Americans Are Using More Alternative Pain Therapies

By Pat Anson, PNN Editor

It’s fair to say that almost every person living with chronic pain has been told by a doctor, loved one, friend or even strangers that they should try a “complimentary health approach” to pain management. Also known as a “multimodal” or “comprehensive” care, the idea is to get pain patients to reduce or stop using opioids and other medications by utilizing alternative health therapies such as massage, meditation and acupuncture.

A new study shows that there has been surge in the use of those therapies by Americans over the last two decades, with chronic pain sufferers leading the way.   

Researchers at the National Institutes of Health looked at data from the 2002, 2012, and 2022 National Health Interview Survey (NHIS) to evaluate the use of seven alternative therapies: yoga, meditation, massage, chiropractic care, acupuncture, naturopathy, and guided imagery/progressive muscle relaxation.

Their findings, published in JAMA Network Open, show significant increases in the use of all seven therapies. The most widely used alternative therapy was meditation, which rose from 7.5% of respondents in 2002 to 17.3% in 2022.The largest increase in utilization was for yoga, which rose from 5% of respondents in 2002 to 15.8% in 2022.

Complimentary Health Approaches Used by U.S. Adults

NATIONAL INSTITUTES OF HEALTH

By 2022, over a third of respondents (36.7%) reported using at least one complimentary health approach (CHA), up from 19.2% in 2002. Nearly half said they used a CHA for pain management.

The CHAs most widely used for pain in 2022 were chiropractic care (85.7%) and acupuncture (72.8%). Researchers think that expanded insurance coverage for those treatments may have contributed to their growing use. Significant reductions in opioid prescribing over the last decade may have also driven people to try other treatments.  

Complimentary Health Approaches Used for Pain

NATIONAL INSTITUTES OF HEALTH

“Between 2002 and 2022, US adults increasingly used CHAs, including for pain management. This shift in utilization coincides with increased pain prevalence nationally and may be attributable to several factors, including randomized clinical trials suggesting that some CHAs provide low to moderate levels of pain management, incorporation of CHAs into best practice pain management guidelines, and the need to mitigate unnecessary use of potentially harmful opioids through use of nonopioid interventions,” wrote lead author Richard Nahin, PhD, lead epidemiologist at the National Center for Complementary and Integrative Health.

As with many of these data mining studies, the NIH researchers did not document what kind of pain conditions the respondents had, how often they used an alternative therapy, or even whether the treatment worked.  

According to one estimate, 55 million U.S. adults spent $28.3 billion on CHAs in 2012, about 9% of total out-of-pocket health care expenses that year.

Yoga Can Help Manage Chronic Illness, Including Pain

By Herpreet Thind, University of Massachusetts Lowell

The popularity of yoga has grown tremendously in the past decade. More than 10% of U.S. adults have practiced yoga at some point in their lives. Yoga practitioners spend on average US$90 a month, and the yoga industry is worth more than $80 billion worldwide.

Yoga is now a mainstream activity in the U.S. and is commonly portrayed as a healthy lifestyle choice. I am a behavioral scientist who researches how physical activity – and specifically yoga – can prevent and help manage chronic diseases.

Many people attribute improvements in their physical and mental health to their yoga practice. But until recently, research had been sparse on the health benefits of yoga. As the body of rigorous research on yoga grows, more and more work is showing the many health benefits of a yoga practice. 

‘Stilling the Mind’

The name “yoga” is derived from the Sanskrit word “Yuj” meaning to unite, join or connect the mind, body and soul. The first text on yoga was written by the sage Patanjali over 2,000 years ago in India. Patanjali described yoga as “citta-vrtti-nirodhah,” or “stilling the mind.” This was achieved through a mix of breath work, meditation, physical movement and body purification practices, as well as ethical and moral codes for living a healthy and purposeful life.

Over the years, various yoga teachers have modified the original Patanjali yoga, resulting in different styles that vary in their intensity and focus. For example, some yoga styles such as Vinyasa focus more on intense movements similar to an aerobic workout. Restorative yoga includes more relaxation poses. Iyengar yoga uses props and emphasizes precision and proper alignment of body. These different styles provide options for individuals with different physical abilities.

Generally speaking, yoga instructors in the U.S. today teach styles that incorporate postures, breathing exercises and sometimes meditation.

Physical and Mental Health Benefits 

As yoga has grown in popularity in recent years, researchers have begun to study its effects and are finding that it has great benefit for mental and physical health.

Yoga involves physical movement, so it is no surprise that most types of yoga can help to improve a person’s strength and flexibility. In one study with healthy untrained volunteers, researchers found that eight weeks of yoga improved muscular strength at the elbow and knee by 10%-30%. Flexibility at the ankle, shoulder and hip joints also increased by 13%-188%.

There are a number of less obvious but meaningful benefits from yoga as well. Research has shown that yoga practice can reduce risk factors for heart disease such as high blood pressure, high cholesterol and abdominal obesity. Studies on older adults have shown significant improvements in balance, mobility, cognitive function and overall quality of life.

Yoga seems to be effective at managing pain, too. Research has found that yoga can improve symptoms of headaches, osteoarthritis, neck pain and low-back pain. In fact, the American College of Physicians recommends yoga as one of the options for initial nonpharmaceutical treatment for chronic low-back pain.

Yoga also provides many benefits for mental health. Researchers have found that a regular practice over eight to 12 weeks can lead to moderate reductions in anxiety and depressive symptoms as well as help with stress management.

Exercise With Mindfulness

Yoga is a type of exercise in that it is a form of physical exertion that helps build fitness. A lot of the benefits researchers have found are due to the physical activity component and are similar to benefits from other forms of exercise like running, weightlifting or calisthenics.

But unlike these other activities, yoga practice incorporates mindfulness as a key aspect. With its focus on controlling breath, holding postures and meditation, yoga increases how much a person pays attention to the sensations of their body and the present moment. This mindfulness leads to many benefits not found from other forms of exercise.

Studies have shown that mindfulness training on its own can increase a person’s self-awareness, along with the ability to recognize and skillfully respond to emotional stress. It can even give a person greater control over long-term behavior. One study found that increased mindfulness from yoga can help people better recognize and respond to feelings of being full when eating, decrease binge eating and alleviate concerns over how their body looks.

My colleagues and I observed a similar effect in a pilot study on the benefits of yoga for individuals with Type 2 diabetes. After doing yoga twice a week for three months, several participants reported paying more attention to their diet, snacking less and eating healthier, even without any nutrition intervention. Our patients also reported less stress and an increased willingness to engage in other types of physical activities.

Yoga is clearly different from Western exercise in how it approaches mental health. With more research, it may be possible to understand the biological mechanisms as well.

Before You Start

Yoga may not be helpful for all medical conditions or right for every person, but people of all age groups, body types and physical abilities can practice yoga. It can be a form of mental and physical exercise for people who do not enjoy sweating during strenuous forms of exercise or for individuals with medical or physical conditions who find working out in the gym challenging.

It is important to consider that although yoga is generally safe, just as with any other form of exercise, there is some risk of getting injured. Individuals with medical conditions who are new to yoga should practice it initially under the supervision of a trained instructor.

If you do decide to give yoga a try, talk to the yoga instructor first to assess whether the style they offer meets your preference and fitness levels. Remember, you may need to practice a couple of weeks to feel the benefits, physically and mentally.

Herpreet Thind, PhD, is an Associate Professor of Public Health at University of Massachusetts Lowell. Her research interests include physical activity and yoga interventions for chronic disease prevention and control. She has received funding from the National Institutes of Health to examine the feasibility of yoga for adults with type 2 diabetes.

This article originally appeared in The Conversation and is republished with permission.

Only 1 in 7 Chronic Pain Patients Use Opioids

By Pat Anson, PNN Editor

Have you tried physical therapy? What about yoga or Tai Chi? Did massage help you feel better?

Just about everyone in chronic pain has been asked that by family members, friends, doctors and sometimes even complete strangers.  The questions are innocent enough and usually well-meaning, but they often imply that a pain sufferer hasn’t looked beyond opioids for pain relief.

A new study shows that most people with chronic pain make extensive use of non-opioids and other “alternative” pain treatments – and that it’s relatively rare for a patient to only use opioids for pain relief.

The findings, published in JAMA Network Open, are based on answers to the 2019 National Health Survey by nearly 32,000 U.S. adults with chronic pain. The 2019 survey was the first to ask people about their use of 11 pain management techniques during the previous three months.

It turns out most people with chronic pain (54.7%) only used non-opioid pain management. And nearly a third (30.2%) used no pain therapy whatsoever. The rest either used opioids alone (4.4%) or a combination of opioids with one or more alternative treatments (10.7%).

That means only about 1 in every 7 adults with chronic pain even use opioids – a startling number when you consider the constant harping from anti-opioid activists and public health officials about how opioids are “overprescribed” in the U.S.   

“This study found that adults with chronic pain in the US use a variety of pain management techniques, including opioids,” wrote lead author Cornelius Groenewald, MB, a pediatric anesthesiologist and associate professor at the University of Washington School of Medicine. “Nonpharmacologic and nonopioid pharmacologic therapies are preferred treatments for chronic pain, and it is encouraging to note that most adults with chronic pain use a combination of various nonopioid modalities for treatment.”

Alternative Chronic Pain Therapies Used in 2019

• 18.8% Physical Therapy

• 17.6% Massage

• 15.6% Meditation or Relaxation Techniques

• 11.6% Spinal Manipulation or Chiropractic Care

• 8.5% Yoga or Tai Chi

• 5.1% Pain Self-Management Workshops

•  3.8% Psychological or CBT Therapy

• 1.8% Peer Support Group      

Nearly 40% of chronic pain sufferers reported using other therapies that were not listed in the survey. That may include treatments such as cannabis, kratom, medical devices, acupuncture or even ice packs. It would be good to include more of those options in future surveys.

Groenewald and his colleagues were disappointed that so few people used psychological techniques such as cognitive behavioral therapy (CBT), which was the only alternative pain therapy that they said was “underused.”   

The researchers found that complementary, psychological or psychotherapeutic therapies were more likely to be used by younger adults, females and people with more education. Adults using physical, occupational or rehabilitative therapies were more likely to be older, female, highly educated and have medical insurance.

Holistic Therapy Won’t Cure You, But It Can Help

By Mia Maysack, PNN Columnist 

To mark the end of Pain Awareness Month,  I'd like to share a few holistic therapies that have proven helpful on my journey. 

I’m not suggesting they are magic remedies or that they're the right choices for everyone. Many of us who live with chronic or intractable pain have our minds closed off to new things. And after all we've been through, who could blame us?   

There is an endless amount of misinformation and misinterpretation regarding holistic and preventative medicine, and no shortage of judgement. I'll be honest by confessing that I have also been a skeptic to some extent about holistic therapy, but it has ultimately helped me more than two decades of “mainstream" traditional medicine.  

I'd like to think I have established credibility as it pertains to my own personal experiences, just as I honor anyone else's. Here is what I have learned about holistic therapy:   

Having an open mind and willingness to expand consciousness about the limitations that pain imposes on our lives -- and taking leadership in our own journey – means coping, managing, adapting, transcending and evolving as best we can.  

These therapies don't really work until WE WORK ‘EM and add them to a tool box full of different things to pull from.  Allow yourself the curiosity of what could be possible if you were to try something new. If there are still doubts or if you tried and failed with them in the past, then ask yourself: When’s the last time anything went perfectly right the first time?   

We cannot know unless we try. To have found anything that's assisted, helped or if you're lucky enough to have something that actually works would not be possible without an attempt to try it in the first place.  

The great thing I have found about these holistic therapies is that they have positive side effects, are healthy and habit forming.  

Soaking in Warm Water:  I use generous amounts of Epsom salt (magnesium sulfate) in a bathtub. It creates a soothing buoyancy that makes the body seem weightless.  

Massage Therapy:  Manipulation of soft tissues of the body, consisting primarily of manual techniques, such as applying fixed or movable pressure, holding, and moving muscles and body tissues. 

Mindfulness:  A mental state achieved by focusing one's awareness on the present moment, while calmly acknowledging and accepting one's feelings, thoughts, and bodily sensations. 

Energy Healing:  Also known as Reiki or Qigong, energy healing offers the potential for a positive shift in physiological state and present moment awareness that may alter the perspectives that sustain the burden of symptoms. 

Yoga:  A mind and body practice. Various styles of yoga combine physical postures, breathing techniques, and meditation or relaxation to promote mental and physical well-being. There are several types and many different disciplines. 

None of these are meant to replace any existing care plan, but rather contribute to a well-rounded approach to our whole being and health. Imagine committing the same amount of energy spent fighting against these concepts into exploring ways to incorporate them into your life. You just might find that they help.          

Mia Maysack lives with traumatic brain injury, migraine disease, cluster headache and fibromyalgia. Mia is the founder of Keepin’ Our Heads Up, a Facebook advocacy and support group, and Peace & Love, a wellness and life coaching practice for the chronically ill. 

Mia was recently chosen as a recipient of the 2021 iPain Community Impact Award for her advocacy work.

Good Attitude Improves Effectiveness of Yoga and Physical Therapy

By Pat Anson, PNN Editor

Yoga is a four-letter word for a lot of chronic pain patients, who are often urged to try yoga or physical therapy to ease their pain. Many pain sufferers believe exercise will only make their pain worse.

But a new study by researchers at Boston Medical University found that people with chronic lower back pain are more likely to benefit from yoga and physical therapy if they have a positive attitude about exercise.

The study involved 299 mostly low-income patients with chronic lower back pain who took weekly yoga classes or had physical therapy for 12 weeks. They were compared to a control group who had “self-care” – which consisted of reading a handbook on self-management strategies for back pain, such as stretching and strengthening exercises.

Nearly half (42%) of those who had yoga or physical therapy responded to the treatment, while only 23% of those in the self-care group had improvement in their pain and physical function.

Interestingly, participants who continued taking pain medication during the study were more likely to benefit from yoga (42%) than those who had physical therapy (34%) or self-care (11%).

"Adults living with chronic low back pain could benefit from a multi-disciplinary approach to treatment including yoga or physical therapy, especially when they are already using pain medication,' said lead author Eric Roseen, DC, a chiropractic physician at Boston Medical Center.

Another important finding from the study, which was published in the journal Pain Medicine, is the effect that “fear avoidance” can have on patient outcomes.

Among the participants who had less fear of exercise, 53 percent responded to yoga, 42 percent responded to physical therapy and 13 percent responded to self-care. In contrast, participants who had a high fear of exercise usually had a poor response, regardless of what therapy group they were in.  

Other factors that appeared to improve patient response were a high school education, higher income, employment and being a non-smoker.

"Focusing on a diverse population with an average income well below the U.S. median, this research adds important data for an understudied and often underserved population," said Roseen. "Our findings of predictors are consistent with existing research, also showing that lower socioeconomic status, multiple comorbidities, depression, and smoking are all associated with poor response to treatment."

It doesn’t take a lot of time to benefit from exercise. A 2017 study found that just 45 minutes of moderate physical activity a week improved pain and function in patients with osteoarthritis.

A few weeks of yoga significantly improved the health and mental well-being of people suffering from arthritis, according to a 2015 study at Johns Hopkins University.

Mindfulness Is More Than Yoga

Barby Ingle, PNN Columnist

For years I’ve used mindfulness meditation techniques to help with my chronic pain. So imagine my surprise last week as I was watching the Pain Management Best Practices Inter-Agency Task Force meeting and a practitioner on the panel said yoga and mindfulness are essentially the same thing.

I’ve never done yoga as part of my mindfulness meditation. But it made me start to wonder. Have I been doing mindfulness wrong for years?

A quick Google search showed me there are more than 25 mindfulness activities. Yoga was one of the items on the list, but not everyone doing yoga is doing it for mindfulness. Most use it for physical exercise.

Another practitioner on the task force said that mindfulness is not a treatment by itself and that it is typically done in conjunction with other modalities. I totally agree. There are many group and individual activities that use mindfulness to reduce stress, anxiety, depression and pain.

Mindfulness is just one form of self-care that I use do to help manage the symptoms of living with chronic conditions. By itself, mindfulness is not enough to sustain me, but in conjunction with other treatments I find it helpful.  

I personally like individual mindfulness activities. Some of the activities are really short and some take up to an hour. Depending on what I need, I choose one that best suites me in the moment. Some of the activities I use for improving my life include virtual reality, self-compassion, reviewing my "I Am" list, meditation, 5 senses exercise, breathing exercises, music therapy and aroma therapy.

If you have trouble practicing mindfulness alone, one of the group activities is known as the FAKE plan, which involves about 8 members meeting for 2 hours every week for 12 weeks. The first portion of each session is devoted to a short mindfulness exercise and discussion, and each week is dedicated to a specific type of mindfulness exercise.

This is great for patients with social anxiety disorder but can also be helpful for others who want to work on their social skills through group mindfulness activities.  

Another mindfulness exercise that I found in my Google search (but have not yet tried) involves staring at a leaf for 5 minutes. A leaf is like a fingerprint or snowflake -- no two are the same. You can focus on the leaf’s colors, shape, texture and patterns. This type of activity brings you into the present and helps align your thoughts.

When I am not able to perform the physical or cognitive tasks I want to because of physical pain, I can get situational depression. For me, this is the best time to use my mindfulness activities. One study identified three ways mindfulness helps when you are depressed:

1.  Mindfulness helps people learn to be present in the moment, take stock of their thoughts and feelings, and choose an appropriate response rather than get caught up in negative emotions.

2.  Mindfulness teaches people that it’s okay to say “no” to others, which helps them balance their own lives and enhance self-confidence.

3.  Mindfulness allows people to be present with others, making them more attentive to their relationships, aware of their communication problems and more effective in relating to others.

These are important tools that can help chronic pain patients better manage their lives. Mindfulness activities help clear your mind of worry about the past or future and allow you to focus on the present.

Whether you are using mindfulness for anger, depression, chronic pain, anxiety or just for overall mental health -- it is important to keep an open mind. I know that is easier said than done when you are in severe pain. But the more you practice mindfulness the easier and more useful it becomes.

Can mindfulness cure you? No. Its purpose is to relax and help put life into perspective. If you are angry and distressed, that’s okay. I go there too sometimes. I use mindfulness to live in the moment and manage my emotions so that I am better able to manage my physical pain.

Barby Ingle lives with reflex sympathetic dystrophy (RSD), migralepsy and endometriosis. Barby is a chronic pain educator, patient advocate, and president of the International Pain Foundation. She is also a motivational speaker and best-selling author on pain topics. More information about Barby can be found at her website. 

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

48 Alternative Therapies to Help Lower Pain Levels

By Barby Ingle, Columnist

A year ago, I began this series of columns on alternative therapies for chronic pain management. There are so many different treatments, we presented many of them by letter – the 4 A’s, the 4 C’s, the 4 E’s, etc. This is my final column in the 12-part series.

In all, we covered 48 different treatment options. But we only scratched the surface. There are literally hundreds of alternative pain therapies and I've tried many of them myself. Many didn’t help me or provided only minimal relief. But I know of others who received great benefits from them.

This final month I am spotlighting trigger point injections, virtual reality, yoga and the yucca plant.

Trigger Point Injections

Trigger point injections can be beneficial in treating myofascial pain syndromes. That is when a patient has chronic musculoskeletal pain in specific parts of a muscle where a knot has formed due to inflammation. This is known as the “trigger point.” Steroids or analgesics (or both) are injected into the trigger point area to get the knot to release and the muscle to relax.

I have had trigger point injections done on my wrist and shoulder at various times. Although it was helpful long-term for my wrist injury, which occurred prior to my developing reflex sympathetic dystrophy, it was not as helpful with managing the RSD symptoms in my shoulder.

I could usually feel the muscle knots under my skin, but that was not always the case. I would also get a twitching response, which my doctor first thought was a sign of low calcium.  But after ruling that out, he realized that it was tight muscle fibers and inflammation.

There are risks with any type of injection. The injection or solution can cause damage to the skin and small nerve fibers, or cause infections and bleeding. If you think that trigger point injections could help, talk with your doctor first to find out if this would be a good option for you.

Virtual Reality

Virtual reality (VR) has been used in different forms of pain management since 1996. It operates under the theory that pain perception can be reduced by refocusing the patient’s attention away from their pain. Typically, that means wearing a headset or goggles that provide a 360-degree view while watching a realistic video or animated game.

AppliedVR in Los Angeles is developing a variety of virtual reality content to help treat pain, depression and anxiety. To give you an idea how it works, watch this promotional video by the company:

VR was first used to alleviate severe pain in patients treated at a burn center in Seattle, Washington. Since then, it has shown to be effective in treating acute pain in hospitals or when patients undergo lengthy testing procedures and need a distraction. I am hearing more and more from providers that VR can help lower the need for medication. 

VR is a fun activity that my husband and I have both tried. We quickly realized that it had therapeutic benefits and helped me to relax and keep my mind focused during long MRI’s and infusions. Like most therapies, the benefits of VR are usually short term. But VR is a promising field that is likely to improve as technology and personalized experiences are brought together in practice. 

Yoga 

Yoga is a mind-body exercise that uses controlled breathing, meditation and movements to stretch and strengthen your body. There are several types of yoga and people have been using yoga moves and thinking for thousands of years. The emphasis for all of them is on treating the mind and body equally.

Yoga can be used for pain relief for many types of chronic conditions, but patients must be cognizant of not pushing themselves into a flare by doing too much at one time. 

One study found that patients with chronic low back pain who took a weekly yoga class increased their mobility more than standard care like physical therapy. Other studies have shown that yoga is comparable to exercise therapy in relieving symptoms from arthritis, fibromyalgia and migraine. 

I have been using yoga in modified positions to strengthen myself. I don’t push myself too hard, because when I did I found myself in a pain flare. But when I go slow and easy, I find that it helps me build strength. For example, I will do the moves in a chair instead of on the floor and skip certain positions that may aggravate my pain. 

Practicing yoga has also helped with my mood, positive thinking and overall well-being. A typical yoga session lasts 45-90 minutes; mine are shorter, about 15-20 minutes at a time. Many people will go to a yoga class, but I do it at home using routines that I modified. Each session usually begins with deep breathing exercises that help me relax and lower stress levels. Then I use a series of yoga positions that are either seated, standing or laying down. Some positions are done quickly and others are held for a few minutes. If it starts to get too much for me, I stop or take a break.

At the end of the yoga session, I go back to breathing and mediation exercises to cool down. Be sure to modify your yoga to fit your needs. Doing some movement and breathing is better than nothing, even if it’s only a few minutes each day.  

Yucca

The Yucca is a plant with more than 40 species that typically grows in desert regions. It is used to make medicines for many conditions, including migraines, headaches, gastrointestinal disorders, osteoarthritis, high blood pressure, diabetes, vascular constriction, and more. 

Yucca medications are applied directly to the skin, made into extracts, or used in carbonated beverages. Some Yucca compounds have even been used in the manufacture of new medications. 

I first heard about the use of Yucca derivatives to treat pain while on a tour of the Desert Botanical Gardens in Phoenix, Arizona. That was where I found out that the Yucca can be used to treat sores, bleeding, sprains and joint pain. My husband is almost bald, and they suggested some people even use it for baldness. 

Researchers have found several Yucca compounds that are similar to anti-inflammatory medications.  Some of the chemicals in Yucca can also help reduce blood pressure or control cholesterol levels. For me, it helps reduce osteoarthritis symptoms by lowering the aching pain, swelling and stiffness I deal with. 

The Yucca plant is native to the southwest United States, where I currently live, as well as Mexico. Around here it is common for people to use the bark and root of the Yucca as a dietary supplement to promote joint health. There are even Yucca products on the market for treating pain in horses, dogs and other animals.

Be Open Minded

My alphabet series on alternative pain management is meant to spark ideas and discussion about treatments that you may not have known about before.  Before you try any of them, I encourage and remind you to talk it over first with medical professionals who are familiar with your past and present care. It is important to also remain open minded about your options and only do what you are comfortable with. 

There is no cure yet for chronic pain. So the more proactive we are in managing the symptoms -- even if we don’t get complete relief -- the better off we’ll be. Being positive, hopeful and creative in finding new ways to manage our conditions can help get our pain levels down.  

Want to see the rest my series on alternative treatments?  Here’s where to find them:

• The 4 A’s: acupressure, acupuncture, aromatherapy and art therapy.  
• The 4 C’s: Calmare, Chinese medicine, chiropractic, and craniosacral therapy. 
• The 4 E’s: energy therapy, electromagnetic therapy, equine therapy, and exercise. 
• The 4 F’s: faith healing, Feldenkrais Method, food, and functional medicine. 
• The 4 H’s: hypnotherapy, hyperbaric therapy, holistic living and herbal therapy.
• 4 Infusions: Ketamine, lidocaine, immunogoblins and stem cells.
• The 4 M’s: Mindfulness, magnets, massage and music.
• The 4 N’s: Nerve blocks, nitric oxide, neurotransmitter regulation and nabilone.
• The 4 O’s: oral orthotics, orthomolecular medicine, osteopathy and occupational therapy.
• The 4 P’s: Physical therapy, pain medications, prolotherapy and psychology. 
• 2 R's, a Q and an S: Quell, radiofrequency ablation, reflexology, sonopuncture

As I have stressed in all 12 articles, each of us is different, even if we are living with the same diseases. Your task is to find creative, effective ways to get the pain conditions you live with under control. I look forward to reading what worked and didn’t work for you.

Barby Ingle lives with reflex sympathetic dystrophy (RSD), migralepsy and endometriosis. Barby is a chronic pain educator, patient advocate, and president of the International Pain Foundation. She is also a motivational speaker and best-selling author on pain topics.

More information about Barby can be found at her website. 

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

9 Holistic Approaches to Relieve Joint Pain

By Nicole Noel, Guest Columnist

Whatever your ailment may be, holistic medicine has an answer.

A therapeutic method that dates back to early civilizations, holistic medicine takes into account the mind, body, emotions and spirit -- with the aim of helping patients achieve or restore proper balance in life and prevent or heal a range of conditions, including musculoskeletal pain. Holistic treatments offer a ray of hope for many patients suffering from arthritis, osteoporosis, fibromyalgia and other conditions that cause joint pain.

Not all alternative medicine is created equal, and some natural healing methods will produce better and quicker results. If you want to treat arthritis and other joint aches with holistic treatments, here are a few natural pain relievers you can try.

1. Tai Chi

A low-impact activity that can increase range of motion and strengthen joints and surrounding muscle tissue, tai chi is an ancient physical and spiritual practice that can help arthritis patients soldier through their pain.

According to a 2013 study, tai chi can relieve pain, stiffness, and other side-effects of osteoarthritis. In addition to pain relief, tai chi can help improve range of motion and alleviate joint pain for people living with fibromyalgia and rheumatoid arthritis.

2. Yoga

Another ancient technique which promotes natural healing, yoga is perfect for individuals suffering from lower back and joint pain. Gentle stretches and poses opening the joints can help prevent and alleviate chronic soreness in the shoulders, hips, and knees.

A form of yoga called mudras utilizes a series of hand gestures to increase energy, and improve mood and concentration.

3. Massage

An invigorating massage with warm essential oil can help many conditions, and joint pain is one of them.

By enhancing blood flow, relaxing the muscle tissue and soothing inflammation, a well-timed massage can ease joint stiffness and increase range of motion in individuals suffering from arthritis, fibromyalgia, and osteoporosis.

4. Acupuncture

A 2013 review of medical studies has shown that acupuncture can help relieve musculoskeletal pain caused by fibromyalgia. By activating the body’s natural pain relief system and stimulating the nerves, muscles and connective tissue, acupuncture can relieve joint aches for people who are resistant to other holistic pain relief techniques.

A 2010 study found that acupuncture can also be a beneficial for peripheral joint osteoarthritis.

5. Diet Changes

An apple a day may or may not keep the doctor away, but a custom-tailored diet can help you with joint pain. Nutritional tweaks can begin with increased intake of chondroitin sulfate, glucosamine, and Omega 3 fatty acids, which can reduce joint pain in arthritis and osteoporosis patients.

To ease joint problems, your pantry should be stocked with foods that promote healing and reduce inflammation, such as onions, carrots, and flaxseed. Herbs and spices such as turmeric (curcumin) and cayenne pepper can also help with pain relief.

6. Aromatherapy

If you think pain relief can’t smell good, you’re mistaken. Studies have shown that peppermint and eucalyptus oil can reduce swelling, pain and discomfort in patients with inflamed joints. For joint soreness and stiffness caused by arthritis, aromatherapy experts recommend regular application of myrrh, turmeric, orange, or frankincense oil to ease inflammation and pain, and to increase range of motion.

You can also combine aromatherapy with heat and cold treatments.  Be sure to keep the tender joints elevated during treatment to reduce swelling.

7. Spa Treatments

Few things can beat the appeal of a full-scale spa experience. If you’re suffering from knee, hip, shoulder or elbow pain and other holistic methods haven’t helped, try balneotherapy, which combines aqua massage with deep soaks in heated mineral water and medicinal mud baths.

One study found that balneotherapy significantly reduced knee and back pain in older adults.

8. Aquatic Sports

If you don’t want to immerse yourself in mud, you can supplement your holistic pain therapy with water aerobics, swimming, aqua jogging or aqua spinning. According to a 2014 study, water exercises can ease pain and improve joint function for osteoarthritis patients.

Additionally, a 2015 study found that aquatic circuit training can help relieve knee pain in cases of progressed osteoarthritis.

9. Capsaicin cream

Another natural treatment for joint pain and stiffness is homemade capsaicin cream, which can help reduce swelling and increase range of motion. To stay on the safe side, you should be careful when handling hot peppers when preparing the cream, and avoid using it on sensitive and damaged skin.

As our bodies age, joint pain can become a chronic. If you don’t want to take your chances with conventional pharmaceuticals, you can always turn to holistic medicine for answers and help. When musculoskeletal pain hits home, one or more of these holistic treatments can help.

Nicole Noel is a lifestyle blogger who is passionate about yoga and healthy living. She enjoys sharing her experiences and ideas on how to lead a happy and healthy life. If you want to read more from Nicole, you can find her on Twitter and Facebook.

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represent the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

What Alternative Treatments Work for Chronic Pain?

By Pat Anson, Editor

A review of over a hundred clinical trials has found that some alternative pain therapies such as acupuncture, yoga, tai chi, and massage are effective in treating chronic back and neck pain, osteoarthritis of the knee, migraine and headaches.

But only weak evidence was found that they might help people with fibromyalgia.

The review was conducted by scientists at the National Center for Complementary and Integrative Health at the National Institutes of Health (NIH). The study,  published online in the Mayo Clinic Proceedings,  was conducted to give patients and primary care providers better evidence on the effectiveness of non-drug treatments for chronic pain.

“One major goal for this study was to be as relevant as possible to primary care providers in the United States, who frequently see and care for patients with painful conditions. Providers need more high quality information on the evidence base for pain management tools, especially nondrug approaches,” said lead author Richard Nahin, PhD, an epidemiologist with NIH.

“Overall, the data suggest that some complementary approaches may help some patients manage, though not cure, painful health conditions.”

The scientists “found promise” in the safety and effectiveness of these treatments:

• Acupuncture and yoga for back pain
• Acupuncture and tai chi for osteoarthritis of the knee
• Massage therapy for neck pain  
• Relaxation techniques for severe headaches and migraine.

Though the evidence was weaker, the researchers found that massage, spinal manipulation, and osteopathic manipulation may provide some help for back pain. Relaxation approaches and tai chi might also help some people with fibromyalgia.

Mixed or no evidence was found that glucosamine, chondroitin, omega-3 fatty acids, and S-Adenosyl methionine (SAMe) are effective in treating chronic pain.

Each year Americans spend about $30 billion on alternative and so-called complimentary health treatments, even though few studies have been conducted on their effectiveness. The NIH researchers had to go back 50 years to find enough clinical studies to review. Many of the studies involved fewer than 100 people, which weakens the conclusions drawn from them. Some of the same studies were used by the Centers for Disease Control and Prevention as evidence for its opioid prescribing guidelines, which encourage "non-pharmacological" treatments for chronic pain.

“It's important that continued research explore how these approaches actually work and whether these findings apply broadly in diverse clinical settings and patient populations," said David Shurtleff, PhD, deputy director of National Center for Complementary and Integrative Health.

Give and Take Needed on CDC Guidelines

By Fred Kaeser, Guest Columnist

I wish we could all get along. Millions of people in chronic pain usually need opioids in adequate supply in order to manage their day and have some semblance of a quality of life. At the same time, tens of thousands of people's lives are destroyed, ruined, and ended each year from the very same drugs we pain sufferers find comfort from.

Looking objectively at the situation, there needs to be humane action on both sides of this conundrum. Whatever the result of the CDC's new prescribing guidelines, people in chronic pain must not be denied adequate access to opioids when absolutely needed, and yet some action needs to occur to reduce the outrageous rates of opioid addiction.

Think of what has happened in 15 very short years. We have gone from thinking that long term opioid use should only be provided for end-of-life care; to thinking that it is appropriate and acceptable to provide opioids on a regular basis for a myriad of pain causing illnesses and syndromes; back to thinking they are too dangerous and should be sharply limited. All within a 15-year period.

Yes, opioids reduce pain, just what all of us pain sufferers want. And yes, opioids destroy lives, something none of us want.

The truth is there have been no studies of long term opioid usage. And we know very little about just who is more prone to succumbing to the addictive aspects of these drugs once they are used for any length of time.

I do think there has got to be some give and take on both sides. The CDC has to understand that many, many chronic pain sufferers do indeed improve the quality of their lives by taking opioids. And I do think that we pain patients have to show a good faith effort that we are doing all we can to mitigate our pain through alternative pain treatments.
If you look at the CDC survey results attached to this website, you will see that almost 100% of pain respondents report little or no relief from alternative pain strategies. Over half of us say alternative strategies don't work and over a third of us say that they provide little relief.

Yet, if one explores the rich empirical research that exists on exercise, yoga, mind-body techniques like meditation and guided imagery, and their various permutations, we see that they can have a profound effect on reducing pain and discomfort. There is a huge body of research that supports just how powerful of an effect these modalities can have on reducing pain. Yet, almost all of us say they have little if any effect.

So, how can this be? I can only speak for myself, but when my pain started to become constant and severe I too did not think any of these alternative techniques were worth it. The time, energy, and sometimes additional pain that went in practicing them just didn't seem worth it. After all, I could find significant relief in 20 minutes or so just by taking 10 milligrams or so of oxycodone.

So why go through all that other stuff when I could be feeling relief in less than a half hour? But as my pain became every day, all day, I decided that I wasn't going to walk hand-in-hand the rest of my life with a drug that could very easily do more harm to me than the medical condition I was taking it for.

Days, weeks, and months went by of every day hard work. Exercise, stretching, yoga techniques, learning different meditation strategies, etc. were not easy. Amazingly, none of it cost much in terms of money, but the cost in terms of energy and time that went into practicing them was considerable. BUT, there came a time when it all started to pay off.

The research is correct: alternative pain techniques do work. Maybe not for YOU, but enough so that many of us could be finding significantly more relief than just from our medication. And it doesn't necessarily mean that we still don't need pain medication to get through our pain, but it will likely mean we'll need less of it.

I do think this is what is needed. Some give and take from both sides of the equation.

Fred Kaeser, Ed.D, has suffered from back pain, osteoarthritis and other chronic conditions for most of his life. He recently wrote a column about how he uses exercise to manage his pain.

Fred is the former Director of Health for the NYC Public Schools. He taught at New York University and is the author of "What Your Child Needs to Know About Sex (and When): A Straight Talking Guide for Parents." Fred enjoys exercising, perennial gardens, and fishing.

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represent the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

How I Use Exercise to Manage Chronic Pain

By Fred Kaeser, Guest Columnist

My dilemma may not be yours. I can only speak for myself. But when my intermittent severe pain became everyday severe pain, I felt I had a choice to make. Find a doctor that would prescribe me enough opioids everyday so that my horrible pain could be reduced considerably… or…decide that the risks of using opioids on a regular, constant basis outweigh the benefits.

When making this risk-benefit analysis, I needed to explore as best I could the empirical evidence on both sides of the opioid debate. Just as important, I needed to look at the evidence concerning alternative pain management strategies such as exercise, physical therapy, nutrition, yoga, mindfulness visualizations, and the like.

I am 63 years old and am in severe pain on an everyday basis. I have severe cervical spinal stenosis, multiple osteophytes impinging on my thecal cord, severe spondylosis, and multiple discs that have been severely compromised. I have osteoarthritis throughout my body. My hips have been replaced and one will need revision surgery fairly soon. My knees are shot. My lumbar spine is not as bad as my cervical, but multiple discs are herniated, the stenosis is in the moderate range.

I have crawled around on the floor many times for days and even weeks at a time since I was 25. I also have intermittent, but infrequent bouts of intercostal neuralgia, where it feels like the left side of my ribs are on fire. But without question, my cervical spine is the worst of them all.

      fred kaeser

I was determined to be an educated consumer in my quest to relieve pain, but time was of the essence. It’s brutal being in constant severe pain. It not only hurts, it’s exhausting. Fighting the hurt, trying to stay positive, trying to do your daily stuff, trying to be friendly, just trying to smile becomes harder and harder. .

I had done enough periodic trials of opioids to know several things. They work. But then at a certain point they don’t work as well. Even upping the dosage works for only so long. I can take an opioid for breakthrough pain or an extended release opioid, but the weird haze I’d get, the strange cloudy, foggy feelings I have, I never felt normal doing them.

I mean, is that what I want to feel like for years to come? I hate the pain, but the opioid cloud from any extended use I hate also. And the risks: tolerance, dependence, respiratory distress, sexual disruption, and constipation. That last one can be a bitch. I didn’t want to live in pain. but I didn’t want the risks and that overall crap feeling that opioids presented me. So the search for alternative pain therapies was on.

Let me first say I had to have the right attitude. “Stinkin-thinkin” is out, or as my meditation expert friend says, “If you “awful-ize” regularly you will feel awful.” I cannot emphasize enough the benefit of staying upbeat. I’m not stupid, I get it. You feel horrible, you feel like crap, you want to crawl out of your skin. But I have a choice; get swallowed up in negative thoughts and that is where I’ll stay, or stay as positive as I can and that is where I’ll stay. Not easy by any means, but it is the only means for me.

I was always athletic but I smoked. Smoked from 24 years of age to 56. That had to stop. When I had my second hip replacement I said I would quit right as I entered the hospital. I did and I could write a book on that fun trip.

I knew my diet would have to change. Didn’t want anymore extra weight and I knew I needed to increase my intake of foods that reduce inflammation. I love hot peppers, love those oily fish, those greens like spinach, kale, collard greens, those whole grains, and those almonds (but gotta watch the calories).

It took hard work to stop smoking and change my diet. And there was still a whole bunch more to come. I wanted to exercise more, I wanted to do my physical therapy exercises and stretches regularly, I wanted to give basic yoga posturing a try, I wanted to do some sort of meditation/positive visualizing practice.

I had read about all the benefits these could offer and I also knew it wouldn’t come quick. THIS IS THE HARD PART. I knew I would have to stick with it. I know too many people who say they’re going to make changes in their health status and do not stick with it. They’re in abundance after all those New Year’s resolutions every January, right? I’ve been one of them any number of times! It’s much easier to stop all the hard work and a whole lot easier to just take the pills.

But not this time. I knew that if my chosen alternative pain strategies were to work, I would have to be loyal to them and I would have to give them time. A lot of time, like 3-6 months of everyday, regular time. I have a family, I was working, I had all the stuff that comes with life, and now I had to fit a bunch more things in. I had to get up earlier than before, I had to spend an hour and half to two hours at night after work doing things I hadn’t before, and I had to fit these things into my weekends as well.

My Exercise Regimen

I had a YMCA membership and it’s amazing how many free or very low cost add-ons they provide. Yoga was free. Fairly low cost trainer sessions. My insurance covered a certain amount of physical therapy. A colleague-friend at work was a meditation expert. I get a lot of free senior citizen exercise and healthy activity benefits from the town I live in.

I started an exercise regimen that included cardiopulmonary exercise, weight training, and core exercise. I do an hour and half a day, 6 days a week. The myriad PT exercises and stretches I learned had to be done every day, 7 days a week as well. I don’t do all I know every time, but I usually spend about 20 minutes to a half hour on these.

The meditation/visualization I do is a form of guided imagery. Real easy to learn and real calming to do. I conjure peaceful, beautiful images for a 15 minute period in the morning and before bed I do 15 minutes of a mindfulness type experience where I am aware of positive thoughts, feelings, and images. I try to put my pain into a corner and focus on just the other things.

The yoga may give me the most benefits. I just do poses and stretches. I incorporate most of them in my daily workout routine and at times combine them with my PT work. All nothing real fancy, or too in-depth, but just enough of the basics to really help.

I lost count how many times I would bitch and complain in the beginning. How many times did I feel all this stuff was a waste? How many times would I curse them? How many times my pain hurt when I did them? How many times was my pain worse right after them? How many times did I want to give up? How many times did I want to just take the opioids? The answers: MANY!

A month went by…two months…three months…and I started to actually feel better. My pain was being mitigated. Six months and they worked even better. And now, almost 7 years later, they work better than ever. And my opioids? I am prescribed oxycodone, but I only take it every other day or every two days. I try to allocate myself no more than 10 pills a week.

Do I still have pain? Yep. Do the opioids help? Yep. In fact, when I take them they work as effectively as the first day I started taking them. I know I could easily do more and, considering the level of pain I have, they are easily warranted. But my pain is mitigated by my alternative pain management and my opioid use is minimized.

Just as important, there has been another benefit. The cervical spine surgery that I should be eligible for I don’t have to do because my functioning is normal. You don’t do this surgery unless your functionality suffers considerably.  Removing 2-3 discs, shaving down multiple osteophytes, and fusing 3-4 vertebras pose considerable post-op risks and perhaps even more pain. I’ve been told that my function is so good because of all the exercises I do, so no surgery for now.

Like I said, I can only speak for myself. But I have found a very effective balance to mitigating my pain through alternative pain management and the limited use of opioids. I still have pain every day but I manage it with a lot of hard work.

I know there are many people out there that must take opioids every day. And they should be provided with them. But I felt that I would be cheating myself if I didn’t do my best to mitigate my pain through alternative means.

I always have to be honest with myself. Am I doing all I can to ease my pain other than by taking opioid medication?

Fred Kaeser, Ed.D, is the former Director of Health for the NYC Public Schools. He taught at New York University and is the author of "What Your Child Needs to Know About Sex (and When): A Straight Talking Guide for Parents." Fred enjoys exercising, perennial gardens, and fishing.

Pain News Network invites other readers to share their stories with us. 

Send them to:  editor@PainNewsNetwork.org.

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represent the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

Wear, Tear & Care: Aroga Yoga

By Jennifer Kain Kilgore, Columnist

One of the most popular remedies that pain management doctors like to recommend for patients is yoga. Not only has yoga created a revolution in the fitness and apparel worlds, but it also is touted as a great way for chronic pain patients to exercise.

This generally leaves us patients in a strange spiral of “I hurt too much to work out” and then feeling worse because we aren’t moving.

Physical activity is necessary in whatever form we can manage. I have several instructional DVDs, but only a few of them are actually tailored to people with illness and pain. I decided to go hunting for the Big Kahuna.

My search was not in vain: I discovered Kayla Kurin, creator of Aroga Yoga. “Aroga,” which I thought was just a great rhyme, actually means “healthy, well, or free from disease.” Ms. Kurin is a yoga teacher based in London who focuses exclusively on chronic pain and illness, as she uses it to manage her own chronic fatigue syndrome.

“I had tried some naturopathic remedies and supplements, but didn’t find any relief from them,” she said. “For many years I was on strong sleep medication that helped me get some semblance of a night’s sleep and get through the day, but I became resistant to all of the medications and eventually stopped those as well.”

It was around then that she decided to try yoga, as she wandered into a bookstore and saw an instructional DVD for sale. 

“This was a huge turning point for me,” she said. “Once I started feeling better from yoga and meditation, I made a lot of dietary and lifestyle changes that helped me heal.”

Ms. Kurin has now been practicing for eight years and teaching for almost two, focusing on vinyasa flow and restorative methods with Yoga London. She relies on her own chronic illness in order to find the most effective poses for others, as even though yoga therapy is beginning to get more popular, there is currently only limited information about it. She has had to combine several schools and theories -- mostly vinyasa flow, restorative yoga, and iyengar -- to create her own chronic pain/illness program.

image courtesy of kayla kurin

It didn’t take long for her to realize that yoga was beneficial, as she left her first session feeling “very relaxed, but also alert. It was a unique feeling and led me to believe that there might be something behind this whole yoga trend.”

Even then, it took about two to three months of regular practice before she could see lasting effects. There were days she was too exhausted to get on the mat, and when asked how she managed to keep a daily practice, she said at first she could only make herself do five minutes. Five minutes would turn into ten, and so on. As she said, “I think that for both yoga and meditation, the longer you practice consistently, the more results you will see.”

She recommends that patients start with a few different types of yoga to see what works best, such as restorative, iyengar, and gentle hatha classes. “For example, some people with CFS swear by hot yoga; others found it was much too intense,” she said.

Even patients who are bed-bound or recovering from severe injuries can find a way to participate in their recovery. Ms. Kurin encourages them to first check with their doctors before even trying deep breathing exercises or a bed yoga program.

Every class is adaptable. In the chronic pain/illness yoga program, the first few classes are entirely sitting or prone positions. They can be done from a bed or chair, the latter of which Ms. Kurin is going to implement into future online courses.

“For example, if a patient is not able to stand or has trouble switching positions, we can work together to make adjustments to the class so it works for them,” she says.

Her online chronic illness class runs for six weeks with hour-long videos, and costs about $100. It focuses on breathing exercises and relaxation techniques to lessen pain and stress, improve sleep, and increase energy. Students of any level will find benefits. While each chronic pain/illness series shares the same core lessons, there are enough tweaks that even repeat students will learn something new (as I am sure I will, since I took the previous class and adored it; my only complaints were technical in nature, as the microphone hookup had some reverb in the first two sessions).

While online videos don’t offer the immediate feedback from teachers that a live class does, Ms. Kurin likes this format because nobody has to miss a class because of pain or illness. Everything is at the individual student’s pace.

“If a student is struggling with any of the poses, I can make them a video showing them adjustments for their body,” Ms. Kurin said. She is planning live workshops for later this year, having just taught one on sleep and creativity in Greece; her next idea is a chronic pain workshop in Edinburgh, Scotland. She also wants to offer live classes over Skype, which excites me to no end.

I loved the flexibility of the class, how I didn’t have to push myself through sessions when I felt physically terrible. Instead of feeling like exercise, it felt like a day at the spa for my battered body. Ms. Kurin understands her students on a fundamental level; she knows that there are just some days you can’t do it.

But five minutes a day… We can handle that!

The Takeaway: Aroga Yoga, Yoga for Chronic Illness.

For £65 (or $100.38), you get six one-hour videos of yoga, meditation, and breathing exercises; one-on-one unlimited email support for the duration of the course and three months afterward; and two group chat sessions. The next course begins October 19 and ends November 30, and students have lifetime access to the videos.

I will be taking the course again. I hope to “see” you there!

J. W. Kain is an attorney in the Greater Boston area who also works as a writer and editor in her spare time.  She has chronic back and neck pain after two car accidents.

You can read more about J.W. on her blog, Wear, Tear, & Care.  

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

Yoga Reduces Chronic Pain of Arthritis

By Pat Anson, Editor

A few weeks of yoga can significantly improve the health and mental well-being of people suffering from the two most common forms of arthritis, according to a new study at Johns Hopkins University.

Researchers found that 8 weeks of yoga classes reduced pain and improved the energy, mood and physical activity of patients with rheumatoid arthritis or knee osteoarthritis. The study, published in the Journal of Rheumatology, is believed to be the largest randomized trial to examine the effect of yoga on the physical and psychological health of arthritis sufferers.

"There's a real surge of interest in yoga as a complementary therapy, with 1 in 10 people in the U.S. now practicing yoga to improve their health and fitness," said Susan Bartlett, PhD, an adjunct associate professor of medicine at Johns Hopkins and associate professor at McGill University.

"Yoga may be especially well suited to people with arthritis because it combines physical activity with potent stress management and relaxation techniques, and focuses on respecting limitations that can change from day to day."

Rheumatoid arthritis (RA) is a chronic autoimmune disease in which the body’s own defenses attack joint tissues, causing pain, inflammation and bone erosion. About 1.5 million Americans and 1% of adults worldwide suffer from RA.

Knee osteoarthritis (OA) is even more common and affects over 250 million people worldwide. Nearly 40 percent of Americans over the age of 45 have some degree of knee OA, which causes thinning of cartilage and progressive joint damage.

Johns Hopkins researchers recruited 75 sedentary adults with either knee osteoarthritis or RA. Participants were randomly assigned to either a wait list or eight weeks of twice-weekly yoga classes, plus a weekly practice session at home. Their physical and mental well-being were assessed before and after the yoga sessions by researchers who did not know which group the participants had been assigned to.

Those doing yoga reported a 20% improvement in pain, energy levels, mood and physical function, including their ability to complete physical tasks. Walking speed also improved to a lesser extent, though there was little difference between the groups in tests of balance and upper body strength. Improvements in those who completed yoga were still apparent nine months later.

"For people with other conditions, yoga has been shown to improve pain, pain-related disability and mood," said Clifton Bingham III, MD, associate professor of medicine at Johns Hopkins University School of Medicine and director of the Johns Hopkins Arthritis Center.

"But there were no well-controlled trial of yoga that could tell us if it was safe and effective for people with arthritis, and many health professionals have concerns about how yoga might affect vulnerable joints given the emphasis on changing positions and on being flexible. Our first step was to ensure that yoga was reasonable and safe option for people with arthritis.”

Participants were screened by their doctors prior to joining the study, and continued to take their regular arthritis medication. Instructors in the yoga classes also had additional training to modify poses to accommodate people with limited physical ability.

“Find a teacher who asks the right questions about limitations and works closely with you as an individual. Start with gentle yoga classes. Practice acceptance of where you are and what your body can do on any given day," Bingham said.

How to be Healthy When You're Sick

By Crystal Lindell, Columnist

I’m trying to find ways to be healthy despite the fact that I constantly feel like I’m dying.

Having chronic pain is like waking up every single day feeling like you’ve just been mugged, then hit by a semi-truck, and simultaneously come into contact with the plague.

And when it first hits you, you’re like, “I can’t be expected to function under these conditions. Nobody could function under these conditions. I must call in sick to life.”

But after a month of laying on the couch watching every episode of Burn Notice three times, you suddenly realize you’re probably not going to be getting better any time soon, so maybe you should try to, you know, shower or something.

That’s where the drugs come in. And suddenly, you wake up one day and you’re literally taking six different medications before you even get out of bed in the morning. But hey! At least you’re getting out of bed.

And over the next few months or years or whatever it takes for you, you just sort of live in this drugged-up state of barely existing. It’s how I would imagine high school pot heads hope their life turns out, except without all the stupid stabbing pain in my ribs (or wherever yours may be). 

Aside from being high daily, you find all the shortcuts you can. For me, I ended up working from home. I moved in with my mom because doing my own laundry and washing my own dishes is literally too difficult. I shower once a week to save my energy. I shop online. And I never, ever, ever wear high heels. Ever!

On one level, I’m just happy that I’m no longer in so much pain that I literally hope I don’t wake up alive in the morning. But on another, I don’t really like what I see when I look down the long, dark road that’s probably going to be my life for, what? Another 50? Or even 60 years if I’m terribly unlucky?

Which brings me to the yoga. Yes, it’s true. I have started doing yoga. I’m hoping this is the next stage in the chronic pain life cycle, which will be followed quickly by, “Find a cure, and live happily ever after.”

While I’m here though, barely living, I figure I might as well get really good at downward dog. I started with a 30-minute PM yoga session for beginners on DVD. The hardest part is when I had to take two deep breaths in a plank pose. And, guess what? It didn’t suck.

I mean, I can admit when I’m wrong. And I was totally wrong about yoga. I really, really thought that bending my body in new, crazy ways would only make things worse. It’s just the human intuition in me, saying, “You’re in pain, stop doing stuff.” But, with chronic pain, you have to learn to override that voice.

And so, I’ve even done the 30-minute AM session, and I didn’t even die from that either. Plus, I also found another DVD by the same soothing instructor that’s 51-mintues long, and I did that one too, all without any trips to the hospital or anything! I’m pretty excited about the whole situation.

After each session I feel really relaxed, and it seems like I’m going through fewer pain pills when I do the yoga as opposed to when I don’t.

I’ve also started drinking tea. Back in the day, when my body didn’t hate me, I used to say things like, “Tea is literally just dirty water. Ick.”  But now, I’m sicker and wiser -- and I need to find ways to bring a sense of peace to my wounded body.

So, yeah, tea. It’s got to be better than Coke, right?

There’s a morning tea that seems to ward off the overwhelming feeling of being high that the meds give me. And then there’s a night tea that helps me poop — something I’ve really missed doing ever since my prescription pills took that seemingly natural bodily function away from me.

Truth be told, I am secretly hoping all these new changes will help me lose some of the 50 stupid pounds I’ve gained since getting sick. But if they even help me do more than shower or something, I’d be cool with that too.

Crystal Lindell is a journalist who lives in Illinois. She loves Taco Bell, watching "Burn Notice" episodes on Netflix and Snicker's Bites. She has had intercostal neuralgia since February 2013.

Crystal writes about it on her blog, “The Only Certainty is Bad Grammar.”

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represent the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.