Scientific studies prove, pain relief decreases while pain sensitivity increases from excess use of opioids. In other words, if you’re a chronic pain sufferer and have used opioids for long periods of time, greater sensitivity to pain will occur.
So you ask yourself, how could taking more pain killers cause greater sensitivity to pain? “I thought pain killers were supposed to lessen the pain.” This is true if you are following the doctor’s pain management program. When pain pills are over prescribed, or used in abundance – the body builds up tolerance to them and you feel more pain. The medical term for this relationship is referred to as Opioid-Induced Hyperalgesia (OIH). Taking too many pain pills is the cause of more physical and mental pain addiction and increased health risk and accidental death.
Simply stated, OIH is pain intolerance, meaning to become more sensitive to any pain stimulus. How does tolerance to pain killers cause more sensitivity to pain? The best way to describe this is your body produces a morphine like substance (via spinal cord secretions) known as endorphins to alleviate pain when you stub a toe, or slam your finger in a car door for instance.
This substance lessons the painful stimuli experience. If a person takes too much for too long morphine like drugs, then the spinal cord no longer secrets the body’s natural pain relief agent.
So when your body hurts really bad (chronic) you no longer have that supplemental natural pain killing agent in your body. Instead, you solely rely on your prescriptions. The pharmaceutical prescription at this point is not enough to provide adequate pain relief. Taking too many pain killers results in an overall increase in pain sensitivity because the pain patient now blocks the body’s ability to dose/mask pain naturally for lack of the body’s natural morphine like defense.
In recent years the FDA (Food and Drug Administration) introduced REMS (Risk Evaluation and Mitigation Strategies) guidelines to help manage the known risks for pain medication use. This is a program intended to improve upon patient safety, education and compliance to mitigate risk of abuse, addiction and serious side effects through smart physician-to-patient consults.
Once these guidelines became known to the pain patience, there was fear (among some) REMS would result in limiting their access to needed prescriptions. This simply is not the goal of the FDA REMS guideline program.
Why would pain patients fear such a thing? If your addicted to pain killers and you have a risk evaluation (REMS) by a pain managing specialist, it may be determined the best course of pain alleviation may be to switch pain medications, or reduce the dose, etc. For example, a patient prescribed transdermal fentanyl medication may be reduced dosage by 25%. [Note: Fentanyl is only prescribed for the most serious chronic pain cases and is reported as one of the most lethal drugs an addict could put in their body. Death has occurred simply through skin absorption and inhalation]. Fentanyl is a potent synthetic (man-made) narcotic]. A 100g dose of fentanyl is approximately equal to 10 mg of morphine. Fentanyl stimulates receptors on nerves in the brain to increase the threshold to pain.
So when a pain patient has been using Fentanyl to alleviate pain, a reduction of dose by 25% will appear odd to a patient, but necessary to get pain under control. It takes a bit of education and understanding on how to use high dose pain killers safely and effectively.
After REMS application during a 4 week period – with reduced dose – patients report overall improved coping ability with pain sensitivity.
If pain is not managed effectively, secondary health risks can and do occur. The list below targets the health risks. If you are a patient on pain medication and experience any of the symptom and signs listed below, contact your primary care physician immediately to get help.
5. Musculoskeletal System – Osteoporosis, muscle rigidity and contractions.
6. Skin System – Itching, this may not indicate allergic reaction.
7. Immune System – Data suggests long-term use, indicates immune suppression.
8. Pregnancy & Breastfeed-Neonatal depression, avoid opioid use during feeding.
9. Ocular System – Constriction of pupil.
10. Gastrointestinal System – Constipation, nausea, vomiting, bowel problems, etc.
11. Genitourinary System – Urinary retention.
12. Endocrine System – Hormonal and sexual dysfunction.
13. Withdrawal Syndrome – Runny nose, shivering, diarrhea, gooseflesh, etc.
14. Constipation – Increase fiber intake, and/or use stool softeners will help.
The FDA REMS guidelines are now required within all pain patient-physician consults; providing the patient an excellent opportunity to learn about the benefits and risks of using pain killers. This program will no doubt reduce prescription addiction and secondary ill-health risk factors that also decrease accidental deaths and lawsuits.
If you now have a problem with addiction and/or your pain is getting worse, or out of control – ask for help and get a referral to see a pain management specialist [Physiatrist].
Through smart pain management consults, education and timely/applicable self-referrals your pain alleviation program will work safely for you. Taking a self interest in yourÂ chronic pain and addiction circumstance is important if you want to continue living life to the fullest with loved ones.
Pain Pathways, www.painpathways.org
Federal Drug Administration, www.FDA.gov
American Chronic Pain Association Consumer Guide, www.theacpa.org
Marc T. Woodard, MBA, BS Exercise Science, ARNG, CPT, RET. 2019 Copyright, All rights reserved, Mirror Athlete Publishing @: www.mirrorathlete.org, Sign up for your Free eNewsletter.
The most common muscular skeletal weight bearing pain typically occur within the lower back for many. Whereas soft tissue and bone, or musculoskeletal tissue becomes compromised. Which include nerves, cartilage, disc, ligaments and tendons where localized swelling, soreness and aggravating and radiating pain occur.
Human studies and statistics have shown low back pain will account for more sick leave and disability time than any other single medical condition. Nearly 80% of all adults will experience back pain some time in their lives. It is for this reason it is important to understand how to take preventative and corrective measures to avoid, alleviate and timely treat weight bearing joint pain. Also recognize the difference between common causes of back pain, severity of condition and treatment course options.
Weight bearing and repetitive physical work pain is often medically defined as an acute or chronic pain condition that may be caused by injury, postural imbalance, repeated physical activity and diagnosed as a strain or sprain, or compression injury, or Repetitive Strain Injury (RSI). A Repetitive Strain Injury is also known as Cumulative Trauma Disorder (CTD). Which has a compromised muscle-tendon relationship. Some cause examples of these pain disorders may be a result of the following activities: administrative work, gardening, biking, walking, jogging, running, sports, commercial painting, plumbing, electrical and other laborious work etc.
“There are also chronic nerve compression injuries such as carpal tunnel syndrome, radial tunnel syndrome and cubital tunnel syndrome. In these cases, the spaces through which the nerves run are narrowed due to inflammation or fluids putting pressure on the nerves” (Kriskarr 2012).
Of course there are many pathological musculoskeletal compromise possibilities which could cause weight bearing or low back pain in vertebra joints. Some of the more familiar diseases of the back are: degenerative discs [wear & tear on between vertebra space], herniated discs, [swollen, and irritated overblown discs], spinal stenosis [narrowing of vertebrae canal presenting sciatica radiating numbness and pain down the leg].
Regardless, our focus is not to play doctor or learn all the possible causes of back pain. But instead to understand how to recognize and prevent unnecessary pain through prevention and seek corrective medical treatment when needed.
Poor ergonomic posture or laborious repetitive work or sedentary lifestyle combined with weight gain almost always put undue stress immediately on the low back. And when poor work and activity posture, footwear and overweight conditions are not addressed, it’s just a matter of time before weight bearing joints begin to ache, strain and become painful. If left uncorrected that pain will worsen, slow you down and increase risk of injury and put you out of commission.
The biggest difference between strains vs. sprain is the severity of injury and healing time. For instance sprains are typically long-term injuries which may or may not require surgery and almost always require physical therapy and rest to alleviate the compromised soft tissue condition.
Most of us are familiar, or have experienced a strained [overstretched] or sprained tendon, ligament or muscle. Sprains are often verified and substantiated using MRI (Magnetic Resonance Imaging) equipment to determine exact locality, severity and corrective treatment for tissue damage. The technology can see the degree of partial or full tear of soft tissue sprain often associated with significant swelling and bruising of injury site. Whereas x-ray typically cannot and is mostly used to confirm broken and fractured bone and observe bone density health.
Many who experience weight bearing pain of the foot, ankle, knee, hip, back or neck don’t make the pain origin or cause connection. That pain cause is often the result of musculoskeletal postural misalignment. Whereas misalignment of musculoskeletal weighted posture starting at the feet cause imbalance and joint instability while walking, working and during exercise activity. And this condition often results in multiple radiating joint pain areas up the body’s trunk and can cause a painful limp.
The sole of the foot is like a tree root system. For instance, when the soil erodes from one side of a soil bank, the tree may begin to lean due to a breach of ground foundation stability. Then the roots on the opposite side grow and strengthen and absorb the stress to keep the tree growing upright.
Through time the trunk grows slightly offset to relieve stress on the compromised root system, but may cause the mid-line tree trunk to crack or snap during a heavy wind storm. Similar to upright walking posture, if walking with a painful lower back caused by a compromised foot foundation, if left uncorrected this condition will have an effect on an number of distal weight bearing joints [foot-to-knee-hip-back pain]. Whereas poor foot mechanics like the compromised tree root system make it likely to cause multiple joint pain and injury possibilities.
However it is possible with corrective insoles and supportive footwear to realign and balance body posture and completely alleviate stress and pain of other affected joints, even the neck and shoulders. In this case the corrective lift at the insole, or bottom of foot may realign the low back and neck vertebrae simultaneously while removing a painful limp caused by sciatica for example.
If any type of acute joint pain condition appears more frequent and severe, Pay Attention! It is important to remember weight bearing pain is often a result of unconditioned physical body, sedentary lifestyle, overweight condition and improper footwear, or disease. The good news is it can be corrected if timely action is taken. Like a tire realignment, corrected foot mechanics can achieve the pain free goal.
Recommendations to treat weight bearing pain before it becomes chronic
If experiencing acute weight bearing pain: a) “Apply Ice right away. Ice reduces inflammation and pain. Be careful not to use ice for more than 15-20 minutes, every 2 hours. Even though heat is used to ease tension & soreness, heat might cause more swelling in the first 2-3 days. b) “Place the ice on the painful area in a fanny pack while you are up and moving around. Apply ice consistently as long as you have swelling and pain.” c) “If you have diabetes or circulatory problems, limit applying ice and heat to 8-10 minutes.” d) “Take medication as directed. Common medications are acetaminophen (such as Tylenol) and non-steroidal anti-inflammatory drugs, such as ibuprofen (such as Motrin) and naproxen sodium (such as Aleve). In some cases, prescription pain medications may help. It may take 10 to 14 days of taking it as prescribed to be fully effective.”
Note: If you experience any abnormal pain seek medical advisement, diagnosis and treatment from your doctor immediately.
Maintain Ideal Body Weight. Simply enter into any Internet search engine, BMI (Body Mass Index) use free calculator, enter your height and weight. This will give you an ideal of whether or not you’re underweight, normal or overweight for your current body mass stature. If too heavy over normal body weight for height, you’re at increased risk for weight bearing pain. Most specifically: foot, ankle, knee, hip, back.
Perform daily aerobic exercise to burn fat (e.g., bike, walk, aerobic dance exercise not less than 3/week @ 20-30min/day). When heart rate is increased for extended periods of exercise, the body's metabolism during aerobic activity burns more of the preferred fuel source from body fat.
Balanced nutrition: consume more fiber, drink more water and decrease total calorie intake daily. Remove high processed fat and sugar foods and drinks. Focus more on shopping and consuming fresh whole foods more in line with Mediterranean diet which contains plenty of fish, fruits and vegetables. Avoid fried foods if possible.
If your feet are in pain, the likelihood of sustaining daily aerobic exercise activity is greatly reduced. Seek a referral from your Primary Physician to get a diagnosis and treatment from podiatrist (foot specialist). See if your foot posture is the cause of your weight bearing pain.
Realize: a) In order to perform daily aerobic exercise activity will likely require good insoles and footwear to offset pain and lose weight. b) Don't pay $300-$1500/year for custom molded insoles out-of-pocket from your podiatrist if you don't have to. First try inexpensive insoles at a local pharmacy if your HMO has a high deductible. When you find a Dr. Scholes foot analysis machine: Simply stand on the free foot analysis imprint at the base of the machine to receive corrective insole recommended selection based on foot insole hot spot(s). However, do see your doctor to positively determine pain cause and origin, especially if the generic insoles don't work for you. If you do get a referral to podiatrist, decide if you want to try the inexpensive insoles before paying the cost of customized insoles. Especially if you have to pay over $50.00.
Do you need surgery or other treatment? Ask your doctor about Spinal Cord Stimulation (SCS). "Electrical nerve stimulation is a procedure that uses an electrical current to treat chronic pain. Peripheral nerve stimulation (PNS) and spinal cord stimulation (SCS) are two types of electrical nerve stimulation. In either case a small pulse generator sends electrical stimuli that interfere nerve impulses to alleviate the pain" (WebMD 2014). "Reports show SCS use results in: 84% reported that their quality of life was improved or greatly improved, 77% had good or excellent pain relief, and 82% decreased their use of pain medications" (St. Jude Medical 2016).
Tens Therapy - electro muscular-stimulation can provide significant pain relief. Ask your doctor about obtaining a Tens unit through health care coverage, or if covered to receive electro muscular-stimulation physical therapy sessions. "Transcutaneous electrical nerve stimulation (TENS) is a therapy sometimes used to treat localized or regional pain. During TENS therapy, electrodes deliver electrical impulses to nearby nerve pathways' which can help control or relieve some types of pain. TENS is often used to treat osteoarthritis and chronic and postoperative pain" (Thompson 2014).
Tens units can also be purchased on-line, or provided by HMO.
Acupuncture - May also reduce chances of chronic back pain from occurring. "One of the largest studies to date on acupuncture and chronic pain, a meta-analysis of 29 well-conducted studies involving nearly 18,000 patients and published in October 2012 in the Archives of Internal Medicine, found that acupuncture is effective for treating chronic pain and therefore is a reasonable referral option" (Palermo 2015).
If acute back, or any joint pain seems abnormal or Intolerable, or you’ve recently experienced an injury consult your physician immediately for diagnosis and treatment.
Kriskarr. “What Is a Compression Injury?” VACUPRACTOR. Vacupractor, 23 Oct. 2012. Web. 22 Jan. 2016.
Thompson, Jeffrey, M.D. “TENS Therapy: An Option for Fibromyalgia Treatment?” – Mayo Clinic. Mayo Foundation for Medical Education and Research, n.d. Web. 22 Jan. 2016.
Palermo, By Elizabeth. “What Is Acupuncture?” LiveScience. TechMedia Network, 05 Mar. 2015. Web. 22 Jan. 2016.
St. Jude Medical. “Power Over Your Pain.” Spinal Cord Stimulation: A Proven Therapy for Pain. St. Jude Medical, Inc., 2016. Web. 22 Jan. 2016.
WebMD. “Electrical Nerve Stimulation for Chronic Pain.” WebMD. WebMD, 12 Mar. 2014. Web. 22 Jan. 2016.
Author: Marc T. Woodard, MBA, BS Exercise Science, ARNG, CPT, RET. 2016 Copyright. All rights reserved, Mirror Athlete Inc., www.mirrorathlete.org, Sign up for your Free eNewsletter.
Letâ€™s first look at the fitness and health connection problems from misaligned feet unattended for many years through my personal example and experience (also read preceding article, â€œGood Posture Alignment was Important, What Happened?â€Â Â Mirror Athlete Blog Article, 25 April 2010).
Â Â Â Â Â Â Â When I went into the military; during my physical examination the examining physician said, â€œYou have another 5miles left on those feet,â€ he laughed a little with me [I had no idea what he meant-only to be enlightened 30 years later by a number of orthopedic surgeons] and sent me on my way to the next exam station.Â The docâ€™s diagnosis: I was flat-footed with a little arch left in both feet.
Â Â Â I sailed through the physical exams and off to basic I went.Â Of course, being a young male with plenty of testosterone, I paid no heed to this diagnosis until years later when foot aggravation caused much pain throughout my body at various stages of my life.Â Â I did note during Army field training exercises my feet were always grossly blistered and in pain like many other soldiers.Â So this just seemed to be a normal physical result of the training.Â After years of hard physical military training and poorly supported military boot ware, this took a toll on my feet, ankles, hips, back and neck.Â Today I interchange 3 different insoles into various foot ware dependent on what activities Iâ€™m doing.Â These custom support insoles make a big difference in my ability to alleviate pain during movement activity.Â My overall health is good because my pain tolerance is acceptable to get work done (aerobic walking, hiking, yard work, etc.) while keeping my body conditioned through this corrective ware.
Â Â Â Now letâ€™s look at my potential fitness and health future had I not figured out what was going on and the impact that may have had on my overall health.Â Like many, I could have continued doing work daily while sucking up pain for years due to uncorrected foot problems while slowly becoming a pain prescription junky.Â In time, the misalignment of musculoskeletal tissue would cause permanent nerve and soft tissue damage with more radiating pain.Â This pain disorder would then cause pain depression, possibly affecting my mental health diagnosed as clinical depression.Â If pain becomes chronic, less motivation to take care of overall fitness health often occurs.Â For many, this means weight gain and other associated health problems can get out of control in a very short period of time if not corrected.
Â Â Â I donâ€™t have to tell you that obesity in itself impacts blood pressure, heart, lung, kidney, liver health functionâ€¦ The list goes on.Â At the same time excess weight on otherwise healthy weight bearing joints can and does cause potentially irreversible damage to the integrity of the soft tissues surrounding these areas.Â Itâ€™s never too late to correct misaligned posture, which at a minimum will alleviate pain.Â And in many cases damaged tissues corrected through foot posture alignment may forgo unnecessary surgical correction.Â Although I have structural damage throughout my spine, correction of my foot ware has alleviated enough pain that back surgery is now off the table.
Â Â Â There should be greater importance impressed upon postural alignment and pain prevention programs in all educational institutions.Â When I was a kid, there was minimal information on this matter.Â As an adult, even during my undergraduate work in Exercise Science, there was postural alignment education, but â€œnotâ€ emphasizing the foot relationship to overall effect on â€œhealthy posture-healthy mind-body.â€Â These relationships were implied with no extensive focus on anyÂ scientific modelÂ of the time between foot alignment impacts on wellness.Â I believe at the time of myÂ undergraduate workÂ wellness and alternative health science was experiencing a renaissance of encompassing being (mind, body and spirit).Â Now there are literally thousands of such books available.
Â Â Â In the military, there was no emphasis on the postural alignment system at all, except PT (Physical Training) form to standards.Â In our school systems, your children may/may not receive corrective information with regard to sitting up straight during the early grade school years; and less, if any emphasis on proper foot ware.Â It appears our shoe manufacturing industry has incorporated better designs for proper foot alignment per activities (sport, walk, running, etc.).
So will our foot ware industry take care of our feet and body alignment needs?
Â Â Â There are a few problems with this line of thought.Â If the foot to total body health is not prioritized in our schools and community at large, priority to postural health will not be emphasized starting at the feet.Â This means one will give less priority to good shoe designÂ when purchased. Â And also, less priority on replacing shoes that are badly worn.Â Wearing shoes badly worn and also shoes with bad design can cause much pain to weight bearing joints.Â If this practice continues on without correction, irreversible soft tissue damage and pain can and does occur throughout the postural system.
The point is, preventative illness and disease education is up to each and every parent and educator.Â Hopefully in the near future our education systems will teach our children early on in matters of this importance. Â Â Take a preventative course of action now.Â See our icon links (skeleton, posture chart, or foot icon on Chronic Pain page at the home site), click, Â read up and learn aboutÂ Posture Control Insoles if you, or your children are in sports are experiencing any pain in the following weight bearing points of the body:Â Foot, ankle, knees, hips, back, neck and read up on how posture correction starting at the feet can help to promote greater activity, fitness and health benefits for life.Â Words of wisdom, â€œif you have little arch in the feet and go into the military, walk and run a lot, or sports professions, ensure you invest in some good insoleÂ shoe support, â€œeven if your feet are in good shape!â€ This will preserve the integrity of the foot anatomy and body health for a lifetime.
Â Author: Â Marc T. Woodard, MBA, BS Exercise Science, USA Medical Services Officer, CPT, RET.Â 2010 Copyright.Â All rights reserved, Mirror Athlete Publishing @: www.mirrorathlete.org,Â Sign up for your Free eNewsletter.