pain - Musculoskeletal Australia (MSK)

11/Jun/2020

Sore neck? Back? Knees? Feel like you’ve aged 20 years with all the niggles, twinges and outright pain you’re feeling lately? You’re not alone. Many of us, even those who don’t live with a musculoskeletal condition, are feeling the physical effects of months of isolation, changes to our routine and living more sedentary lives than usual.

There are many reasons for this, and the good news is there’s lots you can do to deal with these annoying aches and pains.

Working or studying from home

When many of us first started working from home, it felt strange but also pretty cool. No dreaded peak hour commute. Yay! Instead we moved a bit more leisurely, lingered over coffee and our slippers stayed on all day. But after months of sitting at makeshift desks, or using laptops for hours on end, or struggling with tech issues and video calls, the cool phase is well and truly gone.

You may notice that you’re getting a sore neck more often, or your back aches, or you’re really tight across your shoulder blades. Or when you stand up your knees and/or hips let you know quite emphatically that you’ve been sitting in one place for a loooong time.

The problem is most of us don’t have a dedicated working space that’s set up as well as the one we had in the office. And since we’re likely to be working from home for quite some time, we need to deal with these issues rather than continuing to put up with them and the resulting aches and pains. Some simple things you can do include:

Have a routine – and stick to it. Find what works best for you and your specific situation. Whether you’re home schooling your kids, sharing your work space and equipment with your partner, or keeping your pets off your laptop, all of these things will factor into your routine. For me, internet access is really poor during the late afternoon, so starting work earlier and finishing earlier meant I could work more productively and with much less frustration. We’ll all have different solutions to suit our unique situations. So work out what’s best for you and stick with it. And don’t forget to talk with your employer if your new routine affects how/when you work.
Check out your work space. Is it helping or hindering you? Are you putting up with an uncomfortable space because you’re not sure what else to do? If so Safe Work Australia has a guide to help you set up your workstation and ABC News also has some practical hacks to take some of the pain out of working from home.
Move. When you’re working from home it’s easy for time to get away from you. We don’t have our usual cues to move such as getting up to go to the copier or attending a meeting in another room or just going to chat with a workmate. We’re sitting more and moving less. So you need to schedule time to get up, move around, stretch, go outside. Set up regular alerts on your phone/computer/watch – whatever works for you – and make sure you move. You’ll really notice a big difference at the end of your day.
Talk with your employer. If you need to adjust your hours, or you’re having issues with equipment or tech, or you’re having other issues working from home, discuss this with your manager or with HR. Together you should be able to come up with some solutions to ease these issues.

Managing stress

We’re living through a worldwide pandemic. Even after several months it feels surreal to say that. It’s important to acknowledge that it’s a really stressful time. Apart from worrying about getting sick, we’re also stressed about work, making sure the kids don’t fall behind at school, managing our chronic conditions, our finances, our family, and concern about the future. Add in the current unrest across the globe and it’s amazing we’re not all hiding under the bed.

But stress can cause physical aches and pains. It can also affect the quality of our sleep, our pain levels and can trigger a flare. So it’s important we find ways to manage stress effectively.

Many of the practical strategies we use to manage pain can be used to manage stress. These include: deep breathing, exercising, pacing, talking with a friend, mindfulness, guided imagery, progressive muscle relaxation and doing something you enjoy (e.g. reading, gardening, walking your dog, playing music).

But if you’re finding it difficult to manage your stress, talk with a professional such as your doctor or psychologist. There’s help available. And remember you can access them via telehealth if you prefer.

Spending more time at home

Even though isolation is easing we’re still meant to stay at home as much as we can. And with the weather getting really chilly, we’re getting cosy on the couch with the doona and the remote, as we binge lots of TV (or is that just me). There’s just so much to watch!

Hanging out on the couch and binge watching TV is ok occasionally, but we don’t want to get into the habit of doing it too often. Slouching on the couch and not moving for long periods can aggravate our existing musculoskeletal conditions. And if we’re not moving and being active regularly it can also make it difficult to manage our weight.

So make sure you get up and move. Take a break. Go for a walk or do some exercises or stretches.

Break up your day with a mix of activities – both physically active (e.g. walking, gardening, tidying) and more passive (e.g. reading, watching TV, sitting at a computer).

Be aware of your posture

Bad posture can sneak up on us. Working at a computer, sitting on the couch reading a book, standing around watching the kids in the playground, lifting shopping out of the boot of your car – if you’re not paying attention to your posture, it’s easy to slouch, hunch over or strain.

As I’m typing this I’m literally straightening up from the curled position I was in, hunched over my laptop. And wow – it feels amazing when you sit up straight. It’s the same when you’ve been sitting on the couch for a while – when you stand up, stretching feels soooo good.

So be aware of your posture as you’re sitting and standing. For more info read our tips for good posture.

Increase your incidental exercise

Because we’re more sedentary than usual, and don’t have many of our usual outlets for exercise, we need to find ways to become more active. Increasing our incidental exercise is one way to do this. Incidental exercise is the little bits and pieces you do over the course of your day such as walking to a letterbox to post a letter, playing with the grandkids, cleaning the house. It’s not a part of your structured exercise plan, but it is important. There are many ways you can increase your incidental exercise without too much effort or disruption to your day. Read our blog to find out more. Before you know it you’ll be feeling more energised and noticing a difference with your pain levels, sleep quality and mood.

Dress appropriately

It’s getting really cold and many of us are a little stressed at the thought of high energy bills as we stay home and use the heater more. It’s tempting to keep the heat down, but that can cause your muscles to become tense, aggravating your musculoskeletal condition. So it’s important to keep warm. One of the simplest things you can do to stay warm is to dress for the weather. Let’s face it we’re not going anywhere, so wear the thick socks, the cuddly jumper and the daggiest track pants. Whatever keeps you warm.

We also need to be mindful of our footwear. Although it’s tempting to stay in our slippers all day, our feet and ankles need proper support. Wear the right footwear for whatever you’re doing. Going for a walk? Put on your sneakers. Working at home? Wear your casual shoes/boots that support your feet and keep you warm. And lounging around in the evening? Get those slippers on.

Be careful of trips and falls

Hands up if you’ve tripped over cables, laptop bags, files, excited dogs, folders, exercise equipment, books, and other stuff that’s suddenly cluttering your home? With all of the other things going on at home at the moment, school, work, exercise, entertainment…we’ve had to make space for all sorts of things in order to be get by. Which means our risk of tripping or falling has suddenly increased, especially if you’ve got nowhere to put these things and they’re constantly in the living area. So be careful as you move around your home – don’t rush, put things away if you can and tie or tape down cables. Preventing a fall, especially if you have a musculoskeletal condition, is easier than dealing with the significant injuries a fall can cause. So please be careful.

Treating pain

Even when you’ve done everything you can to prevent joint pain and muscle strain, you may still find you’re a bit sore. Depending on how severe this pain is, you may be able to treat it simply with heat and cold, massage, short term use of medication, distraction and many other strategies. Check out our A-Z guide for managing pain for more hints and tips.
However if the pain is severe, it’s affecting your day to day activities, your ability to sleep, or it’s lasted for some time with no relief, it’s a good idea to talk with your doctor about it. Together you can find out what’s causing the pain, and the most effective ways to treat it. Don’t simply put up with it.

Contact our free national Help Line

If you have questions about things like COVID-19, your musculoskeletal condition, treatment options, telehealth, managing your pain 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.

Lisa Bywaters

04/Jun/2020

The opium poppy is such a pretty, delicate looking flower. And humans have been actively growing them and enjoying their medicinal benefits since at least 3,400 B.C. The Sumerians referred to it as Hul Gil or the “joy plant.”

It’s from these delicate plants we get opioids, a group of medications with which we have a long and complex relationship. They can provide great pain relief, but can also cause great harm.

That’s why on 1 June 2020 the Australian Government introduced some changes which affect how we use and access opioids. So let’s look at what opioids are, how they work, and why these changes have been brought in.

What are opioids?

Opioids are pain relieving medications that come in a variety of formulations, dosages and strengths. They include: tramadol, codeine, morphine, oxycodone and fentanyl. You need a prescription from your doctor to buy any medications containing opioids.

Opioids may be:

natural – created using the milky substance found inside the pods of the opium poppy, or
synthetic – created in a lab to have a chemical structure similar to natural opioids.

How do they work?

Opioids attach to opioid receptors in brain cells and dull our perception of pain. The pain isn’t gone, nor is the cause of the pain. It’s simply been dampened so that we can function with less discomfort. They also cause the brain to release the hormone dopamine, which can make us feel happy or relaxed.

Opioids are used to treat severe pain associated with cancer or for acute pain – e.g. following surgery.

They’ve also been used for many years to help people with severe, persistent non-cancer pain, like the pain associated with musculoskeletal conditions. However their long-term benefit is controversial for persistent pain or chronic pain. This is mainly due to the large body of evidence that shows that opioids have a limited effect on this type of pain. In addition they can also have serious side effects particularly with long term use, including breathing difficulties, addiction, overdose and death.

We also know that our body adapts to opioids when we use them long-term. We have to increase the dosage to get the same effect, and an increased dose brings an increased risk of harm.

Every day in Australia there are nearly 150 hospitalisations and 14 emergency department admissions due to opioid use, and three people die from drug-induced deaths involving opioids. (1)

Because of these alarming statistics the Australian government has been changing the way we access opioids. Last year we saw all opioids, even the lowest dose available, requiring a prescription from your doctor. You can no longer buy them over-the-counter.

The latest changes are a continuation of this plan to reduce the harm that opioids can do, and ensure that we use them cautiously and safely.

What’s changing?

From 1 June 2020 changes include:

smaller medication packs containing fewer opioids will be provided for short-term opioid use – for example after surgery or an injury,
improvements in medication information so people are better informed about the potential risks of opioids and how to reduce them, and doctors are following best-practise when prescribing opioids,
updating prescribing ‘indications’ (or when they’re used) to ensure opioids are only prescribed where the benefits outweigh the risks. (2)

Can I still use them for my musculoskeletal pain?

If you’re using opioids to manage the pain associated with your musculoskeletal condition, continue taking them as prescribed and talk to your doctor.

We do know some people experience pain relief using opioids for persistent pain, so if they’re proving to be clinically effective for managing your pain, your doctor will be able to continue to prescribe them. However these new changes will require your doctor to weigh the risks and benefits of these medications, and to explore possible alternatives with you, including enrolling in a pain management program. Also, where opioid use exceeds twelve months or is expected to exceed this time, a second opinion will be required to renew ongoing prescriptions.

Opioids aren’t a magic bullet and should be used in conjunction with other pain management therapies such as physiotherapy, exercise, weight management, cognitive behavioural therapy and mindfulness.

What now?

Living with persistent pain is exhausting. And the possibility of changing your medication can be stressful, especially if you feel like you’re managing your condition and your pain effectively. If you’re worried about these changes, talk with your doctor. Be honest about how you feel, but also be open to the possibility of trying new things to manage your pain. The aim is to keep your pain at a level that allows you to live your life and do the things you want and need to do. Opioids may be part of that, or they may be something that you’ll be able to phase out. It’s something that you and your doctor will need to discuss so that you get the best and safest outcomes.

Contact our free national Help Line

More to explore

Prescription opioids: What changes are being made and why
Therapeutic Goods Administration, 29 May 2020
Prescription opioids: Information for consumers, patients and carers
Therapeutic Goods Administration, 29 May 2020
What are opioids?
Alcohol and Drug Foundation, 28 January 2020
Smaller pack sizes from today: could new opioid restrictions stop leftover medicines causing harm?
The Conversation, 1 June 2020
Opioid medicines and chronic non-cancer pain
National Prescribing Service, 2 October 2019
Managing your pain: An A-Z guide
Musculoskeletal Australia

References

(1) Prescription opioids: What changes are being made and why
Therapeutic Goods Administration, 29 May 2020

(2) Prescription opioids: Information for consumers, patients and carers
Therapeutic Goods Administration, 29 May 2020

Lisa Bywaters

04/Jun/2020

As COVID-19 restrictions came into force at the end of March, life as a Musculoskeletal Help Line Nurse began to change. Like many who were lucky enough to be able to work from home, I packed up my office, put it in the boot of my car and set-up my new workspace at home.

Work looked a little different now – face to face meetings became Zoom meetings, COVID-19 health news dominated our searches and we began recording videos to keep consumers updated. But most importantly one constant remained – we were still on the end of the phone or email for when a consumer needed some help or advice.

While the usual enquiries kept coming, there were also stories of personal struggles during the lockdown. People shared their feelings of anxiety surrounding social isolation, their vulnerability and how all too often their exercise routine had diminished, and their pain had increased. We talked over ways to try and overcome this – meditation, mindfulness, online exercise, pain management strategies etc – but sometimes it was just enough to have someone to talk things over with, and to feel like someone was really listening.

While the struggles were evident, it was also lovely to hear reports of some positive experiences that emerged. Social isolation forced many of us to slow down, to reflect on how much we try to squeeze into a day/week, and perhaps allowed us to reflect on the simple things in life that make us happy. For some it was spending more quality time with their immediate family, others enjoyed time to potter in the garden, clear out the cupboards, do some DIY or simply relax with a good book. In a hectic world, pressing the pause button seemed to bring a little light relief in one form or another.

As a nurse I am privileged to be able to share in peoples life experiences, including their ups and downs, and as we all get used to the ‘new normal’ I hope that I can continue to provide a friendly ear to make the COVID-19 journey just that little bit easier.

Clare

And some feedback from one of our recent callers:

“Thank you so much for your caring, helpful time with me, giving me very important vital information that I truly need in this very big, busy, fast city…I have received your email with excellent advice in all possible ways and hope for a better way of going along this painful journey with chronic conditions…in which I may be able to benefit and try…and not to feel so alone. I truly hope that things will change for the better. Thank you again Anne, have a gentle relaxing evening and keep warm. Can’t wait to see and read all the goodies inside the email you sent me. With best wishes and kind regards, VC”

Contact our free national Help Line

Lisa Bywaters

28/May/2020

It’s a good thing iso is starting to ease around the country. Did you know people have been injuring themselves with all this time at home? Who knew taking time to get fit, being creative with exercise or tackling some of the DIY jobs around the house could be so dangerous?

So here are some tips to help you stay safe at home:

Exercise

We’ll soon be able to go back to our gyms, pools and fitness centres – but the number of people who can be in these spaces at one time will be strictly limited. So you’ll probably still have to make do with home exercise. To keep safe we suggest you:

talk with your doctor, exercise physiologist or physiotherapist – in person or via telehealth – if you’re concerned that you’re feeling more pain than usual when exercising or after exercising. They can also tailor a home exercise program to suit your specific needs and health conditions.
book an appointment to talk with an instructor at your fitness centre. They can run through your exercises and give you feedback about your exercise technique.
before using online exercise videos, classes or apps, check the qualifications of the instructor. Do they have the expertise to provide these exercises safely? And for people with musculoskeletal conditions? Read our blog about evaluating online exercise.
warm up before you exercise, and cool down when you finish. Many of us skip this because we don’t feel like we have the time or just can’t be bothered. But it’s an important part of exercising and may help reduce injury. Warming up increases blood flow to the muscles and gives you the chance to get in the right headspace for exercise. Cooling down helps your body return to the resting state it was in before you started, allowing your heart rate to lower and your body to cool down.
don’t push yourself too far too quickly. Many of us saw iso as a chance to jump in and get fit. Yay – all this time to exercise, nothing can stop us. Until you hurt yourself or do too much. That’s why it’s important to build up slowly and progress over time. But you do need to challenge yourself, so ensure that your exercise gets more difficult over time.
if your joint/s feel particularly painful after exercising (for longer than two hours after an exercise session), reduce the intensity of your next session. And if an activity causes you pain or increases your pain beyond what’s normal for you, then stop this activity. Get advice from a professional to ensure you’re doing the exercise correctly or to modify it for you.

Cycling

Wow that’s really taken off! And it’s great to see so many people and families out cycling together. But if you’re not used to riding a bike regularly you can get hurt. So:

be realistic. We’ve all heard the saying “it’s just like riding a bike” so we assume it’s simple, but if you’re not riding regularly, start small. It’s easy when you have the wind in your hair and the sun on your face to just ride and ride and ride. But remember, you need to return to where you started. So plan a bike route that’s easy, flat and achievable. You can increase this over time.
make sure you have all the right bits and pieces to keep you and others (like pedestrians) safe. So wear a helmet, use your bell when approaching others and have a light fitted just in case you get caught out when the light begins to fade. And wear comfortable, high visibility clothes so you can be seen.
use a bike path if there’s one nearby. Especially if you’re starting out or fairly new to riding. Riding in traffic can be scary and intimidating, and if you’re not confident it can be dangerous. So build up your confidence on bike paths.
read our blog for more tips about riding a bike.

DIY

Like getting fit, iso was going to be a time when we got all those odd jobs and repairs done around the home. But this has seen people falling off ladders and injuring themselves with power tool – yikes. So before you tackle that DIY job:

ask yourself – does it require a professional? There are some jobs – like electrical work and larger plumbing repairs or installations – that should only be done by someone with the necessary skills and qualifications.
do a risk assessment. Most of the time we just want to get the job done – the gutter unclogged, the new towel rail hung. But are there any risks involved? Do you have the right tools and equipment? Do you know if there are electrical cables behind the wall? You don’t need to write up a full risk assessment report, but just take some time before you get started to make sure you have everything you need to proceed safely.
be careful if you use a ladder. This is one of the biggest hazards for the DIYer – falling from a ladder or stepladder. And you can really hurt yourself. So if you’re using one, make sure you have someone around to help you move it and to ensure you’re safe. Move the ladder when you need to – don’t lean over or stretch to reach something – that’s when you can overbalance and fall.
whatever DIY job you’re doing – dress for it. Wear suitable clothing, footwear, gloves, and a mask if there’ll be dust or fumes.
don’t do anything if you’re not 100% – so if you’re tired, you’ve been drinking or you’re affected by drugs (including prescription meds) – don’t do anything. The job will still be there tomorrow.

Mental health

As well as physical injuries we may have suffered during this time, our mental health may have also taken a hit. There’s been a rise in the number of people experiencing anxiety and depression from being cooped up in iso and the loss of normal life and routines. And there’s also the stresses of working and schooling from home, financial pressure and general worry about the future. These issues are no less serious than falling from a ladder or stacking your bike, so if you’re struggling talk with someone. Whether it’s your partner, family member, a close friend or a professional, talk with someone. Don’t ignore these feelings. There’s a lot of help available.

Talk with the nurses on our Help Line 1800 263 265 – weekdays
Contact Lifeline Australia 13 11 14 – 24 hours/7 days
Contact Beyondblue 1300 22 4636 – 24 hours/7 days

Get help

Finally, if you do hurt yourself seek medical advice. Many people are putting off going to see their doctor or the emergency department for fear of COVID-19. However medical facilities have measures in place to keep the general public and their staff as safe as possible. So if you injure yourself, don’t ignore it or soldier on – make an appointment to see your doctor, or if it’s serious go to the emergency department or call an ambulance.

Contact our free national Help Line

More to explore

Check out some of our health articles and blogs for more info.

Lisa Bywaters

21/May/2020

For many of us our pain is always there – sometimes in the background and at other times it’s very much in the front of our minds. It’s a constant – just like taxes. Even with a pandemic causing so much chaos and uncertainty, our pain persists, it’s always there.

And quite frankly it’s a pain in the arse. It hurts. It’s exhausting. And it’s invisible.

The Australian Institute of Health and Welfare last week released their latest report Chronic pain in Australia. It highlights that 1 in 5 of us lives with chronic pain. So next time you’re standing in a physically distant queue at the shops or taking a walk around the park – consider the fact that 1 in 5 of the people see you around you is also living with pain. It’s a massive problem, but there are things we can all do to manage our pain effectively.

Know your pain and yourself

It’s so important when you live with a chronic condition that you understand it. Learn as much about your condition as you can so that you can take an active role in managing it, including the pain associated with it. For example, what makes your pain better? What makes it worse? Do you tend to overdo things when you’re feeling great and end up paying for it over the next couple of days with increased pain? Or when you’re experiencing a flare and your pain is worse – do you get anxious, and everything becomes negative and too hard?

Knowing these things – really understanding how your pain affects you physically, emotionally and behaviourally – will help you manage your pain and your condition better, even in this time of crazy COVID.

Tackle the big three – exercise, eat, sleep, repeat

I don’t know about you, but I’m finding my exercise, diet and sleep have all taken a hit due to the pandemic and iso. Not being able to get to the gym, changes to work and my normal routine and stress has really impacted how and when I’m eating, sleeping and exercising. And not in a positive way.

This has had a very noticeable effect on my pain levels. If you’re experiencing this too, acknowledging it is the first step to changing things. So I can’t get to the gym – there are other ways to be active. So my routine has changed and as a result so has my diet. I can manage that. Stress and pain is impacting my sleep? I’ve managed that before – I can do it again.

It’s all about finding the right mindset. This is a strange, new normal we’re living in. And it’s going to change and evolve as we continue through 2020. We have no roadmap for what’s been, and what’s to come – so we need to do the best we can to change and adapt to the constantly shifting landscape.

Get help

OK, that all sounded sooooo easy, right?? Nope.

We may be able to change and adapt to some things but there will be times when we need to ask for help. From our family and friends, from our doctor, physio, psychologist. Whether it’s medications or physiotherapy to directly manage the pain, or asking a family member to carry the heavy laundry basket to the clothesline, or talking with a friend about your frustrations – whatever it is, there’s help available. You just need to acknowledge the fact that you need it and reach out. And remember the nurses on our Help Line are just a call or email away.

Use your mind

It’s a powerful tool. You can use it for distraction, mindfulness, relaxation, visualisation and guided imagery. None of these things will take your pain away completely, but they can provide temporary relief while you do a painful task, try to fall asleep, or wait for your pain medication to kick in.

‘P’ yourself – plan, prioritise and pace

We’re often our own worst enemy. We do too much when we’re feeling great, and end up feeling rubbish for hours/days afterwards. Something ‘simple’ we can do to prevent this from happening time and again is to plan, prioritise and pace ourselves. First plan – what do you need to do today? Write it down. Now prioritise. How much of those zillion things do you really need to do? Often things we see as hugely important aren’t. And do you need to do them yourself? Can someone else do it? Now pace yourself. It’s not a race – so be generous with your time, spread your jobs over the day and build in space for rest breaks.

Look after your mental health

Living with persistent pain can sometimes be a roller-coaster of emotions. It’s perfectly natural that from time to time to feel sad, worried, angry, anxious, depressed or frustrated. Add a pandemic, and it’s no wonder many of us are feeling as if our worlds have turned upside down and inside out. It’s important that you acknowledge these feelings. You may want to write in a journal, talk with a family member or close friend or talk with a counsellor or psychologist. Don’t ignore these feelings or keep them bottled up.

Your GP can refer you to a psychologist if needed on a GP Mental Health Management Plan. At the moment because of COVID-19 you can arrange to speak to a psychologist via telehealth (over the phone or a video call).

Be kind

To yourself and to others. It’s an unprecedented, really strange time and we’re all doing the best we can. So be kind to yourself – you’ll experience ups and downs, stumbling blocks, and barriers that get in your way. And some days you’ll need to work really hard just to keep moving. So give yourself a break. And remember 1 in 5 people are living with invisible chronic pain. And even more people are dealing with all kinds of stuff we can’t even imagine. So be kind to the people you encounter. It makes us all feel so much better than the alternative.

More to explore

Our nurse Clare discusses some simple things you can do to manage pain while at home in isolation, including pacing activities, exercise, getting a good night’s sleep and heat and cold packs.

We also have some great blogs to give you more tips and info about managing pain:

Lisa Bywaters

31/Jan/2020

With our crazy, busy lives it can sometimes feel next to impossible to squeeze in time for exercise. Add to that the unpredictability of living with a chronic condition, and our planned activities can often go flying out the door.

But there are things you can do to be more active. Incidental exercise – or the little bits and pieces you do over the course of your day – can really add up. It’s important to note that incidental exercise should not replace your regular, structured exercise program, but they’re a great way to boost your activity levels.

Here are some things you can do to increase your incidental exercise.

Watching TV? Whether you’re watching the latest episode of your favourite show or binge watching an entire series, get up and move around during the ads. No ads? No problems. At the end of each episode, do something active. Go outside and check the letterbox. Take the dog for a walk around the block. If you have an exercise bike or treadmill, use it while watching your show.
Love reading? Download an audio book and listen to it as you go for a walk. Just be mindful about how far you walk. It’s easy to get caught up in a book and walk further than you planned! Which has the potential to aggravate your condition and pain levels if you do too much.
Going for a long drive? Make your journey more interesting, and more active by scheduling stops for you to stretch, walk around and discover new areas. It’s amazing what you can find when you take the time to explore.
Shopping? Park your car a little further away from the shops than you normally would. Walk up or down the travellator or escalator – even if it’s just for part of the ride – rather than just standing in place.
Work meeting? Take it outside. Suggest that you have walking meeting. You get to be active and less sedentary, with the added benefit of fresh air.
Catching public transport? Get off a stop before your usual one. Explore your neighbourhood while getting some exercise and breathing deeply.
On the phone? Walk around while chatting, rather than sitting down. But avoid moving about if you’re texting or looking at your screen. Our aim is to increase activity levels safely, not get injured in the process!
Gaming? Fun! But it’s so easy to get caught up in the heat of the battle/chase/adventure, so set your phone alarm to go off every 30 minutes so you can get up and move.
Cleaning? Go hard. Give the tiles an extra vigorous scrub. Flatten your recyclables rather than just tossing them straight into your recycling bin. Clean your windows (groan – but how good do they look when you’re done?). Vacuum the house and use all of the little attachments (who knew they made such a difference?).

Obviously there’ll be times when these activities are not possible or practical – especially if you’re having a flare. However some of them may actually help with your pain – things like standing and moving when your back is really sore, breaking up long trips with stops and stretches – they’ll provide exercise and pain relief.

Give incidental exercise a try. Before you know it, you’ll be feeling more energised and noticing a difference with your pain levels, sleep quality and mood.

Plus your house will be sparkling! Win-win!

More to explore

Queensland Health – What is incidental activity?
Exercise Right – Does incidental exercise actually help?

Lisa Bywaters

31/Jan/2020

If you live with persistent pain, then you’ve probably had many nights when sleep has eluded you. You’ve tossed and turned, gotten up, watched TV, checked your phone, gone back to bed, and then tossed some more.

Pain, muscle tension, anxiety and other factors can interfere with your ability to get to sleep, stay asleep and the quality of your sleep. And sadly, not getting enough good quality sleep can affect your pain levels, your muscle tension and your anxiety levels.

It’s like a colossal feedback loop that’s spiraling out of control and you can’t break free. OK, that was a little dramatic, but I’m also a little tired and cranky 🙁

The good news is there are many things you can do to break this cycle and get back to having a good night’s sleep.

Try not to put too much pressure on yourself to go to sleep. This leads to anxiety and stress if you don’t fall asleep quickly. Feeling anxious or stressed will affect your ability to sleep. 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.
Develop a sleep routine. Try to go to bed and get up at the same time each day.
Try some relaxation techniques. Consider 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 you go to sleep, and sleep well.
Write it down. Thoughts, worries and anxiety can prevent good sleep. Don’t take them to bed. Write them down and then put them away. You can deal with them tomorrow.
Be active during the day. As well as the many other benefits of regular exercise, it will help you fall asleep and stay asleep longer.
Keep a sleep journal. This will help you and your doctor work out what may be causing your sleep problems because it tracks the things that may affect your sleep. Make sure to write down things like the time you went to bed, the time you got up the next morning, how easily (or not) you fell asleep, how many times you woke up and for how long, things that woke you up (full bladder, outside noise, anxiety, pain etc).
Keep a water bottle by your bedside so that you don’t have to get up if you wake up thirsty in the middle of the night.
Avoid caffeine and alcohol for several hours before going to bed.
Don’t look at the clock. Constantly checking the time can make you anxious and anxiety makes it hard to sleep. Try removing your clock from the bedside, or cover it up at night.
Avoid using technology in bed. The blue light from laptops and tablets suppresses the hormone (melatonin) that makes us sleepy at night, so be sure to stop screen use at least one hour before bed.
Light. Is your room dark enough to allow you to sleep well? If not, look at solutions such as window coverings or a dim switch on your alarm clock. You might also try using an eye mask.
Noise. If you have no control over the noise in your environment (e.g. a barking dog, loud party, your partner’s snoring), ear plugs may be an option. Or playing soothing, gentle music softly in the background can also be helpful at cancelling out other noises.
Clear your bedroom of clutter. Researchers have found a link between being surrounded by lots of “stuff” and your ability to fall asleep quickly and easily.
Seek help. If pain is constantly keeping you awake at night, discuss it with your doctor for information and advice.

More to explore

Read our more detailed page on sleep.

Lisa Bywaters

23/Jan/2020

Using humour and laughter to help manage your pain

I think there’s a reason we respond so positively to the memes, social media posts and jokes that poke fun at pain, chronic illness and the trials and tribulations that come from living with both.

Having a foggy brain isn’t particularly funny, being unable to sleep isn’t a joke, and pain – wow, that’s probably the un-funniest thing you can think of. But we all do tend to laugh at, and share with others, the well-crafted meme or social media post that ridicules and scoffs at these things because we identify with the truth behind them. And with the best ones, you can tell that someone who knows what it’s like to live with pain and illness has created them. You’re recognising a fellow traveller.

Laughter and humour are such powerful forces. Just think about the last time you had one of those huge, spontaneous belly laughs with your friends or family. Something was said, a joke was told or you all saw something ridiculous. There’s nothing like it. You snort, you chortle, your eyes water, you gasp for breath, your belly starts to hurt and, when you look at each other, you laugh some more. When you finally do stop, you feel euphoric. Everything seems better, you feel happier and you can’t wait to do it again.

Always laugh when you can. It is cheap medicine. – Lord Byron

However when you’re in the grips of pain, laughing is probably the last thing you feel like doing. But laughter can actually help you deal with your pain. A good joke, a funny movie or just seeing something silly can distract you from your pain and make you feel better, at least for a while.

A good laugh heals a lot of hurts. – Madeleine L’Engle

Laughter causes a variety of chemical responses in your body. The ‘feel good’ hormones – endorphins, serotonin and dopamine – are released into your bloodstream. They boost your mood and make you feel more positive. Endorphins are your body’s natural pain reliever. Releasing them into the body reduces your feelings of pain. Laughter can also help boost your immune system. And, let’s face it, it’s just a lot of fun!

So next time your pain is getting you down, why not give laughter a go?

Finally, it’s important to remember that laughter and humour are temporary distractions from pain. They’re great and we should definitely cram as much into our day just for the sheer joy of it. But when you have a chronic illness and persistent pain, a balanced treatment approach that involves appropriate medications and medical care, healthy lifestyle, exercise, mindfulness and yes – laughter – is the best way to live with a chronic condition.

Laughter serves as a blocking agent. Like a bulletproof vest, it may help protect you against the ravages of negative emotions that can assault you in disease. – Norman Cousins

Things to try:

watch/stream a funny movie, TV show
listen to a funny podcast
talk with a friend and reminisce about a funny experience you had together
watch cat/dog/panda videos on YouTube (you know the ones you see pop up on social media regularly!)
think about the funniest joke you ever heard.

Lisa Bywaters

22/Jan/2020

Written by Steve Edwards, MSc(Oxon), MSc(Edinb), BSc(Pod)

“A cortisone injection? You want to stick a needle in my sore foot?”

Your health care clinician has suggested you have a cortisone injection into your foot. As with any medical procedure, both of you are best advised to discuss the benefits and risks before proceeding. It helps to know what cortisone is, what it does, and why it’s been offered to you.

Cortisone is an anti-inflammatory medication that’s often used to treat musculoskeletal conditions. It’s a synthetic version of cortisol, a hormone that naturally occurs in your body. Injected into the affected area, cortisone can lower inflammation and pain, remove fluid, and thin scar tissue or adhesions. So if your clinician diagnoses a musculoskeletal condition affecting your foot or ankle – such as arthritis, bursitis, neuroma, or tendinitis – a cortisone injection is commonly raised as an effective treatment option.

Cortisone injections also contain a local anaesthetic. For certain conditions an injection can be painful, so the anaesthetic may be injected separately before the cortisone to block this pain.

The clinician may or may not use ultrasound technology to guide the injection. For pain relief in the foot or ankle, research finds no statistically-significant difference between procedures conducted with or without ultrasound. Interestingly, trials on cadavers injected with dyed cortisone show how it rapidly spreads from the injection-point to adjacent tissue, indicating that pinpoint accuracy is not key to effectiveness.

There are several types of cortisone. In most cases the clinician will administer a long-duration cortisone, taking effect within 1-3 weeks, with benefits lasting between 1-9 months, depending on the condition and its severity. There’s a clinical consensus that no more than 3 injections should be administered to the same body-part within a 12-month period, though there’s no research literature to clearly support this belief.

After the injection, you can quickly return to most activities. The clinician may recommend you avoid strenuous physical exertion such as gym workouts or running for a few days, so the cortisone isn’t displaced from the target tissue.

As for risk-factors, there’s been research into whether the injection may risk tearing tendons in the target area. There’s no recorded case of this in human trials, though it has occurred in trials on dogs and horses. There were cases of more general tissue damage recorded in early trials on American gridiron players, but various factors could have produced this result – the needle used, the amount of fluid injected, and the subjects receiving multiple injections within a short period.

No medical procedure has a 100-percent success rate, but a single cortisone injection administered by a trained clinician is both safe and effective in providing medium-term pain relief. Side effects are minimal, and the benefit to your musculoskeletal condition is potentially vast. And for some foot-specific conditions – such as a neuroma (pinched nerve), or plantar fasciitis (heel pain due to scar tissue) – a cortisone injection can often be a cure.

Our guest blogger

Steven Edwards is a trainee foot and ankle surgeon with the Australasian College of Podiatric Surgeons. He also teaches pharmacology and foot surgery to undergraduate podiatry students at La Trobe University.

Lisa Bywaters

02/Aug/2018

Written by Thalia Salt

My name’s Thalia and I’m twelve years old. I was diagnosed with osteoarthritis when I was five years old, which was caused by a joint infection in my left hip when I was ten months old. I like to sing and act, and I love hanging out with my friends after school.

Living with arthritis from such a young age is hard, but it has some advantages. I’ve been finding different ways to cope for my whole life, which means I have some quite effective strategies up my sleeve. But there are many things that aren’t so great. I learned to walk with arthritis, so my gait was awkward. I don’t know what it’s like to have no pain, and sometimes when I do have lots of pain my body tunes out of it until it’s unbearable.

The arthritis has also gotten in the way of my life outside of school activities. I have to sit down when I sing, and I’ve had to do several performances in my wheelchair. When I’m with my friends, we have to limit our activity accordingly. I haven’t been able to participate fully at school and have had to resort to a mobilised scooter in the past just to get around.

This story has a happy ending though. In June 2017, I had a total hip replacement. Since then, I‘ve been walking up to 3km, running, getting around school without my walking aids. I’ve also been swimming and riding my bicycle.

Something else that’s changed is the amount of medication I’m taking. Before, I was taking a large range of medications, including some very strong painkillers. Now I take hardly any medication. My personal lifestyle has also been greatly altered. I’ve been able to move around the house freely, participate in my outside of school activities like any other person, although I’m still not up to standing up for more than a few minutes. I’ve been discharged from the physiotherapist and have started to see a personal trainer.

In the future, I should be able to participate in P.E. at school, stand up for as long as I like, walk around my neighbourhood with my friends after school. I should have no pain, which is something that I’ve not experienced before. I can’t wait to go to the beach without my crutches and being able to do whatever I want when I get there, without worrying about the consequences.

My top 5 pain management tips

Heat packs. Something that affected me a lot was the cold in the dead of winter. A heat pack when relaxing can often ease the pain, particularly when I go to sleep.
Crutches. These help take the stress off your joints. Obviously this only works for pain in your legs.
Reducing movement before a large amount of exercise. If I know that I’m going to participate in an activity that requires a lot of physical movement, I’ll take it easy for a few days, as if I’m “saving” the soreness for later.
Not constantly being on all the meds. That way, when you’re in a lot of pain you have something you can take.
Stretch constantly. I know that maintaining the right amount of exercising and protecting your joint is hard, but a large cause of pain is stiffness from not moving enough. So, you need to stretch. A lot.

Our guest blogger

Thalia is a positive ambassador for young people living with arthritis and chronic pain.

She’s worked tirelessly to raise the profile of arthritis in young people and how it affects them. She’s held fundraising events, received many awards, created a Facebook page, a vlog on YouTube about her surgery and much more.

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Be aware of your posture

Increase your incidental exercise

Dress appropriately

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What are opioids?

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Can I still use them for my musculoskeletal pain?

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Using humour and laughter to help manage your pain

Written by Steve Edwards, MSc(Oxon), MSc(Edinb), BSc(Pod)

“A cortisone injection? You want to stick a needle in my sore foot?”

Our guest blogger

Written by Thalia Salt

My top 5 pain management tips

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