Pain and Lyme

Many of you fellow Lymeys already know the treatment of Lyme takes holistic approach. One cannot just treat one infection. Coinfections, secondary infections, viruses, allergies and any component that might effect the patient’s health has to be taken into consideration when deciding treatment plan for Lyme patients. You often end up having to change your diet either due to allergies or simply to avoid foods that cause inflammatory reaction or candida. You take antivirals and also take supplements to support the immune system. You have to detox to clear toxins. If you don’t, you have severe Herxheimer reaction (Click here, if you are not sure what Herxheimer reaction is). Ahhh that lovely thing Herxheimer reaction. It intensifies everything you feel. Pain, insomnia, arthritis, you name it. They all come in 10 fold (If you are wondering how bad the pain can be click here). You turn to your doctor, who encourages you to hang in there. You turn to fellow Lymeys online, they give you tips on which detox technique is the best. Let’s face it the more you detox the less pain you feel…right? Well, you supposed to….and you should not stop detoxing, it certainly helps. How about that pain that is considered good when it is at level 7 because comparing to 10 it is an improvement? You know the type of pain I am talking about. The aching all over your body as if you have the flu with a fever of 104. The soreness as if someone beat you with a baseball bat ruthlessly. The heaviness of your body that makes you want to be horizontal at all points, because your muscles feels so weak they cannot hold your body up even to a sitting position. See that pain is the reason today I want to talk about pain management. Pain is the worst aspect of Lyme, yet pain management is the least addressed part of Lyme treatment. You all suffer through it and you wish it would just go away, but the most you ever do is detox and maybe take some Motrin. Well that all needs to change now and I hope this article will help you in doing it so.

What is pain management?

Pain management is the combination of techniques that involves invasive and noninvasive (non-drug and pharmacologic) pain management protocols to help ease the suffering and increase the quality of life of the patient with chronic pain. Some people see pain management as giving up on getting better, which is definitely not true. Pain triggers pain, then it becomes a dead cycle of pain all around. Think of your home, when intruders enter your home from the living room, your alarm doesn’t go off in only the living room. You hear the alarm throughout the house. Our body functions in a very similar nature. That is why it is important to keep your pain level under control. It is not giving up. It is taking matters in your hand, while you fight this battle. Out of all the other horrible issues you have to suffer through, at least pain should be crossed off your list. When the pain is under control, you will see many improvements in your life. If you are bedridden, you might get around more (even if it is with the help of a cane or a walker.) You might not gain your full independence, however becoming more active will help reduce your stress levels. Increased morale and mobility will help you focus better on fighting your battle or at least motivate you to try harder. See it is all for the better.

Types of Pain Management

You need a pain management specialist to start treating your pain. During your initial appointment with your pain specialist she will evaluate your problematic areas, take your general health history, order X-rays and MRIs to determine the cause of the problems and the proper way of treatment.There are many different ways to get pain under control. All of these techniques can be categorized under three main categories: noninvasive-nondrug, noninvasive-pharmacologic and invasive pain management.

Noninvasive-Nondrug Pain Management is things like manual manipulation, massage, exercise, superficial heat or cool compress, electrotherapy, ultrasound therapy, and behavior modification. Usually this technique is the first technique your pain management specialist will opt for. Although many of these techniques can be used at home, generally they can all be combined at Physical Therapy (PT). I find PT very helpful. Generally the therapist spends an hour consulting with you, before creating a dynamic program that targets your problematic areas. A typical PT session will start with the therapist massaging the problem areas. She will also manipulate the joints, muscles and ligaments – similarly to the chiropractic techniques but not exactly the same. Massage and manual manipulation will be followed by stretch like exercises to help release the tense areas. As you get used to these exercises you will see more strength exercises added in your routine. Followed by either an electrotherapy or ultrasound therapy. Electrotherapy is applied by a device called transcutaneous electrical nerve stimulation (TENS) unit. This device reduces pain by sending low voltage electric stimulation that interacts with the sensory nervous system. Ultrasound therapy is applied by a device that reduces pain by generating deep heat through a piezoelectric crystal sound head. Therapeutic ultrasound provides heat to the problematic body parts that lie deep within your body that are not able to be heated with a standard hot compress alone. If ultrasound therapy is not used during PT the session will end with moist heat or cold compress. Heat compress helps relax the muscles, while cold compress takes any swelling down. Your therapist will select the most suited option for you based on your needs. At the end of each session your therapist will assign you exercises to do at home. Generally she will provide a printout with pictures and description of each exercise. She will also talk to you about life adjustments, whether it is avoiding lifting heavy items, your posture or so on based on her observations of your behavior. Behavior modification is one of the key components to healing pain. For instance if you have bad posture, you are contributing to your problem. The more you get educated the better results you will get with your PT.

Noninvasive-Pharmacologic Pain Management route should be taken, if Noninvasive-Nondrug Pain Management alone is not getting rid off the pain long enough. When you have chronic pain Noninvasive-Nondrug Pain Management might not be enough. It takes a long time for pain to become chronic and even longer time to heal – sometimes it isn’t even possible to restore to full pain-free state. Of course the goal is always to reach a permanent pain-free state, however you have to sometimes settle for the next best thing. There are many pharmacologic options available. These are options are analgesics, nonsterodial anti-inflammatory agents (NSAIDs), muscle relaxers, opioid pain killers, antidepressants or anticonvulsants, neuromodulating medications. A pain specialist will discuss your options for pain management. It will be my recommendation to continue the noninvasive-nondrug pain management techniques, even if you end up resorting to the noninvasive-pharmacologic pain management techniques. Also don’t forget to detox during this treatment. Here is a good article I wrote on how to properly detox.

Invasive Pain Management route is the last resort to pain management. Some of these techniques are more commonly applied than others. These treatment options include trigger point injections, prolotherapy, radiofrequency radioablation, surgically implanted electrotherapy devices. There is a variety of trigger point injection types available, such as NSAID, steroid, analgesic, Botox and X-ray guided cocktail injections that combines NSAID, steroid and analgesic. Trigger point injections not only deliver the medication, but also cause the muscles to contract. When an area of your body is in pain the muscles in the surrounding area will tense up. Since the pain is chronic in these areas the muscles will stay tense and stop contracting, which in turn cause even more pain. Just the poking alone from these injections can liven up the muscles (although not guaranteed) and this is way they are referred to as trigger point injections. X-ray guided cocktail injections differ than other injection options. These injections go deeper in the body (hence why x-ray assistance is required) to help reach out of reach areas such as hip joint. Trigger point injections can be combined with noninvasive-nondrug and noninvasive-pharmacologic techniques. Prolotherapy involves injection of an irritant solution to stimulate blood circulation and ligament repair at affected site. radiofrequency radioablation involves deadening of painful nerves via heat administered through a small nerve. Surgically implanted electrotherapy devices are implantable spinal cord stimulators (SCS) and implantable peripheral nerve stimulators.

Conclusion

Constant pain is traumatizing physically and mentally. Physical part is obvious, but the mental part is more complicated. There are sensors in nerves that are sensitive to stress chemicals flowing in your blood. The more stressed, anxious, nervous or upset you are, the more you will experience increase in pain. The more stress chemicals that run through your body, the more stress sensors are activated. Let’s face it the type of pain Lymeys feel cause all of the above, stress, anxiety, nervousness and anger. As I always say we need to create a dictionary of special words just for us Lymeys to describe the type of pain we experience. Your pain can take you to a different mental level (if you want to understand more click here and here). It can go as far as life feeling pointless and committing suicide. Suicide rates in Lyme patients are very high. I say before we reach that level of hopelessness let’s take this beast under control and focus on what is really important – HEALING.