Blog - Page 4 of 15 - Michigan Spine & Pain

Missing Sleep? How Helpful is Counting Sheep?

Image courtesy of amenclinics.com

For pain patients, sleep is precious. Sleep is a respite from a tough day and allows pain patients to tolerate discomfort. Lack of sleep not only isn’t restorative enough, it also inhibits our abilities to handle pain.

Unfortunately, many pain patients also suffer from insomnia.

What to do?

The traditional answer has always been to literally “count sheep”. This has meant envisioning sheep going by and counting them. The practice probably is a relic from an old shepherding tradition of having to count the herds before bedtime.

But not every old practice works, and apparently, counting sheep actually extends wakefulness.

So, what can help you get to sleep?

A cool room, but not too cold.
Comfortable bedding and pillows.
The optimal amount of noise (white noise if you need it; silence if that is better)
Comfortable proximity to your significant other. Many people like to sleep while in physical contact with their partner. Others like their partner nearby but not touching.
All screens off (and no screen time for several minutes before bedtime.)
Comfortable breathable nightwear (or none at all, if it’s more comfortable).

If these conditions still don’t bring on sleep, instead of counting sheep, which apparently is actually too boring, consider these exercises:

Reading a fairly mundane book–no thrillers, mysteries or bodice-ripping romances. I’m reminded of my friend who was a camp counselor and would read to his campers from his college macroeconomics textbook every night.
Don’t rehash the day or make lists of what you need to do (although these are great things to do as you’re preparing for bed, just not as you’re getting into bed.)
Visualize relaxing settings that you like (a peaceful coastline, a mountain view, a snowy walk, a path in the woods).
Breathe naturally but slowly and deliberately.
You can play some mind games, particularly if they are a little boring. Alphabet games are great because you typically won’t make it to “z”. Think of a place that begins with each letter or a celebrity (first or last name).
Spiritual or prayerful thoughts. If you’ve memorized a few psalms or Bible verses, say them to yourself silently. Think of every person you know and say a silent wish for them.

If you consistently cannot fall asleep (or stay asleep), discuss this with your health care team. You may need to be evaluated by a sleep specialist to rule out sleep apnea and evaluate if you would benefit from a mild nighttime sedative.

Not Just Hot Flashes…Joint Pain During Menopause

Among the many symptoms of menopause, an underlooked one is joint pain.

Women in menopause transition (perimenopause) and actual menopause often have more pervasive complaints: hot flashes and night sweats as well as pain or discomfort during sexual intercourse.

In addition, however, a significant segment of this population also experiences increased pain in joints like ankles and hips as well as back pain. Aches, stiffness and swelling around the joint and sometimes heat are typical symptoms of menopausal joint pain. These may be worse in the morning, improving as the day continues.

Why?

The presence of estrogen protects joints and as estrogen decreases in the body, it can contribute to some of this discomfort.

Prevention and Treatment:

Non-steroid anti-inflammatory medications like ibuprofen and naproxen sodium may provide relief but should be taken as sporadically as possible.
Stress increases all pain experiences, including these pain episodes. Decreasing life stress (sometimes impossible) can improve these pain outbreaks.
Drink enough water. Again, women who wake up in the night and go to the bathroom perceive that they should decrease their water input, but that is not the case.
Get enough sleep. Unfortunately, many menopausal women have interrupted sleep due to night sweating. This subset also became more susceptible to pain. Sleep is restorative, not only psychologically, but allows you to tolerate and even ignore minor pain outbreaks.
Women who exercise more actually had greater complaints about back pain. So, the answer is to change your exercise regimen to stave off back pain. Move away from running on hard surfaces and even treadmill work for a time and add in swimming and yoga and Pilates, at last temporarily.
Maintain an ideal body weight. Extra body weight puts more strain on all your joints. Menopause is a typical age when women gain weight. It is critical to eat nutritional food that doesn’t contribute to weight gain during this time.
Consider a calcium supplement.
Discuss hormone replacement therapy with your health care provider. This should only be considered if your symptoms are severe, as HRT adds a risk of breast cancer for many women.
Massage may provide significant relief to overall body pain.

Talk to us as you traverse the transition into menopause so we can help craft safe solutions to your everyday pain.

Take Me Out to the Ball Game…Without Pain

The snow is a distant memory (we hope!) and sports fields and ballparks are buzzing. If you are heading to see the Tigers or your own child or grandchild play, you can be in for a great treat: time outside, camaraderie and hopefully, adding to the win column.

But, if you suffer from back, neck or hip pain, the ballpark can be a somewhat uncomfortable experience. A few tips to lessen the aches and pains and avoid having a Bleacher Bum. (Bleacher Bums are the fans in the cheap seats, but it’s also the way your tush feels after sitting on the cold metal bleachers.)

Bring a comfortable seat with you to children’s games. You can purchase portable seating that comes with a carrying sack. These seats aren’t perfect, offering insufficient neck support, but they are typically warmer than the bleachers and at least they have back support. If you cannot tolerate carrying the chair, see if you can leave one with the coaches’ equipment or drop it off as close as you can to the seating area.
If you must sit on the bleachers, many bleachers have a top row with a back. These are significantly more comfortable than the unsupported lower seats; you just have to make your way to the top.
Bring blankets and padding. Bleachers are hard and cold. Putting a cushion down really helps a lot, in terms of protecting your lower back and hips as well as keeping your temperature up.
Walk around as often as possible. Don’t wait for the 7th inning stretch. Walk as often as you need to. Stand on your tip toes. Stretch your arms above and to the side. Bend at your waist. Do a few slow squats. Turn your ankles in circles.
Dress in layers. If cool temperatures are a trigger to headaches, bring multiple layers to stay warm. If you suffer from heat flashes, by all means, wear clothing that can be taken off without leaving you uncovered.
Don’t be a martyr. If the weather is inclement, take a break inside or in your car. Your family will forgive you. And if it’s a Tigers game, forget about the ticket price. Your health is more important and more valuable.
Stay hydrated. Soda and beer aren’t good sources of hydration. Only good old water does the trick. It’s especially important for those patients who take prescription medication and diabetics to maintain hydration when outdoors.
Don’t forget to wear sunscreen especially early in the season when we’re out of practice in terms of encounters with bright sunlight. Hats and sunglasses are important, especially if it’s team swag!
Plan ahead for trips to Comerica Park. If you have trouble walking or climbing stairs, consider your parking plans and seat assignments long before the trip. You may have to trade tickets through the box office for more appropriate locations. Pay the extra money for parking that is more convenient and involves less walking and less exposure to extreme temperature (if they are present).

Pregnant and in Pain?

You’re Not Alone. Many pregnant women report a variety of aches and pains that accompany the tremendous body changes that occur during these 40 weeks.

But one pain is always at the top of the list and may be preventable.

60% of pregnant women report that they suffer from back pain. This back pain is a result of the increased curvature of the spine during pregnancy and the added weight that the lower back has to support. In addition, a woman’s center of gravity shifts as her pregnancy progresses.

If your doctor allows it, a gentle regimen of specific exercises can help alleviate and may even prevent back pain during pregnancy.

Exercises that strengthen the back muscles and the abdominal muscles are recommended by the American College of Obstetricians and Gynecologists.

Recommended exercises include:

Cat stretches
Wall sits
Sit-ups
Stationary bicycling
Swimming (highly recommended!)
Walking

Check with your health care team, but most women can do these specific exercises during and after their pregnancy. Certain complications may rule out specific exercises or even any physical activity whatsoever including preeclampsia and placenta previa.

Here is a great resource on recommended exercises released by the American College of Obstetricians and Gynecologists: ACOG report on physical activity and exercise during pregnancy

The first sign of Michigan Spring? Asparagus!

Michigan produce is legendary from its berries to vegetables to its amazing apples.

But the earliest crop to be ready in Michigan year after year is asparagus. Depending on the length and intensity of the winter, the asparagus crop becomes ready in late April or May. This year’s relatively mild winter bodes well for fresh asparagus right about now.

Did you know that Michigan is the #2 producer of asparagus in the country with the majority of the farms in western Michigan? You probably didn’t.

So, what’s so great about asparagus? First of all, ½ cup of asparagus is only 20 calories. It has no fat or cholesterol and is very low in sodium and carbohydrates. But it provides these benefits:

18% of your recommended daily Vitamin A
12% of your recommended daily Vitamin C
5% of your recommended daily iron
2 Grams of fiber

Cook asparagus and serve them as a side dish, topped with a splash of lemon juice and Parmesan cheese, added to salads of all kinds, as a base for chicken dishes or grilled with savory dipping sauces.

From the Pure Michigan website, here is a terrific recipe:

Herb Frittata with Michigan Asparagus and Goat Cheese

Servings : 4
Time : 15 minutes

Ingredients:

6-8 ounces asparagus, trimmed and cut into 2-inch pieces (May also roast, steam or sauté asparagus)
1/4 cup water
3 tablespoons chopped fresh chives
2 tablespoons chopped fresh dill
3/8 teaspoon salt
A pinch of fresh-grated nutmeg (optional)
1/4 teaspoon freshly ground black pepper
7 large eggs, lightly beaten (can substitute with Egg Beaters)
1 teaspoon olive oil
2 ounces soft goat cheese (about 1/4 cup)

Directions

Combine asparagus and 1/4 cup water in a small microwave-safe bowl; cover and microwave at HIGH 2 minutes or until tender. Rinse with cold water; drain. Combine chives, dill, salt, pepper, nutmeg and eggs in a medium bowl; stir with a whisk.
Preheat broiler to high. Heat a small ovenproof nonstick skillet over medium heat. Add oil; swirl to coat. Add asparagus and egg mixture to pan; cook 3 minutes or until eggs are partially set, stirring occasionally. Sprinkle with cheese.
Place pan under broiler. Broil 2 minutes or until eggs are set and top is lightly browned.
Remove pan from oven. Run a spatula around edge and under frittata to loosen from pan; slide frittata onto a plate or cutting board. Cut into 4 wedges.

Treating Ankle Pain: Using all of the Tools Available

Last week’s blog was about the possible causes of ankle pain and how best to diagnose it.

This week, we will discuss ankle pain treatment. Ankle pain can be treated with various modalities: medication, fracture repair and physical therapy are the most commonly-used tools.

Medications for treating ankle pain include:

Nonsteroidal anti-inflammatory drugs (NSAIDS), which can be particularly useful if the underlying condition is arthritis of all forms.
Steroid injections into the affected joint is also utilized for arthritic ankles.
Pain medications like aspirin, ibuprofen and naproxen sodium can be used, with supervision.
Oral steroid medication
Specific arthritis medications

Fracture repair typically means one of the following:

Splinting and/or bracing a broken ankle.
Surgical repair, including the insertion of a metal screw and/or metal plate to fortify a joint that cannot heal on its own. Sometimes ankle fusion is also recommended, although this limits mobility forever, but can be quite effective in lessening chronic pain.
Ankle arthroscopy is a less invasive surgery, where a narrow instrument can be utilized to remove small segments of cartilage or bone chips or even to tie or repair a torn ligament.

Physical Therapy to Combat Ankle Pain is really important. Your ankles bear the weight of your body and their appropriate, relatively pain-free functioning is the key to lifetime mobility.

Typical physical therapy regimens will work to

Strengthen the ankle joint,
Strengthen the muscles that support the functioning of the ankle
Increase the range of motion
Increase flexibility
Decrease pain

Ankle pain can be debilitating. A proper diagnosis of the cause and a multifaceted approach to easing pain including medication, surgical options (as a last resort) and physical therapy can be a very effective combination.

Why Do My Ankles Hurt?

Ankle pain is not unusual. Some people perceive that they have “weak ankles” and are prone to twists and sprains. Others notice a gradual change in their ankle pain and functioning.

The ankle is actually a complex joint between three bones: the tibia, the fibula and the talus with bands of ligaments that connect the bones.

In addition to the bones and the ligaments, several tendons traverse the ankle. The tendons connect the muscles of the lower long to the ankle and foot bones. The most famous of these tendons is the Achilles tendon.

It’s important for your health care team to diagnose the cause of ankle pain accurately. Some typical causes of ankle pain include:

Sprains, which occur when ligaments are overstretched typically as a result of an injury or fall, often a missed step.
Broken ankles: these fractures are actually quite common, again, usually the result of a fall or missed step, sports injury or traumatic event like a car accident.
Rheumatoid arthritis affects the synovium, which lines the joints, causing pain, swelling and immobility. Most people with rheumatoid arthritis have ankle issues.
Osteoarthritis, which contributes to a deterioration of the cartilage in the joints. As this cartilage wears away, the bones rub against one another, and can cause pain, swelling and immobility.
Gout is another type of arthritis which can affect the joints and is caused by a buildup of uric acid throughout the joints of the body.
Lupus, an autoimmune disease, often affects many joints, Although many forms of arthritis and related conditions can affect the ankles, the most common cause of ankle pain is a sprain. A sprain occurs when the ligaments that support the ankle become stretched or torn. Here is what you need to know about sprained ankles and some other common ankle injuries.

Your health care team will evaluate your pain, your mobility and the circumstances that surrounded your ankle issues. They will then order a series of exams including x-rays and perhaps other diagnostic tools to determine their next steps. It is very important for a physician to distinguish between sprains and fractures of ankles because they often present themselves in a similar fashion.

Next week: Recovery from ankle pain

Treating Pain after the Surgery

Undergoing surgery is the ultimate stressful lifetime event. The physical battering, combined with the time spent in the unfamiliar environment of the hospital and the worrying before the procedure easily ratchet up a person’s stress level.

But the surgery is just the beginning. As soon as the stitches are tied and the patient is returned to the room, recovery begins.

For many patients, the road to recovery is not a smooth one, made rougher by post-surgical pain.

The American Pain Society has recently published its own set of clinical practice guidelines, to be used for treatment of post-surgical pain control. The publication’s lead author was Dr. Roger Chou.

Post-surgical pain management faces a few obstacles including communication issues regarding the patient’s perceived severity of pain and the physician’s understanding of the pain levels, staffing issues in recovery settings which can impede proper monitoring of pain levels, and the use of opioids in the general population. Opioid users often develop a strong tolerance to pain medication and are not as responsive as other members of the public to a typical pain regimen.

The guidelines divide their recommendations based upon evidence. They list recommendations which are backed by high quality of evidence, those that are backed by moderate evidence and those that have weak evidentiary underpinnings (but may have anecdotal evidence.)

Among the strong evidence recommendations are the use of acetaminophen (Tylenol) as well as other non-steroidal anti-inflammatory medications for pain relief for nearly all patients as well as site-specific pain treatment (local anesthesia). The study also recommends that every hospital and surgery center retain a qualified pain specialist on staff. The study also deals with the administration of pain medications, including opioids, recommending that they be given orally and not intravenously, if possible. Furthermore, the study recommends that all patients be individually counseled regarding pain relief during recovery, taking into account their current use of all pain-relief medications and procedures.

Surgery is already tough enough. It’s important for health care teams to be “on the cutting edge” of post-surgical recovery and pain abatement.

It’s Back to Walk Time in Michigan

When was the last time you had to shovel your front porch or scrape the ice off of your car? If it’s been more than a few weeks, then spring may actually be here in Michigan. It’s true that April snowshowers happen, too. But odds are that it is warm enough and the sidewalks and roads are clear enough that you can get back to walk.

If you’re a regular walker, you don’t need much preparation. Just lace up the shoes and get out there. But, if there’s a permanent dent on your couch since the fall, you might need to baby yourself before embarking on a walking program.

Here are some tips to get you on the road:

Try on your shoes. If you’ve lost weight or gained weight, the fit might not be right. Walk with them in the house for a while and determine if they are comfortable and in good enough shape.
Set the mood for your walk. If you need a partner, find one. If you prefer meditative walking, pick a time to walk when you won’t be bothered by landscapers, children, or lots of obstacles in your path. If you need music to motivate you, get your playlist ready. Or maybe you like podcasts or audio books.
Get your gear on. Do check the temperature and wind before you leave. It’s better to wear layers in order to stay warm and strip them off if you become overheated. If the temperature is below 40 degrees, starting off with a hat and gloves will be more comfortable, but you may want to take them off later. Wear sunscreen, sunglasses and even a hat.
Stretch and move before you walk. No more static stretches where you stay in one position and hold it before you walk; the latest science says that you just need to increase your range of motion and get your blood flowing for five minutes before exercising in earnest. This can be accomplished through toe touches, twists, arm circles, jumping jacks (which can be one-legged if the traditional kind is too taxing) and a boxer shuffle.
Hit the road. Walking is great. We all know how to do it and we have mastered it for a long time. Find a route that is safe and interesting. If you have no stamina, walk for 10 minutes and then turn around and go back. If this is your only exercise, try to work up to 30 minutes of walking per day.
Stay hydrated. Drink a bit before your walk, drink if you need to during your walk and drink again when you return.
Cool down. If your walk is vigorous, then walk at a slower pace before you stop exercising altogether. After your walk, you can do some of those static stretches including hamstring stretches and quadriceps stretches.
Evaluate, recalibrate and go back out again. Reflect on your walk. What was good? Did you think you wanted to be alone but then you were uneasy? Did you pick a road that had poor sidewalk conditions? Do the dogs on the corner annoy you? Change what didn’t work and hit the road the next time with the changes in mind.

Walking is America’s most favorite exercise. It’s easy, it’s cheap and requires no equipment. Walking is of great benefit for many conditions that cause pain. We encourage all of our patients to hit the road.

The Sleep-Pain Paradox

It’s a problem.

People who suffer pain need restorative sleep, more than the general population. Yet, people in pain tend not to get enough restorative sleep. The 2015 Sleep Poll conducted by the National Sleep Foundation says that 23% of chronic pain sufferers say they have been diagnosed with a sleep disorder.

It’s important for pain sufferers to take control of their sleep as if it were a high priority project. Pain sufferers need sleep in order to function in their already somewhat compromised state. So, here are some reminders:

Try to sleep for at least eight hours per night, not too much more and not too much less. If it takes you a long time to fall asleep, you need to create a sleep schedule that gets you into bed for more than eight hours to allow for that extra “sleep prep” time.
Regarding too much sleep: it is a real thing. Pain sufferers benefit greatly from daily physical activity and too much bedrest contributes to poor circulation, weight control issues, and even more pain.
Some people find naps restorative. If you must take a nap, limit the nap to 30 minutes. Make sure your nap is at least six hours prior to your scheduled bedtime.
In addition to scheduling your sleep, schedule your physical activity with a goal of 30 minutes of stretching, cardiovascular or weight-bearing exercises daily. Avoid exercising just before bedtime.
All days are equal. You need to have a sleep routine on Tuesday night and on Saturday night that allows for eight hours of sleep. Weekends are a great opportunity to catch up on sleep, but overdoing socializing or overscheduling is a missed opportunity. In addition, oversleeping is a mistake, too.
Eat dinner at least two to three hours before bedtime.
If caffeine affects your sleep, avoid it after 12:00 noon. If you can, wean yourself from caffeine altogether.
Avoid alcohol use or limit your intake to one drink in the evening.
Remove all screens from the bedroom. From the TV to your smartphone, the temptation is too great to keep watching, keep reading or keep texting. Better to read in bed or do crosswords than have a screen to stimulate your brain and visual cortex and prevent deep sleep.
See a sleep specialist if you consistently cannot obtain restorative sleep to rule out sleep apnea and other sleep disturbances.

Getting enough sleep is as important as pain treatment. It is a lifestyle decision that only you can control.

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