Did you know?
Editor’s note: This article was written based on my experience and what I have researched about the topic. Everyone is different. The decision to use supplements should be a decision between doctor and patient.
As part of the week-long Mayo Clinic fibromyalgia program I attended in 2016, I met with a pharmacist to review the long list of prescription medicines, over-the-counter medicines, and supplements I was taking at the time. My medicine cabinet looked like a GNC store.
I was instructed to bring the actual bottles with me to the appointment, so I packed the bottles into a gym bag (yes, I was taking a lot of medicines and supplements) and went to see her.
I was surprised as she read each bottle, making comments and recommendations about each pill – including product quality, labeling issues, ingredient safety, and dosing.
When the appointment ended, my medicine and supplement list was much shorter with her recommending stopping most of the supplements and my gym bag much lighter – throwing away the pills was going to stop taking.
Unlike prescription or over-the-counter drugs, which must be approved by the Federal Drug Agency (FDA) before they can be marketed, the FDA doesn’t review supplements for safety and effectiveness before they are sold.
We don’t know where the products are made, how they are made, what is in them, and if the dosage is appropriate.
Safety is left up to the manufacturers and distributors of the supplements.
You assume all risk when using supplements. While some may be valuable, many aren’t.
A friend of mine, Sara Villa, a molecular neuroscientist who lives with chronic pain, recently posted an insightful Twitter thread about working with pain.
While her post was specific to working with pain, I saw in her tweet some key messages for anyone living with chronic pain and collaborated with her to distill the messaging into nine helpful tips:
Thank you, Sara!
How do you think about and react to your chronic pain? Are you the victim? Are you overly-worried about the pain?
We all experience pain. That we can't choose.
The choice we have as humans is how we respond to the pain. We can either choose to let the pain control our lives or we can choose to live life, despite the pain.
For many people with chronic pain, a vicious circle can form between pain and suffering. Research has shown the psychological and social distress associated with pain is often more important to the pain experience as the perceived pain severity.*
Resilience is important
I just watched a great TEDx Talk from Dr. Trung Ngo about resilience that everyone who lives with chronic pain or treats chronic pain should watch.
He talks about how there are three types of people: those who are victims, those who are catastrophizers, and those who are resilient.
I can identify with all three types during my personal journey with pain. Early in my journey, i was the victim. It was the surgeon's fault for my pain. I was set on on making that doctor pay for his mistake and make my pain go away.
As the pain continued, I became the catastrophizer. It quickly became gloom and doom. I become fearful of the pain. I worried about all the bad things that might happen because of the pain. And I worried about my future and the future of my family.
Fortunately, my mindset changed to resiliency. Many thanks to the Mayo Clinic Pain Rehabilitation Center for helping me transition to that stage.
How to be resilient
According to Dr. Ngo, the keys to being resilient:
* Ojala, T., Häkkinen, A., Karppinen, J., Sipilä, K., Suutama, T., & Piirainen, A. (2014). Chronic pain affects the whole person – a phenomenological study. Disability and Rehabilitation, 37(4), 363–371. doi: 10.3109/09638288.2014.923522
Before I begin, let me clarify I’m not a trained clinician nor a pain expert. I share my experience as a pain patient (I tapered off opioids while attending the Mayo Pain Rehabilitation Center – it’s an expectation when you start the program) and my research. My treatment approach may or may not be right for everyone else. I don’t mean to dismiss anyone’s beliefs or experience. If opioids work for you, so be it. Treatment is a decision between patient and doctor.
Opioids are a hot topic. In the 1990s, they became the quickest and least expensive treatment option for chronic pain. Then came the opioid crisis and a hard push to reduce opioid use. More recently, there is a movement to de-stigmatize opioids.
Bottom line for me
While opioids are appropriate for acute pain, there’s no quick fix for chronic pain. While some chronic pain patients report short-term improvement with opioids, there is a question of when do the risks exceed the rewards.
It isn’t fair to ask chronic pain patients to lower or stop opioids with little or no tapering and no alternative treatments. If the decision is to reduce or stop opioid therapy, tapering should be done with oversight and alternative treatment. Chronic pain patients shouldn’t be expected to abruptly stop opioid therapy.
If used, opioids should be prescribed at the safest lowest dose and be used as part of a comprehensive pain management plan, including non-opioid medicines and non-biomedical therapies like ACT, CBT, relaxation training, exercise, and other coping strategies.
More research is needed about all sorts of pain treatment.
Barnett, M. L. (2020). Opioid Prescribing in the Midst of Crisis — Myths and Realities. New England Journal of Medicine, 382(12), 1086-1088. doi:10.1056/nejmp1914257 https://www.nejm.org/action/showPdf?articleTools=true&fbclid=IwAR0k_gaCI6MDzN8r-N33UwWqyIC8IqmPEjRwdnzl3LGbO2UAbHLFHIBw880&downloadfile=showPdf&doi=10.1056/NEJMp1914257&loaded=true
Busse JW, Wang L, Kamaleldin M, et al. Opioids for Chronic Noncancer Pain: A Systematic Review and Meta-analysis. JAMA. 2018;320(23):2448–2460. doi:10.1001/jama.2018.18472 https://jamanetwork.com/journals/jama/fullarticle/2718795
Chou R, Deyo R, Devine B, Hansen R, Sullivan S, Jarvik JG, Blazina I, Dana T, Bougatsos C, Turner J. The Effectiveness and Risks of Long-Term Opioid Treatment of Chronic Pain. Evidence Report/Technology Assessment No. 218. (Prepared by the Pacific Northwest Evidence-based Practice Center under Contract No. 290-2012-00014-I.) AHRQ Publication No. 14-E005-EF. Rockville, MD: Agency for Healthcare Research and Quality; September 2014. https://doi.org/10.23970/AHRQEPCERTA218. https://effectivehealthcare.ahrq.gov/products/chronic-pain-opioid-treatment/research
Morasco BJ, Yarborough BJ, Smith NX, et al. Higher Prescription Opioid Dose is Associated With Worse Patient-Reported Pain Outcomes and More Health Care Utilization. J Pain. 2017;18(4):437-445.doi:10.1016/j.jpain.2016.12.004 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5376359/
Khomula EV, Araldi D, Bonet IJM, Levine JD. Opioid-Induced Hyperalgesic Priming in Single Nociceptors. J Neurosci. 2021 Jan 6;41(1):31-46. doi: 10.1523/JNEUROSCI.2160-20.2020. Epub 2020 Nov 17. PMID: 33203743; PMCID: PMC7786210.
Stannard C. Where now for opioids in chronic pain? Drug and Therapeutics Bulletin 2018;56:118-122. https://dtb.bmj.com/content/56/10/118
Turner JA, Shortreed SM, Saunders KW, LeResche L, Von Korff M. Association of levels of opioid use with pain and activity interference among patients initiating chronic opioid therapy: a longitudinal study. Pain. 2016;157(4):849-857. doi:10.1097/j.pain.0000000000000452 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4939796/
There's still a core you despite the pain.
What you can do
Chronic Pain Champions is an information resource/blog/support group to help chronic pain patients, their families, and friends, as well as healthcare professionals. Learn more about this site and the author.
Chronic Pain Champions