Oct 6, 2018

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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.

Self-management

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.

Medications

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

References

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.
Hilton, L., Hempel, S., Ewing, B. A., Apaydin, E., Xenakis, L., Newberry, S., … Maglione, M. A. (2017). Mindfulness Meditation for Chronic Pain: Systematic Review and Meta-analysis. Annals of Behavioral Medicine51(2), 199–213.
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. http://doi.org/10.1007/978-3-540-79090-7_2(link 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.

Authorship

"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.

Disclaimer

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. http://agerrtc.washington.edu

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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