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24/Oct/2023

You know what it’s like. It’s 3.00am and you’ve just woken up. Again. You glance at your clock and do the maths – only 4 hours until it’s time to get up. This is really taking a toll on you – your mood, your performance at work, and your pain levels.

So what can you do?

  1. Avoid using technology in bed. The blue light from laptops, tablets and smartphones suppresses the hormone melatonin, which makes us sleepy at night. So be sure to stop screen use at least one hour before bed.
  2. Get out of bed. Don’t lie in bed tossing and turning. Have a warm drink (e.g. milk, no caffeine), do some gentle stretches or breathing exercises and go back to bed when you feel more comfortable.
  3. Develop a sleep routine. There’s a reason we do this with babies and small children – it works! As often as possible, go to bed and get up at the same time each day. Your body will become used to this routine and you’ll find it’s easier to fall asleep and stay asleep.
  4. Don’t look at the clock. Constantly checking the time can make you anxious, which makes it hard to sleep. Try removing your clock from the bedside, or cover it up at night.
  5. Try some relaxation techniques. There are as many ways to relax as there are stars in the night sky (well, almost) so there’s bound to be something that suits you. Consider trying mindfulness, visualisation, deep breathing or a warm bath before bed. These techniques will help you become more relaxed and may help you manage your pain better so that when you go to sleep, you sleep well.
  6. Be active during the day. As well as the many other benefits of regular exercise, it’ll help you fall asleep and stay asleep longer.
  7. Seek help. If pain is constantly keeping you awake at night, talk with your doctor about other things you can do to manage your pain and get some decent sleep.

And check out our A-Z guide to managing pain. It’s full of tips and strategies to help you manage your pain.

First written and published by Lisa Bywaters in June 2018

 


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24/Oct/2023

Medicinal cannabis and you

Marijuana, dope, pot, grass, weed, Mary Jane, doobie, bud, ganja, hashish, hash, wacky tobaccy…they’re just some of the common names for cannabis.

Whatever you call it, it’s been used for medicinal purposes for thousands of years, until it became a banned or controlled substance in most parts of the world.

But for decades there’s been renewed interest in its use in healthcare, with many countries – including Australia in 2016 – decriminalising it for medicinal use.

Last year alone the Therapeutic Goods Administration (TGA) granted over 25,000 applications from doctors to prescribe cannabis, mostly in the form of an oil.

So let’s weed out some of the facts and explore the use of medicinal cannabis for pain and musculoskeletal conditions.

Is it marijuana or cannabis?

It’s both. They’re just different names for the same plant – marijuana is the commonly used name, cannabis is the scientific name. The preferred name for its use in healthcare is medicinal cannabis, to draw the distinction between medicinal use of cannabis and the illegal, recreational use of marijuana.

The tongue twisters – cannabinoids

It’s a tough word to say – far harder than musculoskeletal! – but an important one when we talk about the properties of cannabis. Cannabinoids are the chemicals found in the cannabis plant. They bind onto specific receptors (CB1 and CB2) on the outside of our cells and can affect things like our mood, appetite, memory and pain sensation.

Cannabis has more than 140 cannabinoids. The two major ones are tetrahydrocannabinol (THC) and cannabidiol (CBD). THC is the cannabinoid linked with the sensation of feeling ‘high’ that’s associated with recreational marijuana use.

Cannabinoids also occur naturally in our body (endocannabinoids) and can also be created artificially (synthetic cannabinoids).

How’s it taken?

Medicinal cannabis, both plant-based and synthetic, comes in many forms including oils, capsules, oral sprays and vapours. Smoking isn’t an approved preparation as it can cause damage to the lungs and airways.

Does it work?

At the moment, evidence for its use to treat pain associated with arthritis and musculoskeletal conditions is lacking.

Cannabis has been illegal for so long that we don’t have the thorough, scientific evidence we need about: side effects, which cannabinoids (e.g. THC, CBD or a combination) may be effective, dosages, the best form to use (e.g. oil, capsules etc), the long-term effects, or the health conditions or symptoms it may be beneficial for. Research is emerging, but we need a lot more.

Because of this lack of research, the Australian Rheumatology Association doesn’t support the use of medicinal cannabis for musculoskeletal conditions. Their concern is that we don’t have enough info to ensure cannabis is safe and effective for people with musculoskeletal conditions.

The Therapeutic Goods Administration (TGA) has also stated that there’s “not enough information to tell whether medicinal cannabis is effective in treating pain associated with arthritis and fibromyalgia”.

Possible side effects

As with any medication – and medicinal cannabis is a medication – it can have side effects. They include: dizziness, confusion, changes in appetite, problems with balance and difficulties concentrating or thinking.

The extent of side effects can vary between people and with the type of medicinal cannabis product being used.

How do I access it?

Unfortunately it’s a complicated process. We aren’t at the stage where a doctor can just write a prescription that you can fill at any chemist. Medicinal cannabis is an unregistered medicine, which means your doctor must be an Authorised Prescriber or must apply for you to have access to it through the TGA’s Special Access Scheme.

But if it’s something you’d like to try, talk with your doctor about whether it’s a possible option for you. Together you can weigh up the risks and benefits for your specific situation.

You need to be aware that medicinal cannabis is not on the Pharmaceutical Benefits Scheme (PBS), so if you can access it, you’ll likely have to pay significant costs.

Another option for gaining access to medicinal cannabis is to consult a doctor at a specialised cannabis clinic. This also comes at a price, however it may be an option if your doctor isn’t an authorised prescriber or they’re not well-informed in the use and prescribing of medicinal cannabis.

Driving and medicinal cannabis

If you’re using medicinal cannabis it’s important that you know exactly what’s in it. If you’re taking a product that you’ve obtained through legal prescribers that only contains CBD, you can drive. However if you’re using a product that has any THC in it, whether on its own or in combination with CBD, you can’t drive. It’s currently a criminal offence to drive with any THC in your system.

Talk with your doctor and/or pharmacist for more information.

Interactions with other medications

As with any substance you ingest, there’s the potential for medicinal cannabis to interact with other medications and supplements you’re taking. So before prescribing medicinal cannabis, your doctor will review your current medications to reduce the risk of any negative effects.

However if while using medicinal cannabis you experience any unusual symptoms, discuss these with your doctor.

Finally

For many people the use of medicinal cannabis could be a long way off. And unlike the way it’s often portrayed in the media, it’s unlikely to be a panacea or magic bullet that will cure all ills.

It also won’t work in isolation – you’ll still need to do all of the other things you do to manage your condition and pain, including exercise, managing your weight, mindfulness, managing stress, pacing etc.

The important thing is to be as educated as you can and be open in your discussions with your doctor.

And be aware that cannabis for non-medicinal purposes is still illegal in Australia.

First written and published by Lisa Bywaters, Dec 2020.

For more detailed information about medical cannabis in Australia watch our webinar

Medicinal cannabis in Australia: Weeding out the facts 
Dr Richard di Natale, outgoing Senator and former leader of the Australian Greens, and Prof Iain McGregor, Lambert Initiative for Cannabinoid Therapeutics, University of Sydney discuss the use of medicinal cannabis in Australia – what it is, available forms, access issues in Australia and the current evidence for use.

Call our Help Line

If you have questions about things like managing your pain, your musculoskeletal condition, treatment options, COVID-19, telehealth, or accessing services be sure to call our nurses. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

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04/Oct/2023

If you’ve been experiencing persistent joint or muscle pain, stiffness and/or inflammation that you can’t explain (e.g. from a fall or strenuous physical activity), you should discuss your symptoms with your general practitioner (GP).

Many conditions can cause these symptoms, so to work out what’s causing your symptoms, your GP will:

  • Take your medical history. They’ll ask you about your symptoms, when they started, how they affect you, your family medical history and other health issues you may have.
  • Do a physical examination. They’ll look for redness and swelling in and around the joint and test your joint’s range of movement. They may also look for rashes, check your eyes and throat, and take your temperature.
  • Order scans and other tests. Depending on the condition your GP thinks you might have, they may send you for tests to check for levels of inflammation in your blood or specific genetic markers. You may also have scans such as x-rays, ultrasound or CT (computed tomography) to get a clearer picture of what’s happening inside your body.

When your GP has gathered all of this information, they may refer you to a rheumatologist.

Rheumatologists are doctors who specialise in diagnosing and treating problems with joints, muscles, bones and the immune system. You need a referral from your GP to see a rheumatologist, whether they’re in private practice or a public hospital outpatient clinic.

Your GP may refer you to a rheumatologist if:

  • they think you have, or they’ve diagnosed you with, an inflammatory type of arthritis such as rheumatoid arthritis or ankylosing spondylitis, so that treatment can be started as soon as possible
  • your symptoms improve with treatment but come back when you stop taking medicine
  • your symptoms don’t respond to treatment or get worse over time
  • you develop unexpected complications, such as a fever, rash, or fatigue
  • you have unusual test results.

Preparing for your first consultation

When you make an appointment to see a rheumatologist, you should ask them some questions so that you’re prepared. This may include:

  • What do I need to bring with me?
  • How much will my out-of-pocket expenses be?
  • How long will my appointment be?
  • Is there parking available, or accessible public transport?

Armed with this information, you can be proactive and prepare for your consultation.

It can be helpful to make notes about your symptoms – when you first noticed they appeared, how they affect you day-to-day – as well as other health conditions you have, medicines or supplements you take regularly and information about your family medical history.

It’s also helpful to write down questions you want to ask your rheumatologist. Put them in order of the most important first, in case you don’t get through your entire list.

Your consultation

Seeing a specialist can sometimes be overwhelming, especially if you’re feeling unwell or anxious. There can also be a lot of information to absorb. That’s why it can be helpful to bring a family member or a friend to your appointment. They can provide emotional support, help you ask questions or write down any important information. They can also be a second set of ears to hear what the specialist says and help you recall this information later. It can be hard to remember everything, especially when you’re feeling anxious.

Wear comfortable clothing that can be easily adjusted or removed if necessary, so that the rheumatologist can examine you.

And don’t forget your referral, x-rays, scans and other test results, your list of questions and any other bits and pieces you were asked to bring!

Your first consultation with your rheumatologist will be more thorough than your consultation with your GP. They’ll:

  • review your medical history
  • ask lots of questions about your symptoms, such as when you’re most stiff or sore, and how long you’ve had pain and symptoms
  • do a comprehensive examination of your joints, including counting the number of tender and swollen joints
  • refer you for further blood tests and imaging if required.

It’s important to know that there are many different types of musculoskeletal conditions, and many have similar symptoms. So it can take time to get a diagnosis. Your rheumatologist may provide you with a prescription for medicines and suggest some self-care options that you can do while you wait for your diagnosis.

Follow-up consultations

Once your diagnosis has been made, your rheumatologist will provide you with information about your condition and a treatment plan.

Your treatment plan will fit your specific symptoms, needs and preferences. However, it will usually involve a combination of:

Depending on your diagnosis, you may need regular consultations with your rheumatologist.

How often they occur will depend on your condition, how well it’s responding to treatment and the medicines you’re taking, as some specialised medicines can only be prescribed by a rheumatologist. Some people see a rheumatologist regularly, while others are mainly treated by their GP, with the rheumatologist on hand for specialist advice. Some consultations with a rheumatologist may be done via telehealth.

Follow-up consultations are generally shorter than your initial one. Your rheumatologist will talk with you about how you’ve been doing since you began treatment. They’ll assess how well you’re responding to treatment and if you need to change your medicines or add additional ones. They’ll also do a physical exam and order any further blood tests or imaging if required.

Your rheumatologist will also talk with you about your self-care and other things you can do to manage your condition.

It’s important to take an active role in these consultations. Ask questions, and if you don’t understand the answers, ask them to explain further or for more information. Talk with your rheumatologist about your goals for treatment – they may be things like reducing pain and fatigue, but also more personal goals such as getting back to playing golf regularly or planning an overseas trip. Together you can ensure your treatment plan supports your goals.

Ongoing care

The aim of treatment for musculoskeletal conditions is low or no disease activity. This is called remission. It doesn’t mean your condition has been cured, but your treatments keep it under control.

With the significant advancements we’ve had in medicines in the past few decades and targeted treatments for many types of musculoskeletal conditions, achieving remission can be a real possibility.

If you achieve remission, your rheumatologist may reduce the dosage and/or frequency of the medicines you’re taking. They’ll monitor you to see how you’re doing and make changes as required. And you won’t need to see them as often.

If you haven’t achieved remission, the aim will be to control your condition and its effects on your body and life as much as possible. This will determine how often you need to see your rheumatologist in the future.

Costs

The cost to see a rheumatologist varies. Part of the cost is subsidised by Medicare, but there is usually a gap payment that you’ll need to make. When making an appointment, ask about out-of-pocket costs.

If you have a Medicare card, you may be able to attend a rheumatology clinic at a public hospital if you cannot afford out-of-pocket expenses to see a rheumatologist privately. Talk with your GP about your options.

Contact our free national Help Line

Call our nurses if you have questions about managing your painmusculoskeletal condition, treatment options, mental health issues, COVID-19, telehealth, or accessing services. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

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First written and published by Lisa Bywaters in May, 2022.


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04/Oct/2023

We talk about inflammation a lot. But what is it? What’s happening in your body when you have inflammation?

Acute and chronic inflammation

There are two types of inflammation – acute and chronic.

Acute inflammation

Acute inflammation is your body’s reaction to things such as an infection (e.g. a cold or infected wound) or an injury (e.g. a sprained ankle or bee sting).

Symptoms associated with acute inflammation are:

  • pain
  • redness
  • swelling
  • heat
  • loss of function (e.g. difficulty moving a swollen ankle after spraining it or difficulty breathing through your nose when you have a cold).

What’s happening in your body with acute inflammation?

When you sprain your ankle, or get an infection, your immune system automatically springs into action.

Cells close to the source of the injury or infection release chemicals known as inflammatory mediators (e.g. histamine). They increase blood flow to the area, widening blood vessels and allowing more blood to reach the injured tissue. As a result, the area becomes red and feels hot.

The extra blood to the area enables more immune cells to reach the injured tissue. This includes white blood cells, or leukocytes, whose role it is to defend your body against infections and disease and start the healing process.

Depending on the cause, acute inflammation can occur quickly and generally goes away quickly.

Chronic inflammation

Chronic inflammation is persistent, low-level inflammation that lasts for months or years. With chronic inflammation, the inflammatory process often begins when there’s no injury or illness present; and it doesn’t end when it should. When this happens, white blood cells may target and damage nearby healthy tissues and organs.

We don’t really know why chronic inflammation occurs. It doesn’t seem to serve a protective purpose as acute inflammation does.

However researchers have identified factors that increase your risk of developing chronic inflammation, including:

  • chronic infections
  • physical inactivity
  • poor diet
  • obesity
  • imbalance of gut bacteria
  • disturbed sleep
  • smoking
  • stress
  • ageing.

Many people don’t know they have chronic inflammation, but they may feel symptoms such as:

  • body and joint pain
  • fatigue and insomnia
  • weight gain or loss
  • frequent infections
  • depression, anxiety and mood disorders
  • digestive problems (e.g. constipation, diarrhoea, acid reflux)
  • skin rashes.

Chronic inflammation is associated with many diseases, such as rheumatoid arthritis, lupus, heart disease, diabetes, cancer, and bowel diseases like Crohn’s disease and ulcerative colitis.

If you’re concerned about chronic inflammation and have symptoms like those above that have been troubling you for some time, see your doctor . They’ll talk with you about your symptoms, do a physical exam, and may decide that blood tests are necessary to look for signs of inflammation.

The blood test will look for elevated C-reactive protein (CRP), which rises in response to inflammation.

Inflammation is helpful until it’s not

It’s important to remember that inflammation isn’t inherently bad. Acute inflammation serves a vital role in our health and survival. It helps us recover from injury and infection. However, when it’s chronic, it can negatively affect our health.

Always talk with your doctor if you have symptoms that are distressing you or making you feel unwell.

Contact our free national Help Line

Call our nurses if you have questions about managing your painmusculoskeletal condition, treatment options, mental health issues, COVID-19, telehealth, or accessing services. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

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This article was first written and published by Lisa Bywaters in April, 2022.


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02/Oct/2023

It occurred to me today that I really don’t understand as much about my condition as I should. I see my doctor regularly, I take my meds, exercise and manage my pain as best as I can.

But I actually don’t understand exactly what’s happening to my body at the basic level. How my condition works, progresses, and the nitty gritty of potential causes.

Don’t get me wrong, I don’t want to know the cellular level stuff – though some of you may want to know that – I just think I should know more, so that I can make informed decisions and play a more active role in the management of my health.

So where to start?

There’s information everywhere and it can be overwhelming. It can sometimes be difficult to work out what information is good and helpful, and what information is wrong, misleading and even dangerous.

As a general rule, libraries, your health professionals, peer support groups, reputable websites/social media sites and peak organisations like Musculoskeletal Australia can give you great information to help you learn about, and understand, your condition.

And the information they provide will help in different situations. For example, your doctor can provide evidence-based information about your condition and treatment options, whereas members of a peer support group can give you practical information about the experience of living with a chronic condition.

I also find that asking lots of questions and being sceptical is key. The information you get – from any source – could potentially affect your health, so you should be cautious.

Some questions I ask when looking at new health information:

  • Who wrote/gave me the information? Do they have the proper qualifications?
  • Where does the information come from? Does it have the scientific evidence to support it?
  • Is the information balanced? Does it give me a variety of options, or provide only one?
  • Does the information provide links to scientific evidence? Or does it only use personal anecdotes from satisfied customers or celebrity endorsements?
  • Is the information up-to-date?
  • Is the information regularly reviewed and updated?

Information is power. So use it to take control over your health and your body.

And if you get confused about any information you find, talk with your doctor. You can also contact our National Arthritis and Back Pain+ Help Line on 1800 263 265 for information and support.

“Information can bring you choices and choices bring power – educate yourself about your options and choices. Never remain in the dark of ignorance.” – Joy Page

Originally written and published by Lisa Bywaters in 2018


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06/Sep/2023

Let’s take advantage of the warmer days and and look at how we can sweep away the winter cobwebs and make ourselves sparkle this spring!

  • Unplug. We’re always connected these days, immersed in the news, social media, video chats, work/school, and phone calls. We’re never far away from a phone, tablet or computer – and we need to step away. Schedule time to put it all aside: perhaps after dinner, or for an hour during your day, or for your entire Sunday. Whatever works for you and your commitments. Just make sure you take some time away from the digital world, step outside and breathe in the fresh, sweet-smelling spring air.
  • Say no. We’re wired to want to please others, so we often find it difficult to say no. But that can make us become overwhelmed and stressed with the number of commitments we have. That’s why we need to look after ourselves and start saying no. The next time someone asks you to do something, give yourself a moment. Don’t answer immediately with an automatic ‘yes’. Ask yourself if this is something you want to do. Are you able to do it – physically and mentally? Do you have the time to do it? Will it bring you happiness? If you answered no to these questions, then you should say no to the request. You may disappoint some people, and they may be a little unhappy with you. But you need to be true to who you are and stand firm. And don’t feel the need to give detailed reasons for saying no. Saying no is really hard, but it will become easier.
  • Change your routine. Do you feel like you’re stuck in a rut? I know it feels like Groundhog Day at times! So look at your routine. What can you change? Take your work/school commitments out of the equation for now. Do you spend your evenings on the couch? Or weekends doing the same old things? Stop and really think about what you would actually ‘like’ to do with your free time. Go for a bike ride? Take up painting? Visit a new place each week? Find things that you enjoy, and fill you with anticipation and happiness, and do them. Now think about your work routine. There may not be things you can change about work – but why not put on your favourite outfit/earrings/shoes/lipstick – even if you’re working from home. Or use some new stationary or bit of tech. It’s amazing how these small changes give us a mental boost.
  • Focus on the basics – eat well, move, sleep – repeat. This time of the year we have access to amazing fresh produce that’s just crying out to be made into delicious salads and stir fries. The days are getting longer and warmer so we can get outside more for our exercise. We can shed the heavy blankets and adjust our sleep habits. There’s never been a better time than now to focus on these basics and make improvements if needed. And finally, make sure you’re staying hydrated by drinking enough water each day.
  • Surround yourself with positive, upbeat people. Positivity and happiness is contagious. These people will inspire you, make you feel good about yourself and the world in general. Too much contact with negative people (in person and via social media) does the opposite and makes the world a gloomy place. So seek out the happy, positive people and enjoy their company. And if you can, ditch the negative people.
  • Take some time out to relax. Try strategies like mindfulness, visualisation and guided imagery. Or read a book, listen to music, walk the dog, create something, play a computer game, have a bubble bath or massage. Whatever relaxes you. And make sure you do these things on a regular basis. They’re not an indulgence – they’re a necessity and vital to our overall happiness and wellbeing.
  • Let’s get serious – sugar, fats, alcohol and drugs. Many of us seek comfort in sugary and/or fatty foods more than we’d like. Or we’ve been using alcohol and/or drugs to make us feel better. Over time this becomes an unhealthy habit. So it’s time to get serious. Ask yourself if your intake of these things has changed or increased? If it has – what do you need to do to fix this? Can you decrease their use by yourself? Or do you need help from your family, doctor or other health professional? The sooner you acknowledge there’s a problem, the sooner you can deal with it.
  • Nurture your relationships. It’s easy to take the people around us for granted, but these people support and care for us day in and day out. They deserve focused time and attention from us. So sit down and talk with your kids about their day. Make time for a date night with your partner and cook a special meal to share together. Call or visit your parents and see how they’re really doing. Reminisce with your siblings about childhood antics and holidays. Our relationships are the glue that holds everything together for us – so put in the effort. You’ll all feel so much better for it.
  • Quit being so mean to yourself. You’re valued and loved. But sometimes we forget that. And the negative thoughts take over. “I’m fat”, “I’m hopeless”, “I’m lazy”, “I’m a burden”. If you wouldn’t say these things to another person, then why are you saying them to yourself? Ask yourself why you even think these things? And how can you reframe these thoughts? If, for example, you tell yourself you’re fat – are you actually overweight or are you comparing yourself to the unrealistic media image of how a person should look? And if you do know you need to lose weight, and want to make that happen, put those steps in motion. Talk with your doctor for some guidance and help. And congratulate yourself for taking action. And as you make these changes be kind to yourself along the journey. There will be stumbles, but that’s expected. You can pick yourself up and move on. Kindly.
  • Throw away the ‘should’s. This is similar to the negative self-talk…we need to stop should-ing ourselves to death. This often happens after we’ve been on social media and seen someone’s ‘amazing’ life. You start thinking “I should be better at X”, “I should be doing X”, “I should be earning X”, “I should look like X”. Remember that most people only put their best images on social media, so everyone’s life looks wonderful. But you’re just seeing the superficial, filtered person, not the whole, and they probably have just as many insecurities as the rest of us. Instead of thinking “I should…”, be grateful for who you are and what you have.
  • Be thankful and grateful. You exist! And yes, the world is a strange and sometimes frightening place at the moment, but you’re here to see it. People love and care for you. Focus on the people in your life and the things you’re grateful to have in your life. Celebrating these things – both big and small – reminds us why we’re here. To bring joy and happiness to those around us, and to make the world a better place.

(Originally written and published by Lisa Bywaters 2020).

Call our Help Line

If you have questions about things like managing your pain, your musculoskeletal condition, treatment options, telehealth, or accessing services be sure to call our nurses. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

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06/Sep/2023

Neck pain is a common problem many of us will experience at least once in our lives. The good news is that most cases of neck pain get better within a few days.

So what is neck pain? What causes it, and how can you manage it and get on with life?

Let’s start with a look at your spine

It helps to know how your spine works to understand some of the potential causes of neck pain.

Your spine (or backbone) is made up of bones called vertebrae, stacked on top of each other to form a loose ‘S’-shaped column.

Your spinal cord transports messages to and from your brain and the rest of your body. It passes through a hole in each of the vertebrae, where it’s protected from damage. It runs through the length of your spinal column.

Each vertebra is cushioned by spongy tissue called intervertebral discs. These discs act as shock absorbers. Vertebrae are joined together by small joints (facet joints), which allow the vertebrae to slide against each other, enabling you to twist and turn. Tough, flexible bands of soft tissue (ligaments) also hold the spine in position.

Layers of muscle provide structural support and help you move. They’re joined to bone by strong tissue (tendons).

Your spine is divided into five sections: 7 cervical or neck vertebrae, 12 thoracic vertebrae, 5 lumbar vertebrae, 5 fused vertebrae in your sacrum and 4 fused vertebrae in your tailbone (or coccyx) at the base of your spine.

So what’s causing the pain?

It’s important to know that most people with neck pain don’t have any significant damage to their spine. The pain they’re experiencing often comes from the soft tissues such as muscles and ligaments.

Some common causes of neck pain are:

  • muscle strain or tension – caused by things such as poor posture for long periods (e.g. hunching over while using a computer/smartphone or while reading), poor neck support while sleeping, jerking or straining your neck during exercise or work activities, anxiety and stress.
  • cervical spondylosis – this arthritis of the neck is related to ageing. As you age, your intervertebral discs lose moisture and some of their cushioning effect. The space between your vertebrae becomes narrower, and your vertebrae may begin to rub together. Your body tries to repair this damage by creating bony growths (bone spurs). Most people with this condition don’t have any symptoms; however, when they do occur, the most common symptoms are neck pain and stiffness. Some people may experience other symptoms such as tingling or numbness in their arms and legs if bone spurs press against nerves. There can also be a narrowing of the spinal canal (stenosis).
  • other musculoskeletal conditions such as osteoarthritis, rheumatoid arthritis, fibromyalgia, osteoporosis.
  • herniated disc (also called a slipped or ruptured disc). This occurs when the tough outside layer of a disc tears or ruptures, and the soft jelly-like inside bulges out and presses on the nerves in your spine.
  • whiplash – this is a form of neck sprain caused when the neck is suddenly whipped backward and then forward. This stretches the neck muscles and ligaments more than normal, causing a sprain. Whiplash most commonly occurs following a car accident and may occur days after the accident.

Symptoms

The symptoms you experience will depend on what’s causing your neck pain but may include:

  • pain and/or stiffness in the neck and shoulders
  • pain when moving
  • difficulty turning your head
  • headache.

In most cases, neck pain goes away in a few days. But if your pain doesn’t get better, or you develop other symptoms, you should see your doctor.

Or you can answer a few questions in the neck pain and stiffness symptom checker by healthdirect to find out if you need medical care. Simply click on ‘N’ and select ‘neck pain and stiffness’.

Seeing your doctor

If you need to see your doctor because of your neck pain, you can expect a discussion about potential causes or triggers of your pain, whether you’ve had neck pain before, things that make your pain worse, things that make it better. Your doctor will also conduct a thorough physical exam.

This discussion and examination by your doctor will decide whether more investigations (e.g. x-rays, CT or MRI scans) are appropriate for you. However, these tests are generally unhelpful to find a cause of the pain unless there’s an obvious injury or problem (e.g. following an accident or fall). It‘s also important to know that many investigations show ‘changes’ to your spine that represent the normal passage of time, not damage to your spine.

Often it’s not possible to find a cause for neck pain. However, it’s good to know that you can still treat it effectively without knowing the cause.

For more information about questions to ask your doctor before getting any test, treatment or procedure, visit the Choosing Wisely Australia website.

Dealing with neck pain

Most cases of neck pain will get better within a few days without you needing to see your doctor. During this time, try to keep active and carry on with your normal activities as much as possible.

The following may help relieve your symptoms and speed up your recovery:

Use heat or coldthey can help relieve pain and stiffness. Some people prefer heat (e.g. heat packs, heat rubs, warm shower, hot water bottle), others prefer cold (e.g. ice packs, a bag of frozen peas, cold gels). Always wrap them in a towel or cloth to help protect your skin from burns and tissue damage. Don’t use for longer than 10 to 15 minutes at a time, and wait for your skin temperature to return to normal before reapplying.

Rest (temporarily) and then move. When you first develop neck pain, you might find it helps to rest your neck, but don’t rest it for too long. Too much rest can stiffen your neck muscles and make your pain last longer. Try gentle exercises and stretches to loosen the muscles and ligaments as soon as possible. If in doubt, talk with your doctor.

Sleep on a low, firm pillow – too many pillows will cause your neck to bend unnaturally, and pillows that are too soft won’t provide your neck with adequate support.

Be aware of your posture – poor posture for extended periods, for example, bent over your smartphone, can cause neck pain or worsen existing pain. This puts stress on your neck muscles and makes them work harder than they need to. So whether you’re standing or sitting, make a conscious effort to be aware of your posture and adjust it if necessary, or do some gentle stretches.

Massage your pain awaymassage can help you deal with your physical pain, and it also helps relieve stress and muscle tension. You can give yourself a massage, see a qualified therapist or ask a family member or friend to give you a gentle massage.

Take time to relax – try some relaxation exercises (e.g. mindfulness, visualisation, progressive muscle relaxation) to help reduce muscle tension in your neck and shoulders.

Try an anti-inflammatory or analgesic cream or gel – they may provide temporary pain relief. Talk with your doctor or pharmacist for advice.

Use medication for temporary pain relief – always follow the instructions and talk to your doctor about alternatives if you find they don’t help.

Treating ongoing neck pain

Sometimes neck pain lasts longer than a few days, and you may have ongoing neck pain. There are things you can do to manage this:

  • See your doctor if the pain is worse or if you have other symptoms in addition to your neck pain such as numbness, pins and needles, fever or any difficulty with your bladder or bowel.
  • See a physiotherapist or exercise physiologist – they can provide you with stretching and strengthening exercises to help relieve your neck pain and stiffness.
  • Injections – some people with persistent neck pain may benefit from a long-acting steroid injection into the affected area. Talk with your doctor about whether this is right for you.
  • Surgery – is rarely needed for neck pain. However, it may be required in cases where severe pain interferes with daily activities, or the spinal cord or nerves are affected.

(Originally written and published by Lisa Bywaters 2022)

Contact our free national Help Line

If you have questions about managing your pain, your musculoskeletal condition, treatment options, mental health issues, COVID-19, telehealth, or accessing services be sure to call our nurses. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

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09/Aug/2023

I’ve never really thought about my shoulders. They’re just there. Useful for hanging a handbag on or supporting a heat pack for my neck. I only really notice them when, graceful person that I am 😉, I bash one on a door frame.

That was until a few years ago when I slipped in the bathroom and fell hard on my arm, with my shoulder in an unnatural position. I was suddenly very keenly aware of my shoulder! I honestly thought I’d broken it. Fortunately, scans revealed nothing had broken, but I had injured the soft tissues.

However, it was during that time I learned about shoulders. I know, I know, the crazy fun times never end for me 😂. But in my defence, I was stuck on the couch for a few days with my arm in a sling and an ice pack on constant rotation. So I didn’t really have a lot going on.

And what I learned was fascinating.

And since shoulder pain is incredibly common, I thought I’d share what I learned with you. Because if you haven’t had shoulder pain, you probably know someone who has. So buckle up, and let’s learn about shoulders, shoulder pain and how to treat it.

Let’s start with the basics – how your shoulders work.

DYK, the shoulder has not one, but four joints???

This makes them complex, flexible structures with a large range of movement. Unfortunately, this flexibility can also put the shoulder at risk of injury and dislocation, especially through contact sports and falls.

Your shoulder is made up of three bones: the shoulder blade (scapula), collarbone (clavicle), and upper arm bone (humerus).

The main joint is the glenohumeral joint. This is where your humerus connects with your scapula. Like the hip, it’s a ball and socket joint. The top of your humerus is shaped like a ball and fits inside the socket or cup-shaped indentation in your shoulder blade. However, this socket is shallow, giving your shoulder great flexibility but also making it less stable.

The other joints are:

  • the acromioclavicular joint – where the top of your shoulder blade (acromion) meets your collarbone
  • the sternoclavicular joint – where your collarbone meets your breastbone (sternum) near the base of your neck
  • and the scapulothoracic joint – where your shoulder blade meets the chest wall (thorax). It allows your shoulder blade to move smoothly over your ribs.

Soft tissues surround the glenohumeral joint to form a capsule. This keeps the head of the arm bone in place in the joint socket. The joint capsule is lined with a synovial membrane that produces synovial fluid to lubricate and nourish the joint. Tendons, ligaments, bursa, and muscles also support the joints and bones in your shoulder to stabilise it and allow it to move freely. The bones, joints and soft tissue work together to make your shoulders incredibly mobile, so you can do all kinds of things like throw a ball, hug a friend, brush your hair, and scratch your back.

When things go wrong – shoulder pain.

Shoulder pain may come on quickly, e.g. if you injure yourself, or it can occur more gradually. It can be mild pain or, as I experienced, very painful 😥.

There are many causes of shoulder pain, not all due to problems with the shoulder joints or associated structures. They include:

  • Other musculoskeletal conditions, such as rheumatoid arthritis, osteoarthritis, and polymyalgia rheumatica can affect the shoulder, causing pain.
  • Inflammation or injury to the soft tissues (e.g. muscles, bursae, tendons, ligaments) in and around the shoulder, for example, bursitis and frozen shoulder.
  • Ongoing stress or anxiety that causes your muscles to remain tense.
  • Neck and upper back joint and nerve problems can cause pain to be felt in and around the shoulder.
  • Referred pain. Shoulder pain may also be caused by problems affecting your abdomen (e.g. gallstones), heart (e.g. heart attack) and lungs (e.g. pneumonia).

Note: if you feel shoulder pain radiating down your arm or you’re experiencing a tight feeling across the chest and shortness of breath, dial 000 immediately.

Symptoms of shoulder pain.

Unsurprisingly, the main symptom of shoulder pain is pain! Other symptoms include:

  • Reduced movement, stiffness and pain when moving your shoulder.
  • Weakness of the shoulder/upper arm.
  • Pain when lying or putting pressure on the affected shoulder.
  • Pins and needles (tingling). This is more likely to be associated with neck problems than the shoulder itself.

Diagnosing shoulder pain.

If you have shoulder pain that’s causing you distress or affecting your ability to do your daily activities, you should see your doctor. Your doctor will:

  • ask you questions about your shoulder pain, including potential causes (e.g. recent injuries, other health conditions), if you’ve had shoulder pain before, and how it affects you
  • ask about any other symptoms or health issues you have
  • do a thorough physical examination.

From this, they can work out the likelihood of particular structures in the shoulder being involved.

Sometimes they’ll suggest that scans are needed. They may include X-rays, ultrasounds, computed tomography (CT), or magnetic resonance imaging (MRI). The type of scan/s required will depend on the suspected cause of your shoulder pain. However, it’s important to know that many scans show changes to your shoulder that will likely represent the normal passage of time (even by age 45), not damage to your shoulder.

Treating shoulder pain.

Treating shoulder pain begins with understanding the cause of the problem. What works for one shoulder issue may not work for another. Your doctor will create a treatment plan based on your diagnosis.

The following are some commonly used treatments for shoulder pain.

  • Heat and cold packs may provide temporary relief from pain and stiffness. Generally speaking, heat can relieve muscle spasms and tension. Cold can reduce swelling.
  • Physiotherapy will aim to fix problems such as shoulder, neck and upper arm stiffness and weakness. A physiotherapist will provide exercises to help improve mobility and the range of movement for your shoulder. They’ll also help you modify movements and activities that worsen your pain. This often includes learning new ways to do things related to your work, sport, or everyday activities that aggravate your shoulder. They may also tape your shoulder and show you how to use taping to support your shoulder and reduce stress on it.
  • Occupational therapy. If your shoulder pain makes everyday activities difficult, seeing an occupational therapist (OT) may be helpful. They can help you learn better ways to carry out activities such as bathing, dressing, working or driving. They can also provide aids and equipment to make everyday activities easier.
  • Medicines may help reduce the pain you’re experiencing while you work to maintain and restore movement and function. But it’s important to understand they’re not a long-term solution to shoulder pain. Talk with your doctor or pharmacist for advice about pain medicines. There are different types available, both over-the-counter and by prescription. They include:
    • Non-steroidal anti-inflammatory drugs (NSAIDs). NSAIDs reduce inflammation and pain but have side effects, so using the lowest dose for the shortest period is best.
    • Topicals. Rubs, gels, ointments, sprays, patches and creams applied to your skin (topically) can provide temporary pain relief.
    • Corticosteroid injection. If you have persistent shoulder pain and haven’t had relief from oral medicines or other treatments, your doctor may suggest a corticosteroid (steroid) injection. Corticosteroid injections into the joint can reduce inflammation and provide short-term pain relief for some people. However, pain relief varies and may last a few days to weeks. The number of injections you can have is limited due to potential harm. Discuss the benefits and risks of steroid injections with your doctor.
  • In cases of a frozen shoulder, hydrodilatation may be recommended. This is an injection of fluid (saline and a steroid) into the joint. There’s some evidence that it may relieve symptoms and improve range of motion. However, it’s unclear if this is due to the hydrodilatation, the steroid in the injection, shoulder exercises, or a combination.

What about surgery?

For most people, shoulder pain will improve over time with appropriate, conservative treatment. However, in some cases, surgery may be required.

When considering surgery, you should be informed about what it involves, the rehabilitation process, and its potential benefits and risks.

Managing shoulder pain to prevent future problems.

Most people with shoulder pain will find it gets better over time. But there are things you can do to proactively prevent future problems.

  • Learn more about your shoulder pain. Are there activities or jobs that trigger your shoulder pain or make it worse? Knowing as much as possible about your shoulder pain means that you can make informed decisions about your healthcare and actively manage it.
  • Follow the advice of your healthcare team. The information, exercises, and modifications provided by your physio or occupational therapist during the worst of your shoulder pain will help prevent you from aggravating your shoulder and causing future issues.
  • Exercise regularly. Although you might think you need to protect your shoulder by not moving or resting it, it’s made for movement. And resting can make things worse. Regular exercise is vital for maintaining flexibility, muscle strength, and bone health. When starting an exercise program, you should incorporate activities that improve flexibility, muscle strength, balance, and overall fitness and endurance. Start exercising slowly and gradually increase the time and intensity of your exercise sessions over weeks and months. A physiotherapist or exercise physiologist can help you work out an exercise program right for you.
  • Manage your stress. Living with stress or anxiety can worsen your pain by causing the muscles throughout your body to tense or spasm. This is often felt in the shoulders and neck. There are many ways to reduce stress or anxiety, including exercise, massage, mindfulness, heat, breathing exercises, and guided imagery.
  • Get back to your normal activities. Try to be as active as possible and get on with your day-to-day life, including work and exercise. Returning to heavy manual jobs may take longer, and you may need support from a physio and/or OT.

Contact our free national Help Line

Call our nurses if you have questions about managing your painmusculoskeletal condition, treatment options, mental health issuestelehealth, or accessing services. They’re available weekdays between 9am-5pm on 1800 263 265, email (helpline@msk.org.au) or via Messenger.

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09/Aug/2023

Not much has changed since ABBA sang in 1976 “All the things I could do, if I had a little money.” Money – or the lack of it – has been causing us headaches and stress since we started using it.

Living with a musculoskeletal condition – or multiple conditions – can be expensive. Medications, healthcare appointments, time off work (or not being able to work), exercise classes, complementary therapies, and aids and equipment are costly on top of everyday expenses.

When you add rising living costs, financial stress is almost inevitable.

Fortunately, there are things you can do if you’re in this situation. And it starts now.

Acknowledge the situation.

This is the crucial first step. As much as we’d like to bury our heads in the sand when we feel anxious or worried about anything (I know that’s my go-to reaction 😑), it won’t solve the problem. We need to look it in the eye, acknowledge it exists and start to deal with it – one step at a time.

Create a budget.

This may sound daunting, but you need to know where your money’s going. You need to be able to track what money is coming in and what you’re spending it on. MoneySmart is an Australian Government website with many tools and resources to help you manage your money. They have a section on budgeting to help you create a budget that works for you and your circumstances.

By understanding where your money’s going, you can start to see where you can make some savings or cut some costs. It’ll also put you in a better position when/if it comes time to talk with your bank, utility companies etc.

Know your rights.

When you’re struggling and stressed, it’s easy to become overwhelmed. But there are laws to help protect you if you’re suffering from financial hardship. The National Debt Helpline has information to help you understand your rights and protections.

Seek help.

If you’re finding it challenging to create a budget or find a way out of your financial problems, contact the National Debt Helpline and talk with a financial counsellor. They’re free, confidential, and independent. You can call them on 1800 007 007 weekdays 9.30am-4.30pm. They also have a live chat function on their website, available weekdays from 9.00am-8.00pm, or you can also send them a message outside of hours, and a counsellor will get back to you. National Debt Helpline also has a huge range of other resources to help you if you’re struggling with debt or controlling your finances.

Talk to your bank.

If you’re having difficulties paying your mortgage, personal loans or credit card repayments, talk with your lender about your options, such as making smaller repayments over a longer period or pausing repayments.

The Australian Banking Association has some useful resources on their website, including information about your rights and what your bank can do to help you.

Talk to your utility companies.

Contact your supplier if you can’t afford to pay your gas, electricity, water, and phone bills. But first, check out this information from the National Debt Helpline about how to do this.

Be wary of buy now, pay later schemes, payday loans, and consumer leases.

If you’re under financial stress, these options may seem like a convenient way to pay for things you need. However, they’re also an easy way to get into even more debt. Learn more by reading MoneySmart’s info on the potential problems with payday loans, consumer leases, and buy now, pay later schemes.

Talk with your doctor about GP management plans.

Living with a chronic condition (or multiple conditions) can cost a lot of money. Discuss accessing a GP Management Plan and Team Care Arrangement with your doctor so that you can get coordinated care to manage your health condition. You may be eligible for Medicare rebates for certain allied health services. You can find out more on the Department of Health website.

Talk with your doctor and pharmacist about safety nets.

They exist to help lower the out-of-pocket medical costs for people who, due to their health condition/s, spend a lot of money on Pharmaceutical Benefits Scheme (PBS) medications. Your doctor and pharmacist can give you more information about these safety nets.

Talk with your doctor about 60-day scripts.

From 1 September 2023, eligible people living with chronic conditions can buy 60 days’ supply of some medicines. This will reduce the cost of some medicines for people with stable, chronic conditions. For more info, check out the Consumers Health Forum 60-day scripts website, and talk with your doctor about whether this is an option for you.

Find out about government allowances and benefits.

The Australian Government provides a wide range of allowances and benefits you may be eligible for, including:

The Australian Government’s Services Australia website provides a lot of information about these payments (and others), including information about eligibility criteria.

You can also talk with our nurse on the MSK Help Line if you’re having trouble navigating through these social services schemes. Contact them on 1800 263 265 weekdays or email helpline@msk.org.au.

Find out about the National Disability Insurance Scheme (NDIS).

The NDIS helps people under 65 with permanent and significant disability get care and support. It pays for reasonable and necessary support that a person needs to live and enjoy their life. The NDIS also provides information and connections to local services to people who aren’t eligible for funding. Find out more about the NDIS.

There’s light at the end of the tunnel.

When you’re in debt or dealing with financial hardship, it can seem like there’s no way out. But there are a lot of organisations and services available to help you. This article has just scraped the surface of them.

There are more for you to explore in the links below.

If you need help with debt or just want to learn how to manage your money better, I’d urge you to look at MoneySmart, National Debt Helpline and The Salvos. They provide excellent, easy-to-understand resources on a wide range of issues relating to money.

Contact our free national Help Line

Call our nurses if you have questions about managing your painmusculoskeletal condition, treatment options, mental health issuestelehealth, or accessing services. They’re available weekdays between 9am-5pm on 1800 263 265, email (helpline@msk.org.au) or via Messenger.

More to explore


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09/Aug/2023

Your genetics and personalised medicine

You may have heard something about personalised medicine and the tongue twister – pharmacogenomics. But what is it? And might it be beneficial? We take a quick look at this exciting field of research and things to consider before diving in.

Let’s start with the word… it’s a mouthful!

The word “pharmacogenomics” is a combination of pharmacology and genomics:

  • Pharmacology is the study of the uses and effects of medicines.
  • Genomics is the study of all of a person’s genes (their genome), including how genes interact with each other and with your environment.

A (very) little bit of biology 101.

Almost all the cells in your body contain DNA. DNA is the genetic information that helps make people who they are.

DNA is a double helix. You’re probably familiar with the image – it’s shown on practically every crime or detective show. 😉 It looks like a twisted ladder.

Four different chemicals (nucleotides) pair up to make the ladder’s rungs.

Genes are stretches of DNA. They can be long or short. You inherit your genes from your parents – one copy of each gene from each parent. They contain the instructions to build your body and make you uniquely ‘you’.

Where drugs come into the story.

Your genetic makeup affects the way you respond to medicines.

It can affect whether a medicine is effective, whether it has no effect or whether you have a bad reaction or side effect. It can also affect the dosage you may need. For example, some people absorb medicines too quickly, meaning they need a higher dose to experience any benefit; others process them too slowly, leading to side effects.

Knowing this information about your genes has the potential to help your doctor provide more personalised medicine and a more effective treatment plan.

So how do you know how your genes will react to medicines? You can take a test.

Pharmacogenomic tests are available via some GPs and pharmacists and through direct‐to‐consumer services. They’re generally not covered by Medicare, so you’ll have to pay the total cost of about $150-200.

These tests usually require a cheek swab, salvia sample or blood sample. The sample is sent to be analysed, and a report is provided. If you have gone through your doctor or pharmacist, they’ll explain the results.

Before you jump.

Before jumping on board and spending your hard-earned dollars on a test, there are some things to consider.

  • Do you need another test? Many people with chronic conditions already have lots of routine tests to manage their condition. This is not only costly but time-consuming. So ask yourself, “Am I experiencing significant problems with my medicines? And does this test have the potential to provide real benefit?” If so, talk with your doctor. It may be alternative medicines or treatments are an option. Or it might be that your doctor thinks a pharmacogenomic test will help. But first, have the conversation. And read Choosing Wisely Australia’s 5 questions to ask your doctor or other healthcare provider before you get any test, treatment, or procedure.
  • The cost. It’s not covered by Medicare, so you’ll have to pay for it yourself.
  • Pharmacogenomic tests aren’t available for all medicines. And not all genes and gene variants are tested. International guidelines have so far identified about 15 genes for which testing can inform the prescribing of 30 different medications with good evidence of clinical benefit.
  • Not all GPs or pharmacists have the experience or training to understand how to best use these tests and understand the results.
  • Your genes aren’t the only player in this game. It’s much more complicated, and many other factors affect how your body reacts to medicines. They include your general overall health, age, other medicines and supplements you’re taking, body size, inflammation, and kidney or liver problems. Your genetics are just one part of the puzzle.
  • Safety of your information. Many direct-to-consumer companies offering these tests are overseas, even if the initial delivery address is within Australia. Australian law protects your privacy rights for services provided in Australia, but these protections don’t apply to overseas services. So ask questions about the company – where’s it located, where’s your data stored, who has access to it.

Pharmacogenomics in practice.

We’ve just touched on the briefest of info about pharmacogenomics, so for more comprehensive information about pharmacogenomics in practice in the real world, read this excellent fact sheet from the NSW Government Centre for Genetics Education.

Finally.

The field of pharmacogenomics is growing, and it’s an exciting new world. But you also need to weigh up whether this is something that will benefit you now.

Take the time to do your research, ask questions, and talk with your doctor. These tests aren’t going anywhere. In fact, they’ll likely become more comprehensive and more mainstream as time goes on.

Contact our free national Help Line

Call our nurses if you have questions about managing your painmusculoskeletal condition, treatment options, mental health issuestelehealth, or accessing services. They’re available weekdays between 9am-5pm on 1800 263 265, email (helpline@msk.org.au) or via Messenger.

More to explore

References

  1. A brief guide to genomics, National Human Genome Research Institute
  2. Pharmacogenomics in general practice: The time has come. Australian Journal of General Practice 2019; 48



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