Dec 12, 2018

How polio still affects survivors decades later

Canada has been polio-free for the last 20 years but it was once among the most dreaded childhood diseases in the country.
The disease hit hard in Canada in the early 1950s. At the peak of the outbreak in 1953 alone, there were 9,000 cases and 500 deaths. 
But in 1956, American researcher Jonas Salk developed the polio vaccine and the disease was virtually eradicated in North America by the early '60s.  
Terry Wiens was a March Of Dimes poster child. (
Today, it's estimated there are 31,000 polio survivors in Canada. One of them is Terry Wiens. He was diagnosed with polio in the 1950s. And by the time he was 16, Wiens had spent a total of eight years in hospital.
"It was very different time then. So you didn't see your family. Eighty per cent of the kids in the hospital [had] polio so that was my family. Parents could only visit twice a week ... Siblings you sort of waved to them down in the parking lot," Wiens tells The Current's Friday host Nora Young. 
But the difficulty of a childhood in hospital isn't where the story ends for many polio survivors. 
Most now in their late 60's and early 70's are still living with the long-term legacy of the disease. Post-polio syndrome is mainly characterized by new weakening in muscles that were previously affected by the polio infection and in muscles that seemingly were unaffected.
For polio survivor Lois Hall, it wasn't until she was in her 40's that she started to take her onset of post-polio symptoms seriously, after occasional tripping led to a hard enough fall that broke her hip.
She tells Young that after several trips to specialists, she was finally diagnosed. Hall now uses a ventilator for breathing when she sleeps, swallowing has been difficult, and she's able to get around with a leg brace and elbow crutches.
What makes it challenging for the survivors — and the doctors who care for them — is that polio is seen as a disease of the past. And the knowledge of how to properly treat it is also fading. 
Dr. Ming Chan says post-polio syndrome is hard to diagnose because symptoms can mimic other ailments like fibromyalgia.(Supplied)
"I did have one bad experience when I was outside my own community once and I had to get some medical assistance. They didn't believe [post-poilo syndrome] even existed," recalls Hall.
That's no surprise to Wiens. 
 "You really need to be able to advocate for yourself," he says.
Dr. Ming Chan, a rehab medicine specialist at Edmonton's Glenrose Rehabilitation Hospital, says that despite the fact that 50 to 70 per cent of polio survivors suffer from post-polio syndrome,  it can be hard to diagnose because symptoms can mimic other ailments like fibromyalgia. 
A further challenge is that it can be hard for patients to recall an illness that happened more than half a century ago.
"If you take a child at the age of three, I think their recollection of something happening in any detail is difficult. I have patients who only realized years later when they started asking their parents," says Chan.
Listen to the full segment at the top of this web post.
This segment was produced by Winnipeg network producer Suzanne Dufresne and Vancouver network producer Anne Penman.

Post Polio Litaff, Association A.C _APPLAC Mexico

Nov 2, 2018

What is the biological cause of PPS ? Dra. Susan Pearl

                 Post Polio Litaff, Association A.C _APPLAC Mexico

Polio: Wild poliovirus cases in 2018 top 2017 total


With the reports of three additional wild poliovirus type 1 (WPV1) in Afghanistan, bringing the total global cases to 25, it has eclipsed the total WPV1 cases for all of 2017 (22).
Poliovirus Image/CDC
Poliovirus Image/CDC
The three new cases have been reported from Maywand district, Kandahar province, from Pornus district, Nuristan province, and from Nawzad district, Hilmand province. This brings the total cases reported in Afghanistan to 19 (Pakistan has reported 6 cases this year).
The third polio endemic country, Nigeria, has not reported any WPV1 cases in more than two years.
The Global Polio Eradication Initiative (GPEI) says:
Nominal variations (up or down) in the number of newly-reported cases at this point of the polio endgame – although tragic for the affected children and their families – are not operationally overwhelming, especially considering the population size in the 3 remaining endemic countries (upwards of 90 million children aged less than five years).  However, confirmation of even a single polio case anywhere points to remaining vaccination coverage gaps which must be filled, to achieve eradication.
Concerning circulating vaccine-derived poliovirus cases, Papua New Guinea reported three new cases of circulating vaccine-derived poliovirus type 1 (cVDPV1), bringing their total to 21.
The Democratic Republic of Congo saw one new case of circulating vaccine-derived poliovirus type 2 (cVDPV2). The total cases in DRC is now 16.
Finally, Nigeria reported two new cases of circulating vaccine-derived poliovirus type 2 (cVDPV2), bringing their total in 2018 to 19.

Post Polio Litaff, Association A.C _APPLAC Mexico

Oct 28, 2018

Polio Outbreak Warning Upgraded in 5 Countries

african children
October 27th, 2018 – The US Centers for Disease Control and Prevention (CDC) published 5 separate Alert - Level 2, Practice Enhanced Precautions, regarding the increased spreading of the polio virus on 
These CDC Travel Alerts for the Democratic Republic of the Congo, Nigeria, Papua New Guinea, Somalia, and Syria note that progress had been made in these countries, but that the contagious virus continues to spread. 
The CDC strongly recommends that all travelers to these 5 countries be vaccinated fully against polio. In addition, adults who have been fully vaccinated should receive a single lifetime booster dose of the polio vaccine. 
Even if you were vaccinated as a child or have been sick with polio before, you may need a booster dose to make sure you are protected, said the CDC. 

Moreover, long-term visitors staying more than 4 weeks may be required to show proof of polio vaccination when leaving these polio-infected countries. 
To meet this travel departure requirement, long-term visitors should receive the polio vaccine between 4 weeks and 12 months before the date of departure, to ensure their immune systems immunized against polio. 
These upgraded Alert - Level 2 warnings are for these countries:
  • Democratic Republic of Congo: Cases of vaccine-derived polio have been reported in the Democratic Republic of the Congo, according to the World Health Organization (WHO). The cases occurred in Haut-Lomami Province and in Maniema Province.
  • Nigeria: The Nigerian Ministry of Health has reported several cases of poliovirus in the state of Borno in northeastern Nigeria. The Nigerian government is conducting widespread immunizations to prevent further transmission.
  • Papua New Guinea: An outbreak of polio has been reported in the provinces of East Sepik, Madang, Eastern Highlands, Enga, Jiwaka, Morobe Province, and National Capital District in Papua New Guinea. This outbreak is caused by vaccine-derived poliovirus (VDPV), a sign of low oral polio vaccine coverage in the country.
  • Somalia: A polio outbreak has been reported in Mogadishu and the Hiran and Middle Shabelle regions. This outbreak is caused by vaccine-derived poliovirus (VDPV), a sign of low oral polio vaccine coverage in the country.
  • Syria: Cases of vaccine-derived polio have been reported in Syria, according to the Global Polio Eradication Initiative. Most cases have been reported in Mayadeen District, in Dayr az Zawr Province.
vaccine-derived poliovirus (VDPV) is a strain of the weakened poliovirus that was initially included in oral polio vaccine (OPV) and that has changed over time and behaves more like the wild or naturally occurring virus, says the CDC.   
This means it can be spread more easily to people who are unvaccinated against polio and who come in contact with the stool or respiratory secretions, such as from a sneeze, of an infected person. 
For this reason, the eradication of polio requires stopping all OPV in routine immunization, as soon as possible after the eradication of wild poliovirus (WPV) transmission. 

To protect Americans against all 3 types of WPV, the CDC has exclusively endorsed the inactivated polio vaccine (IPV), which requires 4 doses, since 2000. 
Travel vaccination appointments can be scheduled at Vax-Before-Travel and vaccine discounts can be found here. 
Polio is a crippling and potentially deadly disease that affects the nervous system. It is spread through contact with the feces of an infected person. It is also spread by drinking water or eating food that is contaminated with infected feces. 
Most people with polio do not feel sick. Some people have only minor symptoms, such as fever, tiredness, nausea, headache, nasal congestion, sore throat, cough, stiffness in the neck and back, and pain in the arms and legs. 
In rare cases, polio infection causes permanent loss of muscle function. Polio can be fatal if the muscles used for breathing are paralyzed or if there is an infection of the brain. 
For specific information related to US travelers and guidance on interpreting any ad hoc doses of polio vaccine in relation to the individual’s vaccine schedule, please consult the CDC MMWR, "Interim CDC Guidance for Polio Vaccination for Travel to and from Countries Affected by Wild Poliovirus," specifically the section titled Interim Vaccination Guidance to Comply with WHO International Health Regulations Temporary Recommendations for Countries Designated as “Polio-infected.” 
For more information on OPV cessation, please visit the Global Polio Eradication Initiative’s website or the Polio Vaccine Information Statement (VIS) for more information. 
Vaccines, like any medicine, can have side effects. You are encouraged to report negative side effects of vaccines to the FDA or CDC.

Post Polio Litaff, Association A.C _APPLAC Mexico

If Polio Is Eradicated, Why Vaccinate?

by Sanofi Pasteur(CC BY-NC-ND 2.0)
Today is World Polio Day. Polio is a highly infectious viral disease that mainly affects the nervous system of young children. Worldwide, the WHO says 99 percent of polio cases have been eradicated, while the last recorded case in Mexico dates back to 1990. If polio is already eradicated in Mexico, why do vaccination campaigns continue?
Although the incidence of polio is a distant memory for most of the world, according to the WHO there are still cases in countries like Afghanistan, Nigeria and Pakistan. The existence of poliomyelitis in these countries could mean a spread of the disease to other countries where vaccination is insufficient. “Polio can spread from these countries to infect children in countries that do not have an adequate vaccination system,” explains the WHO.
However, anti-vaccination movements are as old as the vaccines themselves. When British physician Edward Jenner discovered the first vaccine against smallpox in 1796, these movements began to emerge. The Lancet Infectious Diseases journal, however, emphasizes that vaccination is among the most effective public health interventions. The publication also says that vaccines have eradicated many diseases, which in turn has increased anti-vaccine movements, which question the use of vaccines when these diseases are no longer common. “Misinformation, suspicion about vaccines and distrust of governments and health authorities have led many parents to oppose the vaccination of their children,” the Lancet Infectious Disease Journal reported.
Recently, some diseases that were believed eradicated have re-emerged around the world. For example, last year, the Lancet Infectious Disease Journal revealed that countries such as Romania, Italy and France had experienced a reappearance of diseases such as measles due to low immunization rates. Similarly, in March, the Ministry of Health of Mexico reported three cases of measles in Mexico; the authorities affirmed that the infected persons were a woman of Italian origin, her son and her nanny. According to the institution, Mexico has had no record of measles cases since 1996.
In this context, the Ministry of Health and other authorities recommend that, given the interconnected nature of today’s world, it is important to have vaccination campaigns regardless of whether the diseases are no longer present in the country. Until a disease has been eradicated worldwide, there is always the possibility that it will reappear if the proper vaccine is not available. Alessa Flores On October 24, 2018 · 

Alessa Flores

Post Polio Litaff, Association A.C _APPLAC Mexico

Oct 16, 2018

Meet the Smartchairs

When the creators of The Jetsons imagined the automated world of the year 2062, they assumed robot technology would take care of life’s drudgery — shopping, washing dishes, vacuuming. We still hold on to that fantasy, even as we embrace a time in which microcomputers enhance our lives in countless invisible ways. Who wouldn’t want a robot that could change diapers? Admittedly today’s reality is subtler, but it’s no less exciting. Autonomous vehicle technology. Self-compensating drive control. Predictive maintenance apps. A virtual seating coach. All of these things are happening now in wheelchair technology — and they’re transforming our mobility, health and independence in this lifetime.

Two sleek, futuristic wheelchairs drove themselves through Tokyo’s Haneda International Airport this past August, one obediently following the other like a friendly robotic dog. They smoothly navigated a turn, traversed bumpy grates and sedately pulled up alongside a group of reporters who were there to record the future.
Their short journey is a promising sign of where the future of power wheelchair design is headed. Why? Because the first chair autonomously traveled to a woman standing nearby who summoned it using her cellphone, and the second followed independently.

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The chairs were part of a demonstration of a new project to shuttle passengers through the airport when Japan hosts the 2020 Olympics. While these specific chairs will likely be of little use for most wheelchair users, the underlying technology — state-of-the-art mapping software and built-in sensors to avoid running into obstacles — could change the way you drive your power wheelchair, or … the way it drives you.
With all the similarities between driverless chairs and driverless cars, it makes sense that the autonomous chairs are made by WHILL, a company founded by former Japanese auto designers. They are not the only auto industry players getting involved in the mobility world. In 2016, Japanese car maker Nissan showcased the ProPilot, a self-driving chair designed for customers to sit on while waiting in line at restaurants. When the first person in line leaves their chair to go inside, the chair goes to the back of the line and the other chairs move forward.
And if you watched even a fraction of the recent Olympics, you probably saw at least five ads for Toyota’s “Start Your Impossible” campaign. Instead of just featuring Toyota’s traditional vehicles, each ad ended with quick shots of disabled athletes and an array of non-traditional mobility devices, including a peek at the long-promised iBot II. That didn’t happen by chance.
“Toyota believes that ‘mobility’ goes well beyond cars and that movement is a human right. This campaign, and our partnership with The Olympic and Paralympic Games, are a reflection of our commitment to providing freedom of movement for all,” said Ed Laukes, group vice president, Toyota Division Marketing, Toyota Motor North America, in an interview with CNET.
This overlap between the auto industry and the mobility industry is not new. It turns out many varieties of self-driving chairs are already being tested, and power chairs have had some of the “smart” features we might more readily associate with autonomous cars for quite a while.
Some of the similarities are obvious, like the integration of hands-free wireless technology, but you may not even know of others you’ve been taking advantage of every time you roll out. The impact is already huge, and will continue to grow, touching every aspect of chairs — from the drive systems, to how they navigate, to maintenance, to actually helping you monitor your health. It won’t happen overnight, and there are real challenges involving funding and regulations, but it is coming.

What’s Next

Dubbed the WHILL NEXT, the aforementioned driverless chairs look almost identical to WHILL’s better-known models, the Model A and the Model M. But unlike the A and M, NEXT — which WHILL and co-designer Panasonic refer to as a “mobility robot” — was designed specifically to transport ambulatory people who have difficulty walking long distances.
Airport visitors will be able to summon a WHILL NEXT by tapping on a smartphone app. The chair self-drives to their location, picks them up and delivers them to their destination. The app will even tell them how long it will take to get to their gate. With the aging population, it is easy to envision a growing market for similar mobility devices at resorts, malls, parks and other expansive destinations.
Ted Fagenson, former vice president of sales and marketing at WHILL, explains the simple economic incentive behind the chairs. “It costs X amount of dollars to pay an employee to push a person from the check-in terminal to the boarding area of the airplane. If you are doing that a thousand times a day, that adds up to a lot of money in labor. It is going to be economical for the airline, and for the user it will be a much better experience,” says Fagenson.
Testing of the NEXT at Haneda is expected to have been completed by March 2018.
While cool, the NEXT technology isn’t quite what full-time chair users need. “We would love an autonomous power chair that could navigate any sidewalk, and/or chairs that can perform obstacle avoidance for people using sip-and-puff or head array controls, but the technology isn’t there yet,” says Mark Smith, general manager of public relations for Pride Mobility/Quantum Rehab. “Obstacle avoidance and autonomous technology is moving into the power chair market for indoor use in the coming years because it’s easy for sensors to avoid vertical objects on a flat indoor surface, but outdoors is another story. Current technology can’t tell a puddle from a dark patch from a pot hole. And current sensors aren’t capable of distinguishing between curb angles, or if a curb is shaded by a tree.”
For now, the closest manifestation of this technology lies in the WHILL Model A’s iPhone app, which allows users to summon and drive their Model A. Imagine being able to easily move your chair away from a sofa or bed after transferring or being able to call it to you in a crowded room.
Emily Oakley, of Campbell, California, takes full advantage of the app whenever she is out with her WHILL. Oakley, 44, is able to walk, but has multiple sclerosis and uses the Model A to do what her body won’t always let her. The Model A is called a personal electric vehicle rather than a power wheelchair because it has not been submitted to the FDA for review and is typically not covered under insurance.
“I’ve always been very active and having four-wheel drive on the Model A enables me to go hiking again,” she says. The app comes in handy when she and her husband, Ken, are out and about. Oakley prefers to transfer into a regular seat at restaurants. She can then use the remote to drive the chair out of the way, usually into a corner. And when she transfers into the front seat of their van, she uses the remote to drive the Model A around the back of the van and onto the rear lift.

Sticking to the Straight and Narrow

The idea of software that keeps your wheelchair going in a straight line may not be quite as sexy as the possibility of ghost-driving your chair via remote, but for many users, such software is invaluable. Self-compensating drive control is one of the earliest smartchair systems, and it is so seamlessly integrated that most wheelers aren’t even aware it is on their chair.
It’s basically the wheelchair equivalent of the lane centering technology that is being rolled out on many high-end automobiles. Just like lane centering technology keeps your car in the lane, self-compensating drive control autonomously corrects a chair’s direction, keeping it going where controller input intended by compensating for uneven or bumpy surfaces. This makes driving with a joystick easier because you don’t have to make constant corrections while cruising down a sidewalk, path or off-camber surface.
Self-compensating drive makes a huge difference for those who use a switch control, like sip-and-puff or a head switch, to drive. Before self-compensating systems existed, a driver using switch input would have to make continuous adjustments to keep a chair going straight. Wheeling on sidewalks and streets required so much input to control the chair that it was difficult to carry on a conversation or enjoy the scenery. Self-compensating drive enables a switch driver to give an input and the chair stays in the intended direction until another input is given, which enables the driver to relax, talk and enjoy their surroundings.
G-TRAC automatic course correction lets Kenny Salvini keep his head on the game.
G-TRAC automatic course correction lets Kenny Salvini
keep his head on the game.
Kenny Salvini, a C3-4 quad and frequent NEW MOBILITY contributor, drives an Invacare TDX SP using an ASL head array switch input control. He taps his head on a switch to his right or left to turn, while a switch at the back of his head controls forward, speed, stop and reverse inputs. He is a believer in G-TRAC, Invacare’s self-compensating drive system. “For a brief time, I didn’t have G-TRAC, and wow, it really gave me an appreciation for it. The road I wheel on in front of my house has a mild arc for water drainage and I had to constantly re-hit the switch input to course correct. It was fairly maddening to say the least and really gave me an appreciation of how important self-compensating drive control is.”
All the major power chair manufacturers now offer some sort of self-compensating drive control. Invacare has G-TRAC, Quickie has SureTrac, Quantum Rehab has Accu-Trac and Permobil has the boldly named Enhanced Steering Performance. Iterations of self-compensating drive control have been around since 2001, but manufacturers are continually working to improve it, resulting in new additions like Invacare’s Adaptive Load Compensation. It provides autonomous adjustments for consistent low speed driving on different surfaces from concrete, to padded carpet to grass. In addition, ALC adjusts motors as they wear so the ride stays consistent. For the wheelchair user, this means that ALC keeps the chair at a steady speed over changing surface textures, in addition to staying on the intended course.

Fix Problems Before They Start

You can’t keep on course if your chair isn’t working. Thankfully, a new wave of predictive maintenance apps is aiming to make it easier to keep your wheels on the road and not in the shop. Car drivers have grown so used to oil check warnings, tire pressure lights and other built-in warning systems that they take them for granted. But put similar systems on a power wheelchair and they could make the difference between getting out of the house and waiting weeks to months for someone to service what is often a minor problem.
Predictive maintenance apps continuously monitor the systems in your power chair. They allow you to see the basics, like battery status, driving habits and distance traveled, while also enabling real-time troubleshooting of error codes on your smartphone and sending complex information about systems on your chair to your dealer. This can make it easier to solve minor problems, like a joystick that suddenly isn’t working because a wheel-lock or attendant control is engaged.
A quick look at the predictive maintenance app on your phone will either show the problem or bring up a phone link to your dealer, who can look at your chair on their computer screen and diagnose the problem live. This would save the user down time and the dealer a service call. Sharing detailed information about your chair’s status with the dealer also allows you both to see if maintenance is coming up and plan for it well before parts fail.
Research done at Human Engineering Research Laboratories at University of Pittsburgh shows that waiting for parts can leave a power chair user without access to their chair for an average of three months.

Post Polio Litaff, Association A.C _APPLAC Mexico

Oct 6, 2018

Great Polio Musians

How to Manage Disability-Related Pain as You Age

People with physical disabilities often experience pain related or in addition to their disability condition. When this pain lasts for more than three months, it is called chronic pain. Chronic pain seems to be most common in middle age (45-65 years). However, as some individuals with physical disabilities age, the frequency and severity of pain may increase. Chronic pain can have negative effects on sleep, mood, fatigue, thinking, work, and daily activities.
With help from health care providers, you can learn to manage your chronic disability-related pain and limit its impact on your life.

Types of Pain

You can have chronic pain in different parts of your body for different reasons. Three common types of chronic pain in people withphysical disabilities are:
  • Musculoskeletal - This pain comes from problems in the muscles, tendons, and joints. It is often described as "aching" or "heavy." People with physical disabilities are at a greater risk than those without disabilities to develop the kind of pain as they age. For example, people who use a manual wheelchair for many years may experience musculoskeletal pain in their shoulders due to overuse.
  • Neuropathic - This pain is caused by abnormal signals from damaged nerves. It is often described as "sharp," "shooting," "electric," or "burning." People with physical disabilities are at a greater risk than those without disabilities to have neuropathic pain, especially if their disability condition involves damage to the nerves. For example, the most common symptom reported by people with multiple sclerosis (MS) is chronic neuropathic pain. Below injury-level neuropathic pain is also common in individuals with spinal cord injury (SCI).
  • Visceral - This is pain in the abdomen or pelvis and can be caused by conditions such as ulcers, constipation, or appendicitis. This pain is often described as "squeezing," "pressure," or "aching." Visceral pain is more common in people with SCI.

Maintaining a Healthy Lifestyle

Maintaining a healthy lifestyle can help you reduce and manage your chronic pain as you age. It may be the most important thing you can do to minimize pain and its impact in the long run. A healthy lifestyle includes:
  • Activity - Keeping busy and challenging yourself physically and mentally will help you have the energy and focus to manage your pain.
  • Diet - Eating healthier can help to relieve chronic pain. Diets high in fruits and vegetables, legumes, and whole grains and low in sugar and red meat have been related to lower levels of pain.
  • Weight - Added weight places more stress on joints and can make pain worse. Maintaining a healthy weight can help you move easier and with less pain.
  • Sleep and Rest - Adequate sleep and rest can make it easier to manage your pain.
For more information on how to maintain a healthy lifestyle as you age, check out our other factsheets in this series including How to Stay Physically ActiveTips for Healthy Eating and Healthy Aging, and How to Sleep Better.

Seeking Help for Your Pain

  • Talk to your health care provider about your chronic pain. Pain is a personal experience, and health care providers often rely on your description of the pain to diagnose and treat it.
  • When meeting with your health care provider, be honest about how much (or little) pain is affecting you.
  • The best treatment plans for chronic pain are tailored to the person and the type of pain he or she has. Your treatment plan should include input from you, your family, and other members of your health care team.

Pain Management

There are several treatments available to help you effectively manage your pain as you age. Chronic pain is often best managed by using more than one strategy.


While it is important to rely on expertise from your health care provider, you play the most important role in managing our day-to-day pain. Self-management techniques for chronic pain include:
  • Tracking your pain - Keep a record of your pain and take it with you to your medical appointments. You may discover that your pain is unpredictable. Notice what triggers and what relieves your pain, such as changes in your activities, time of day, weather, or other conditions like stress or depression. Track your strengths. What are you doing well to deal with pain and its effects.
  • Setting goals - Use the information from tracking your pain to set goals for managing your pain. Ask your health care provider to help you create long-term goals, such as increasing your level of physical activity, learning relaxation techniques for pain, or decreasing the impact pain has on your mood. Break the long-term goals into smaller, more specific short-term goals.
  • Monitoring your progress - Monitor how different pain management strategies are working or not working. If one strategy does not work, tell your health care provider and discuss trying a different strategy.

Behavioral and Coping Skills Treatments

Behavioral treatments can help you manage pain and reduce the impact of pain on your life. Behavioral treatments for chronic pain include:
  • Cognitive Behavioral Therapy or "CBT" - Involves learning relaxation skills, goal-setting skills, strategies for becoming more active, and skills for pacing your activities. It can also include examining your thoughts about pain and learning new ways to replace any unhelpful throughts with more helpful ones. CBT has been shown to reduce pain, improve mood, and improve function.
  • Mindfulness training or meditation - Involves focusing on your present experience in a manner that is open and non-judgmental. Mindfulness can be helpful in managing the suffering that can occur with pain.

Physical Treatments

It is important to consult with your health care provider about physical treatment options to reduce risk of further pain. Physical treatments for chronic pain include:
  • Regular Exercise - Exercise is often helpful in managing pain and improving function. Potential goals for exercise include aerobic fitness, improved flexibility, increased strength, and increased skill in performing physical activities. Some people report that movement activities such as yoga, Tai Chi, swimming, or water aerobics are helpful in managing pain. If you have limited mobility due to age or disability, there are modified at-home and group exercise programs available.

Complementary and Alternative Treatments

There is some evidence that complementary medicine approaches may provide additional relief from chronic musculoskeletal and neuropathic pain. These may include things like massage, acupuncture, or self-hypnosis training. Most evidence does not support the use of homeopathic remedies or herbal treatments for chronic pain.


Pain is often treated with over-the-counter or prescription pain relivers. Categories of medications and the types of pain they are used to treat include:
  • Over-the-counter medications - These medications are effective for the management of mild to moderate pain. Common ones include:
    • Acetaminophen, such as Tylenol®, is often used to relieve pain associated with mild arthritis and osteoarthritis.
    • Non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, and Aleve®, are often used to relieve pain associated with mild arthritis, osteoarthritis, and rheumatoid arthritis.
  • Prescribed pain medications - Prescribed medications are sometimes used to treat or reduce the symptoms of chronic pain. Some common ones include:
    • Anticonvulsants (also known as anti-seizure medications) are used to treat neuropathic pain.
    • Several kinds of antidepressants are sometimes used to treat neuropathic pain and depression and to assist with sleep.
    • Opioids are sometimes used to treat neuropathic pain, acute tissue injury, and musculoskeletal pain. Long-term use of opiods can result in tolerance and other health problems. It is important to discuss the risks and potential benefits of opioids with your health care provider.
    • Muscle relaxants and anti-spasticity medications are sometimes used to treat spasm-related and musculoskeletal pain.
    • There is some evidence that medical marijuana reduces central neuropathic pain and spasticity in people with MS, and more research is underway. As of 2018, medical marijuana is legal in 29 US states and Washington DC.
Although it is common to think that pain is "normal" as we age, there are treatments to reduce the impact of chronic pain on your life. Be open to the options your provider suggests for managing for pain but also be active in looking for solutions!

Additional Resources


Fitzgerald, K., Tyry, T., Salter, A., Cofield, S., Cutter, G., Fox, R., & Marrie, R. (2017). Diet quality is associated with disability and symptom severity in multiple sclerosis. Neurology, 90(1), E1-11.
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Morris, M. A., Yorkston, K. & Clayman, M. L. (2014). Improving communication in the primary care setting: Perspectives of patients with speech disabilities. Patient, 7, 397-401.
Kogos, S., Richards, J., Banos, J., Ness, T., Charlifue, S., Whiteneck, G., & Lammertse, D. (2005). Visceral Pain And Life Quality In Persons With Spinal Cordinjury: A Brief Report. The Journal of Spinal Cord Medicine, 28(4), 333-337.
Marck, C. H., De Livera, A. M., Weiland, T. J., Jelinek, P. L., Neate, S. L., Brown, C. R., … Jelinek, G. A. (2017). Pain in People with Multiple Sclerosis: Associations with Modifiable Lifestyle Factors, Fatigue, Depression, Anxiety, and Mental Health Quality of Life. Frontiers in Neurology, 8, 461.
Molton, I., Cook, K., Smith, A., Amtmann, D., Chen, W., & Jensen, M. (2014). Prevalence and impact of pain in adults aging with a physical disability: Comparison to a US general population sample. The Clinical Journal of Pain, 30(4), 307-15.
Molton, I., Hirsh, A., Smith, A., & Jensen, M. (2014). Age and the role of restricted activities in adjustment to disability-related pain. Journal of Health Psychology, 19(8), 1025-1034.
Murphy KL, Bethea JR, Fischer R. Neuropathic Pain in Multiple Sclerosis—Current Therapeutic Intervention and Future Treatment Perspectives. In: Zagon IS, McLaughlin PJ, editors. Multiple Sclerosis: Perspectives in Treatment and Pathogenesis [Internet]. Brisbane (AU): Codon Publications; 2017 Nov 27. Chapter 4.
Norrbrink, C., & Lundeberg, T. (2011). Acupuncture and massage therapy for neuropathic pain following spinal cord injury: An exploratory study. Acupuncture in Medicine, 29(2), 108-15.
Sengupta, J. N. (2009). Visceral Pain: The Neurophysiological Mechanism. Handbook of Experimental Pharmacology, (194), 31–74. Advance online publication. is external)
Widerström-Noga, E. & Finlayson, M.L. (2010). Aging with a Disability: Physical Impairment, Pain, and Fatigue. Physical Medicine & Rehabilitation Clinics of North America, 21(2), 321-337.


"How to manage Pain You Age" was developed and published by the University of Washington Aging RRTC. Content is based on research evidence and/or professional consensus.


This information is not meant to replace the advice from a medical professional. Consult with a qualified and licensed health care provider in your state.
Suggested attribution:
University of Washington. (2018). How to Manage Pain as You Age [Factsheet]. Aging Well with a Physical Disability Factsheet Series. Heathy Aging & Physical Disability RRTC.

Post Polio Litaff, Association A.C _APPLAC Mexico

Sep 30, 2018

The Bill Gates polio vaccine push in India has created a more deadly 'super' strain of the disease, say doctors

A mutated strain of Polio has made its way to Europe – as medical authorities admit that the Polio vaccine program led by Bill Gates had ended up creating a more deadly strain of the disease. 
In 2011 Doctors in India reported that young children were being crippled in huge numbers after receiving the oral polio vaccine –  with 47,000 children crippled and permanently disabled as a direct result of the vaccine.
According to the Washington Post, polio has returned to Europe for the first time in five years – but now in a mutated form that even the mainstream media admits was caused by the vaccine itself. The Washington Postreports:
Polio virus has returned to Europe after a five year reprieve, paralyzing a 4-year-old and 11-year-old in the Ukraine, the World Health Organization said Wednesday.
The strain responsible, vaccine-derived poliovirus type 1 or cVDPV… is a rare, mutated form of the virus that comes from the vaccine itself. Oral polio vaccines contain a weakened form of the virus that activates an immune response in the body so that it builds up antibodies to protect itself. But it takes some time for this to happen, and meanwhile the virus replicates in the intestines and can be excreted by the person immunized and can spread to others in the community.
[…] the vaccine-virus can circulate for long time, 12 months or longer, and genetically change into a more virulent form that can paralyze.
Authorities with the World Health Organization (WHO) are concerned that there is a high risk this mutated strain will continue to spread in and around Ukraine and to its neighbors in Poland, Romania, Slovakia and Hungary near where the incidents occurred.
Other confirmed cases of vaccine-derived polio have been recently reported in India as well as Madagascar and South Sudan. This is a significant problem.
What should be particularly alarming – and upsetting – and telling – is that oral polio vaccines were discontinued in the West more than 15 years ago for the very reason that the WHO and other authorities KNEW it was causing vaccine-derived polio paralysis cases!
They know that this vaccine will – statistically anyway – harm some children and could potentially spawn outbreaks, but they use it anyway, supposedly because less developed regions are not equipped to handle refrigerated vaccines that don’t contain the live virus.
Truthstream Media reported back in 2013:
Perhaps the worst part of this tragic backlash in what is meant to be a campaign to improve public health is that the Bill and Melinda Gates Foundation and the UN’s World Health Organization knew that oral polio vaccines caused paralysis – but they thought the trade off was worth it.
After years of controversy in the United States, the use of oral polio vaccine (OPV) was discontinued in 2000 due to its proven link with vaccine-derived poliovirus (VDPV), and in the UK circa 2004.
The use of an injected and inactivated polio vaccine (IPV) replaced its usage in the Western world, while oral polio vaccine continues to be used in the developing world.
Wikipedia notes that the WHO “considers the benefits of vaccination to far outweigh the risk of vaccine derived polio.”


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Post Polio Litaff, Association A.C _APPLAC Mexico

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