Back pain is one of the leading causes of disability in the United States. Whether caused by injury, defects of the spine, or a degenerative disease, the pain can make even the most routine tasks seem like a massive effort.
Sciatica, especially, has the ability to stop you dead in your tracks. The gripping, intense pain that it brings is not easily relieved, often causing frustration, anxiety, and dismay. Herniated discs are often the cause of sciatica, so it’s fair to say that the two go hand in hand.
What is sciatic nerve pain?
Sciatic nerve pain, also known as sciatica, is pain associated with the sciatic nerve. When the nerve is compressed, pinched, or trapped, it can cause intense, even excruciating pain that radiates down the leg, sometimes all the way to your feet.
The pain can be sharp and stabbing, but it is also characterized by numbness and tingling that radiates down the back of one or both legs. For some, sciatic spasms can be so intense that it is impossible to think about anything else.
Causes of sciatica
We all have two sciatic nerves, one on either side of our body. These nerves start in the spine and extend down the leg. When there is a herniated disc present, it may compress the nerve and cause it to flare. However, there are several other possible causes of sciatica.
Sciatica can also be caused by an inflamed piriformis muscle, which runs directly over the sciatic nerve at the bottom of your buttocks. If this muscle is overworked or stiff, it can compress the sciatic nerve, causing intense pain. If this is the cause of the sciatica, stretching the piriformis muscle may give you relief. In severe cases, a steroid injection may reduce the inflammation enough to release the nerve.
Spinal stenosis is a narrowing of the spinal canal, which is essentially a conduit for your nerves and spinal cord. This narrowing may put pressure on the sciatic nerve and cause it to flare up. Stenosis is something you can be born with, but it can also develop later in life. It is most common in adults over the age of 60. There is no cure for stenosis, but anti-inflammatory medications may help if there are symptoms present.
Herniated discs are hands-down the most common cause of sciatic nerve pain. Positioned in between each vertebra, the discs in your spine can best be described as cushions. As we age, they tend to degenerate, but other things can cause them to bulge, such as injury, or being overweight. If a disc herniates, bulges, or slips out from between the vertebrae, this may cause it to press on the sciatic nerve. Depending on the disc that is affected, the pain may manifest itself in various places, including the lower back, the hip, the side and back of the leg, the calf, or the foot.
Spinal disc herniation
Treatment for herniated discs and sciatica largely depends on the severity of the situation and can range from stretching exercises to orthopedic or neurosurgery.
Exercise is the first line of defense, focusing on strengthening the core muscles and releasing the piriformis.
NSAIDs can sometimes help, as can steroid injections and medications for nerve pain, such as pregabalin. In any case, it is essentials to obtain an accurate diagnosis before committing to a course of treatment.
Many people who struggle with chronic pain will experience a dramatic increase in their pain from time to time. This is what we refer to as breakthrough pain or, more simply put, a flareup.
The intensity and duration of the pain during each episode may vary, but when it happens, it can cause a significant amount of disruption to your life, forcing you to cancel plans, miss work, or decrease activity until the pain subsides.
What causes flareups?
Many things can cause flareups, and the circumstances vary from person to person, making it challenging to offer a “blanket” solution that works for everybody.
Knowing the triggers that lead to a flareup may help you avoid them, but again, these are different for each individual. For this reason, it is important to be mindful and to make at least a mental note of your activity, what is going on around you, and what you are eating and drinking right before the flareup happens.
Overwork or overactivity, stress, injury, and fatigue are just a few of the triggers that may lead to an increase in pain. Sleeping poorly, cold or damp weather can also be at the root of the problem, as can inflammation-causing food and drink, medication, or environmental factors.
For some, simple tasks like getting dressed, coughing, going to the bathroom, or exercising can cause a flareup. Sometimes, however, there may not be any discernable reason at all.
If you are taking a long-acting opioid or another type of long-acting pain medication, you may experience a flareup if the medicine stops working in between doses. According to the National Pain Institute,
Listening to your body, being cognizant of your surroundings, and being willing to do what it takes to mitigate the situation is critical.
How to avoid pain flareups
There are many effective techniques to help you manage your pain and prevent flareups. One of the most significant is pacing.
Pacing and goal setting are frontline strategies in chronic pain self-management. Pacing involves breaking down your daily activities into smaller, more manageable chunks. The philosophy is such that once you know how long it takes to start feeling pain from a particular task, you should decrease the time you are engaged in that activity by at least 20 percent.
For instance, at work, you may want to take “mini-breaks” every 20 minutes or so, just to give yourself time to reset, change positions, walk around a bit, get a change of scenery, drink a glass of water, or have a stretch. Some people find it useful to set a timer on their smartphones or computers to remind them.
When your flareup is active
When you experience a flareup, your best strategy is to address the symptoms immediately.
- Stop doing the activity that is causing you pain.
- If you have been prescribed medication for breakthrough pain, take it right away.
- Apply ice, take some ibuprofen or naproxen.
- Do not stay inactive for too long: get up, stretch, and move around if you can.
- Practice deep breathing, mindfulness, and relaxation techniques.
- Don’t panic – this will make the pain worse.
Always remember – flareups will pass. Learning strategies like pacing and goal-setting will help to lessen their frequency.
Do these four things to get a better night’s rest
Chronic pain has the potential to disrupt your life in a multitude of ways. Lifestyle changes are necessary to mitigate pain, and it is recommended that you always get plenty of sleep.
It’s a vicious cycle. Chronic pain, poor sleep, and depression do a good job of feeding each other. Some studies show that sleep deprivation can actually lead to depression and chronic pain, and the same is true in reverse, with chronic pain leading to depression and poor sleep.
Whether you have difficulty getting to sleep or sleeping through the night, the exhaustion may have a significant impact on your ability to cope with even the most mundane day-to-day tasks.
If chronic pain is disrupting your sleep, here are four things you do today (and tonight) that are sure to help:
Chronic pain sleep tip #1: Reduce or eliminate caffeine and alcohol intake
Consuming caffeine or alcohol at any time of the day changes your physiology, but at night, they can have a devastating impact on your sleep patterns. If you must consume caffeine, stick to having it in the mornings, and never past three in the afternoon. Be aware of foods and drinks with “hidden” caffeine, too, such as cola drinks, white, black, or green tea, anything with chocolate, anything coffee-flavored, aspirin, protein bars, energy supplements, candy, and even decaffeinated coffee.
As for alcohol, even the kinds that are not sweet will turn to sugar in your system, spiking your blood sugar, and disrupting your sleep cycle. You may initially feel sleepy, but chances are you’ll wake up in the middle of the night and not be able to get back to sleep.
Chronic pain sleep tip #2: Avoid napping in the afternoon
While it may be challenging to avoid napping altogether, try to limit your daytime naps to no more than 30 minutes at a time.
Chronic pain sleep tip #3: Make your bedroom a sleep-only zone
Studies have proven that screen time, either on your phone, the computer, or the television, is highly disruptive to normal sleep patterns. Shut everything down at least 30 minutes before bedtime to ensure your brain is relaxed.
Additionally, if you can’t sleep, don’t lie there in bed, tossing and turning. Get up, sit in the living room and read a book, meditate, or take a warm, soothing bath.
Chronic pain sleep tip #4: Cognitive Behavioral Therapy (CBT) or Biofeedback
There are several very effective behavioral therapies, like CBT and biofeedback, that have helped to address sleep issues for people with chronic pain. CBT, in particular, can help you identify thoughts and behaviors that interfere with sleep and may help you cope with depression and chronic pain as well.
A word about sleep medications
Medications can be prescribed to help you sleep, but often they are recommended only for use on an “as needed” basis, and some may disrupt your sleep patterns if taken too much or on a continual basis. Speak to your doctor about your options but focus on sustainable behavioral modifications for long-term success.
Is chronic pain disrupting your sleep? We can help. Reach out today to get started.
Back in 2016, the Centers for Disease Control and Prevention (CDC) issued new guidelines for opioid prescribing. Aimed at mitigating risk, the recommendations sought to lessen the volumes of opioid prescriptions, thus reducing the incidence of opioid-related overdose and death.
With more than 115 deaths attributable to opioid overdose every single day, something had to give. However, the response has left many people wondering just how far things have to go before the remedy becomes more deadly than the underlying cause.
Though the guidelines were meant for doctors, they have influenced state regulators, disability administrators, and insurers, prompting them to start making some pretty tough across-the-board decisions that have had a significant impact on a very vulnerable population.
Many people who suffer from chronic pain and other debilitating conditions have since been denied access to these medications, and in some cases, this means losing the ability to cope with the daily tasks of living that most of us take for granted.
In one example, a man who had worked 25 years for GM was forced to retire early because of a back injury. His surgery failed—a not-uncommon occurrence—and subsequent therapies only worked for a short time or not at all. The pain medication he was prescribed worked consistently, allowing him to lead a relatively normal life, but a judge who was reviewing his workers’ compensation disability case decided that his medications should be reduced to an extreme degree.
Now barely able to walk or leave his home because of his reduced mobility and pain, this man’s life as an independent human being is in peril. His doctors, fearing that they will lose their license or ability to prescribe, will not intervene.
Unfortunately, his story is not unique.
“What we meant to say is …”
In June of 2019, the CDC clarified its position on opioid prescribing, recognizing that some physicians had misinterpreted the guidelines and had taken the recommendations too far. They iterated that patients undergoing cancer treatments or having pain following surgery should not be affected by the 2016 guidelines because such conditions fell outside the scope of the report.
They said that if doctors were to set hard limits on opioid prescribing that they were not applying the guidelines as they were intended. These guidelines, they stated, were meant to focus on primary care physicians who were treating patients with chronic pain.
So, what were their recommendations? It was suggested that:
- Doctors should prescribe the lowest possible dosage of pain medication in every situation.
- Avoid prescribing more than the equivalent of 90 “morphine equivalent units” per day.
- If the dose was raised to that level, the rationale must be “carefully justified.”
- Patients at or above that dose should be continued if deemed necessary.
- Doctors should avoid abrupt tapering or discontinuation to prevent pain and psychological distress.
They also allowed as how hard-and-fast policies conflict with the ability to provide individualized assessments of the benefits and risks, given the specific circumstances of each patient.
Doctors sanctioned, patients at risk
Following the release of the 2016 report, many doctors were disciplined. Clinics and practices were forced to close, leaving a large number of pain sufferers out of options.
Though the guidelines have been revised, it has not helped those doctors who faced action during the crackdown. Some have even served jail time, arguably, just for doing their job.
The general consensus is that there is a lack of innovation in pain medication, and methods do not exist that will accurately quantify pain. This is a significant barrier in bringing new solutions to the table, and there is still a lot at stake.
Chronic pain is not a crime
While doctors have been let off the hook following the CDC’s 2019 review, chronic pain patients continue to feel the pinch.
When state regulators make decisions that affect how doctors can proceed, there is a ripple effect that is driving more profound disabilities in some chronic pain patients.
For instance, if an individual who suffers from chronic pain is on disability or workers compensation, they are subject to the decisions of an adjudicator. For non-acute pain, it is easy for such decision-makers to conclude that a long-standing prescription is no longer necessary because there has been little or no improvement in the patient’s condition.
Weighing the risks against the benefits, the conclusion is often that the medication should be drastically reduced, resulting in reduced mobility, increased pain, and ultimately, a significant decrease in the quality of life.
The state’s role in the war on pain
Across the nation, 33 states have responded to the opioid crisis by passing laws that limit opioid prescribing. In some cases, this means that doctors are limited to a three-day, five-day, or a seven-day supply. In Florida, physicians are required to register their practice as a “chronic pain clinic” to be able to prescribe more than a three-day supply of opioids.
Though the federal guidelines have been revised, doctors continue to fear disciplinary action at the state level, and many will refuse to treat or will drop patients with chronic pain; patients who now crowd the lobbies of pain clinics looking for relief.
Why adequate pain management matters
It is impossible to generalize chronic pain. Each patient’s experience is vastly different from the next, and if doctors aren’t part of the solution, they are part of the problem.
New approaches often delay adequate pain management, but they are aimed at developing a better understanding of what works well for the individual patient as opposed to applying a standardized solution. In other words, pain doctors are taking a more comprehensive and systematic approach, trying alternative therapies like physical therapy, acupuncture, injections, cognitive behavioral therapy (CBT), and psychological counseling to shape the course of ongoing treatment.
Reducing the risk
When patients can self-manage their pain, either through behavioral modification, pacing, modified activities, or a combination of several modalities, it eases the burden, both on the medical system, and on the patient’s own health and potential for optimized wellbeing.
If pain can be managed in ways that either do not include opioids or if a combination of therapies result in decreased reliance on opioids, the risk to the patient is reduced, as is the potential for dependence and abuse.
The ultimate goal, no matter what treatments are prescribed, is to improve the patient’s quality of life, to support their independence, and help them maintain their productivity. In many cases, if their pain is well-managed, these patients won’t be forced to give up their jobs or the things they love to do. It helps them stay off of benefits and continue as a contributing member of society, and even if they do experience pain episodes that prompt them to intervene with opioid pain medications, the reliance on them is significantly reduced.
Many doctors, however, still need to be educated about pain and addiction. While most stakeholders can agree that regulators had to do something to address the opioid crisis—deemed the biggest public health crisis in history—a balance still needs to be struck between over and under-prescribing. At its core are a lot of good people in unfortunate circumstances, and they deserve a chance to live life to its fullest, just as much as anybody else.
If you have a sensitive nervous system, it means that you are more responsive than the average person to triggers in your environment – and this, in itself, is a broad topic.
Nervous system triggers could be anything from the fabric of the clothes you are wearing to something that somebody says to you in passing. It could be an uncomfortable situation you find yourself in, an incident that startles you, or any other occurrence that activates a response.
Fight or flight?
Our inherent “fight-or-flight” response is normal. It warns us of imminent danger, helping to guide our decisions on what to do about it. For a more sensitive individual, however, taking action may be difficult as we don’t want to upset the status quo, even if we know it is going to make us uncomfortable.
If you feel overwhelmed by your surroundings, you may have a sensitive nervous system.
Here are ten signs that you may have a sensitive nervous system:
1. You need to be in a calm environment all the time
Seeking out a peaceful, tranquil, and controlled environment is often used as a method to deal with sensitivity issues. If you find yourself unable to cope without the comfort of this tranquility, this may be a sign of hypersensitivity.
2. You scare easily and become overly upset if startled
When people sneak up on you or otherwise startle you, you completely lose your composure.
3. You have a difficult time staying asleep
Tossing and turning in bed and not being able to stay asleep because you are mulling over conversations or the events of the day.
4. All of your senses are heightened
In the hyper-sensitive individual, any stimulus can be an energy drain. Excessive noise, intense smells, bright colors, extreme heat, or cold – all of these things can potentially cause you stress.
5. You feel overwhelmed a lot
You may feel overwhelmed by even the most mundane day-to-day issues, like going to the bank or meeting up with coworkers after hours.
6. You do not handle stress well
Everybody deals with stress in their own way. However, a person with a sensitivity disorder may amplify these issues beyond what is necessary to process it.
7. You don’t do well in crowds
Crowded places, like the mall, city streets, concerts, or even meetings at work, may be a trigger for sensitivity issues.
8. You feel uncomfortable around strangers
You may find yourself avoiding situations where you will have to interact with people you don’t know.
9. You feel things more intensely than others
You find yourself overly emotional to the point of crying, becoming fearful, or angry, and it happens more often than not.
10. Hypersensitivity to physical stimuli (sound, smell, touch)
Any stimuli can elicit an emotional response. It’s when these responses get in the way of enjoying life that you should be concerned.