Sunday, December 29, 2013

Pain Patterns

Chronic pain is unique in that it manages to be both predictable and unpredictable simultaneously. While long-term pain becomes familiar and unsurprising, sometimes flares of pain come on seemingly at random. It’s common to wonder, “Gee, why am I hurting so much more today?” Sometimes, flares are truly random. But often, when we look through the chaos of the flares we can see that there’s some sort of underlying pattern that precedes periods of higher pain.

Understanding these patterns is difficult, because chronic pain is so multifaceted and private that it’s sometimes hard to notice which outside factors are affecting your pain. Pain journals can be helpful tools while trying to discover what pain triggers you have; use the journal to track your daily pain, along with your daily exposure to various triggers. After a couple months, patterns should begin to emerge. Most of the triggers are unavoidable, but recognizing them is an important step in being able to engage in preemptive self-care.

While each person’s pain is fiercely individual and thus no list can be totally inclusive, there are some common pain patterns Chronic Pain sufferers might want to track.

Stress. There’s no question that stress affects how we experience pain, but the way it affects pain is not well known. For example, in cases of acute pain, induced stress (like the stress from a test) may serve as a useful distraction against pain. However, chronic pain patients have internalized, chronic stress, and the prolonged pain often makes it impossible for the body to stop producing stress hormones. This is correlated with increased pain perception and depression. It seems likely that the association between pain and stress largely depends on whether the stress is chronic or acute, as the difference of their effects on the body can be seen on a cellular level. When keeping track of stress in a pain journal, try to identify the sort of stress you’re experiencing (short-term or long-term, good or bad, etc.) as well as any other symptoms you think the stress might be exacerbating, such as mood problems, digestive issues, sleep changes, etc. If you find that stress is aggravating your pain, learning some new coping mechanisms might help you manage times of stress.

Weather. Changes in weather, particularly changes in barometric pressure, are scientifically shown to have a significant effect on pain, particularly if your pain is inflammatory in nature. As the barometric pressure drops, there’s less air-pressure around us compressing our bodily tissues, so tissues that are prone to swelling will swell. Conversely, weather systems of increasing pressure can help relieve some pain. If you notice that changes in the weather seem to accompany a change in your pain level, tracking the barometric pressure, temperature and relative humidity is a fairly thorough way to record patterns. If you’ve kept a pain journal before and would like to compare your pain levels to the weather you can do so here. Some ways to deal with weather-related pain changes are by applying compression to areas prone to swelling, keeping warm, and gentle exercise to encourage movement of fluids in the body.

Food. Food sensitivities are extremely individual, but can be an important factor in pain management. Some people might find that particular foods actually trigger a pain flare; for example, people with migraines often find that consuming MSG directly triggers an episode. Other times, it may not be noticed that a type of food causes increased pain symptoms until you eliminate it from the diet; some have found this true of things like gluten, lactose or food dye. Keeping a dietary log along with your pain journal can help clue you in on any correlations between your food intake and your pain. Always check with your doc before starting any sort of restrictive diet!

Activity. The relationship between pain levels and activity is often complex; too much or too little can cause your pain to increase. Although it often seems the intuitive response to pain, remaining sedentary can cause the body to stiffen up and muscles to lose strength, resulting in even more pain. Activity is imperative to well being when living with chronic pain because it releases feel-good endorphins , but activities that are too strenuous may cause pain to increase. By writing down what exercises and activities you preform along with your pain level, you can begin to notice what exercises leave you feeling better and which ones leave you feeling worse.

Sleep. Sleep is the time that when the body repairs itself, so it’s no surprise that sleep affects pain levels so deeply. Not all sleep is created equal; deep restorative sleep requires the sleeper passing through 5 stages of progressive relaxation. When sleep is interrupted, the body must try to start the cycle over again. If you’re tracking your sleep, some things that are beneficial to write down in the morning are: how soundly you feel you slept, how many times you woke up during the night, and how easy it was for you to fall asleep. Don’t worry too much about tracking specific times, since looking at the clock often causes anxiety over getting to sleep—totally counterproductive.

Acute Illness & Injury. One of the cruel realities of living with chronic illness is that we still have to suffer acute illnesses, too. We may describe our illness to others by saying, “Every day feels like the worst flu you’ve ever had” as a way to shed perspective on how uncomfortable we are. So when a chronically ill person experiences a terrible virus, the results are basically like getting hit by a Mac truck; incredible pain. Even minor infections can sometimes play a huge part in increasing pain and fatigue. It’s the same with acute injuries; if you experience an injury in a place that already experiences pain, it can cause your pain levels to skyrocket. Interestingly, sometimes an acute injury can help distract from chronic pain in other places. Tracking these acute problems can help explain pain fluctuations.

Saturday, December 21, 2013

The Quiet Joints the No One Ever Knows

 One of the misconceptions commonly faced by people who suffer from autoimmune arthritis is that it is exactly the same as osteoarthritis, the wear-and-tear form of arthritis which mostly affects people in old age. The fact is that autoimmune arthritis is a systemic disease which causes your autoimmune system to attack and destroy your joints; it's not known what causes it, but it certainly isn't related to wear-and-tear. The mechanism of attack is different too-- autoimmune arthritis causes blood to flood the area and cause a lot of swelling, rather than the mechanical rubbing of cartilage caused by osteoarthritis.

Something that many people don't realize about autoimmune arthritis is that it isn't picky where it will take up shop during a flare. Technically, it can affect even non-articular organs, like your heart and lungs, but it has a preference for joints. Any joint will do. Of course autoimmune arthritis affects the joints that are commonly attacked by osteoarthritis, like knees, hips, and hands, but it can also manifest itself in joints that are more exotic. It can manifest in joints most people don't know even exist.

Here are some out-of-the-way joints that can be affected by autoimmune arthritis:

Temporomandibular Joint (TMJ). 

Anatomy of TMJ. Source.
When you meet with a friend to go out for dinner and chat, you might not realize that there's a joint working overtime: the jaw (or TMJ).  Talking, chewing and brushing your teeth are all very basic, necessary life-tasks that require motion in your TMJ. They all become very difficult to do when arthritis flares in these joints. When inflammation sets in, a person can experience clicking, popping, and locking of the jaw, as well as intense pain.

Sternocostal joints. 
Anatomy of the Rib Cage. (It swells where blue meets yellow). Source.

Generally, we tend to think of our rib-cage as being a pretty solid and immobile, but there are actually several joints that help facilitate twisting, turning, and the in-and-out motions necessary for breathing. In fact, these are some of the most-used joints in the human body which never get a break from moving since we must continue breathing throughout the night, while most joints get a chance to rest. Unfortunately, it's a playground for autoimmune arthritis. Inflammation of the sternocostal joints is called Tietze Syndrome. (When inflammation isn't remarkable, the term costochondritis is often used). Sufferers experience extreme pain and difficulty breathing, wearing a bra, or moving their torsos.

Inner Ear. 
Anatomy of the Human Ear. Source

Some people may be surprised to learn that our hearing is actually controlled by the motion of joints located in our ears. Very simply, the bones in our ears get hit with wavelengths from the things around us and clang together like tuning forks, vibrating noise signals into the brain. So when the joints in your ear start getting attacked by your immune system and swelling up, the tuning forks don't have room to vibrate and your hearing can run amok. Inner ear swelling can also cause tinnitus (ringing in the ears) and balance problems. This condition is sometimes referred to as Autoimmune Inner Ear Disease

Anatomy of the Throat. Source.
The process of speaking takes places when we make our vocal chords vibrate together. What facilitates this vibration? You guessed it, a joint. The cricoarytenoid joint, to be specific. In a healthy throat, the cricoarytenoid joint helps make the vocal cords move up, down, and together, which is what allows us to change the pitch in our voice. When the joint is attacked by autoimmune arthritis, it inhibits these motions, and can cause hoarseness, difficulty breathing, and pain. Kelly Young has a great article about cricoarytenoid arthritis over at her website, RA Warrior.

Look at how many vital life processes, like breathing and eating, are made difficult and painful due to autoimmune arthritis.

Sunday, December 1, 2013

Silly Silver Linings

Chronic pain is an ugly, black rhinoceros of a cloud, like in Tim Burton's adaptation of Roald Dahl's, "James and the Giant Peach." Pain clouds our perspective, separates us from our loved ones, and sometimes forces us to the pits of despair. That's just what unrelenting pain is like.

Every cloud has a silver lining.

There are lots of big-ticket lessons that can be learned quicker due to dealing with chronic pain, but none of them necessarily required suffering pain to learn. Compassion, advocacy, empathy, activism... chronic pain may lead you there quicker, but there are plenty of other ways to get there too. It’s impossible for me to say that I haven’t learned a lot from my disease, but I certainly could have learned most of those things vicariously.

However, there are some things I absolutely would never have learned if not dealing with autoimmune arthritis. I never would have needed too. Silly things. Practical things. They certainly don’t make up for a life of pain, but here are some of the silver linings and lessons I never would have had without chronic pain.

1. Chronic illness makes you amazing at filling out forms. I have filled out so many forms since getting sick that I can figure out and complete almost any form like a machine. Sure, maybe there are other ways to get good at filling out forms, but by and large, healthy people don’t ever experience the variety and depth of forms that sick people do. Not only are there the medical history forms (which each doctor wants done individually, even though many medical history forms ask exactly the same question), personal symptom forms, and the corresponding insurance forms, but also a myriad of government forms if you need to utilize any public assistance. These forms then force you to familiarize yourself with all of the tax forms. There are accommodation forms if you’re physically able to work or go to school, disability forms if or when you’re not.

2. Having hand pain has taught me a million different ways to manage writing. Particularly my signature. I can give a passable signature using either hand, with my fingertip, with my fingers but without moving my hand or wrist and using my shoulders, with a pen stuck between any of my fingers, and occasionally with my right foot. I’ve learned three different types of computer dictation software, and experienced what it’s like dictating to a real person. I’ve tried non-standard keyboard configurations to try and help make typing easier (though my mind can’t escape QWERTY). Never would have tried any of these if I didn’t have to, which goes hand in hand (pun intended) with the filling out forms thing.

3. Having a cane means you always have a great resource with you. This would be even more true if you carry a sword cane, but even the standard aluminum ones (like I have) are pretty darn handy. For tasks that don’t need much dexterity, a cane easily doubles your reach—perfect for sliding things to you when you need them. It can be rolled across sore muscles for a cooling massage. It’s a great tool for stretching. It makes me feel safer knowing I could use it to defend myself. It kills spiders.

4. The health-related contents of my purse can save people in emergencies big and small. After years with no doctors really helping me, I’ve developed a compact OTC arsenal that I keep with me: Excedrin, aspirin, ibuprofen, Benadryl, antacids, etc. I always have snacks and water because they’re needed to take medication with. Also on deck are hand sanitizer, alcohol wipes and a rubber glove, because periods of being immunocompromised leave you terrified of germs. Portable hot-packs meant for outdoorsmen because they’re great for sore joints. Matches for after tummy troubles. Basically, my daily needs are what other people need in a disaster.

5. My body has become an almost entirely accurate meteorologist. It can predict fluctuations in barometric pressure and humidity with astounding precision. It always lets me know when to bring a jacket, or an umbrella. Or if an event is going to be rained out. I wish there was a way to market this knowledge to the TV meteorologists; the locals would be happier and I could use the funds!