Living a Healthy Life with Chronic Pain (38 page)

Sometimes long-term health problems make it difficult to gain weight or keep it on. Your condition or its treatment may make it hard for you to eat because you aren’t hungry. Sometimes if you are sad or depressed, your body is unable to use the food it gets, or it burns up calories faster than you can replace them.

When you aren’t hungry or have trouble eating, few foods sound appealing. When this happens, it is important to keep eating. You need to eat for energy and strength. That overrides making sure that what you eat is healthy. During those times, eat whatever you can. It will probably only be temporary, and then you can return to healthy eating.

With weight gain, just like with weight loss, slow and steady wins the race. Try the 200 Plan (see
page 242
) and eat an extra 100 calories a day every day. This alone can result in a 10-pound weight gain over a year. Choose foods that you really enjoy, focusing on your favorites. Keep easy-to-fix or already-prepared foods handy so that you don’t need to spend much time cooking.

If you experience a continual or extreme weight loss or have trouble keeping weight on, you’re not alone. Let’s look at some common weight management challenges and some ideas for dealing with them.

The following are some ways to increase the calories and nutrients you eat without increasing the amount of food you eat:

• Because fat gives us many more calories than carbohydrates or protein, choose foods that are higher in fat. Remember to stick with foods that contain good fats (see
  page 212
  ). For example, snack on calorie-rich foods such as avocados, nuts, seeds, or nut butter.
  

• Eat dried fruit or nectars instead of fresh fruit or regular juice.
  

• Choose sweet potatoes instead of white potatoes.
  

• Use whole milk instead of lower-fat dairy products. Use it instead of broth or water in soups and sauces too.
  

• Try a liquid supplement drink with or between meals.
  

• Drink high-calorie beverages such as milk-shakes, malts, fruit whips, and eggnog.
  

• Top salads, soups, and casseroles with shredded cheese, nuts, dried fruits, or seeds.
  

Check with your doctor or a registered dietitian to see if the following tips are appropriate for you:

• Eat tiny meals or smaller meals several times a day.
  

• Keep some nuts or dried fruit handy, and eat a few pieces each time you walk past the bowl.
  

• Eat the highest-calorie foods first, saving lower-calorie foods for later (for example, eat buttered bread before cooked spinach).
  

• Add extra whole milk or milk powder to sauces, gravies, cereals, soups, and casseroles.
  

• Add melted cheese to vegetables and other dishes.
  

• Use butter, margarine, or sour cream as toppings.
  

• Consider keeping a snack at your bedside so that you can eat something if you wake in the middle of the night.
  

People come in many shapes and sizes, but if they carry too much or too little weight, it can affect their pain symptoms and overall health. There is no such thing as a perfect or “ideal” weight, but rather there is a range of pounds that is good for you. Being in a healthy weight range helps you achieve overall well-being, both for your body and your mind.

The smartest and best approach to achieving a healthy weight range involves both healthy eating and being active. Once you get to your healthy weight, it is important to keep it in a good range. Choose realistic lifelong strategies that you can stick to instead of trying quick fixes, which most often do not work. Set your sights on success by building on small changes over time.

To learn more about the topics discussed in this chapter, we suggest that you explore the following resources:

Ferguson, James M., and Cassandra Ferguson.
Habits, Not Diets
, 4th ed. Boulder, Colo.: Bull, 2003.

Hensrud, Donald D., ed.
Mayo Clinic Healthy Weight for Everybody
. Rochester, Minn.: Mayo Clinic Health Foundation, 2005.

Nash, Joyce D.
Maximize Your Body Potential
, 3rd ed. Boulder, Colo.: Bull, 2003.

Schoonen, Josephine Connolly.
Losing Weight Permanently with the Bull’s-Eye Food Guide
. Boulder, Colo.: Bull, 2004.

Zentner, Ali.
The Weight-Loss Prescription: A Doctor’s Plan for Permanent Weight Reduction and Better Health for Life
. Toronto: Penguin Canada, 2013.

Y
OU MAY BE TAKING ONE OR MORE MEDICATIONS FOR CHRONIC
pain. You may also be taking medicines for other medical conditions. It is a very important management task to understand your medications and to use them appropriately. This chapter will provide general guidelines to help you do just that. Be sure to read this chapter first before reading
Chapters 16
. That chapter provides information on medicines used for chronic pain specifically.

Few products are more heavily advertised than medications. If you read a magazine, listen to the radio, or watch TV, you see a constant stream of ads. These are aimed at convincing you that if you just use this pill, your symptoms will be cured. “Recommended by 90 percent of the doctors asked,” they say. But be aware that they may have asked doctors who work for the company that makes the pill, or only a handful of doctors. And have you noticed
that in TV ads, the benefits are presented in a slow, upbeat voice, while the side effects are recited very rapidly? It can be very confusing.

Your body is often its own healer. Given time, many common symptoms and disorders improve. The prescriptions filled by the body’s own “internal pharmacy” are frequently the safest and most effective treatment. Patience, careful self-observation, and monitoring with your doctor are often excellent choices.

Medications can be an important part of managing a chronic condition—but they do not cure it. Medications generally serve one or more of the following purposes:

• To relieve symptoms.
  A nitroglycerin tablet expands the blood vessels, allowing more blood to reach the heart, thus quieting angina. Acetaminophen (Tylenol
  ^®
  ) can relieve pain. An antidepressant medicine can lighten depression and improve mood.
  

• To prevent further problems.
  For example, medications that thin the blood help prevent blood clots, which cause strokes and heart and lung problems.
  

• To improve or slow the progress of a disease.
  Nonsteroidal anti-inflammatory drugs (NSAIDS) can help arthritis by quieting the inflammatory process. Likewise, antihypertensive medications can lower blood pressure.
  

• To replace substances that the body is no longer producing adequately.
  Insulin is used to manage diabetes and thyroid medication for underactive thyroid.
  

When you take medication to relieve symptoms such as pain, depression, or anxiety, you expect to get relief from your symptoms right away. But sometimes, medication has to build up in your body before you will experience relief. It is important to talk with your doctor or nurse practitioner about how long you need to take the medicine before deciding whether or not it is right for you.

When a medication’s purpose is to lessen the consequences of disease or slow its course, you may not be aware that the medication is doing anything. This may make you think that the drug isn’t working. It is important to continue taking your medications, even if you cannot see or feel how they are helping. If this concerns you, ask your health care provider.

Modern society pays a price for having such powerful pharmaceutical tools at our disposal. Besides being helpful, all medications have undesirable side effects. Some of these effects are predictable and minor, and some are unexpected and life threatening. Approximately five to ten percent of all hospital admissions are due to drug reactions. At the same time, not taking medications as prescribed is also a major cause of hospitalization.

Medication affects your body in two ways. The first is determined by the chemical nature of the medication. The second is triggered by your beliefs and expectations. Your beliefs and confidence can change your body chemistry and your symptoms. This reaction, called the
placebo effect, is an example of how closely the mind and body are connected.

Many studies have shown the power of the placebo—the power of mind over body. When people are given a placebo (pill containing no medication), some of them improve anyway. Placebos can relieve back pain, fatigue, arthritis, headache, allergies, hypertension, insomnia, asthma, irritable bowel syndrome and chronic digestive disorders, depression, anxiety, and pain after surgery. The effect will not last indefinitely but it may last for some time. The placebo effect clearly demonstrates that our positive beliefs and expectations can activate our self-healing mechanisms. You can learn to take advantage of your powerful internal pharmacy.

Every time you take a medication, you are swallowing your expectations and beliefs as well as the pill. So expect the best! Let’s look at some ways to do that.

• Examine your beliefs about the treatment.
  If you tell yourself, “I’m not a pill taker” or “Medications always give me bad side effects,” how do you think your body is likely to respond? If you doubt that the prescribed treatment is likely to help your symptoms or condition, this negative attitude will undermine the ability of the pill to help you. You can change these negative images into more positive ones. Review the discussion of positive thinking in
  Chapters 5
  for guidance on how to do this.
  

• Think of your medications the way you think of vitamins.
  Many people associate healthful images with vitamins. Taking a vitamin makes you think you are doing something positive to prevent disease and promote health. If you regard your medications as aids to restore and promote health, like vitamins, you may obtain more powerful benefits.
  

• Imagine how the medicine is helping you.
  Develop a mental image of how the medication is helping your body. For example, if you are taking a pain medication, tell yourself that it is finding its way through your central nervous system and closing the pain gate. For some people, forming a vivid physical image is helpful. An antibiotic, for example, might be seen as a broom sweeping germs out of the body. Don’t worry whether your image is medically correct. It’s your belief in a clear, positive image that counts.
  

• Keep in mind why you are taking the medication.
  You are not taking your medication just because your health care provider told you to. You are taking your medication to help you live your life. Therefore it is important to understand how the medicine is helping you. Use this information to help the medicine do its job. Suppose a man with lower back pain is given an antidepressant medication to improve his pain and his mood. He has been told it will make him feel drowsy and dizzy and it will cause him to have a very dry mouth. So of course, that is what he thinks about and that is what happens. But suppose he is also told that the symptoms will likely be only temporary, and that they mean the drug is building up to a therapeutic level in his body. In a few weeks he should start to experience an improvement in his pain and mood.
  These side effects indicate that the drug is starting to work. He can then take actions to counter these effects and often have an easier time tolerating them. (See
  Chapter 16
  ,
  page 276
  , for tips on how to manage pain medications.)
  

People with chronic pain often have other health problems. When this is the case, they often take many medications: analgesics for pain, medications to lower blood pressure and cholesterol, drugs to elevate mood or manage depression, antacids for heartburn, plus a handful of overthe-counter (OTC) remedies and herbs. The more medications (including vitamins and OTC remedies) you take, the greater the risk of unpleasant reactions. Also, not all drugs work together well, and when they are taken together, they sometimes cause problems. Fortunately, it is often possible to take fewer medications and lower the risks. However, you should not do this without the help of your doctor or nurse practitioner. Most people would not change the ingredients in a complicated cooking recipe or throw out a few parts when fixing something in the car. It is not that these things can’t be done. It is just that if you want the best and safest results, you may need expert help.

As a self-manager, you need to know about your medications in order to successfully manage them. How you respond to any one medication depends on your age, your metabolism, your daily activity, the waxing and waning of your symptoms, your chronic conditions, your genetics, and your frame of mind. To make sure you get the most from your medications, your doctor depends on you. Report what effect, if any, each drug you take has on your symptoms, as well as any side effects. Based on this critical information, your doctor may decide to continue, increase, discontinue, or otherwise change your medications. In a good doctor-patient partnership, there is an ongoing exchange of useful information.

Unfortunately, this vital communication is often neglected. Studies indicate that fewer than five percent of patients getting new prescriptions ask any questions about them. Doctors tend to interpret patient silence as understanding and satisfaction. Problems occur when patients do not receive enough information about medications or do not understand how to take them. In addition, all too often people do not follow instructions. Safe, effective drug use depends on your health care provider’s expertise. But equally important is your understanding of when and how to take the drug. You must ask questions, and you must take the necessary precautions. (The discussion about communication in
Chapters 11
can help.)

Some people are afraid to ask questions. They are afraid they will seem foolish or stupid or be perceived as challenging the doctor’s authority. But asking questions is a necessary part of a healthy relationship with your health care provider.

The goal of treatment is to maximize the benefits and minimize the risks. This means taking the fewest medications, in the lowest effective doses, for the shortest period of time. Whether the medications you take are helpful or harmful often depends on how much you know about them and how well you communicate with your doctor and other health care providers.

Even if your doctor or nurse practitioner doesn’t ask, there is certain vital information about medications you should mention during every consultation.

List all the prescription and nonprescription medications you are taking, including birth control pills, vitamins, aspirin, antacids, laxatives, alcohol, and herbal remedies. An easy way to do this is to maintain an updated list of all medications along with the amount you take (dosage) and bring it with you to all medical appointments. Or bring all your medications with you. Saying that you are taking “the little green pills” isn’t very helpful.

Communication about all the medications you take is especially important if you are seeing more than one health care provider. Each caregiver may not know what the others have prescribed. Knowing all your medications and supplements is essential for correct diagnosis and treatment. For example, if you have symptoms such as nausea, diarrhea, sleeplessness or drowsiness, dizziness, memory loss, impotence, or fatigue, they may be caused by a drug side effect rather than your chronic pain or other conditions. If your health care provider does not know all your medications, he or she cannot interpret your symptoms appropriately or protect you from drug interactions.

Describe any symptoms or unusual reactions caused by medications. Be specific: report which medication (if you know) and exactly what type of reaction. Developing a rash, fever, or wheezing after you take a medication is often a sign that you have had a true allergic reaction. If you experience any of these symptoms, call your doctor at once. Nausea, diarrhea, ringing in the ears, light-headedness, sleeplessness, and frequent urination are likely to be side effects rather than true drug allergies but you still want to mention them when you discuss medications with your provider.

Many diseases can interfere with the action of a drug or increase the risk of using certain medications. Diseases involving the kidneys or liver are especially important to mention because they can slow the metabolism of many drugs and increase toxic effects. Your provider may also avoid prescribing certain medications if you
have or have had such diseases as high blood pressure, peptic ulcer disease, asthma, heart disease, diabetes, or prostate problems. Be sure to let them know if you are possibly pregnant or are breastfeeding. Many drugs cannot be safely used in those situations.

It is a good idea to keep your own records of your previous prescriptions as well as your current medications. Knowing what has been tried and how you reacted will help guide the provider’s recommendation for any new medications. However, the fact that a medication was not effective in the past does not necessarily mean it can’t or shouldn’t be tried again. Chronic pain and other diseases change, and the same medication may work the second time.

There is important information you need to know about your medications as a self-manager. When you discuss medications with your doctor, nurse practitioner, or pharmacist (learn more about pharmacists in the “A Special Word about Pharmacists” box in this chapter), ask the following questions:

Some providers prescribe medications not because it’s really necessary but because they think patients want and expect drugs. Don’t pressure your provider for medications. Many new medications are heavily advertised and promoted by their manufacturers. Quite a few heavily marketed and prescribed medications were later found to be so hazardous that they were withdrawn. So be cautious about requesting the newest medications. Know your options. When any treatment is recommended, ask what is likely to happen if you forego or postpone treatment. Although sometimes a powerful medication is called for, other times the best medicine is none at all. If your provider doesn’t prescribe a medication, consider that good news. Ask about nondrug alternatives. For chronic pain, lifestyle changes such as exercise, diet, and stress management may have better results than medications.

Keep and regularly update a record of each medication you take. Note its brand name, if any; the generic (chemical) name; and the dosage prescribed (for example: Tylenol
^®
, acetaminophen, 200 mg three times a day). Check your order when you receive it from the pharmacy. If the medication doesn’t match the information in your records, ask the pharmacist to explain the difference. This is your best protection against medication mix-ups.

Your health care provider should tell you why the medication is being prescribed and how it might help you. Is the medication intended to prolong your life, relieve symptoms, or improve your ability to function? For example, if you are given a medicine for high blood pressure, it is primarily to prevent later complications (such as stroke or heart disease) rather
than to stop a headache. On the other hand, if you are given a pain reliever such as ibuprofen (Motrin
^®
), the purpose is to help ease the headache. You should also know how soon you should expect results. Drugs that treat infections or inflammation may take several days to a week to show improvement. Antidepressant and some chronic pain and arthritis drugs typically take several weeks to start providing relief.

If medications are going to be effective, you must take them
when
you are told to,
in the amounts
you are told to, and
for as long as
you are told to take them. This is crucial to safe and effective use. Does “every 6 hours” mean every 6 hours while awake or every 6 hours around the clock? Should the medication be taken before meals, with meals, or between meals? What should you do if you accidentally miss a dose? Should you skip it, take a double dose next time, or take it as soon as you remember? Should you refill and continue taking the medication until you have fewer symptoms or until you finish the current medication? Some medications are prescribed on an as-needed basis. For these medications, you need to know when to begin and end treatment and how much medication to take. Work out a plan with your provider to suit your individual needs.

It is vital to take all medications properly. Yet nearly 40 percent of people report that their doctors failed to tell them how to take a medication or how much to take. If you are not sure about your prescription, contact your doctor, nurse practitioner, or pharmacist.

Food may help protect the stomach from some medications, but certain foods can also make some drugs ineffective. For example, milk products or antacids block the absorption of the antibiotic tetracycline. This drug is best taken on an empty stomach. Some medications may make you more sensitive to the sun, putting you at increased risk for sunburn. Ask whether a medication will interfere with driving or operating machinery safely, or if alcohol should be avoided while taking it. Other drugs, even recreational or over-the-counter drugs, can either amplify or lessen the effects of the prescribed medication. Taking aspirin along with an anticoagulant medication, for example, can result in possible bleeding. The more medications you are taking, the greater the chance of an undesirable drug interaction. Ask about possible drug-drug and drug-food interactions.

All medications have side effects. You need to know what symptoms to look for and what to do if they develop. Should you seek immediate medical care, discontinue the medication, or call your provider? While the doctor or nurse practitioner cannot be expected to describe every possible adverse reaction, the most common and important ones should be discussed. Unfortunately, a recent survey showed that 70 percent of people starting a new medication did not recall being told about precautions and possible side effects by their physicians or pharmacists. It may be up to you to ask.

Most medications are monitored by whether symptoms improve or worsen. However, some medications can disrupt body chemistry before any symptoms develop. Sometimes these adverse reactions can be detected by laboratory tests such as blood counts or liver function tests. In addition, the levels of some medications in the blood need to be measured on a regular basis to make sure you are getting the right amounts. Ask your provider if the medication has any of these special requirements.

If a drug does not seem to be improving your pain or other symptoms, is not allowing you to do more, or is causing unacceptable side effects, you may be tempted to stop taking it. Some drugs, especially for chronic pain and some other conditions, cannot be stopped suddenly. They need to be “tapered” by reducing the dosage gradually. Tapering needs to be done under the supervision of your health care provider. It is important that you do not attempt this by yourself. Talk to your provider about which drugs need to be tapered and how this can be done safely.

Almost every drug has at least two names: a generic name and a brand name. The generic name is the drug’s chemical name. It is used to refer to the medication in the scientific literature. Generic names are also used for certain drugs that are not marketed under a brand name. The brand name is the unique name given to the drug by its developer. When a drug company develops a new drug in the United States, it is granted exclusive rights to produce that drug for 17 years. If a drug is developed in Canada, the exclusive rights are for 20 years. After this period, other companies may market chemical equivalents of that drug. These generic medications are generally considered as safe and effective as the original brand-name drug but often cost much less. In some cases, your provider may have a good reason for preferring a particular brand. Even so, if cost is a concern, ask if a less expensive but equally effective medication is available.

You may also be able to save money by knowing how to use your insurance to your advantage. For example, your copayment may be less if you obtain your medications from a company designated by your insurer. Also, many pharmacies have discount programs for seniors and individuals with low income. It pays to ask and then ask again. And it is wise to shop around. Even in the same town, different stores may sell the same medication at different prices

Your doctor or nurse practitioner may not have time to answer all your questions. You may not remember everything you heard. Fortunately, there are many other good sources of information, including pharmacists, nurses, package inserts, pamphlets, books, and websites. Several useful sources are listed at the end of this chapter.