Nitrous Oxide Safe for Labor Pain, But Few Women Stick With It

By Pat Anson, PNN Editor

A new study is touting an older form of anesthesia for women going through labor pain. Researchers at the University of Colorado College of Nursing say nitrous oxide – commonly known as laughing gas – is a safe and effective option for pain relief.

Their study, published in the Journal of Midwifery & Women's Health, is based on a survey of 463 women who used nitrous oxide (N2O) during labor.

"Nitrous oxide is a useful, safe option for labor analgesia in the United States. And for some laboring mothers, that's all the pain relief they need,” said lead author Priscilla Nodine, PhD, a Certified Nurse-Midwife and Associate Professor with the University of Colorado College of Nursing.

Nitrous oxide was once widely used in American hospitals to relieve labor pain, but it fell out of favor as more Caesarean sections were performed and women opted for epidural injections and spinal blocks, known as neuraxial analgesia.

Some hospitals are now reintroducing nitrous oxide as a safer and less invasive option. The inhaled gas helps reduce anxiety and makes patients less aware of their pain, but does not eliminate it. 

While side effects from nitrous oxide were rare (8%), less than a third of the women studied stuck with it. Sixty nine percent wound up using neuraxial analgesia or opioids during labor. The reason most often cited (96%) for converting from N2O to another therapy was inadequate pain relief.

Women who had previously given birth vaginally were more likely to stick with nitrous oxide, while those who had a Cesarean section were six times more likely to use neuraxial analgesia. The odds of conversion from N2O tripled when labor was induced or augmented with oxytocin, a hormone that helps women bond with the baby and stimulates milk production.

“Understanding predictors of conversion from inhaled nitrous oxide to other forms of analgesia may assist providers in their discussions with women about pain relief options during labor," said Nodine.

The findings are similar to a 2019 study, which found that nearly 70 percent of the women who tried nitrous oxide switched to an epidural or another pain management method.  

Epidurals allow mothers to stay awake and alert throughout delivery. But they are not without risks. A poorly placed needle can damage the spine permanently, as Dawn Gonzalez learned years ago.

“The blind insertion of the epidural during birth is basically playing roulette for spinal damage. Normally birthing mothers are told the only side effect possible during epidurals is a spinal headache that lasts a few days,” said Gonzalez, who developed adhesive arachnoiditis, a chronic and disabling inflammation of her spinal nerves.  

“Every woman deserves to know that when she opts for any kind of invasive spinal anesthesia, the risks are very grave and by far much more common than anybody realizes.”

The American Society of Anesthesiologists has defended the use of epidurals, calling them “one of the most effective, safest and widely used forms of pain management for women in labor.”

Nerivio: What’s All the Buzz About?

By Mia Maysack, PNN Columnist

If you have migraines and are open to more holistic approaches to treating them, I’d like to share my experience with Nerivio. It’s the first smartphone-controlled neuromodulation device for the treatment of migraine, with or without aura. I was provided one of the devices, which is worn on the arm, at no cost by the manufacturer, Theranica Bio-Electronics.

Nerivio requires a prescription from a doctor. I was able to be seen via telemedicine through Cove for my appointment, which was convenient. A script was written for 12 treatments, which are thought to be most beneficial within the first 30 minutes of experiencing aura or the onset of pain.

Given that my head hurts 24/7/365, I was hesitant to even try Nerivio, but ultimately decided it was worthwhile due to the low risk of side effects. I've tried different types of neuromodulation devices before, without success, and went into this with an open mind and minimal expectations.

Nerivio didn't take any of my discomfort away, but it did cultivate a decent enough distraction. Despite my blaring head pain, I love loud music. I realize that could seem odd, but I figure since it hurts anyway, turn it up! Anything to switch up the frequency of this migraine that's stuck on repeat. 

I view Nerivio similarly. You have to chill out for the treatments, which are 45 minutes in length. Though it is possible to go about daily activities during treatments, I found it more comfortable not to. I'd take deep breaths and visualize the armband just like music, disrupting the head pain and transmitting restorative waves.   

Much like the beloved 12" subwoofer in Ophelia (my car), I controlled the volume, using my smartphone to dictate the intensity of Nerivio.

When it’s on, Nerivio delivers small electric impulses into the upper arm that disrupt pain signals in the brain. I first compared the feeling of neuromodulation to that of a tingle or itch, but after becoming more familiar, I'd label it as vibrational. It doesn't hurt, and the sensation is a welcome change of pace for anyone experiencing head pain 

It's important to remember there is a weak current of electricity, so fingers shouldn't be directly placed on the device when it's on, nor should it be used in any place other than your arm. 

The device costs about $100. That can be a significant amount of money, especially for those of us unable to maintain any sense of normalcy regarding employment or income. But I’ve paid out of pocket far more than that, regularly, for co-pays and uncovered treatments, not to mention pills that demanded Benjamin Franklin’s face for not even a week’s worth of treatment.   

What I appreciate about Nerivio is that it’s something I can do on my own. I altered the arms I used it on and always incorporated relaxation with my experiences to whatever extent I could.  It worked nicely in conjunction with mindfulness breaks, as well as first thing upon waking up or last thing before bed. 

IMAGES COURTESY OF THERANICA

IMAGES COURTESY OF THERANICA

It’s also relieving to literally be holding the “power” in the palm of my hands. If there’s a need to halt a session, there is a pause button. Although I didn’t get around to utilizing it, Nerivio also has a feature that assists in promoting guided imagery and meditation as a further enhancement.   

For each treatment, all that’s necessary is to hit the power button on the armband and ensure it has synced up to your device. Within the first few moments when starting, a questionnaire pops up on the screen asking how you’re feeling. This acts similarly to a virtual diary to track symptoms and hopefully improvement. This step isn’t necessary, although never a bad idea to monitor or check in as to where you’re at.

All in all, I’d have to say if you’re curious enough and able to, go ahead and give Nerivio a try.  I believe it could be beneficial for other migraine conditions not as complex as mine.  

I haven’t been paid or endorsed at all for this review and offer these words solely as a resource for those who are considering it.  Feel free to follow up with questions, as I’m honored to help navigate the Nerivio process with you in any way I am able.

Mia Maysack lives with chronic migraine, cluster headache and fibromyalgia. Mia is the founder of Keepin’ Our Heads Up, a Facebook advocacy and support group, and Peace & Love, a wellness and life coaching practice for the chronically ill.

‘Sound Healing’ With Crystal Singing Bowls

By Madora Pennington, PNN Columnist

It’s 6 in the evening, on day 31 of "Safer at Home" quarantine in Los Angeles.

I am logging into a Zoom call for sound healing. The invite said:

“The great sleeping prophet Edgar Cayce noted "Sound will be the medicine of the future.” Well the future is now.

Share this link with anyone you know that is experiencing physical pain in the body. In about a half an hour that pain will be substantially reduced or eliminated. This works every time.”

The invite is from Jeff Klein, who uses "Crystal Singing Bowls" to make harmonic tones and vibrations. Jeff says his "sound therapy" helps people relax, rejuvenate and feel less pain. You can watch one of his singing bowl concerts below.

I am not in pain, but I am rather stressed out. And curious. Plus, I do love sound. Why not?

I get Zoomed in.

We have trouble getting started as our host, Jackie, isn’t close enough to the microphone and there is a strong background hum. No one can hear what she is saying, various attendees’ blast into their microphones.

Eventually Jackie figures it out and welcomes us. She’s the “surrogate,” the person Jeff will be working on, while about 30 of us watch and listen.

Jackie tells us to, “Sit into energy of gratitude and allow that into our system.”

I am not a spiritual person, but I do my best.

I have newspapers opened on the side of my screen I’d rather be reading. I am a news junkie. But Jackie convinces me to close my eyes and let go for now, and just be grateful.

This probably is a good idea.

“I am grateful,” Jackie says, with authority.

She encourages us to feel our breath, feel the warmth and experience openness.

Okay then, I can do this.

In comes Jeff, a portly man in his 60’s, who does live singing bowl concerts where he lives in Colorado, although not during coronavirus lockdown.

Jeff explains how his sound concert cured a woman’s hearing deficit, and how another man with neck pain had it permanently relieved from sound healing.

I am skeptical, but Jeff is ready to address this.

Jeff says placebos work because the heart and mind connect and healing occurs. Not a theory I had heard of.

“We are here to raise consciousness and vibration,” Jeff tells us. “Physical mental and emotional healing can happen, just like that,” as he snaps his fingers.

He instructs us to sit back, close our eyes, relax and be ready to receive.

Nothing I object to yet, except for his description of placebo effect.

And the sound quality. Zoom is not the best for a sound healing demonstration, with the chronic, scratchy, feedback audio. It’s so abrasive, I have to turn my volume down.

Jeff is fun to watch as he maneuvers the bowl like a master pastry chef. Swirling the rod around the rim to make sound, also swirling the bowl over Jackie’s body. I wish I were her right now. I’ll bet that feels good. At times, Jackie twitches on the table.

But I can multitask. Peeking out from behind my Zoom screen is the world map of coronavirus outbreaks from the New York Times. There’s a relaxation killer.

Jeff gets a bigger bowl, this one of stainless steel. I haven’t seen bowls like this before. Jeff has strong arms. Jackie twitches a lot with this one.

I stop watching. I let the sound play. It’s beautiful, layers of reverberations without a melody or structure. It makes it easy to let go.

I read about the failure of hydroxychloraquine on the side of my screen. Who didn’t see that coming? Then on to other headlines:

Italy’s poorer south suffers under lockdown, and fears a second blow from the virus.

The number facing acute hunger could double this year, the World Food Program says.

A port city in Ecuador has become an epicenter of the outbreak in Latin America.

Yet, I feel relief in my head and body from listening to these bowls, even over dreadful sound quality.

I must hunt down music like this on Sonos. I do a search for “Tibetan Singing Bowl.” Oh good, a playlist exists.

Then I remember: Don’t I own a Tibetan singing bowl myself? Got it in Santa Monica years ago. Oh yes, it’s in my living room. I should bang it daily. Since it has mercury in it (or is it lead?), I don’t like to touch it. It’s made of seven metals, some toxic.

I read all the news during the Zoom sound healing: The Los Angeles Times, New York Times and Washington Post. Yet, I feel relaxed. I was not in pain, but if I had been, I think I would feel better.

Managing pandemic anxiety has been a challenge. My technique has been to cognitively challenge distorted thoughts. I question what I am thinking and if it is valid, since it’s making me uneasy. At the end of quarantine, I think I will emerge a saner human. But this bowl stuff was really relaxing and requires way less effort.

When it ends, Jeff invites us to share. I want to tell him this was much better than I thought and I might attend again, but I’m not really a joiner.

Other participants chime in. They talk about the mystical (or are they hallucinatory?) experiences they had: tingling sensations, warmth, visions of light. They sound happy and relaxed, like I feel. I didn’t have those phenomena happen, but I wasn’t really trying.

I will definitely add this music to my day. I’m convinced this will help me get through the pandemic, and it has less calories than wine.

I have to think relaxing and letting go probably would help pain, at least temporarily. This is an easy way to do it.

More soothed than I have been in weeks, I’m hungry for the chicken and dumplings a friend made for us. I’ll steam some green beans, too.

Madora Pennington writes about Ehlers-Danlos Syndrome and life after disability at LessFlexible.com. Her work has also been featured in the Los Angeles Times.

Low Dose Naltrexone Saved Me from a Lifetime of Pain

By Madora Pennington, PNN Columnist

The first place I felt a ripping pain in my body was in my feet, when I was 14 and growing fast. But that’s only because I don’t remember the severe abdominal hernias I was born with. They probably felt the same. After I screamed for the first two months of life, a surgeon repaired them. I still have the scars.

In adolescence, very soon after my feet began to fail me, I was distracted by the snapping of my kneecaps. More trouble walking. Next came the low back aching. Carrying my schoolbooks and sitting in class became unbearable.

My merry-go-round of symptoms could have driven me mad, I suppose, but I was overtaken with such debilitating fatigue, I did not have the energy for big emotional reactions. My clique of junior high friends were agony, isolation and loneliness that I was too tired to accept or reject.

Then my abdomen herniated again. That pain was drowned out by everything else, to be repaired years later when surrounding tissue got caught in it, requiring an emergency operation.

In spite of exhaustive doctor visits throughout my life, no one gave a me a name for what was wrong with me until I was 33: Ehlers-Danlos Syndrome (EDS). Ah, so that’s what the other kids had that I lacked: stable collagen. My life began to make sense.

EDS was named for the doctors who first noted it in the medical literature. If it had been assigned a descriptive name, it would be called Contortionist Syndrome.

If I had joined the circus, my job would have been freaky back bender. My spine is impressively loose and a particular source of torture. I spent the last half of my 20’s begging for a guillotine to make the pain in my neck and head stop. No one obliged. Rib dislocations have been another problem. Is this what it feels like to get stabbed in prison? I am in prison in my body, so that would be consistent.

Before you feel too sorry for me, or recoil in horror that a human could be born so flimsy, note that my story has a happy ending. By the end of my 30’s, I got experimental treatment that made my body produce better collagen, strong enough to end my life of disability and begin a new one, functioning in the world.

Pain Changes the Brain

It was one thing to have a more stable body, but I still had a problem. Pain creates a disease state of its own. I had been in chronic pain for about 25 years.

Pain signals danger to the body: Do something because you are getting hurt! But what happens when the pain never stops or cannot be adequately relieved? The more a brain experiences pain, the better it gets at experiencing it. That is how brains are. They get good at what they practice.

Ongoing, unrelieved pain causes a downward spiral of maladaptive changes. Chronic pain triggers fatigue and depression. Sufferers tend to avoid activity, often quite legitimately, out of fear of injury or pain aggravation. Chronic pain also seems to induce troublesome changes in learning, memory, and body perception that are similar to emotional disorders. As pain changes the brain, sufferers are likely to feel less motivated and become less able to initiate or complete goals.

These brain changes are real. Researchers have noted widespread abnormalities in the brain, such as “grey matter density, in the connectivity of the white matter, as well as in glutamate, opioid and dopamine neurotransmission.”

How Naltrexone Works

One promising treatment for disrupting and rehabilitating the vicious cycle of chronic pain is an off-label use of an old drug: Naltrexone. Naltrexone treats opioid addiction by blocking the opioid receptors so drugs like heroin cannot take effect.

However, given at much smaller doses, naltrexone blocks the opioid receptors only slightly. This creates a stimulating, re-regulating effect The result: relief and even healing. Even better news, naltrexone is one of the safest drugs around.

How does low dose naltrexone (LDN) have such a profound effect? Opioid receptors are not just in the brain, they are spread throughout the body in the guts, blood, joints, skin and nerves. The hypothalamus and adrenal glands produce hormones with opioid-like effects, creating a complex hormonal feedback system that governs everything from immunity, pleasure and pain, to how connected we feel to others. Naltrexone in low doses gently interrupts these inter-body communications, which can cause a cascade of healing.

Dr. Linda Bluestein is a pain doctor at Wisconsin Integrative Pain Specialists and host of the Bendy Bodies podcast. She often prescribes low dose naltrexone for her chronic pain patients.

“LDN acts on microglial cells and is a novel CNS anti-inflammatory agent,” says Dr. Bluestein, adding that LDN works well not only on persistent pain (fibromyalgia, complex regional pain syndrome, migraine, irritable bowel syndrome, etc.), but also for autoimmune diseases, inflammatory conditions, neuropathic pain, chronic fatigue syndrome and myalgic encephalomyelitis.

“Results are very positive. Many patients get outstanding pain relief. The remainder get moderate pain relief,” said Bluestein. “Some don't really observe much pain relief but want to continue taking the medication because the incidence of infections is lowered. This is because naltrexone given in low doses (1.5 to 4.5 mg) can act as an immunomodulator benefiting both autoimmune diseases and immune function.”

As for side-effects, Dr. Bluestein notes that a patient must be off opioids to take LDN.

“The most common side-effect is vivid dreams. Occasionally a patient will have GI issues, abdominal pain, or even more rarely, loose stools. Cost is sometimes a barrier as insurance rarely covers LDN. Access is another occasional barrier as it must be obtained from a compounding pharmacy,” she explained.

Back to my story, my life of pain interrupted. I have been taking low dose naltrexone for years now. In spite of healthier connective tissue, pain had ravaged me. LDN went far to undo that. Results took time, but were well worth the wait. I would say LDN gave me my personality back, which chronic pain (and also long-term opioids) had altered.

As someone with Ehlers-Danlos, my body is overly-sensitive and overly-perceptive. Activity that is moderate, normal, and completely safe can cause alarm bells of injury and trauma to my brain, even though I am not actually injured.

Why this happens with EDS is not understood, but in my experience, LDN keeps this phenomena from becoming a downward spiral of more pain, depression, fatigue and dysfunction.

Madora Pennington writes about Ehlers-Danlos and life after disability at LessFlexible.com. Her work has also been featured in the Los Angeles Times.

The Pros and Cons of Telehealth

By Barby Ingle, PNN Columnist

The coronavirus lockdown has many providers now offering telehealth or telemedicine – ways to connect with a doctor without actually seeing them in person. Telemonitoring and concierge medicine are also becoming more popular.

The tele-words are often used interchangeably, but they have different meanings. How do you use them? What are the pros and cons?

Telehealth is the distribution of health-related services and information, usually over the phone or online. It allows long-distance patient and clinician contact, care, advice, reminders, education, intervention, monitoring and remote admissions.

Telemedicine is the practice of medicine using technology to deliver care at a distance. A physician in one location uses telecommunication to deliver care to a patient at a distant site.

Telemonitoring refers to the transmission of health data, such as heart rate, blood pressure, oxygen saturation, and weight directly to providers by phone, online or some other electronic means.

Concierge medicine is a relationship between a patient and a primary care physician in which the patient pays an annual fee or retainer. Be sure to check with your insurance to see if they cover concierge medicine or it can be pricey.

Ken (my husband and caretaker) and I have been using telehealth and concierge medicine for more than 5 years. We didn’t choose concierge medicine, but when our primary doctor decided to go that route, we looked into it heavily and made a decision to stay with him.

Our doctor joined MDVIP, a national network of primary care physicians who treat fewer patients and focus on personalized medicine. We can visit him in his office or by phone, text, email and video calls. He offers a wide range of preventive care that is covered in his fees.  And because he works in a network with other providers around the country, if we are traveling and have an emergency, we can see another doctor and it is covered.

Studies published in peer-reviewed medical journals show patients in concierge medical practices receive more preventive services and enjoy better control of chronic conditions than patients in traditional practices. Other studies show concierge patients are hospitalized and readmitted less often, and visit urgent care and emergency rooms less often.

I love having a true partner on my health team.  When you can’t leave home, you can still get that one-on-one service with a provider.  Transportation issues, taking time off from work, and finding child care are no longer an issue for routine visits and follow-up care. Yet, we still have the option for in-person visits when lab tests and other diagnostic tools are needed.

Providers who use telehealth can benefit from the streamlined reimbursements, improved patient satisfaction and retention, reduced no shows and cancellations, and boost the efficiency of their staff and themselves. Providers who use telehealth are also exposed to less virus and bacterial spreading — so its an important safety measure for them, as well as patients.

There can be a few drawbacks to telehealth. If you are not a “tech person,” your first few video calls can be an issue. A recent visit I had with a doctor by video was harder for him than me since I was only his second video appointment ever. For telehealth to work, the patient and provider need to have good internet connections, and some remote places in the U.S. still don’t have that.

If you are using telemedicine services that are not always with the same care team, you could also get a reduction in care quality. What might stand out to your longtime doctor or nurse may not be significant to a provider who doesn’t know your medical history. There is also a lack of personal touch.

Telemedicine is more for cases that don’t require a physical exam.  Telemonitoring is beneficial for chronic patients and the elderly. Concierge medicine is a great combination of telemonitoring, telemedicine and keeping the relationship strong between the patient and provider.

Barby Ingle lives with reflex sympathetic dystrophy (RSD), migralepsy and endometriosis. Barby is a chronic pain educator, patient advocate, and president of the International Pain Foundation. She is also a motivational speaker and best-selling author on pain topics. More information about Barby can be found at her website.  

Can Vitamin C Treat COVID-19?

By Madora Pennington, PNN Columnist

Viral infections like COVID-19 are difficult to treat. Unless and until a targeted anti-viral drug or vaccine is developed, symptomatic support is what is given to patients to ease suffering and prolong life -- until their own body hopefully defeats the coronavirus.

While most coronavirus infections are mild or even lack symptoms, to vulnerable patients they can be devastating. The virus can infect various organs, including the brain, lungs and nervous system, which leads to a cascading response of damaging inflammation. Patients can die from respiratory failure or septic shock, ironically caused by an over-reaction of their own immune system battling the virus.

One adjunctive therapy that emerged from the desperation to save patients in Wuhan, China is intravenous ascorbic acid. Yes, that is Vitamin C. A placebo-controlled study has begun in Wuhan to determine if Vitamin C infusions are helpful in treating 140 patients with coronavirus pneumonia. A similar clinical study is underway in Italy.

Doctors in New York are currently administering Vitamin C intravenously to coronavirus patients in large doses that are well above the recommended daily dose.

"I have to hope that this, or any new idea, may help," Peter McCaffery, Professor of Biochemistry at the University of Aberdeen in the UK, told Newsweek.  

"Just to reiterate though, taking large doses of Vitamin C tablets would be very unlikely to protect you from COVID-19 -- unless you were actually Vitamin C deficient, which with a normal diet is quite rare."

McCaffery says Vitamin C is relatively safe because, unlike many other vitamins, it does not build up to toxic levels. The worst side-effect is a potential kidney stone. Large amounts of C taken orally can also upset the stomach.

Previous studies have found that Vitamin C can help prevent death from the deadly complication of sepsis. Scientists believe Vitamin C stops the surge of immune cells that lead to lung destruction and helps reduce fluid buildup in the lungs. Vitamin C helps modulate the immune system, meaning it helps the immune system function properly, not over-reacting and not under-reacting. It also has antiviral properties.

Important for Overall Health

Vitamin C is critical for the maintenance of body functions and normal physiology. It helps the body maintain homeostasis -- the constant adjustments the body makes to keep conditions stable. For example, when a person eats and experiences a rise in glucose, insulin is produced to bring sugar levels down to normal. A breakdown in the body’s ability to maintain homeostasis is what leads to diabetes.

Vitamin C is essential for the formation of collagen, which is everywhere in the human body, gluing everything together. It is necessary for wound healing.

Vitamin C also supports the development of neurons and plays a role in learning and memory. Studies have shown that people with higher concentrations of Vitamin C are more cognitively intact compared to cognitively impaired individuals.

Some studies have shown Vitamin C can shorten the length of a cold, prevent it entirely under certain circumstances, and also reduce flu symptoms. But more research is needed in this area because findings have been mixed. Scientists suspect inconsistent results may be due to the variability of an individual’s ability to absorb Vitamin C and handle oxidative stress.

Some people need more Vitamin C than others to achieve healthy levels of ascorbic acid. Oxidative processes are especially altered in patients with obesity, cancer, neurodegenerative diseases, hypertension and autoimmune diseases. Lower concentrations of Vitamin C are also found in patients with metabolic syndrome.

Nearly all mammals manufacture their own Vitamin C when they are ill or injured. But chimpanzees and humans have a broken copy of the C manufacturing gene. We must obtain ours from food.

During the Age of Sail, a disease of profound Vitamin C deficiency — scurvy — killed an estimated 2 million sailors. At the time, no one knew Vitamin C was such a vital nutrient. Ships set sail on long voyages without enough food that contained it.

Scurvy was a terrible disease and a terrible way to die. Initially overcome with severe fatigue and weakness, sailors became unable to think or work. This created suspicion that laziness itself caused this mysterious disease.

As the body became more and more depleted of Vitamin C, healed fractures re-broke. Old wounds reopened and bled. Bruises formed at the slightest touch. Gums bled and teeth fell out. Joints ached. Flesh turned black and gangrenous. Fatal aortic ruptures or brain bleeding came on suddenly. Scurvy this severe is rarely seen in the modern world.

My interest in Vitamin C is very personal. I have an inherited collagen disorder called Ehlers-Danlos Syndrome (EDS), a poorly understood disease. Vitamin C loading is recommended for my condition, as many of my symptoms are similar to scurvy.

My doctor and I discovered I benefit exponentially from injecting Vitamin C, rather than taking it orally. Why is a mystery. For those interested in oral supplementation, liposomal C is the best choice.

Madora Pennington writes about Ehlers-Danlos and life after disability at LessFlexible.com. Her work has also been featured in the Los Angeles Times.

Study Finds ‘Good Evidence’ Acupuncture Can Treat Migraine

By Pat Anson, PNN Editor

Recent advances in treating and preventing migraines with new drugs have created a “treatment revolution” in migraine therapy.  But a more ancient technique may work even better, according to a small study recently published in the British Medical Journal (BMJ).  

Researchers in China say acupuncture was up to four times more effective than a non-steroidal anti-inflammatory drug (NSAID) in reducing attacks of episodic migraine without aura.

The study involved 147 migraine patients treated at seven hospitals in China from 2016 to 2018. The patients were divided into three groups; with one group getting 20 sessions of manual acupuncture, another group getting sham (fake) acupuncture, and the third group getting “usual care” that included use of the NSAID diclofenac.  

By the end of the study, patients who received acupuncture were having 2.3 fewer migraine attacks a month, compared to 0.4 and 1.6 fewer attacks for the usual care and sham groups, respectively. 

“In this study in acupuncture naive patients with episodic migraine without aura, 20 sessions of manual acupuncture produced a relatively long lasting reduction in migraine days and migraine attacks compared with sham acupuncture and usual care,” researchers reported. “Overall, the therapeutic effects in the manual acupuncture group occurred earlier, were larger, and might last longer.”

‘Useful Additional Tool’

According to one migraine expert, the study shows that acupuncture can be a “useful additional tool” in migraine therapy.

"We now have good evidence that acupuncture is an effective treatment for episodic migraine," writes Heather Angus-Leppan, MD, a neurologist at the Royal Free London NHS Foundation Trust, in a BMJ editorial. "(The study) helps to move acupuncture from having an unproven status in complementary medicine to an acceptable evidence-based treatment."

The study drew a mixed reaction from readers in The Daily Mail.

“Great if it works for you, but it did absolutely nothing for me except wasted money I could Ill afford,” one poster wrote.

“Unfortunately, never worked for me. But good for those who it did. Migraines are a debilitating thing to have,” said another.

“I suffered weekly migraines for decades before trying acupuncture, given by a lady who trained for years in China. After the first session the migraines stopped completely for around 20 years. When they recurred, I tried acupuncture again, from the same lady, and it had no effect at all. I'd still say it's really worth giving it a go,” wrote another poster.

“I had severe and frequent migraines as a teenager - the doctors tried everything from beta blockers to a dairy free diet. Acupuncture was the only thing that really worked - it broke the cycle and my migraines became less severe and more infrequent,” another poster said. “Now I rarely have a migraine at all and if I get a headache using pressure points really helps. It worked for me but may not work for everyone.”

Migraine affects about a billion people worldwide and 36 million adults in the United States, according to the American Migraine Foundation. In addition to headache pain, migraine can also cause nausea, vomiting, blurriness or visual disturbances, and sensitivity to light and sound.

As many as 3 million Americans receive acupuncture treatments, most often for relief of chronic pain. While there is little consensus in the medical community about the effectiveness of acupuncture, the Centers for Medicare & Medicaid Services (CMS) recently said it would start covering acupuncture for Medicare patients with chronic low back pain.

Are You Back on the Pain Chain?

By Ann Marie Gaudon, PNN Columnist

Societal messages constantly tell us that we need to control any and all pain before we can be happy.

What happens when this is not possible? I’ve said it before: In order for me to be pain-free, I would have to be rendered unconscious.

Control of “clean pain” -- biological pain that can’t be fixed --  is very attractive, but in a never-ending quest to control it, we end up with the pain controlling us. That’s when “dirty pain” begins -- we focus too much attention on the negative thoughts and feelings associated with pain.

One form of dirty pain is called “Mental Scripts.” These include what our mind tells us about our pain experience. Here are some examples: 

  • Searching for reasons you’re in pain: You might say to yourself, “I told you not to lift that. You know what happens when you aren’t careful!” 

  • Yelling epithets to yourself in your head: Your mind might be shouting, “You hopeless idiot! You’re such a failure at life!”   

  • Reciting rules you’ve established for yourself around your pain: You might tell yourself, “Exercise is not an option while I’m in pain,” or “I cannot live a good life with pain.” 

A second type of dirty pain is called, “Avoidance Behaviours.” This means anything you do or avoid doing in order to try not to feel pain. This behaviour can be particularly perilous because the act of avoiding an experience due to some feared outcome does not always reduce pain, it can actually increase pain. Here are some examples: 

  • Using medications in an attempt to avoid pain altogether rather than to dampen your pain enough to live your life.  

  • Refusing to exercise altogether because you are in pain. 

  • Refusing to work or volunteer in any capacity because you are in pain. 

A third type of dirty pain we subconsciously engage in is called “Values Discrepancy.” This means choosing avoidance and moving far away from the life that you want to live.  

When you are knee-deep in Values Discrepancy you are living the antithesis of a life that you value. For example: 

  • Giving up on a higher education because you fear the pain will not allow you to concentrate. 

  • Quitting your dream job because of the pain you felt when you were there. 

  • Choosing not to have a family because parenting could be difficult if you are in pain.

Avoidance behaviours (a form of trying to control) are indeed very seductive. They look like the answer. Have you ever seen an advertisement for any type of pain control? The patient takes the magic pill or treatment, the pain is completely resolved, and the patient is seen happily playing tennis or rolling around in the grass with their child.

Western culture rarely if ever shows us reality. The control paradigm is such that the more choices we make attempting to control the pain, the smaller and less meaningful our lives end up. We become stuck on the “Pain Chain.” For chronic pain patients, the manifestation of dirty pain typically looks like this:

The more we struggle against what is uncontrollable, the more we will suffer. The good news is that no one is fated to suffer from dirty pain for the rest of their lives. If you find yourself suffering from any of these symptoms, find yourself a qualified therapist in chronic pain management.

When chronic pain is part of our lives, we need more resilience, not less. We grow resilience by practicing and learning not be ordered around by our thoughts and feelings. Psychotherapy can help you with workable solutions to rise above life-draining, self-defeating patterns of behaviour.  

I once was choked off in the Pain Chain, and now I help others to unleash themselves. With the right tools, it is possible to get back to living a life in the service of our values – not in the service of our pain.

Ann Marie Gaudon is a registered social worker and psychotherapist in the Waterloo region of Ontario, Canada with a specialty in chronic pain management.  She has been a chronic pain patient for over 30 years and works part-time as her health allows. For more information about Ann Marie's counseling services, visit her website.

 

Treating Chronic Pain With Lasers

By Madora Pennington, PNN Columnist

Months after surgery for my badly broken foot, the last scab finally fell off, revealing to my horror that the surgical incision had not closed. I have Ehlers-Danlos Syndrome (EDS), a genetic condition that prevents my body from building proper collagen. Poor wound healing is a common complication for people like me. 

A search for a treatment that would help led me to Dr. Harold Kraft, a Southern California anesthesiologist who has built an entire practice around using high-powered lasers. Kraft’s main focus is pain --- from sciatica and back pain to neuropathy, neuralgia and myalgia, as well as post-surgical pain and soft tissue injuries. 

Another thing lasers do is facilitate wound healing. After a few appointments, my wound closed but appeared fragile and Frankenstein-looking. With more treatments, it rapidly filled in, coming to look smooth, strong and, surprisingly, pretty.

I was eager to try laser for my Ehlers-Danlos aches as well. My strange body seems to sustain soft-tissue injuries from the ordinary tasks of life, draining my energy and taxing my nervous system. From the laser treatments, I experienced relief I had never before felt.

Kraft has learned a lot from administering over 20,000 treatments on patients. He noticed Ehlers-Danlos patients got exceptional pain relief from the laser treatments, and came to find that nearly all are super-responders.

“About 90% of EDS patients respond to laser treatment, and get faster and more profound pain relief than typical patients,” Kraft notes.

Light Amplification

The word “laser" is an acronym for Light Amplification by the Stimulated Emission of Radiation. No longer limited to science fiction movies, lasers are now a part of everyday life. You’ve probably seen lasers used as pointers during presentations, as bar code scanners, and in DVD players. In medicine, lasers can be used for precision cutting, such as in LASIK vision surgery or for excising a tumor. For cosmetic purposes, a laser can improve skin imperfections or whiten teeth.

Light particles, or photons, from the laser pass through the skin and stimulate the cells’ mitochondria to release anti-inflammatory modulators, nerve and vascular growth factor. This causes healing and repair.

Kraft came to having a pain practice late in life. He had retired from a long career of performing anesthesia during surgery and left medicine entirely for the business world, developing software for data aggregation. All that changed when his wife took their long-suffering pug for a new treatment.

Harley, a most beloved dog, had trouble walking. He had not benefited from joint supporting supplements like glucosamine and chondroitin, nor acupuncture and doggie physical therapy. But after four treatments of high dose laser from a veterinarian, Harley could walk again. The Kraft’s were elated and also intrigued.

Kraft convinced a family friend who had back pain to see that same veterinarian for lasering, even though she is a human. Like Harley, she found pain relief.

Seeing the promise of what this could offer, Kraft began training in laser techniques and got laser machines of his own. He went back to practicing medicine, treating pain exclusively with lasers. Kraft uses Class IV lasers, which are the most powerful available. He employs them at high doses, in order to do the most good for patients. Great care must be taken in this endeavor.

“The more power you use, the more care you need to operate and the more likely that misapplication can cause harm,” Kraft says. “There is no discomfort during treatment, although the patient may feel the heat from the laser. It is powerful, non-invasive, and the results can be permanent or long-lasting.”

Kraft says about 7 out of 10 patients get significant improvement, including chronic pain sufferers who failed at other treatments. Genetics seem to play a factor in how well a patient responds. Some are just faster than others. A small percentage respond immediately. Most experience benefit between 4 and 10 treatments, and only about 30% do not respond after 14 or so treatments.

What does the science say about laser therapy? While there isn’t an abundance of research on the healing power of Class IV laser, some exist and are worth noting:

Chronic and acute pain are notoriously difficult to treat, especially in an era when fewer doctors are willing to treat pain or prescribe opioid medication. Pain patients have fewer options.

Dr. Kraft imagines a world where patients will have easy access to laser therapy at their primary care doctor or physical therapist. In addition to running his busy practice, Dr. Kraft has invented an improved laser, one that would optimize treatment regimen. He hopes to have it to market in two years.

Madora Pennington writes about Ehlers-Danlos and life after disability at LessFlexible.com. Her work has also been featured in the Los Angeles Times.

Bunny Boy and Me: A True Story About Chronic Pain and Unconditional Love

By Pat Anson, PNN Editor

When most people think of therapy and support animals, a dog or cat immediately come to mind. But after years of struggle with chronic pain from lupus and fibromyalgia, Nancy Laracy needed a different kind of animal.

“Our family had been through so much that I felt we all needed a family pet other than our lizard. And because my husband was allergic to dogs and cats, we settled on a rabbit,” Nancy explained.

She adopted a baby red satin rabbit, a breed known for its calmness and sociability. “Bunny Boy” quickly became part of the Laracy family and would have a profound effect on Nancy’s life. She wound up writing a book about her furry friend, “Bunny Boy and Me: My Triumph over Chronic Pain with the Help of the World’s Unluckiest, Luckiest Rabbit.”    

“Little did I know that Bunny Boy would become my third child in so many ways and that he would be the perfect therapy for my pain,” Nancy told PNN. 

“I had tried acupuncture, massage therapy, chiropractic, mainstream medicine, slept on a magnetic mattress — just about anything. But it was Bunny Boy who took me away from my pain as he slept with me, snuggled with me, and grew to know when I needed him the most. When I had his warm body on mine, I could feel the muscle pain lessen and of course the stress as well.”

Nancy started taking Bunny Boy to her doctors’ appointments, where he had a similar effect on other patients.

“I would see the positive reaction of the patients in pain, sitting in the lobby while we were there. If only for a short time, Bunny Boy would run around, jump on their laps when they allowed him to, knock the magazines all over, and make the patients laugh and smile,” she said. 

In a cruel irony, Bunny Boy got sick and was diagnosed with a similar autoimmune disease, and needed multiple surgeries for a severe jaw abscess. Most rabbits don’t respond well to painful invasive medical procedures, but Bunny Boy was a plucky hare with a strong will to live.

“I provided that same comfort to Bunny Boy as he underwent numerous surgeries and treatments that normal rabbits don’t survive, but he survived due to the strength and love he received from me and my family,” Nancy said.

“The vets who cared for him eventually called him ‘Iron Bunny’ and said to me over and over again that he was only surviving so many things due to our bond which formed in sickness and in health.”

Bunny Boy not only survived, he helped pioneer a new medical treatment that Nancy credits with saving her life, which she discusses in her book.

Bunny Boy lived a long life for a rabbit – nine years – and Nancy went on to adopt a new rabbit that she named Muffin, who also became a therapy animal.

“I started first by visiting nursing homes to see if she had the right temperament. Not only did I visit the patients in their rooms, but they wanted me to visit the patients in physical therapy and it was amazing how Muffin could help the patients increase their physical therapy programs, simply by sitting on their laps during some of their exercises,” Nancy said.

“For arthritis and fibro patients it is important to keep moving at some level and having pets helps us do that. For me a bunny was perfect because I believe it would have been too difficult for me to walk a dog that dragged me or walk a dog regularly period. A bunny is litter trained, doesn’t have to be walked, and they are equally as endearing and social as a dog or cat.”

Bunny Boy and Me is featured in PNN’s Suggested Reading section, along with other informative books on chronic pain and pain management. Nancy is donating all proceeds from her book to charity.

Missouri Finds Managing Pain Without Opioids Isn’t Easy

By Lauren Weber, Kaiser Health News

Missouri began offering chiropractic care, acupuncture, physical therapy and cognitive-behavioral therapy for Medicaid patients in April, the latest state to try an alternative to opioids for those battling chronic pain.

Yet only about 500 of the state’s roughly 330,000 adult Medicaid users accessed the program through December, at a cost of $190,000, according to Josh Moore, the Missouri Medicaid pharmacy director. While the numbers may reflect an undercount because of lags in submitting claims, the jointly funded federal-state program known in the state as MO HealthNet is hitting just a fraction of possible patients so far.

Meanwhile, according to the state, opioids were still being doled out: 109,610 Missouri Medicaid patients of all age groups received opioid prescriptions last year.

The going has been slow, health experts said, because of a slew of barriers. Such treatments are more time-consuming and involved than simply getting a prescription.

A limited number of providers offer alternative treatment options, especially to Medicaid patients. And perhaps the biggest problem? These therapies don’t seem to work for everyone.

The slow rollout highlights the overall challenges in implementing programs aimed at righting the ship on opioid abuse in Missouri — and nationwide. To be sure, from 2012 to 2019, the number of Missouri Medicaid patients prescribed opioid drugs fell by more than a third — and the quantity of opioids dispensed by Medicaid dropped by more than half.

Still, overdoses linked to legal and illicit opioids killed an estimated 1,132 Missourians in 2018 and 46,802 Americans nationally, according to the latest data available. Progress to change that can be frustratingly slow.

“The opioids crisis we got into wasn’t born in a year,” Moore said. “To expect we’d get perfect results after a year would be incredibly optimistic.”

Despite limited data on the efficacy of alternative pain management plans, such efforts have become more accepted, especially following a summer report of pain management best practices from the U.S. Department of Health and Human Services. States such as Ohio and Oregon see them as one part of a menu of options aimed at curbing the opioid crisis.

St. Louis chiropractor Ross Mattox, an assistant professor at chiropractic school Logan University, sees both uninsured patients and those on Medicaid at the CareSTL clinic. He cheered Missouri’s decision to expand access, despite how long it took to get here.

“One of the most common things I heard from providers,” he said, “is ‘I want to send my patient to a chiropractor, but they don’t have the insurance. I don’t want to prescribe an opioid — I’d rather go a more conservative route — but that’s the only option I have.’”

And that can lead to the same tragic story: Someone gets addicted to opioids, runs out of a prescription and turns to the street before becoming another sad statistic.

“It all starts quite simply with back pain,” Mattox said.

Practical Barriers

While Missouri health care providers now have another tool besides prescribing opioids to patients with Medicaid, the multistep approaches required by alternative treatments create many more hoops than a pharmacy visit.

The physicians who recommend such treatments must support the option, and patients must agree. Then the patient must be able to find a provider who accepts Medicaid, get to the provider’s office even if far away and then undergo multiple, time-consuming therapies.

The effort and cost that go into coordinating a care plan with multiple alternative pain therapies is another barrier.

“Covering a course of cheap opioid pills is different than trying to create a multidisciplinary individualized plan that may or may not work,” said Leo Beletsky, a professor of law and health sciences at Northeastern University in Boston, noting that the scientific evidence of the efficacy of such treatments is mixed.

And then there’s the reimbursement issue for the providers. Corry Meyers, an acupuncturist in suburban St. Louis, does not accept insurance in his practice. But he said other acupuncturists in Missouri debate whether to take advantage of the new Medicaid program, concerned the payment rates to providers will be too low to be worthwhile.

“It runs the gamut, as everyone agrees that these patients need it,” Meyers stressed. But he said many acupuncturists wonder: “Am I going to be able to stay open if I take Medicaid?”

Structural Issues 

While helpful, plans like Missouri’s don’t address the structural problems at the root of the opioid crisis, Beletsky said.

“Opioid overutilization or overprescribing is not just a crisis in and of itself; it’s a symptom of broader structural problems in the U.S. health care system,” he said. “Prescribers reached for opioids in larger and larger numbers not just because they were being fooled into doing so by these pharmaceutical companies, but because they work really well for a broad variety of ailments for which we’re not doing enough in terms of prevention and treatment.”

Fixing some of the core problems leading to opioid dependence — rural health care “deserts” and the impact of manual labor and obesity on chronic pain — requires much more than a treatment alternative, Beletsky said.

And no matter how many alternatives are offered, he said, opioids will remain a crucial medicine for some patients.

Furthermore, while alternative pain management therapies may lessen opioid prescriptions, they do not address exploding methamphetamine addiction or other addiction crises leading to overdoses nationwide — even as a flood of funds pours in from the national and state level to fight these crises.

Prescribers reached for opioids in larger and larger numbers not just because they were being fooled into doing so by these pharmaceutical companies, but because they work really well for a broad variety of ailments.
— Dr. Leo Beletsky, Northeastern University

The Show-Me State’s refusal to expand Medicaid coverage to more people under the Affordable Care Act also hampers overall progress, said Dr. Fred Rottnek, a family and addiction doctor who sits on the St. Louis Regional Health Commission as chair of the Provider Services Advisory Board.

“The problem is we relatively cover so few people in Missouri with Medicaid,” he said. “The denominator is so small that it doesn’t affect the numbers a whole lot.”

But providers like Mattox are happy that such alternative treatments are now an option, even if they’re available only for a limited audience.

He just wishes it had been done sooner.

“A lot of it has to do with politics and the slow gears of government,” he said. “Unfortunately, it’s taken people dying — it’s taken enough of a crisis for people to open their eyes and say, ‘Maybe there’s a better way to do this.’”

Kaiser Health News is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.

Do You Have ANT’s? How Awareness Helps Avoid Negative Thoughts

By Dr. David Hanscom, PNN Columnist  

This is the third in a series of columns on awareness -- a meditative tool that can be used to calm the nervous system to reduce pain and anxiety.  In my previous columns, I looked at environmental awareness (how mindfulness lowers stress hormones) and emotional awareness (how moods affect how we feel physically). 

The third level of awareness I’d like to introduce you to revolves around judgment and storytelling. On this level, you create a “story” or a judgment about yourself, another person or a situation. These judgments tend to be criticisms that are rough and inflexible. The brain has a bad habit of focusing on negative judgments that ramp up our emotions. 

We can categorize these negative thoughts into ten “errors of thinking” outlined by Dr. David Burns in his book “Feeling Good.” Burns calls these thoughts “ANTS,” which stands for automatic negative thoughts.

For example, imagine someone at work walked by you and didn’t acknowledge you. You might think they’re upset with you about a situation that occurred the day before. The error in thinking in this case would be “mind reading.” You can’t read other people’s minds. 

It’s possible that the other person had just received some bad news and wasn’t engaging with anyone. But you don’t really know. If you make assumptions, you’re wasting a lot of emotional energy.

Labeling 

Then there is the error of labeling. For example, a frequently late spouse becomes “inconsiderate.” A forgetful teenager becomes “irresponsible.” In the act of labeling, especially negative labeling, you’re overlooking circumstances and someone’s good qualities, limiting your capacity to enjoy being with them. 

Then there are the labels we have for ourselves: you knock something over and call yourself “clumsy.” If a lover breaks up with you, then you’re “unlovable.”  

Rehashing these critical judgments in our minds turns them into deeply embedded stories. Such stories are much harder to move on from than single judgments. Once a judgment sets into a story, you tend to lose all perspective. Over time, faulty thinking can become your version of reality. 

In my own experience, whenever I have an “ANT,” I become either angry or anxious (or both). I am also sometimes more reactive or impulsive. These emotions fuel negative thought and it becomes repetitive. As the thought keeps whirling around, it becomes stronger, along with my emotions. They quickly destroy my day and negatively affect my relationships. 

I’ve heard this thought pattern described as a vicious cycle or whirlpool. These kinds of thoughts, or stories, can become recurrent and might last for years. They take on a life of their own even though they are often fairly outrageous.  

Regardless of what sets these patterns of thinking off, they are a universal part of the human experience. This is true whether chronic pain is involved or not. With chronic pain you have the added frustration of the physical stimulus to keep these circuits really spinning.  

Self-Perceived Flaws 

To better understand the story concept, consider common situations where the brain focuses on a self-perceived flaw that is not physically painful. It might be your height, weight, the shape of your body, or even an individual body part. Or it might be some particular quality, such as a lack of intelligence, athletic skill, musical talent, etc.  

Thinking about these flaws over and over snares you in a destructive cycle of spinning neural circuits. For example, many years ago I had a patient with neck pain who was absolutely convinced that he was “stupid.” His self-labeling wasn’t rational, as he was clearly a bright guy. I don’t know if his view of himself somehow triggered it, but he eventually developed a significant chronic burning sensation around his mouth. 

Something similar often happens in the entertainment industry, where performers commonly focus only on their negative reviews. My wife, who is a tap dancer, has seen this in her profession for years. She pointed out to me that a performer might have 99 positive reviews but will fixate on the one that’s negative. It’s a common saying among entertainers that, “You’re only as good as your worst critic.” 

ANT’s and Relationships 

Another common phenomenon is focusing on a spouse or partner’s negative traits. The other person usually has innumerable positive qualities that are forgotten in the face of their “flaw.” Over time the “story” we tell ourselves can become so strong it can break apart an otherwise great relationship. 

One particular event from my own life comes to mind. It shows how creating stories has the power to disrupt your peace of mind and detract from your enjoyment of life. 

One day my wife and I were taking my father for a ride up to beautiful Point Reyes, located on the coast north of San Francisco. About 20 minutes into our trip I noticed that the car’s low-tire-pressure light had come on. It was a brand new car with only a thousand miles on it, so I thought it was probably just a malfunctioning light.  

I wasn’t convinced that we’d made the correct decision to buy this car in the first place -- it was more expensive than I was comfortable with -- so I was more than a little frustrated that the warning light had a glitch. 

I stopped to put a little air in the tire, just in case, and then kept driving for another 45 minutes. As we approached Point Reyes in the early afternoon, we realized that the tire was really low, so I pulled over to change it. But when I opened the trunk, there was no spare.  

The story in my head was starting to ramp up as I wondered in frustration why a new car wouldn’t have a spare. I called the car company’s roadside assist line and they told me these new cars had “run-flat” tires that should be good for 150 miles at a maximum speed of 50 miles per hour.  

I felt a little insecure about that concept. We were a long way from the last large town we’d passed and I thought that we should turn back. My wife thought that since my father rarely made it to California from the East, we should go out to dinner. So, we headed toward a restaurant. About three miles down the road the tire exploded. 

It was now about four o’clock in the afternoon and we were miles and miles from anywhere. Our only option was to get towed courtesy of AAA. It was hard for me to accept the fact that I had to get my new car towed for a flat tire.  

The tow truck driver showed up to take us to the service station and let the three of us ride in the cab, with my wife sitting on my lap. She started to complain about the bumpiness of the ride, which I found a little annoying. “I’m the one on the bottom, why are you complaining?” I thought.  

She wanted to have dinner in San Rafael and take a taxi home. I started to grind my teeth to keep my mouth shut. 

Magnifying the Problem

This is how the afternoon unfolded for me. Starting with the low tire, I’d made a decision to enjoy my time with my family in spite of the problem. I took note of my frustrations and concentrated on listening to the conversation and staying involved in the day. I was successful for a while -- until the tire blew up.  

Then my anger began to bubble. I became aware that in spite of everything I’d learned about dealing with stress, I was greatly magnifying the problem with the ANT thoughts in my head. I was thinking things like, “I can’t believe I got talked into buying this car” and “My wife made me buy it.” 

Although there might’ve been some truth in the things I was telling myself, I recognized that it wasn’t helping us get through the situation. Nonetheless, I wasn’t able to minimize my suffering through the stress relief techniques that had helped in the past, which was frustrating. I tried to talk myself out of it, but it didn’t work. 

Then I began to go really dark with thoughts like, “How can I be married to this woman?” I began to notice how irrational and big these thoughts had become. It felt like a bomb had exploded. I was miserable way out of proportion to the situation. 

I was guilty of multiple errors in thinking. They came in the form of labeling – “My wife is irresponsible”— and catastrophizing -- “Why did we get married?”  

Through it all, I negated her many positive qualities. To cite one, she’s great at keeping things light, no matter what the problem. And unlike me, she was able to keep her cool throughout the day. 

In the past, I would’ve remained in this agitated state of mind for days, with some carryover lasting for weeks. I wouldn’t have been able to separate my wife’s actions from my thoughts and realize that the problem wasn’t her, it was my reaction to the situation.  

It was a major step for me to become aware of how out of proportion the stories in my head had become. This degree of awareness changed the game for me. 

Eventually, we did get towed home. We went out to dinner. I still love my wife. And I learned yet another lesson in humility.

Dr. David Hanscom is a retired spinal surgeon. In his latest book -- “Do You Really Need Spine Surgery?”Hanscom explains why most spine operations are unnecessary and usually the result of age-related conditions that can be addressed through physical therapy and other non-surgical methods.

Medicare to Cover Acupuncture for Back Pain

By Pat Anson, PNN Editor

The Centers for Medicare & Medicaid Services (CMS) has finalized a decision to cover acupuncture for Medicare patients with chronic low back pain. Up to 12 visits in 90 days to an acupuncture therapist will be paid by Medicare, but no more than 20 treatments annually.

Acupuncture is an ancient Chinese treatment in which practitioners stimulate specific points on the body by inserting thin needles through the skin. About 3 million Americans receive acupuncture treatments, mostly for chronic pain. Some private insurers already cover acupuncture, but there is little consensus in the medical community about its value.

Lower back pain is the world’s leading cause of disability. CMS researchers reviewed clinical studies and found evidence that older adults with chronic back pain showed small improvements in pain and function after acupuncture treatments, although the exact mechanism of action was “unclear” and there was “inconclusive evidence” about the most effective acupuncture technique.

“Expanding options for pain treatment is a key piece of the Trump Administrations’ strategy for defeating our country’s opioid crisis,” Health and Human Services Secretary Alex Azar said in a statement. “Medicare beneficiaries will now have a new option at their disposal to help them deal with chronic low back pain, which is a common and sometimes debilitating condition.”  

The decision to cover acupuncture overturns decades of previous rulings that took a dim view of the procedure. In 1980, CMS said the use of acupuncture as an anesthetic was “not considered reasonable and necessary.”

In 2004, the agency rejected acupuncture as a treatment for fibromyalgia and osteoarthrosis because there was “no convincing evidence for the use of acupuncture for pain relief.”

CMS said it was “keenly focused” on finding alternatives to opioid painkillers.

“We are dedicated to increasing access to alternatives to prescription opioids and believe that covering acupuncture for chronic low back pain is in the best interest of Medicare patients,” said CMS Principal Deputy Administrator of Operations and Policy Kimberly Brandt.

“We are building on important lessons learned from the private sector in this critical aspect of patient care. Over-reliance on opioids for people with chronic pain is one of the factors that led to the crisis, so it is vital that we offer a range of treatment options for our beneficiaries.”

A recent study of over 140,000 Army veterans with chronic pain found that non-drug therapies such as acupuncture significantly reduce the risk of suicide, as well as alcohol and drug abuse.  

The Truth About Chronic Pain

By Dr. Rachel Zoffness, PNN Columnist

I’ve never been an athlete, but I’ve always loved exercising because of how it makes me feel. One beautiful spring day, I went for a run. On the way downhill, I was stopped by a sudden pain in my knee. When I woke the next morning, I couldn’t step out of bed without burning pain radiating from my feet, up my leg and into my hip.

I was couch-bound for the better part of a year. I saw countless doctors, was prescribed many medications, and would’ve done anything to stop the pain. That was the beginning of a decade-long journey with chronic pain.

I’ve dedicated my life to understanding pain, and not just because of that injury.

I’m a pain psychologist and assistant clinical professor at UC San Francisco School of Medicine, where I teach pain neuroscience to medical residents. I also founded a private practice dedicated to people living with chronic pain.

One of my earliest patients was a teenager. He’d been bedridden with multiple medical diagnoses for four years, seen 12 physicians and tried 40 medications. But nothing worked.

Not surprisingly, he was depressed and anxious. He had no life, no friends and no hope.

DR. RACHEL ZOFFNESS

As a pain psychologist, I use cognitive behavioral therapy (CBT) as one of my primary treatment tools, so we started a CBT-for-pain program. In addition to other strategies, it involved “pacing” or resuming select activities one small step at a time.

It was hard work, but little by little, he got healthier. As his functioning and mood improved, his pain did, too. Within 6 months he resumed school and rejoined his soccer team. His pain wasn’t gone – but it was significantly reduced and he knew how to manage it. He says pain will never control his life again.

Many of us have noticed this link between how we feel emotionally and how we feel physically. That’s because pain is never purely physical. This is confirmed by neuroscience research indicating that pain is produced by multiple parts of the brain, including the cerebral cortex (responsible for thoughts), prefrontal cortex (which regulates attentional processes), and the limbic system – your brain’s emotion center.

Dialing Back Pain

Imagine that you have a “pain dial” in your central nervous system that controls pain intensity. The function of this dial is to protect you from danger or harm. It can be turned up or turned down by many factors, including:

  1. Stress and anxiety

  2. Mood

  3. Attention (what you’re focusing on)

When you’re feeling stressed and anxious – your thoughts are worried, your muscles are tense and tight, and the pain volume is turned up.  

When your mood is low, you’re miserable and depressed, and your brain similarly amplifies pain volume. 

This is also true when your attention is focused on pain. When you’ve stopped going to work, seeing friends and engaging in hobbies, your prefrontal cortex (which controls attention) sends a message to your pain dial, turning it way up. 

However, the opposite is also true. 

When stress and anxiety are low – your body is relaxed, your thoughts are calm and you’re feeling safe. Your cerebral cortex and limbic system send messages to your pain dial, lowering the volume so that pain feels less bad. 

When your mood is high, your thoughts are positive, you’re feeling happy and you’re engaged in pleasurable activities. Your brain determines that little protection is needed, so pain volume is reduced. 

And finally, when you’re distracted you’re absorbed in activities, like watching funny movies with friends. The pain dial is turned down, so pain is less bad. 

In summary, when you’re relaxed, happy, distracted, and feeling safe, your pain volume is lower. The pain is still there -- it hasn’t magically disappeared -- but it’s quieter. Softer. Less. 

The truth about chronic pain is this: Your thoughts, beliefs, emotions and attention can all adjust pain volume. 

This does not mean that pain is “all in your head.” It isn’t. Your pain is real, as real as mine, and no one should ever tell us otherwise. It does mean that there are many ways to change pain. One is medication. Multiple medications have been shown to effectively turn down the pain dial.  

There are other methods for lowering pain volume, too. CBT, mindfulness and biofeedback are three biobehavioral approaches to pain management that research suggests can be helpful. They aren’t magic cures and they take time. But if you’ve never tried to manage your pain with these techniques, consider them. They’ve helped me immensely on my chronic pain journey. 

When I was learning about mindfulness, I remember thinking, “What could mindfulness possibly have to do with physical pain?”  

And then something fascinating happened.  

During the first year of my practice, my pain changed. It didn’t go away entirely and I wasn’t cured. But the pain changed. It became less intense, less frequent, less distracting, and got less in the way of the rest of my life. 

Rachel Zoffness, PhD, is a pain psychologist and assistant clinical professor at the UCSF School of Medicine. Rachel serves on the Steering Committee of the American Association of Pain Psychology, where she founded the Pediatric Division. She is the author of The Chronic Pain and Illness Workbook for Teens. You can find Rachel on Twitter @DrZoffness.  

Emotional Awareness: How I Learned to Connect with Life and Disconnect from Pain

By Dr. David Hanscom, PNN Columnist

Last month I wrote about the importance of environmental awareness – being aware of your moods, anxiety and other senses and learning how to calm them through active meditation.

In this column we’ll look at emotional awareness – living a life full of rich relationships and satisfying endeavors. You must understand the nature of someone else’s emotional needs before you can interact with them in a meaningful way.

In the presence of chronic pain however, this is a problem. When you are in pain, you are justifiably angry, which can block emotional awareness. You are just trying to survive and don’t have the capacity or energy to reach out to others.

Another problem with pain-induced anger is that it not only disconnects you from others, but also from yourself. You are so used to being in this agitated state that you feel it is the norm.

I am quite aware of this scenario, as this was my experience. I was constantly agitated, but did not perceive it as anger. I thought I could hear what others were saying and see issues through their eyes. I was idealistic and thought I was right – but was so wrong.

It wasn’t until I had every layer stripped away in the midst of suffering from severe chronic pain, that I could see the problem. Meanwhile, I lost my marriage.

Self-Discovery

The problem with becoming emotionally aware is that you have to allow yourself to feel unpleasant emotions, such as anxiety, sadness, vulnerability, shame and so on. If you don’t allow yourself to feel the dark side of life (which is core to the human experience), then you won’t be able experience deep joy, happiness and love.

My strategy for most of my life was to suppress all negativity and keep my emotions on an even keel. One of my nicknames was “The Brick.” At the time, I thought it was a compliment because it meant I was tough.

It all worked until it didn’t. At age 37, I began to experience severe anxiety in the form of panic attacks. They came out of the blue and I had no idea what had hit me. I didn’t emerge from this hole for another 13 years.

Unless you actively choose a journey of self-discovery, you can’t connect with your true emotional state. You must commit to stepping outside of your mind and looking at yourself from a different perspective.

Ask yourself these questions: Am I open? Am I coachable? Can I really listen and feel?

That is a starting point. Once you get in touch with what’s going on in your mind, you can embark on a powerful journey. Allowing yourself to feel your emotions is a learned skill with many ways of accomplishing it. You will fail endlessly, but the key is remaining open and persistent.

Many people choose not to take this journey. But they make that choice at their own peril. It is what you’re not aware of that will run your life. The result may be a lot of physical and emotional suffering for the individual and especially for those close to him or her.

Why don’t more people pursue a path of self-discovery? It may be because in our culture most of us spend a lot of emotional energy trying to look good to people around us. We also try to look good to ourselves.  

Truly connecting with your emotions is an act of humility. Most people don’t want to do something so difficult and unpleasant. However, it’s also extremely rewarding and makes life so much easier in the end. It was the beginning of my recovery from my own chronic pain.

Dr. David Hanscom is a retired spinal surgeon. In his latest book -- “Do You Really Need Spine Surgery?”Hanscom explains why most spine operations are unnecessary and usually the result of age-related conditions that can be addressed through physical therapy and other non-surgical methods.