Discovering the Truth About Pain

1. Discovering the Truth About Pain Alternatives to Pain Management

2. Pain is a regular problem in the bleeding disorders community. Acute pain can strike when a person experiences a bleed into a joint, muscle or other tissue. It can then lead to chronic pain from osteoarthritis and repeat bleeds. • Pain can be the primary problem people with bleeding disorders have, more than finding time to infuse or anything else. Bleeding Disorders & Chronic Pain

3. Physically – Pain is exhausting, preventing the person who lives daily with it from accomplishing all that they can or need to accomplish. • It can cause you to lose focus from work or school. • It can disturb sleep, preventing the restorative properties of complete rest that can ease suffering, also leaving you groggy and unfocused. • Chronic bleeds can also mean limited mobility or even confinement to your home. • Socially – Pain disrupts consistency when it comes to scheduling social events, obligations and commitments. • Also, the more time you spend alone, the more time you have to focus on your pain, which can make it worse. • Financially – There can be tremendous financial cost to chronic pain. • Long-term absenteeism from work can translate into financial hardship, loss of income, insurance and even loss of your job. • For students, classwork is constantly interrupted and they can fall behind in school forcing them to defer graduation or plans for higher education. • Emotionally – Pain is associated with an increased incidence of depression, anxiety, irritability, anger and even grief. • The loss of ability and independence can lead to feelings of grief. • Also, feelings of frustration and isolation from being stuck in your home. The Effects of PainPain can affect a person with bleeding disorders physically, socially, financially and emotionally

4. Even though pain medications (both OTCs - over the counter and prescribed) are commonly used to control acute and chronic pain there are many side effects associated with the use of these medications. • NSAIDs can be harmful to people with bleeding disorders because it can interfere with the blood clotting. • Prescribed pain medications have many side effects. • Increased sleepiness • Constipation • Itching • Alteration of mood • Nausea • Abuse, Dependency & Addiction • Lack of attentiveness and alertness Painkillers also can complicate communication. It’s difficult to express what’s going on inside when everything has been dulled. Pain Medications The most commonly used drugs by people with bleeding disorders according to the pain study are nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, naproxen and Celebrex. Other drugs commonly prescribed are Oxycodone (Percocet), Morphine, Methadone and Codeine.

5. More and more healthcare professionals recognize the need to approach pain from different directions. Alternatives to pain medication can be attractive to those whose bodies have built a tolerance to painkillers or they are concerned about becoming dependent on different forms of pain medications. Some alternative forms of managing pain are: • Music Therapy • Hypnosis/Relaxation • Acupuncture • Creative/Art Therapy • Complementary and alternative medicine (CAM) therapies Alternative Forms of Pain Management

6. Music Therapy A health profession that uses music for many purposes, including pain management. • There are more than 70 music therapy programs in the United States • Music therapists work in settings such as hospitals, adult day care centers, rehab programs and schools. • Music is used as a therapeutic intervention based on cognitive behavioral therapy, substituting dysfunctional thoughts for healthy thoughts, feelings and physical actions. • Music’s ability to affect the perception of pain relates to the gate-control theory. • Patients are conditioned to associate the music they are listening to, playing or singing with a relaxation state, based on guided imagery or hypnotherapy/biofeedback principles. • Coupled with imagery of a patient’s favorite spot to unwind, it can redirect your thoughts. • The music can be used to help you relax, distract you and give you something else to focus on. • If you’re focused on something like playing an instrument, singing or listening to music, that’s what’s going through the neurotransmitters – which relay the pain messages to the brain. It’s difficult to focus on two things at once. • The body produces its own pain relievers – serotonin, noradrenaline and endorphins – all of which can decrease or block pain signals. The anticipation of pain, combined with fear and anxiety, can increase the perception of it.Studies have shown that music therapy produces positive affects. Gallagher’s 2006 study of 200 adult patients assessed pain, anxiety, depression shortness of breath, mood and some behaviors. Those who listened to music experienced a reduction in pain, depression and disability.

7. It helps take you to a place where you’re in a very relaxed and focused state, in which your brain is more open to suggestion. • Can be used for pain management in both children and adults • People can be trained in self-hypnosis to reduce acute pain, chronic pain and anxiety • Can help reduce pain because the sensation of pain is influenced by multiple factors, including emotional and cognitive components • Self- hypnosis is a strategy that helps you take your attention off of the pain and close the pain gate in your brain on command Becoming Hypnotized • Induction – the period that helps the participant relax. Ask the participant to center on breathing, gradually slowing it down, or focus inward on the way their body’s organs and systems are functioning • Deepening stage – the person becomes more relaxed until they reach a state of hypnosis. • Next the participant will be asked to “visualize.” • One technique is to imagine a pain dial in the brain that the person will know how to turn down. • Another technique is to go to their favorite place and allow the pain to float away in a balloon. The goal is to enhance their personal control over the pain, so the first step is to show them how the pain could be reduced. Hypnosis

8. Hypnosis in Children • Self-hypnosis can be an effective pain management strategy for children and teenagers. • Elementary-age children are more open to the technique because they haven’t developed the skepticism that adults and teenagers might have. • Children as young as 10 months old can be “hypnotized” by teaching them to blow out an “owie” to feel better. • Children younger than 6 years old require a different kind of hypnosis than older children and adults. It is more active and doesn’t require them to close their eyes. • Children can become hypnotized much faster than adults; However, they come in and out of the state more easily. • The goal of ALL hypnosis is to make it self-hypnosis. For children to benefit from it parents must be supportive and not project any doubts onto the child. • By helping children manage their pain, not only do they feel better, but they also become empowered. Their level of confidence rises; their school attendance will go up and their willingness to try new things increases. • Hypnosis is a way of narrowing and focusing the patient’s attention and repatterning the physiology.

9. . Acupuncture • Works by restoring the flow of qi through the stimulation of pressure points located on channels called meridians. • There are approximately 14 main meridians and about 400 acupuncture points. The meridians have names, and the points have numbers. Each point has a different function. Stimulating the points increases or decreases function or sensation in different areas of the body. • Pain is relieved by promoting changes in the body’s biochemistry, particularly neurotransmitters in the brain. It stimulates the release of enkephalins, the body’s natural pain-relieving chemicals, and endorphins, the relaxation chemicals. Treatment • Placement of 5 to 20 stainless steel needles in various parts of the body for 15 to 30 minutes • Low- level electrical stimulation called moxibustion therapy can be used on the needles. This is done by burning an herb called moxa and putting it on top of the needle. The burning herb transmits the therapeutic heating sensation through the needle into the acupuncture point. Studies have shown that patients with arthritis and pain in their knees experienced relief and improved function after 26 weeks of acupuncture treatments. AcupunctureTherapy based on the premise that two opposing forces in the body control health: yin and yang. Yin is described as cold, slow and passive; yang as hot, excited and active. When one is out of balance, there is a blockage in the flow of energy, or qi, and disease or pain results

10. . • Appropriate for all ages, and can be done individually or in a group • Can help people open up to resolve conflicts • Can help to develop interpersonal skills, manage behavior and reduce stress • Can increase self-esteem and self-awareness, and help people to achieve insight • Creative work gives people a sense of control they may not feel when they’re dealing with a serious condition • Distracts from the chronic pain by engrossing the person in an activity that is inherently relaxing and that eases stress • Can help people work through anxiety that comes with routine medical procedures, such as self-infusion (ex. If a person is afraid of needles, the practitioner may recommend drawing a “pain monster” or a needle) • Helps people articulate how they feel • Helps relieve stress which in turn tends to cause pain levels to fall as well For people with bleeding disorders and their families, art therapy can be a helpful complement to treatment. It doesn’t require artistic talent or ability, just the willingness to give it a try. Creative Treatment (Art Therapy)Art Therapy is a mental health profession where practitioners use a creative outlet to keep a patient’s mind off of their physical pain and help them to release their emotional pain.

11. . Herbs & Supplements • Nonvitamin, nonmineral, natural products, such as fish oil, Echinacea, ginseng or flaxseed oil or pills. • Glucosamine and Chrondoitin sulfate – used widely for treating pain of arthritis • Omega fatty acid supplements • Willow bark tea • Herb milk thistle – used to treat liver cirrhosis and chronic hepatitis As with any treatment, you should consult your healthcare team before using herbs and supplements as many products may interfere with clotting and have actions similar to blood-thinning agents. Exercise • Meditation - can help change the way a person feels, their blood pressure, energy level and even their sense of what their pain is like by using a wide variety of mind control techniques. • Tai Chi – a “soft” martial art that consists of slow, controlled movement and gentle stretching of the joints that aid coordination and stability • Yoga – a form of exercise that incorporates stretching, strengthening and balance A regular exercise program should be followed to help cope with pain. The program should include special range-of-motion exercises to help keep your joints moveable. It should also include general exercise such as walking and swimming to help keep your heart, lungs, bones and muscles strong. Exercise helps relieve stiffness and gives you an improved sense of well-being. Complementary and alternative medicine (CAM) therapiesComplementary and alternative practices which are used in addition to, but not instead of, traditional medicine

12. Massage Therapy & Topical Lotions Alexander Technique Focuses on improving body awareness, which leads to the release of the chronic tension that has become part of the way we move and act.Feldenkrais MethodUses physical movement to focus on learning about the connection between thought and action. This approach is said to improve posture, flexibility and ease muscular tension and pain. Reiki“Universal life force energy”An ancient approach where allegedly the energy enters the practitioner through the top of his/her hands and exits through the hands, being directed into the body. Craniosacral therapy (CST)Gentle pressure is applied to the head and spine, which is thought to correct imbalances and restore the proper flow of the fluid that surrounds the brain and spinal cord.ReflexologyInvolves manual stimulation of reflex points on the ears, hands and feet which is believed to relieve stress and tension, to improve blood supply, to promote the unblocking of nerve impulses and to help restore balance to the body. • Can be useful in lessening pain, improving stress relief and inducing relaxation and decreasing muscle spasms • Increases blood flow and brings warmth to the sore area • Use massage in conjunction with the following topical lotions, oils & creams to enhance pain relief • Menthol gels • Pure comfrey and beeswax rub • Indomethacin – topical spray • Topical “deep-heating” rubs • Lavender oil • Capsaicin cream, made from chili peppers Aromatherapy Uses oils extracted from aromatic plants to enhance health, relieve pain and have subtle effects on the mind and emotions Oils are used in massages, baths, compresses, inhalations & vaporization Chamomile, clary sage, lavender & sandalwood are beneficial for relaxation To help relieve pain associated with joint damage prepare a bath oil mixture which contains: 25 drops fennel oil, 15 drops of juniper oil and 15 drops of cypress oil. Add 4 drops of this mixture to the bath water, along with two handfuls of Epsom salts.

13. Heat or Cold Treatments • Can reduce stiffness and pain • Cold packs numb the sore area • Heat treatments relax your muscles • Heat or cold treatment options: • Soak in a warm bath, shower or spa • Use a heating pad on painful area • Use an electric blanket • Use flannel sheets. They feel warmer against your skin. • Use a hot water bottle wrapped in a towel • Warm your clothes in a dryer or on top of a heating vent before putting them on • Place hot packs on the painful area • Try a paraffin bath – dipping your hands in a mixture of melted paraffin and mineral oil to help sooth stiff painful fingers. • Contrast bath - Use a combination of heat and cold • Place a cold pack or ice bag on the painful area, or even a bag of frozen vegetables

14. . • Improving management of stress related symptoms • Easing your perception of pain • Increasing mobility • Decreasing anxiety • Reducing tension • Improving posture and flexibility • Improving appetite or weight gain • Restoring a sense of “balance” in your body • Improving sleep • Enhancing your sense of well- being • Assisting you in experiencing inner calm and peacefulness • Assisting you in obtaining better insight into your personal healing • Improving blood circulation • Decreasing swelling • Increasing range of motion in joints Consult with your physicianprior to attempting any of the abovementioned therapies. Benefits of Alternative Therapies