Pain and Mirtazapine

I know, I’ve not blogged for a while but I’m hoping to be a little freed up from now on. So, I’ll start with a major change in my pain management.

I’ve mentioned a few times about the disasters that I’ve had with medication for pain management. I ended up settling on paracetamol (acetaminophen in the USA) for taking on and just managing the rest of the pain, using lidocaine patches (it’s an anaesthetic) placed on two points on the problematic pain sites. Due to the various issues with opioids and opiod-derived drugs, I hated taking them but have to admit the pair helped considerably, especially in allowing me to get out an exercise (walking and hiking, mostly).

But though useful, use of either – or both – still meant constant, careful pacing and a rigid adherence to a pain management routine, which meant a part-time job. And regular breakthrough instances were common, especially when the routine broke down. As anyone with Chronic Pain will tell you, breakthrough pain is highly distressing, deadening and agonising, frequently reaching a nine on the pain scale (10 being unconscious through pain, which isn’t much use).

But, for a year or more, I’ve had some new medication that has meant managing my pain is sooo much easier. Sure, I still occasionally have to use patches and paracetamol more than a non-PM person, but the frequency of use is much less and breakthrough events are far less common. It’s even got to a state where I can regularly run through a full day’s work with – which has meant I have applied for and been offered a full-time job (hopefully a start date will come through soon).

Sure, the job spec had to be carefully analysed as I still can’t do overly physical work with my arm/shoulders (lifting, even shelf stacking) or be involved in constant shaking that arises from driving or travel. But it’s a job, and one I’m pretty sure I can do day-in and day-out. It helps, of course, that it’s in an area of work I find fascinating and absorbing, so distraction is already built-in!

I’ve mentioned about depression and pain management, before, and probably also that I suffer from SAD, no doubt exacerbated by the pain. Just over a year ago I was put on a new drug, mirtazapine, one which I was informed was also used for pain management in the USA. In the UK we use amitriptyline for pain control, amongst other anti-depressants, but none worked for me. In constrast, on a high dose of mirtazapine I found no negative intellectual or emotional impact, though they make me drowsy about 4-6 hours after taking them (so I take them in the afternoon), BUT I did find that the day-to-day pain levels were significantly reduced.

I really do mean significantly. The difference in my quality of life is fantastic.

The pain is still there – I have some now, as I type – but the general levels are so much reduced that I can manage the pain much easier, sometimes even ignoring the pain and forgetting pain management strictures completely. For a while, that is, as forgetting a PM routine always leads to increased pain and eventually breakthrough and a lack of ability to do anything… it does mean that I have to be more mindful of following my routine even when the pain is low.

Is it a cure? No. Am I still in pain? Yes. Do I have to take the maximum dose? Yes. Do I still have to be mindful of my pain management routine? Yes. Has it made a positive difference? Emphatically YES. Cure or not, it has become a major plank of my PM routine and one I am relieved has made so much difference.

Exercise and pain

There’s a number of steps to exercising with pain which are worth bearing in mind. Why? Predominantly because, in my case, walks in the open air, amongst the green, are fantastic for health, well-being and enjoyment. Others may find the social contact or body support in a swimming pool useful, the low-impact nature of cycling and swimming achievable. But there are a number of steps it’s worth bearing in mind before doing the exercise.

Whatever you do, though, it’s worth bearing in mind that finding the right exercise for _you_ may be difficult, but it is worth it. The health, breath and relaxation it brings can be immense. And that’s good for pain management.

The steps I consider worth looking at are:

1) Discovery. Explore the options you think might work, or which others suggest, and be prepared to fail. Yes, I know failure means pain, but it’s a process in which all results are steps onto the next. Try cycling, swimming, walking, pilates, yoga, even jogging, etc – as long as it will not overly impact pain. For me, for example, I was aware that stretching of arms and impact jogging will cause pain due to aggravation, so that drew a line under a bunch of types, but I tried returning to cycling and swimming just to see. As it happened, cycling aggravates my arm too much and swimming involved too much stretching and overload. Some pilates exercises I had already developed (apparently) to resolve intermittent back pain (cause by sitting too long in a couch, really) and they are low-impact, work almost totally on core strength/back, and do not affect the rest of my pain. On-road walking can be high-impact. However, off-road walking, especially hills, is deceptively more strenuous (balance, uneven surfaces, etc) and takes me out in the green spaces and amonst woods.

2) Start gentle. Remember pacing and developing periods of activity. Do a walk/exercise at a gentle pace, but be very aware of how it affects your pain/body at every moment. Build up time and ‘speed’ (however speed is measured – it’s really exercise level). Don’t be afraid to back off for a while and start again – it’s your pain and no-one else knows how it affects you. Once you realise it’s working, then go to step 3 but keep step 2 going.

3) Research good practice. Be aware of what is beneficial about the exercise, walking in my case. Due to humans being so well optimised, slow ambles bring almost no physical benefits but may bring great emotional/spiritual benefits just by being outside in the fresh air – and don’t forget the sunlight vitamins. :slight_smile: However, faster walks and at 20 minutes plus (last time I checked!) bring masses of benefits.

4) Build up. I’ve worked out a maximum time for walks and focus on that. Yes, I go for longer walks, but I stop at the pacing mark or even if pain is building up too much. Don’t be afraid of taking those rests-stops or calling for them if walking with others. And just don’t overdo it: make sure you’re in control or in a comfort zone. More of the exercise means you’ll build up confidence.

5) Take the support and clothing you need. For example, I walk in all weathers. Which means I have a good jacket, decent walking boots, take a hat so as not to get too cold, and carry a sling. And if it looks as if I’m on the edge, I take low-end painkillers beforehand, just in case. Water is always good for longer walks when you think you may have to stop.

6) Be aware of everything around you – it’s not just the exercise itself that’s good. Research is constantly coming up with the benefits of green spaces on well-being, but I find it’s also the views and, when I can, the company that helps. For me, there’s a lot of enjoyment and relaxation to be gained by breathing in the fresh air, being aware of the sights, small and large: the plants, the birds, the trees, dew on a spiders web, frost on the grass, mist in summer and winter hovering in the valleys. Take time to appreciate all this beauty.

Ultimately, an exercise such as walking can help fulfill a whole bunch of pain management goals: relaxation, the physical exercise, encouraging breathing, fitness and just enjoyment – those good brain-chemicals really help beat back the pain. But the exercise that’s good for you is good for oyou – just be aware of the various factors involved and try it!

Happy walking!

Pacing and Pain

I’ve been busy, again, hence no posts. Insanely busy, in fact, and I let something get away from me: Pain Management. I know, I’ve said plenty of times here and on my other blog that PM is a lifestyle, a way of living to allow you to live. But I had a whole host of mini-handbooks to write, some mini-supplements to write and edit, a players pack to finish, and some playtesting, an inquest and its rather stressy fallout…

You get the picture.  Basically I forgot two of the major tenets of PM: pacing and distraction. And probably exercise, too, if I’m honest, but that’s not been too bad.  As a result, extreme pain, opioids, sleepless nights, breakthrough pain, the bust scenario  – if you’re into PM, you’ll know it.

So I bought a book to remind me of it, to place on my desk in front of my eyes: The Pocket Book of Pacing by Hannah Ensor.

A path through unsullied snow

I know, it’s been a long time since the last post. That’s because of a whole range of real life issues, one of which was cutting open my hand due to this annoying nerve problem. It is an example of one of the hiccups that have to be factored into Pain Management: prioritisation. ‘I-want-to-write-a-post’ becomes ‘I-really-need-to’ and doesn’t quite make it into the ‘I-must’ category as it is pushed out by stories, essays and commentaries I am actually writing whilst in added pain.

Problematic Pacing: missing a plank

Breakthrough pain or unknown recurrence of serious pain is a problem sometimes. Recently, I’ve been having a lot of it and nothing I (thought I) did was managing the pain back down. Though things were complicated by a painful, but totally unrelated infection, I was back onto regular opioids, with all the problems they bring.

The Problem: Discovery

It was only a chance conversation with a neighbour that reminded me of what I’d been doing wrong. She is a Mindfulness teacher/practitioner and had just been on a Chronic Pain Mindfulness day (Mindfulness, meditation and similar structured relaxation/thinking techniques have been shown to really help in Pain Management: I use them all the time). Some of what she was talking about was standard Pain Management, effectively ‘slanted’ to Mindfulness, but a key comment was a discussion of how the trainer managed to write the books she had. Apparently the trainer used a timer set to 20 minutes, took a break/did something else (e.g. relax/distract), then came back and continued.

It was through pacing. Plain old, simple pacing.

Recharge: Walking and Castle hunting

I had a quick break last week: a few days in Wales, the Black Mountains. I was camping, alone, and in a very not-glamping style. The purpose was for a recharge before I was pinned back into one place by travel or other commitments.

From a Pain Management perspective, being alone was risky and useful. Useful, as it meant I could take as long as I wanted to get up there; risky, in that pain may overtake the situation. However, on the way up I took frequent breaks, one even being a sight-seeing break and wander around Raglan Castle. Further, since I was alone, I could just crawl into the tent at the end and resst my arm up for a while.

Such a trip, though, was a recharge in several directions: creatively, walking and looking at natural and ancient, man-made sites and allowing the imagination to roam; and physically, going to a place I loved and in which I could have some time for retrospective thinking (meditation, some might call it) and release.