbing effect and decreases muscle spasms. *Do not use cold treatments if you have poor circulation or numbness.

*Apply heat to joints or painful areas. Heat will ease your pain, relax tense, painful muscles and increase the regional flow of blood. You may find it especially helpful before exercising. One of the easiest and most effective ways to apply heat is to take a 15-minute hot shower or bath. Other options are a hot pack, an electric heating pad on its lowest setting or a radiant heat lamp with a 250-watt reflector heat bulb. If your skin has poor sensation or if you have poor circulation, do not use heat treatment.

*Avoid actions that strain joints, including finger joints, if you have arthritis. Choose a purse with a shoulder strap rather than a clutch-style purse. Use hot water to loosen a jar lid and pressure from your palm rather than your fingers to open it.

*Avoid jobs or activities that require repetitive motions, heavy lifting or stress on joints. Other activities that should be avoided are ones that involve overuse or injury to a joint.

*Avoid stress and anxiety. These can cause changes in your body chemistry that can make your symptoms worse. Relaxation techniques or antidepressant drugs can help manage stress and anxiety. Hypnosis, guided imagery, deep breathing and muscle relaxation can all be used to control pain.

*Develop a support system to help you and your family best manage your condition.

*Eat a balanced, healthy diet that allows you maintain a proper body weight.

*Get enough exercise. This helps reduce pain, stiffness and stress while increasing your strength and flexibility.

*Get enough rest. Being tired and feeling pain are signs that it may be time to rest joints and muscles. The pain associated with rheumatic diseases can make getting a good night's sleep difficult. This prevents your body from producing the chemicals that help regulate pain.

*Keep a positive attitude. Make a plan with your doctor for managing your arthritis. This will help you feel that you are in charge of your disease, rather than vice versa. Studies show that people who take control of their treatment and actively manage their arthritis experience less pain and function better.