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The Top 23 Things That Will Cause A Flare In What You Thought Was Endometriosis Adenomyosis Symptoms But Maybe Isnt 13 23 webpage

The Top 24 Things That Will Cause A Flare In What You Thought Was Endometriosis & Adenomyosis Symptoms, But Maybe Isn’t (13-24)

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In the second part of my posts about the top 24 things that will cause a flare in what you thought was endometriosis and adenomyosis symptoms, but may isn’t, I continue with the next 12 causes of what you think is endometriosis, or adenomyosis symptoms, may just be caused by something else?

In this post I continue to bring awareness to the fact that sometimes it is not always Endometriosis, or Adenomyosis causing your current symptoms. It may be one of the following facts only, or in combination. What we need to remember is that many women with endometriosis, and adenomyosis, often have other issues that are flaring their current symptoms, and often present the same as endometriosis and adenomyosis, in their symptomology.

We also know that many other causes of flares of symptoms are often overlooked, and even dismissed, just as endometriosis and adenomyosis is often missed and dismissed.

Many women may have other issues going on at the same time as having endometriosis, or adenomyosis, and it is possible to have both endometriosis and adenomyosis combined and well as having other health issues in combination as well. Just remember that not all your symptoms may be endometriosis, or adenomyosis, and why it is so important to see and expert in these conditions.

If you do need and expert and need help with endometriosis and adenomyosis, please give my friendly staff a call and find out how I may be able to assist you.

 

Let’s have a look at the next 12 causes of “What You Thought Was Endometriosis and Adenomyosis Symptoms, But Maybe Isn’t”

 

Causes of a Flare of What You Thought Was Endometriosis and Adenomyosis Symptoms, But Maybe Isn’t ( 13-24)

13.Tight pelvic floor muscles – Pelvic floor hypertonus occurs when the muscles in the pelvic floor become too tight and are unable to relax. Many women with an overly tight and non-relaxing pelvic floor experience pelvic health issues such as constipation, painful sex, urinary urgency, bladder issues and pelvic pain. Women with pelvic floor hypertonus may also have musculoskeletal issues that cause tightness and tension in surrounding hip, sacrum and pelvic muscles. Have a read on my previous post about this. (Click here to read)

14.Interstitial cystitis– Interstitial cystitis (IC) is a chronic inflammatory bladder condition in which there is persisting chronic pelvic pain, urinary frequency and urgency, bladder pain or pressure, and it can also resemble the symptoms of a urinary tract infection, but there will be no infection present. The pain can range from being mild to severe. Women with interstitial cystitis may experience many of the same symptoms as those with endometriosis. Women can have both Interstitial Cystitis and endometriosis at the same time. Some people with IC may also have irritable bowel syndrome (IBS), Fibromyalgia and other pain syndromes. This is why proper differential diagnosis is very important as this can be missed very often, or completely overlooked. Have a read of my previous post about IC (Click here to read)

15.Pelvic Congestion Syndrome– Pelvic congestion syndrome (PCS) is a chronic condition that occurs in women when varicose veins form below the abdomen within the pelvic region. Pelvic congestion is just like the varicose veins that some women have in their legs, but it affects the veins of the pelvis. Blood backs up in the veins, making them become enlarged and engorged. Pelvic congestion can also cause chronic pelvic pain in some women. Pelvic congestion syndrome does share many of the same symptoms of endometriosis and adenomyosis and it important to have proper differential diagnosis and rule other causes of pelvic pain out first. Sometimes the varicose veins that cause pelvic congestion syndrome can be present alongside endometriosis and adenomyosis, or other pelvic issues. Have a read of my previous post about PCS (Click here to read)

16.Constipation and full bowel- A common cause of pelvic pain and abdominal pain and bloating and caused by constipation and a full bowel that is slowly backing up and starting to compact. In serious cases, the bowel can compact and even perforate if not addressed soon enough. When the bowel is not fully voided, it can lead to backing up of the bowel. Many people are still moving their bowel each day, but just do not realise, it is not being voided properly. This can lead to pain, gastrointestinal issues and also feeling unwell, due to not voiding waste from the body. It is a very commonly overlooked issue. This is why women need look at restoring the microbiome properly and also drinking enough water, eating enough fibre and also creating good bowel habits and not holding on too long at work.

17.Lack of sleep – Lack of quality sleep is a major issue for many women and is a common cause of their fatigue, increased pain, and exacerbation of symptoms, interference of moods, and a whole range of health issues physically and mentally. Sleep deprivation leads to reduction in hormones such as melatonin, which is a precursor to serotonin and then affect the moods etc. Lack of sleep also interferes with the other hormones in our body too. Lack of sleep also stops the body from repairing and can lead to increased inflammation within the body. We know that shift works do have a lot more disturbances with their menstrual cycles and also have lower fertility rates.

18.Over-exercising– Over-exercise can lead to tight pelvic floor muscles and hypertonus, but it can also lead to decrease body fats as well. Body fat plays a regulatory process with hormones and fertility. A significant decrease in body fact (10-15%) can lead to decreased hormone production and actually stop the menses and interfere with fertility. Over exercise can also cause stress and inflammation in the body and can also lead to adrenal exhaustion and fatigue. It is all about balance.

19.Lack of exercise– Lack of exercise if a big factor in a lot of people’s health issues. Lack of blood flow and lack of circulation to muscles and tissues, especially the uterus and vagina, can have some serious consequences for women’s health and gynaecological conditions. Without proper microcirculation into the uterus, and vagina and reproductive organs, these areas can become highly stressed, lack vital nutrients and then leads to inflammation, pain and other irregularities. It is a catch 22 situation. Too much exercise is not good, but similarly, not enough exercise is just as bad for us. While sometimes we may not feel like exercising, the fact is, research has shown that regular exercise can, and does help with pain, and other symptoms of endometriosis and adenomyosis.

20.Environmental Estrogens– According to a landmark US study published by the US department of environmental health, there are 87,000 plus environmental estrogens we are exposed to in all countries around the world, some being worse than others. These can be anything from plastics, detergents, petroleum products, chemicals and even the contraceptive pill ending up in our water ways. These endocrine disruptors (AKA as environmental estrogens) can interfere with hormones within our body and also lead to inflammation and many health issues. They have also been linked to the increase in lower fertility rates and the increase in expression of genetic mutations within the body. Endometriosis and adenomyosis is driven by estrogen and this may be a big factor in the increase in women with endometriosis and adenomyosis.

21.Lack of blood/increase of blood circulation– The microcirculation of the uterus, vagina and reproductive organs is a very important one and one of the reasons getting proper blood flow and improving microcirculation into these areas is important. I talked about this in the lack of exercise part. It is also important to check women for hereditary blood clotting and also bleeding disorders. All women with gynaecological and fertility issues should be screened for blood clotting disorders via prothrombotic studies and also bleeding disorders such as Von Willebrands Disease, when suspected.

22.Musculoskeletal issues– Women with postural issues, or their spine out of alignment can also experience referral pain, and pelvic pain due. It is important to have musculoskeletal causes of pain assessed by a qualified healthcare professional (physio/chiropractor/osteopath). When muscles are too tight, it can cause sublaxations, which can then impinge on nerves and also cause referral pain and other health issues within the body. Damage to nerves and tissue, such as pudendal nerve neuralgia can also cause pain and referral pain in the lower abdomen, pelvis and vagina.

23.Excess weight and body fat– At present up to 70% (or more) of Australians, and Americans, are either overweight, or obese, so we can no longer ignore what the consequences of these statistics mean. We know that excess weight and excess body fat is linked to serious health consequences. Excess body fat in men and women leads to higher levels of the hormone leptin. Excess body fat is also now referred to as obestrogens, as they cause the same health consequences as environmental estrogens (known as endocrine disruptors). These excess body fats and higher levels of leptin do impair production of sex hormones and also reduces fertility. It can also lead to poorer sperm quality, poorer egg quality and can also increase the risk of miscarriage. Excess body fat, especially excess abdominal fat, is also linked to insulin resistance, metabolic syndrome and other health issues. It also interferes with the regulation of sex hormones and sex hormone binding globulin (SHBG).  This can then increase the risk of irregular cycles, PCOS, endometriosis, adenomyosis, miscarriage and other factors affecting fertility. Excess body fat can also be a major driving factor of endometriosis and adenomyosis, due to the estrogenic effects it has. This is why reduction in body fat and a healthy diet and healthy lifestyle is imperative in the management of women’s health and fertility.

24. Iron Deficiency– Iron deficiency can be a very serious issues, and many women do not realise the health risk associated with it, and how often it goes undiagnosed. It can lead to disruption of hormones, and can lead to fatigue and exacerbation of pain and emotionally generated symptoms. Let’s face it, without iron, you aren’t going to be transporting oxygen around your body and then your muscles, brain, hormones and circulation suffer as a result of this. Women with endometriosis and adenomyosis are nearly always iron deficient from the heavy blood losses they suffer, or the internal bleeds they get from flares of endometriosis lesions. Have a look at my previous past on the serious consequences of low iron and why managing iron levels is so important (Click here to read)

 

Opioid Crisis

Let’s Talk About The Current Opioid Crisis & Pain Prescription Crackdown

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Recently there has been so much news about pandemics such as COVID 19, but nobody is talking about an epidemic that is causing more deaths than this global crisis. The Opioid Crisis is an epidemic is expanding on a global scale. In Australia, the rise in prescribing of pain medications, particularly opioids has increased signficantly. This is having has had devastating results, with the levels of harm and deaths due to opioid misuse rising exponentially.

In Australia, over three million people were prescribed 15.4 million opioid scripts in 2016–17. What is most concerning is that opioids now account for 62% of drug-induced deaths, with pharmaceutical opioids now more likely than heroin to be involved in opioid deaths and hospitalisations. In 2016–17 there were 5,112 emergency department presentations and 9,636 hospitalisations due to opioid poisoning, with three deaths per day attributed to opioid harm – higher than the road toll.(2)

The global crisis of opioid crisis is increasing and is very concerning. About 275 million people worldwide (5.6 per cent of the global population aged 15–64 years) used drugs at least once during 2016. There were an estimated 27 million people who suffered from opioid use disorders in 2016. Roughly 450,000 people died as a result of drug use in 2015. Of those deaths, about 118 thousands with opioid use disorders.

Overdose deaths contribute to between roughly a third and a half of all drug-related deaths, which are attributable in most cases to opioids. Lifetime prevalence of witnessed overdose among drug users is about 70%. There are effective treatments for opioid dependence yet less than 10% of people who need such treatment are receiving it. The inexpensive medication naloxone can completely reverse the effects of opioid overdose and prevent deaths due to opioid overdose.

Due to their pharmacological effects, opioids in high doses can cause respiratory depression and death.

In Australia today, unrelieved pain is a major issue. Up to 80 percent of people living with chronic pain are missing out on treatment that could improve their health and quality of life. Some of these people are dismissed and feel isolated and suffer constant pain, anxiety, depression and even attempt suicide. It is big issues that needs to be address.

Opioids and pain medications should never be regarded as the sole approach to people with chronic pain. They should be regarded as one component of a multimodality approach and management plan, and should only be used on a limited basis and monitored regularly so as not to develop and addiction.

A well-defined and well-structured multimodality management pain plan, set out be a qualified healthcare professional, is essential in improving pain outcomes, improving overall health and helping with the complications of withdrawal of pain medications and opioids.

In this video I talk about the current reforms here in Australia and the ongoing opioid crisis that needs urgent attention and people do need to be managed better on all levels.

Regards

Andrew Orr

-No Stone Left Unturned

-Master of Women’s Health Medicine

-Men and Women’s Health Advocate

-The Headache, Migraine and Pain Experts

 

References

  1. Deloitte Access Economics (2019), The cost of pain in Australia.
  2. Royal Australian College of General Practitioners (2018). Australian overdose deaths are increasing – and the demographics are changing. News GP. Access online here.
  3. WHO- Information sheet on opioid overdose (click here to access)
  4. Pain Australia (fact sheets)

 

10 Common Mistake seen with

10 Common Mistakes Seen With Endometriosis

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1 in 10 women are diagnosed with endometriosis and it often takes up to 10 years to be diagnosed. The number 10 seems to be a recurring theme. So, for this post I am going to talk about the 10 common mistakes seen with endometriosis. Hopefully this helps to create some more awareness about this horrible disease and helps those who are suffering, or have not been diagnosed yet.

Below are the ten common mistakes I see with endometriosis.

1. Believing surgery has cured their disease

Many people with endometriosis are often led to believe, or have been told, that once they have surgery that their endometriosis is cured.

There is no cure for endometriosis, so surgery is not a cure. Hysterectomy is not a cure either.

All surgery does is deal with the expressed disease and that is it. It does not prevent further regrowth of the microscopic implants of endometriosis that are waiting to express and develop into lesions again. While surgery is a very valid medical option to address acute pain caused by the disease, it is not a cure. It only helps with symptomatic relief.

2. Not doing follow-up management of the disease after surgery

We know that despite the best medical interventions that women with endometriosis often will still be in pain, or have further expression and regrowth of the disease.

As mentioned previously, surgery is a valid treatment option for acute pain and for when hormones and medications are not working. But, from my experience I do see many have the surgery and then are not doing any ongoing management, except for pain medications. This isn’t necessarily the person’s own fault either. Many are also poorly managed post surgery and are not aware that they will need ongoing management of their disease state. As mentioned, many are literally just unaware that their disease can, and will grow back without ongoing support and healthcare management. It is crucial that all women with endometriosis receive ongoing care and management of their disease from an appropriately trained endometriosis expert.

3. Endometriosis care requires a multimodality/team approach

There is no one single medicine, or modality, that can effectively deal with endometriosis and this is why a multimodality/team approach is needed.

Surgery is just one treatment approach, which is also needed to definitively diagnose the disease, and then for when the disease is acute and nothing else is working. But surgery alone is not adequate to deal with the disease as a stand alone therapy.

Endometriosis is estrogen driven so there does need to be some form of progesterone support to help suppress further expression of the disease. This can be in varying forms and something I will discuss in another post.

There also need to be support of the microbiome and working on the microcirculation to the pelvic area and reproductive organs. There also need to be ongoing emotional support and care such as counselling, or psychology

There also needs to be dietary changes (low inflammatory based diet), physiotherapy, exercise, complementary medicines, acupuncture, nutritional medicine other modalities. All of this can be done alongside ongoing medications and medical support. Each individual with the disease has different symptoms and will require different multimodality care and support, based on their individual needs.

4. Not seeing the right surgeon

I know I always talk about it, but this is because many who are suffering from endometriosis and the associated symptoms, just have not seen the right person in the first place.

In every profession there is good and bad. There are those who specialise in a certain area, and there are those who don’t. The same goes for medicine and the same goes for surgeons too.

When needing a diagnosis, or surgical intervention for endometriosis, it is imperative to see an advanced trained laparoscopic surgeon who specialises in the excision of endometriosis. This way you also know that this surgeon is not only advanced trained and highly skilled, but also specialises in endometriosis and every aspect of it.

Not all gynaecologists and surgeons specialise in endometriosis and some dabble in it and are not highly skilled in the actual surgical requirements to effectively excise the disease properly. Some surgeons do not even do excision surgery and tend to just to ablation only. This is not how you surgical deal with endometriosis.

These advanced trained surgeons also have to do a certain number of surgeries per year to attain the status of being advanced trained. Someone who does a few surgeries here and there is definitely not advanced trained. These advanced trained surgeons also do extra years of surgical training and are the best of the best and why anyone who is suspected of having endometriosis, or has endometriosis need to see these surgeons only.

Too many women are under-serviced surgical, by poorly skilled surgeons, who are not specialised in endometriosis and who are not advanced trained and this is where all the problems start. It can also lead to making the patient worse and only leads to further suffering and years of pain as a result. It also means that the advanced trained surgeons then have to fix up the mess these other surgeons created.

The hard thing is some women are limited by demographic and location when it comes to being able to see an advanced trained surgeon. Unfortunately most of them do private work, and any in the public system have long waiting lists and may only do one day a week public surgical lists. You may not even get to see them unless you see them privately first and they put you on there public waiting list.

5. Not seeking help and intervention early enough

There is two parts to this that need attention and need discussion. We know that it often takes up to 10 years (or more) to be diagnosed with endometriosis. This means that a hell of a lot of women are being missed and dismissed by GP’s, allied healthcare practitioners, complementary medicine practitioners, specialists and so forth. This isn’t meant to be negative, or an attack on any one profession. These are the facts and something that cannot be ignored. It also needs to be discussed.

Then we also have parents waiting way too long to seek help for daughters, using the wait and see if it will go away approach. I see this often and I am often getting asked if a parent should just wait and see if their daughters pain will magically disappear. I often have to point out that if my daughter was passing out, or laying on a bathroom floor crying with pain, I would not be waiting to see if it was going to go away. Early intervention is the key to any disease. The wait and see approach is often the reason many women end up with years of fertility issues and years of pain, and other associated symptoms of endometriosis. The longer a disease is left to spread, the more damage it does, and the harder it is to treat.

Teenagers are not too young to have endometriosis and we are now seeing young girls as young as 5 years old having endometriosis found.

The other issue we see if women who know that they have the disease, putting off seeing someone for fear of more surgery, or fear of being dismissed. Again, this only leads to further complications and disease growth and thing being harder to treat.

Once a woman has endometriosis, the reality is that she may need further surgical intervention. But, it is needed to help with symptomatic relief and reduce inflammatory response in the body. The other thing is that by going and seeing someone who specialises in endometriosis, they are trained to help you manage your disease properly.

There may also be some non-surgical options that can be used and help with symptoms and disease management as well. But, you need to go in the first place, to get the help you need. Please do not put off getting your health and disease state managed properly. If you are in a bad place with your disease, make sure you get on that phone and book yourself in with someone who specialises in endometriosis.

6. Trying to manage the disease by yourself

I’ve covered this a bit in the last statement, but so often I see women trying to manage endometriosis themselves. This only leads to a vicious cycle that keeps going around and around and nothing good ever comes of it. The disease does not get managed properly, the symptoms get worse and then it all becomes way harder to effectively treat and manage.

Sometimes if things are left too long, there can be permanent damage that is not repairable. This is definitely why people should not try to manage their own disease and symptoms themselves.

If your disease state and associated symptoms are out of control and you aren’t being managed properly, please get on that phone and book in to see someone as soon as possible. Do not put it off any longer. Now is the time to do something about it, not tomorrow, or next year.

7. Getting medical advice from support groups

I am a big advocator of anyone with a long-term health issue receiving emotional and physical support. It is a must. But, it needs to be via trained professionals who are specialised to help you properly.

While I am also a big fan of support groups, I am not a fan of non-medically trained, non-healthcare people giving healthcare and medical advice to people within these groups. I love seeing the emotional support in these groups, but I don’t love it when I see people getting medical advice about medications, hormones and medical procedures. This is dangerous. I’ve even seen advice given on how to take ones own IUD out and this is when I have to speak out.

By getting medication advice, medical advice, surgical advice and any other healthcare advice from someone who is not appropriately trained, you are actually putting yourself in great danger. Please do not take the advice of anyone who is not a healthcare practitioner, or a specialist in endometriosis. Sure, get the emotional support from like minded people, and people who understand what you are going through, but leave it there.

The other thing is just being careful of not getting caught up in some of the negativity of some groups, where you also then start to focus and become your disease. You are not your disease and to move forward you need proper healthcare and lots of positivity.

8. Letting pain and associated symptoms get out of hand

Some of this I’ve also spoken about, but this is one thing I see often as well. Many people are at a point of self-managing with pain medications that are not working effectively any longer. This then leads to increased reliance and dependence of pain medications and it can also lead to increase pain and associated symptoms.

I have talked about pain medications and the withdrawal affects in previous posts. I have also talked about how increased pain medication use can actually cause pain and lead to further inflammation in the body. I have also talked about the addiction of pain medications too. It is a catch 22 situation. (Click here to see previous posts mentioned)

The point I am trying to make here is that if your pain levels and associated symptoms are getting out of hand, then you need to do something about it. Please do not try and manage your pain and symptoms on your own. Increasing your medications can have detrimental effects on your body and long term health consequences.

If you have to increase your pain medications, it means something is drastically wrong and that your pain levels need urgent professional attention. Your endometriosis expert/specialist is trained to help you get your pain levels and associated symptoms managed properly.

There may also be something else going on that could be sinister and require urgent medical attention. Never presume that all your symptoms are related to your disease. Seeking proper medical health and ongoing management, could just save your life.

9. Buying into the label and letting your disease own you

Having a chronic health condition myself, I know all too well how easy it is to fall it the trap of buying into the label of the disease. I also know all too well by doing this, you are letting the disease own you.

I also understand how hard it is on the bad days, not to get down about everything and think that there is no help, and how unfair things are. Yep, I truly get it. But, I also know that the more one focuses on the negative, and constantly lives in the disease state, the harder it is to truly move forward and get better.

Our thoughts and being negative can exacerbate pain pathways and they can also disrupt the healing pathways as well. If you listen to people that have overcome and illness, or a disease, they will always tell you it was by getting the right help and being positive. Positive mental outlook is very underrated in healthcare and its healing effects.

This is why I sometimes mention about being careful in certain support groups, where the focus is constantly on the disease, the label, and the negative. It isn’t good for anyone when that is all you hear. You need support, but you need to surround yourself with positive people, see the right healthcare team and also remember that you are not your disease, and it does not own you.

10. Believing that there is no help out there

I know many people have had a hard time and some have really had a terrible journey getting to where they are now. It is one of the reasons I am so big on giving people the facts about this horrible disease and trying to help women get the proper help they need. It is also the reason I do what I do now.

Having lived with a chronic disease and having dealt with my share of really bad experiences, I know all too well what many of you have been through. I thoroughly get it and I understand on all levels.

While many people have been missed and dismissed and many have seen their fair share of terrible healthcare practitioners, I do need to point out that there are some very good ones also. Never let your last experience by carried over with you. Not all healthcare practitioners are bad. There are actually some amazing practitioners out there who are experts in endometriosis.

Like I have said before, in every profession there is good and bad and this is why it is important to do your homework. Don’t just go off a friend’s recommendation, or some recommendation from your mother. Do your homework and make sure the person you are seeing actually specialises in your disease. You also need to be realistic that you need a multimodality team approach, and that you may need to see a few practitioners within a network of specialists.

When you do find someone you think may fit the profile of a true endometriosis specialist, make sure when you see them that they take a full history, listen to all your concerns, give you appropriate care and advice and are empathetic in helping you move forward with appropriate care and health management.

The one thing I tell people is to not go in with a negative attitude based on previous bad experience either. This can then lead to further angst and anxiety and could get a good practitioner offside too. At the same time, while you need to not take your last experience with you, you do need to make sure the person you are seeing is right for you. It is all about balance and not judging each person you see as being the same.

But, if the person you do see has no idea, then don’t be scared to say “Thanks, but not thanks” and be on your merry way. There is no harm in getting multiple opinions and the honest truth is that is what you need to do. Never just take ones person’s advice and be done with it. Get a second, or third, or tenth opinion if you have too.

Last, but not least, if you are struggling and are at a point you believe there is nobody to help you, please remember there is always someone out there. Never give up hope about that. There are some amazing people out there who will know how to help you properly and get you the help and care you need. You just need to find them. There are endometriosis experts out there and when you find them, they will help you.

Final word

If you do need help and assistance with endometriosis, or need help getting diagnosed properly, please give my staff a call, or send an email, and find out how I may be able to assist you. I do consultations in person and online as well. There are some conditions with online consultations, but my staff will explain all this too you. You may also need to come and see me in person, so I can make sure you get all the appropriate investigations and testing done too. I also have a team of experts I work and refer to as well. I do see people from all over Australia, far and wide, and some from overseas as well.

Take care

Regards

Andrew Orr

-No Stone Left Unturned

-The Endometriosis Experts

 

Living With Pain.

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There are lots of people who suffer with pain daily and the one thing I do know for sure, as do many professionals I work with, is that many people who are in pain, or have inflammatory pain conditions, are not being managed really well.

There are so many aspects to pain and so many drivers that make it worse. Everything we do and are exposed to daily can drive, or exacerbate pain. Diet, lifestyle, alcohol, stress, drugs, medications, our environment, chemicals, additives, bad bacteria, disease states, moods and the way we think etc, can all drive and exacerbate pain.

In previous blogs and articles I have explained about how pain works, how long term medications can actually make it worse and also some of the alternatives to some of the hard-core pain medications.

  1. Alternative ways to assist pain and help with pain management
  2. Lets’s talk about pain, pain medications, dependency, detox and withdrawal symptoms

Again in this video I talk about pain and want to let everyone know there is help out there to help you better manage pain.

Please know you do not have to do this alone and that there are professionals out there who can help you better manage your pain levels and get your quality of life back.

If you do need help and assistance in dealing with pain, please give my clinic a call and book in a consultation.

Take care

Regards

Dr Andrew Orr

-No Stone Left Unturned

-Women’s and Men’s Health Expert

01 Dr Andrew Orr 1

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The Importance of Electrolytes

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The reason for this post is to talk about Electrolytes and how important they are for the body. I also need to let people know what proper electrolytes are.

Electrolytes are so important for the body and we actually need to replenish them on a regular basis. Water alone is not enough to hydrate you properly and therefore we need electrolytes for proper hydration and to carry fluids around our body. They also have so many other important actions.

Every single one of us needs electrolytes to be able to survive. Many of our bodily functions require an electric current to function, and electrolytes provide this charge.

Electrolytes are substances that help to conduct electricity when it is dissolved in water. These Electrolytes also interact with each other and the cells in the tissues, nerves, and muscles. A balance of different electrolytes, in the right ratios, is so important for everyone to function daily and to support optimum health.

What are Electrolytes and what do they do for us?

As mentioned before, electrolytes are chemicals that help to conduct electricity current in the body and they also regulate our nerves and help our muscles to function. They also help with the rebuilding of damaged tissue. Muscles and tissue rely on electrolytes to hydrate the cells and the fluid inside them. The heart, muscles and nerves cells also use electrolytes to carry electrical impulses to the cells and other parts of the body.

Their most important function of Electrolytes is hydrating the body, but they also help to balance blood acidity and blood pressure as well. Without proper electrolyte balance people can die. This is why they are so important and people need to know about them. As mentioned before, while water is important for hydration, electrolytes are just as important.

Common electrolytes include are sodium, potassium, calcium , bicarbonate, magnesium, chloride and phosphate. When these substances become imbalanced, it can lead to either muscle weakness or excessive contraction. All our muscles needs calcium, sodium, and potassium to contract. The heart, muscle, and nerve cells use electrolytes to carry electrical impulses to other cells.

These electrolytes also need sugar to help transport them and I will talk about this later. To maintain hydration, there needs to be a balance of electrolytes and sugar, in very specific ratios.

Symptoms of Electrolyte Imbalance

Symptoms will depend on which electrolyte is out of balance. The symptoms of electrolyte imbalances can show as the following:

  • Muscles Spasms and cramping
  • Muscles Twitching
  • Weakness and fatigue
  • Excessive tiredness
  • Dry mouth and throat
  • Not able to quench ones thirst
  • Irregular heartbeat and palpitations
  • Changes in blood pressure
  • Bone disorders and aching bones
  • Confusion and lack of mental clarity
  • Headaches and Migraines
  • Seizures
  • Numbness
  • Nervous system disorders
  • Convulsions
  • Loss of appetite
  • Nausea
  • Feeling faint
  • Dizziness
  • Moodiness and Irritability
Causes of Electrolyte Imbalances

There are many reasons for an electrolyte imbalance and especially those suffering from dehydration symptoms. These include:

  • Prolonged periods of illness, such as vomiting and diarrhea
  • Severe Dehydration
  • Not staying hydrated before and after exercise
  • Prolonged periods in Air-conditioning (due to drying affect)
  • Bladder issues (excessive urination, frequent urination, incontinence)
  • Pregnancy (due to frequent urination)
  • Kidney disease
  • Poor diet and nutrition
  • Incorrect acid and alkaline balance in the body
  • Congestive Heart failure
  • Cancer treatments
  • Some drugs, such as diuretics and steroids
  • Pain Medications
  • Eating disorders
  • Menopause
  • Age, as the kidneys become less efficient as we get older
Monitoring and Testing for Imbalances

If you are feeling any of the symptoms above, or have any of the known causes of electrolyte imbalance, taking a proper electrolyte solution is a good idea. If you are feeling symptoms of dehydration, you should take an electrolyte solution anyway.

There are ways to tests for electrolyte imbalances and these are more fined tuned for which electrolyte may be out of balance. This test is called a Electrolyte panel and this is used to screen for imbalances of electrolytes in the blood and measure acid-base balance and kidney function. Your doctor may order this test to also monitor the progress of treatment relating to a known imbalance. Many drugs and hormone treatments can affect our electrolyte imbalance and it is important to monitor these effects.

Oral Hydration Therapy

Most people will know of oral hydration solutions for dehydration, or after long periods of illness. This treatment is used mainly for people experiencing an electrolyte shortage alongside dehydration, normally following severe vomiting or diarrhoea.

It is important to know what proper electrolyte solution is because some of the so called sports drinks (Powerade, Gatorade) are not electrolytes and should not be used as such. These are really just highly coloured cordials with a bit of extra salt in them.

Those so called sports drinks are not electrolytes and are really over commercialised cordials. They are not even allowed to call themselves an electrolyte solution and nowhere on the bottle will you find the word ‘electrolyte’. They may be able to call themselves re-hydration fluids, but they cannot call themselves and electrolyte, because that would be false advertising. Any drinkable fluid can call itself a re-hydration fluid.

People taking these so called sports drinks thinking they are an electrolyte, could be seriously putting themselves in danger using them thinking they have a therapeutic value.

The World Health Organisation (WHO) has approved a solution to be used in oral re-hydration therapy that contains:

  • 6 grams (g) of sodium
  • 5 g of potassium chloride
  • 9 g of sodium citrate

These are dissolved in 1 litre (l) of water and given orally.

There are now proper electrolyte solutions available through chemists and drugs stores.

The ratios of Electrolyte solutions are important

When using a proper electrolyte solution, it is important that the ratios of electrolytes are in the right proportion. It isn’t just about taking an isolated electrolyte, especially when it comes to dehydration. The world health organisation has standards that these electrolyte ratios should be at, especially for proper hydration after illness.

Electrolyte levels can change in relation to water levels in the body as well as other factors. Important electrolytes are lost in sweat during exercise, if someone is urinating too much, through air-conditioning, illness, certain medications, taking hormones and so much more.

The most common electrolytes imbalances are usually sodium and potassium. The concentration can also be affected by rapid loss of fluids, such as after a bout of diarrhoea or vomiting.

Water alone will not hydrate someone after an illness and if someone is dehydrated. This is why it is important to get proper ratios of electrolytes into a person after an illness otherwise they could become severely ill, or even die.

Sugars Role in Re-hydration

These days people are worried about any solution that contains sugar. I often get people telling me they don’t want to have proper electrolyte solutions because they contain sugar. But, all electrolyte solutions need to have a certain amount of sugar in them. This is the one of the only times I will look at sugar in a positive light.

Sugar plays an important role in replenishing and transporting electrolytes around the body and into cells. What many people do not understand is that rapid and effective hydration depends on the active co-transport of glucose and sodium molecules through the small intestine. In other words, this means that the sugar is needed to help you absorb the electrolyte.

If there’s no sugar in your electrolyte solution, it will not activate the co-transport of glucose and sodium for your body to rapidly replace fluid and electrolytes you’ve lost through sweating, illness, or other factors. It is all about the ratios of what is in the electrolyte solution and these need to be very specific to have a therapeutic value.

When there is too much sugar, such as in these so called sports drinks, you can be left feeling bloated and uncomfortable. Too many of them can also put your diabetes risk up too.  Because there are not proper ratios of electrolytes in these drinks, you are not getting a therapeutic value out if it either.

Research has shown that drinks with high sugar concentrations can lead to unpleasant feelings of fullness, and delayed emptying of the stomach. These sugar drinks can also lead to other health issues as well. Many of them are full of additives and colourings as well. This is why it is important to know what a proper electrolyte solution is, and know the difference between sports drinks and a proper therapeutic electrolyte drink

Coconut Water

While coconut water does contain some electrolytes, we cannot regard it as a therapeutic electrolyte. Too much coconut water can also cause stomach upset as well. Coconut water can be used as part of your daily hydration and is another way of maintaining some crucial electrolytes in the body.

Foods and Electrolytes

There are many foods that we eat daily that contain sodium, calcium, potassium, chloride and magnesium. It is still vital to have these foods to maintain electrolyte balance in the body. Just remember that when you are sick, or are severely dehydrated these electrolytes get depleted and this is why you need an electrolyte solution for rapid hydration.

Fertility, Gynaecology, Pregnancy and Electrolytes

Many of the hormones used in IVF and gynaecology can interfere with our electrolyte balance and why I recommend the use of electrolytes to my patients.

Long term pain, use of steroids, pain medications, hormones etc, can all interfere with certain electrolytes and their absorption into the body. Some medications and hormones actual cause depletion of crucial electrolytes too.

Electrolytes can help with pain management and muscle spasms etc, that many gynaecological conditions, such as endometriosis can cause.

Electrolytes of Ovarian Hyperstimulation Syndrome (OHSS)

Electrolytes are also needed for a dangerous condition called Ovarian Hyper-stimulation Syndrome (OHSS). This dangerous condition is caused by hormones hyper-stimulating the ovaries, which can lead to the painful and sometimes fatal condition. Yes, OHSS can kill you if it isn’t monitored and managed properly. One of the things that helps with the prevention, and the treatment of this syndrome, is proper therapeutic electrolyte solutions.

Pregnancy

Pregnancy is also a time where electrolytes can be out of balance. This can be due to excessive urination and also because the baby stripping you of nutrients and electrolytes also.

If you are Pregnant, or undertaking IVF, or fertility treatments, have a gynaecological condition etc, electrolytes should be a part of your treatment and management.

Final Word on Electrolytes

Electrolytes are a very important and vital part of a person’s chemical makeup, and an imbalance can affect the body’s ability to function properly. Regular monitoring and consuming electrolytes after intense exercise, profuse sweating, illness and even certain medications can help to preserve your body’s levels.

So next time you are drinking lots of water and not quenching your thirst, it may be time to get some electrolytes into you. If you feel faint, or dizzy, or have muscles cramps etc, this could be one of the reasons also. We all need them on a regular basis. Just make sure they are a proper electrolyte and not the lolly water rip offs that line the supermarket shelves. Please remember to stay hydrated at all times and while water is needed for this to happen, electrolytes are a very important part of this also.

Take care and stay hydrated and healthy. If you do want to know what good electrolyte is and the one I recommend, then please call, or email, my friendly staff and they will be able to assist you.

Regards

Andrew Orr

-No Stone Left Unturned

-Women’s and Men’s Health Advocate

-The Women’s Health Experts

disease 4392164 1920

Could You Be Suffering With Interstitial Cystitis?

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Interstitial cystitis (IC) is a chronic inflammatory bladder condition in which there is persisting chronic pelvic pain, urinary frequency and urgency, bladder pain or pressure, and it can also resemble the symptoms of a urinary tract infection, but there will be no infection present. The pain can range from being mild to severe.

Worldwide Interstitial Cystitis affects up to 100 million people and it can affect both men and women, regardless of age. IC is also known as painful bladder syndrome (PBS), bladder pain syndrome (BPS) and chronic pelvic pain (CPP)

Women with interstitial cystitis may experience many of the same symptoms as those with endometriosis. Women can have both Interstitial Cystitis and endometriosis at the same time. Some people with IC may also have irritable bowel syndrome (IBS), Fibromyalgia and other pain syndromes

People with IC have chronic symptoms in the urinary tract that last more than 6 weeks in duration. Infection has not been identified as a cause of IC. Physical and emotional stress can worsen the symptoms of IC.

Interstitial Cystitis can cause the following symptoms:

  • Chronic pelvic pain that lasts 6 months or more
  • Symptoms affected by the menstrual cycle
  • Pain, pressure, discomfort or unpleasant sensation that may worsen as the bladder fills
  • Urinating often alleviates the pain and may give a temporary sense of relief;
  • Suprapubic pain or discomfort
  • Pelvic pain (lower abdominal pain), sometimes extending to the lower part of the back, the groin and thighs
  • In women there may be pain in the vagina and vulva
  • In men, pain in the penis, testicles, scrotum and perineum
  • Both men and women may have pain in the urethra and rectum
  • Pain with sexual intercourse in both men and women (dyspareunia)
  • Pain on ejaculation in men
  • Pain may worsen with specific foods or drinks
  • A frequent need to urinate (frequency), including at night (night-time frequency or nocturia)
  • An often urgent or compelling need to urinate (urgency)

The pain may be experienced as discomfort or tenderness or irritation or burning sensation in the bladder, in the form of spasms in or around the bladder, or stabbing or burning vaginal pain or simply a feeling of pressure on or in the bladder or a feeling of fullness even when there is only a little urine in the bladder.

In many people, the pain is relieved temporarily by urination, while other people may also feel strong pain following urination.

The pain or discomfort may be constant or intermittent. It may also be felt throughout the pelvic floor, including the lower bowel system and rectum. In some patients the pain may be very severe and debilitating.

Other people, particularly in the early stages, may have milder frequency with/without urgency and without a true sensation of pain. What they may experience, however, is a feeling of heaviness, fullness, discomfort or pressure.

Diagnosis

During the evaluation of potential IC, several tests may be completed to make a diagnosis. These tests may include taking a full medical history, completing a bladder diary, pelvic examination, including a neurological exam and urinalysis to rule out or diagnose an infection

Other diagnostic tests that can be carried out include:

Cystoscopy: This is performed inserting a tube, with a camera attached, into the bladder to evaluate the lining and to look for inflammation and signs of disease. A specialist may also evaluate the bladder capacity with a cystoscopy.

Urodynamics: The bladder is filled to test its capacity by measuring the pressure during filling and voiding. These tests evaluate the function of the bladder, urethra, and sphincter muscles.

Biopsy: During a cystoscopy, a biopsy may or may not be taken to rules out cancer or other inflammatory bladder conditions that can cause pain similar to IC.

Potassium sensitivity test: This is a test in which potassium and water are instilled into the bladder. In healthy bladders, pain is not felt with either solution. In cases of IC, however, pain is typically experienced when the potassium is instilled.

Diet

People with IC may be sensitive to certain foods and beverages. There is a range of items a person may need to excluded from their diet after receiving an IC diagnosis. This will be different for each individual but there are certain foods and drinks that an individual with IC should be aware of potentially needing to avoid. There are food and drinks such as:

  • tea and coffee
  • Soft drinks and soda (including diet drinks)
  • alcohol
  • citrus, citrus drinks and cranberry
  • artificial sweeteners
  • spicy food

Some people with IC may need to a food elimination diet over several weeks to see which specific foods and drinks may be exacerbating their symptoms. There are many foods that do not have an irritating effect on the bladder and contain vital nutrients to help fight disease. This is why elimination diets and specific dietary requirements need to be done under the guidance of a healthcare professional.

People with IC should also give up smoking if they are a smoker, as the chemicals can affect this condition too.

Treatment

The treatment of interstitial cystitis is complex and needs a multimodality approach to treat it effectively. It may require treatments such as:

  • Urodynamic Therapies
  • Physiotherapy with a specialised pelvic floor physiotherapist
  • Pelvic Floor Therapy (Kegels, Yoni eggs, Ba Wen Balls, internal TENS)
  • Surgery, including laser surgery
  • Neuromodulators, such as electrical nerve stimulators
  • Injections, such as Nerves blocks, Antispasmodics and Botox therapy
  • Pain medications- including narcotics, NSAIDS, Anti-inflammatories,
  • Hormone therapy, both oral and intravaginal
  • Antidepressants
  • Acupuncture
  • Pilates and Yoga
  • Exercise
  • Herbal Medicines, including Chinese Herbal Medicines
  • Amino acids, vitamins and antioxidants
  • Sex Therapy and counselling
  • Mindfulness
  • Adopting health sleeping habits

Your specialist or healthcare provider will discuss the best forms of treatment for your individual case. People with IC should also be referred to a Urodynamic and Pelvic Floor Specialist who specialises in this area.

Complications

Complications from IC can vary between individuals and why there is no one treatment fix all approach to this conditions. IC can affect a person life on so many levels. It can affect their bladder volume, their quality of life, their sex life, their libido and have an affect on sexual intimacy and it can also cause them emotional distress. It is a complex condition that can affect every aspect of a person’s life both physically and mentally and why a multimodality treatment approach is needed.

Causes

The exact cause of IC is not known, but there are several theories as to what triggers the condition. Some possible causes include:

  • Damage due to previous surgery
  • Defects in the lining of the urinary bladder that cause irritation
  • Overstretching of the bladder due to trauma
  • Pelvic floor muscle dysfunction
  • Autoimmune disorders
  • Spinal cord trauma
  • Genetics
  • Allergy

IC is a chronic inflammatory condition that affects many people world wide. It cannot be fully cured and requires close clinical management and care. A multimodality treatment approach needs to be adopted that is suited to the individual. When this is done properly, people with IC can still have a good quality of life.

Recommended treatment usually involves diet and lifestyle changes, stopping smoking, drinking less before bedtime, and scheduling planned toilet breaks to ensure the bladder does not get too full.

If you do need assistance with Interstitial Cystitis, please call my friendly staff and find out how I may be able to assist you.

Regards

Andrew Orr

-No Stone Left Unturned

-Women’s and Men’s Health Advocate

-The Women’s Health Experts

Migraines

Women with Endometriosis More Likely to Suffer Migraines

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Besides endo belly, pelvic pain, period pain etc, one of the other symptoms I see women with endometriosis experience is migraines. While not all migraines are just related to endometriosis, and can be from a variety of factors, having endometriosis could give you more of a chance of having migraines.

Recent research published in the Journal of Fertility and Sterility has shown that adolescents with endometriosis are more likely to experience migraines than adolescents without endometriosis. While the focus was on adolescents, it would be safe to say that any woman with endometriosis may be more likely to suffer migraines as well.

In the research, it was shown that adolescents with endometriosis were more likely to experience migraines (69.3%) than those without endometriosis (30.7%)

Among those with endometriosis, age of when the period started was associated inversely with the odds of migraines. The research also found that women with endometriosis and migraines have more dysmenorrhea than those without migraines.

The research showed a linear relationship exists between migraine pain severity and the odds of endometriosis, suggesting heightened pain sensitivity for adolescents with endometriosis. Due to the strong correlation, patients who present with either condition should be screened for comorbidity to maximize the benefits of care.

While the research showed a relationship between endometriosis and migraines it is also important to rule out other factors that cause migraines too, if you have endometriosis.

For sufferers of the disease, it is important not to just blame every migraine on endometriosis. Diet, additives, stress, anxiety, tight muscles, sublaxations, nerve impingement, sinusitis, TMJ syndrome, jaw tightness and many other factors need to be ruled out as well. This way the actual cause of a migraine is not missed.

For sufferers of Migraines please make sure you read my article on how to banish migraines too.

https://drandreworr.com.au/banishing-headaches-and-migraines/

If you do need help with endometriosis, or migraines, or both, please call my friendly staff and find out how I may be able to assist you.

Regards

Andrew Orr

-No Stone Left Unturned

-Women’s and Men’s Health Advocate

-The Endometriosis Experts

-The Headache, Migraine and Pain Experts

Banishing Headaches and Migraines

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A multi-modality approach was one of the best ways I found to help Headaches & Migraines

Many years ago I used to suffer lot of debilitating migraines and headaches. Actually if I did get a headache, I was thankful because that was never as bad as a migraine, that could make you bed ridden with a head feeling like ten hangovers accompanied with the vomiting and light sensitivity.

Even when the migraine had subsided I still felt washed out and like a train had run over me. Thankfully I haven’t had a migraine for many years and all thanks to a multimodality treatment approach that made my life much better.

Like many migraine and headache sufferers, mine were most likely caused by a neck injury, or whip lash, along with blocked sinuses. Current research shows that most headaches and migraines have a neck injury or neck complaint as a predisposing factor. Some neck injuries could go back to childhood or even a traumatic birth and you might not even know about it.

While neck related issues seem to be a major cause, there are many other contributing factors such as poor diet and lifestyle habits. Too many high GI carbohydrate foods and highly refined foods that interfere with blood sugars, can also cause headaches and migraine. Certain chemicals and additives in foods can also exacerbate headaches and migraines too. Let’s not forget how alcohol can be a big factor in headaches and migraines too.

Lack of fluids and inadequate hydration can also be a big cause of headaches and migraines too. While water is important to hydrate us, water alone is not enough. We need to make sure we get electrolytes into us as well. These need to be proper electrolytes, not lolly water such as sports drinks such as gatorade and powerade.

An imbalance of hormones, or hormonal surges, can also cause headaches and migraines and can be a big problem for women around the time of their menstrual cycle.

One other area that is overlooked is that the sinuses are inflamed or blocked and the associated inflammation and blockage is causing pressure and pain and causing headaches and migraines. This is a big one for many people and sadly, all too often, it is overlooked. A simple CT scan of the paranasal sinuses can see if the sinus cavity is blocked. If the sinus cavity is blocked by polypoid disease, or obstruction, it may require surgical intervention.

Lastly the one of the biggest headache producer of all….STRESS!

Stress will tighten up those shoulder and neck muscles and then constrict all the blood flow to the head and the next thing you know it is headache and migraine city.

Whichever way you look at it, headaches are caused from an imbalance in the body and need to be rectified. Unfortunately too many people use the band aid treatment of painkillers to try and deal with the mighty headache or migraine.

Nobody can argue with the painkilling properties of a dose of panadeine forte or a pethidine injection. I’d had many a trip to the doctor to get a shot in the behind. It was either that, or my head felt like it was about to explode. Worse still the pain often gets that bad that dying would be a relief. Well, that’s how it seemed anyway. I’m sure anyone who has suffered a really bad migraine wouldn’t have minded ending it all to get out of pain.

The only problem with painkillers, is they really don’t look at fixing the cause of the problem. Not only that, all painkillers have long term side effects that can be very bad for your health and some medication can be very addictive.

Like any health problem you have to look at treating the cause and not just the symptoms. A headache or migraine is actually the symptom of a much bigger cause. The problem for most people is that they only treat this problem symptomatically or seek help when they get a migraine or headache. It is the good old band aid approach to health care.

So how do you treat headaches and migraines and try and prevent them from coming back?

The answer as I’ve said is using a multimodality approach, alongside medical interventions.

I used Korean Advanced Trigger Point needling, the more modern practices of Osteopractic care and addressing dietary and lifestyle changes, alongside medical interventions. Treatment and management of migraines and headaches needs to be an individualized approach, not a one treatment fix all approach for the masses. Everyone cause of their migraines and headaches is different. What worked for me, is not a claim, or recommendation, and is purely what assisted me and may assist someone else.

Of course any other medically related issues need to be ruled out too. Like any health related condition, the management of headaches and migraines require a series of treatments to fix this problem, not a one off when you are experiencing a headache or migraine.

Unfortunately I used to be one of those people who only do something about my headaches and migraines when I was suffering one. This was until I learnt that if I had regular treatments while I didn’t have a headache, then the practitioners could get to the bottom of the cause of my problems and prevent a migraine from happening. I wish I’d learnt that lesson sooner.

You will also need to address any dietary, hormonal and lifestyle issues that may be also exacerbating, or causing your headaches and migraines too.

You also need to rule out any medically related issues as well and this can be done alongside other treatment modalities at the same time.  This is how I now treat people and why I use a multimodality approach to assist people and give them the best results.

You just need to find good practitioners who can help you and who can accurately and precisely pin point the exact cause of your particular problem. Just like with any healthcare professional, a series of questions is asked to get precise evaluation of the overall cause of your particular issue.

Only after a solid treatment plan is formulated, can the patient actually be treated and have a management plan moving forward. It is about looking at the cause of the issue and treating that, rather than just treating the symptoms. You need to treat cause and then the symptoms get treated anyway.

When I finally did get my headaches and migraines sorted, I found that it was a combination of Korean advanced trigger point acupuncture, Osteopractic, diet and lifestyle changes that gave me the best results.

This is why to this day that I firmly believe that with any health condition, headaches and migraines included, that a multimodality treatment approach is the only way to go.

All of this can be done alongside medical treatment options as well. Of course the cause of migraines and headaches are different for each individual and this is why individual assessment and management protocols are needed for each person. This is why people need to see an appropriate healthcare professional and not try to manage headaches and migraines on their own.

If you need help with headaches and migraines, give our clinic a call and find out how I can assist you in helping you with these conditions. You can call my friendly staff and they will explain everything to you.

Regards

Andrew Orr

-Women’s & Men’s Health Advocate

-No Stone Left Unturned

– The Headache, Migraine and Pain Experts

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Alternative Ways to Assist Pain and Help with Pain Management

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After my recent posts of the management of pain, pain medications and how pain affects so many people lives daily, it is pretty clear that there are lots of people out there in pain.

Worst still it highlights what I have known for many years, is that many people who are in pain, or have inflammatory pain conditions, are not being managed really well.

Unfortunately many are also trying to manage their own pain conditions and may even be dependent on pain medications. Some of these medications taken long term may in fact be exacerbating their current symptoms, or actually making their pain and inflammation worse. Some of the medications may in fact by shutting off the body’s ability to know that it isn’t actually in pain anymore, but the body actually thinks it is.

It is such vicious never ending cycle for many people and there seems to be no long-term, or short term, solutions for many who have to endure the physical and emotional consequences of all these things combined.

The one thing for sure, is that pain often isn’t managed well and there need to be more done to help those in pain. But, it also requires those in pain to seek proper help too. Again it is a bit of complex issue and many in pain often get dismissed initially as well, or are looked at as people who are dependent on pain medications just seeking more pain meds.

Pain does need proper management and if pain is not managed properly, it can do more damage than the medications health professionals, and the person in pain, are worrying about. But sometimes the blanket pain medication treatments don’t work, or they just aren’t enough, and this is why when it comes to pain, it need to be managed with a multi-modality approach.

It really cannot just be all about taking medication, or telling people to just go and learn to live with their pain and all will be OK. It won’t be OK and we need to start to educate all concerned that there other options that may assist the current medical treatments and management strategies.

Let’s look at some of the alternatives to pain medications and how these things can help assist those in pain and can be used alongside medications to give better control of pain and also help in reducing dependency of pain medications.

1.Watch your diet

Eating the right foods may provide some protection from the symptoms of pain and the disease state that you may have. The role of diet in inflammatory conditions has been investigated in recent years due to the influence of diet on some of the processes linked to certain disease states that are causing pain and inflammation on a daily basis. Many of the so called anti-inflammatory diets out there are now outdated and have outdated nutritional and dietary advice that don’t really help much at all.

Adopting a low GI and anti-inflammatory diet may help  to assist with settling any inflammation and pain in the body and also help the immune system.  A healthy diet also needs to include prebiotic and probiotic bacteria to help with digestive function, immunity and gut health. Regulation and restoration of gut function and the microbiome is so important and assisting with pain and inflammatory conditions.

Excess bad carbohydrates increase insulin response and this then causes the body to store fats and stops the burning of fat. This also leads to inflammatory conditions and more inflammation in the body. Excess body fat, now known as obestrogens (because it is estrogenic) needs to be controlled and managed through diet and exercise too. Excess fat and excess weight all lead to inflammation and stress on the body and this can also exacerbate pain and pain pathway.

Certain environmental estrogens, known as endocrine disruptors,  such as preservatives, plastics, pesticides and insecticides that can be ingested through certain nutrients have been suggested as risk factors for exacerbating pain and creating inflammation in the body too

2.Try complementary medicine and complementary therapies

Many people with pain and inflammatory disease states find symptom relief from using a range of different complementary and alternative medicines. There is some good solid research to show that some natural medicines may help with the management of pain and inflammatory disease states and the associated symptoms.

There is now some good research to support many natural medicines treatments such as Acupuncture, Chinese herbal medicine, vitamins, omega 3 oils, probiotics, chiropractic/osteopathy, Yoga, Pilates and more. (1)

When it comes to assisting pain, Acupuncture and Chinese medicines has been one of the most researched complementary medicines. There is some good research and evidence to shown that acupuncture and Chinese medicine may assist those suffering pain and chronic inflammatory disease and their associated symptoms, alongside medical interventions. (1,2,3,4)

Acupuncture has been widely researched to assist with many pain conditions and is now even used in some emergency departments around the world, for acute and chronic pain. (4)

Certain strains of prebiotics and probiotics have also been shown to help with the immune system, microbiome, bowel, and digestive associated symptoms of some pain conditions. Probiotics have also been shown to not only help with digestive and immune function, but also with the psychological function as well. It does need to be specific strains of probiotics though. Correction of the microbiome, but using pre and probiotics may assist in reduction of inflammation in the body and thus assist with pain and painful disease states.

There are also western herbal medicines and naturopathic herbal formulations that can assist with pain and assist with pain management. There are also certain amino acids and nutritional medicine supplements that have been shown to assist with managing pain and inflammatory conditions. Like any conditions, management need to be done on an individualised approach and what works for one person, may not work for another.

Chiropractic and Osteopathy have been used for centuries to assist with pain and pain conditions. By correction of the sublaxations and correction of posture, this can assist in better nerve functioning, better blood flow to muscles and also help with pain reduction and reducing inflammation.

Just like with medical treatments, when it comes to complementary medicines, it is important to find someone who is a qualified practitioner and who specialises in pain management. Just like in the medical model, this can also be hard to find. Please find someone who is a registered healthcare practitioner, or part of an association for qualified healthcare practitioners.

3.Boost intake of omega-3 fatty acids

The is lots of research on the health benefits of taking Omega 3 fatty acids and a diet high in these healthy fats. Omega 3 fatty acids may assist many inflammatory conditions such as depression, cardiovascular disease, arthritic conditions and many conditions where inflammatory processes are then leading to pain.

Researchers have also found that the type of fat included in your diet makes a difference in your risk factors for inflammation and pain conditions. Studies have shown that people whose diets were heavily laden with trans fats increased their risk of the expression of inflammatory disease by 48 % when compared with individuals who ate the least of these. By comparison, women whose diets were rich in omega-3 oils lowered their risk of inflammatory conditions by 22 % compared with those who consumed the least amount.

Eating foods high in omega-3 fatty acids, such as salmon, flaxseeds, almonds, and walnuts, may be helpful for pain and inflammatory conditions. Another way to get Omega 3 fatty acids is through supplementation, but please make sure you are using a practitioner only grade omega 3 supplement to ensure higher potency and better quality control.  Just remember, it is all about reducing inflammation.

4.Exercise

Often, people who experience pain fear exercising, in case it causes more problems for them. But over time, regular physical activity may decrease the pain and discomfort that you feel. High-intensity exercise and resistance training may assist in helping to reduce the reducing the symptoms of pain and reducing inflammation in the body.

While resistance training and high intensity interval training may assist in pain management and reducing inflammation in the body, some of the more gentle forms of exercise, such as Yoga and Pilates, may also assist in reducing pain and inflammatory response in the body too.

Yoga and Pilates can stretch and strengthen your muscles, help with core strength, help with circulation, which all may be beneficial for pelvic pain management and stress reduction.There has been lots of research into the benefits of Yoga and Pilates and how it can assist pain and inflammation.

No matter what exercise, you choose, exercise may help those with pain and inflammation in many ways, including:

  • encouraging the circulation of blood to your organs
  • maintaining nutrients and oxygen flow to all your body systems
  • assist with decreasing pain and inflammatory response
  • assist with reducing stress
  • releasing endorphins in the brain, which are pain-relieving, “feel good” chemicals

Research has shown that those who engage in some sort of regular exercise have fewer symptoms of pain and less inflammation that those people who do not participate in regular exercise.

5.Managing Stress Levels

Stress and emotional factors are probably one of the most under rated causes of pain and inflammatory response. Stress and emotional factors, such as anxiety, are big factors in any disease and can make any disease worse. Have a read of my post all about anxiety exacerbating pain.
Not only can stress and emotional disorders be exacerbated by pain and inflammation, but so can pain and inflammatory symptoms be exacerbated by stress and emotional disorders, in a never-ending cycle.

Pain and inflammation could contribute to making your stress levels, or emotion issues worse, due to the impact that the associated symptoms have on all aspects of your life, including family and personal relationships and work.

Stress management, Counselling, Mindfulness and Relaxation techniques may all assist in reducing stress and emotional disturbances that exacerbates inflammation and pain pathways and painful conditions.

People with pain and chronic pain and inflammation need to manage stress and anxiety by using mindfulness and relaxation techniques. These can help you to increase your awareness of your body, refocus on something calming, and reduce the activity of stress hormones and inflammation in the body. It is all about learning coping mechanisms and what works best for you, not what works best for others.

6.TENS and Neuromodulators

Transcutaneous electrical nerve stimulation (TENS) is an inexpensive nonpharmacological intervention used in the treatment of acute and chronic pain conditions. These small battery-powered devices deliver alternating current via cutaneous electrodes positioned near the painful area. The parameters of pulse frequency, and pulse intensity are adjustable and linked to TENS efficacy. TENS activates a complex neuronal network to result in a reduction in pain

Neuromodulation is the process by which nervous activity is regulated by way of controlling the physiological levels of several classes of neurotransmitters. Many pain management specialist now use a common form of neuromodulation involves using a device to deliver electrical current in therapeutic doses to the spinal cord to disrupt pain signals from the spinal cord to the brain, converting them to a more pleasant tingling sensation. This has been proven a safe and effective therapeutic approach for managing chronic pain of the arms and legs, neck and back often after spine surgery, or for other neuropathic conditions.

In Summary

It is important to know that people with pain and disease states that are causing chronic pain, will need a multi-modality, or team approach to deal with this disease.

The team you need and modalities that you will need will be dependent on your individual symptoms. This will mean finding practitioners who will listen to you and also be open to trying some of the alternatives to some of the pain medications and opiates alongside pharmaceutical medications.

As I said before, these alternatives may assist in treating your pain and managing your pain long term and also help with reducing some of the pain medications you may have been dependent on. Try and find healthcare professionals that can offer you a multi-modality approach for ongoing care and support and who also have a team of other people who specialise in the disease you are suffering from too. Again, the approach that you and your pain management specialist, or healthcare provider, choose to take will vary depending on your signs and symptoms.

Before starting any pain management, or new treatment, it is important to know all of your options and the potential outcomes of all of them and to know that the people that you are seeing are specialists in your condition and know how to manage the disease properly. That can often be the hardest thing to find and why you need to do your homework and see people who are specialists in this area of medicine. Too many people are missed and dismissed purely because they are just seeing the wrong people in the first place.

Lastly, if you are in pain and have a pain condition, please do not try and keep managing it yourself, or try to self-medicate. You need to be managed properly and should be getting the advice of a professional, not your friends, family or social media buddies.

Pain needs to be managed and it needs to be managed properly and this also goes for pain medications as well. If you are still in pain and pain symptoms are getting worse, this means that you need to get something done about it because your disease may in fact be getting worse, or your body may not be responding to medication any longer.

Take care

Regards

Andrew Orr

-No Stone Left Unturned

-Women’s and Men’s Health Advocate

References

1.Xue CCL, Zhang TL, Lin V, Myers R, Polus B, Story DF. Acupuncture, chiropractic and osteopathy use in Australia: a national population survey. BMC Public Health. 2008;8:105–112. [PMC free article][PubMed] []

2. Zhu X, Hamilton KD, McNicol ED. Acupuncture for pain in endometriosis. Cochrane Database Syst Rev. 2011;9:CD007864. [PubMed] []

3.Zheng Z, Xue CL. Pain research in complementary and alternative medicine in Australia: a critical review. J Altern Complement Med. 2012;19:81–91. [PMC free article] [PubMed] []

4.Zhang AL, Parker SJ, Smit DV, Taylor DM, Xue CCL. Acupuncture and standard emergency department care for pain and/or nausea and its impact on emergency care delivery: a feasibility study. Acupunct Med. 2014;32:250–256. [PubMed] []

Lets talk about pain

Lets Talk About Pain, Pain Medication, Dependency, Detox & Withdrawal Symptoms

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Previously I have done a post on over the counter pain medicines and how that as of February 2018, that some of these codeine based pain medicines, will now no longer be available over the counter in Australia. I know that in other parts of the world, these medications are not available over the counter anyway and in some countries even paracetamol is not available as readily as it is here in Australia.

The post surely did get people talking and it surely highlighted some very important points. It also highlighted how many people are in pain daily and something that I have known for a long time.

I actually know that pain and people with pain conditions, aren’t managed very well. It also highlighted that many people are self managing pain conditions and that many do not realise that they in fact dependent on medications, alcohol and other drugs.

Many also do not realise that the pain and symptoms they are experiencing daily, may in fact be withdrawal and dependence symptoms from their medications and substances they are using, including alcohol, and may have nothing to do with their condition at all. It is a very complex issue and there needs to be more education around this very sensitive issue.

Now, before we get started and before anyone tries to bring the personal/emotional side of things into this, I need to be very clear on this and set some boundaries up front. I need everyone to listen to this, so it is clear and that what I am about to say is coming from personal experience, clinical experience and someone who cares and is just trying to help with the right advice and right education around this issues.

So before we start I need to get a few things straight

  1. I have lived with a painful condition and have used pain medication and been dependent on pain medications. I have also withdrawn off pain medications
  2. I have loved ones who have pain conditions, who suffer daily and have also used pain medications to get through their day. Also know many of these have learned to manage and overcome their disease and pain too.
  3. People in pain, need help to get out of pain and pain medications are one way of doing this
  4. Many people who are in pain are actually dependent on pain medications and are completely unaware that they are dependent
  5. It is completely OK to take pain medication when someone is in pain. It just needs to be monitored a little better than it has been in the past.
  6. Please take the personal out of this and just sit back and listen
  7. I am not here to judge, or attack anyone
  8. This post is purely from heart, from caring and also about helping people with education so that they can get help if they need to
  9. The first part of any change and getting help is admitting you have an issue, or a problem, in the first place.
  10. The is no guilt, shame, or anything wrong with admitting you have a problem, or a dependency
  11. For the sake of this post I am going to used the word “Dependency”, rather than the words “Abuse” or “Addict”
  12. Perception is reality and sometimes ones perception is not reality, or based on all the facts
  13. Not all pain is from the withdrawal of medications either, but some of it could be.
  14. We are here to support people and care for people, not attack them. Anyone found attacking another on any posts surrounding this subject, will be deleted.
  15. Lastly, to get help, you need to see a qualified healthcare practitioner and you should only ever rely on information from a qualified health expert, not from your friends, your support groups, or anyone without a proper qualification in things to do with medical, medicines, or health conditions.

Right, now we have set the boundaries and we are clear, we can move forward and I can start explaining about pain, pain medications, pain pathways and also withdrawal symptoms

Before I start, I need everyone to open, his or her, minds a bit and think of how you feel when you have had some alcohol. Let’s not forget that alcohol is a drug and it can make you feel good initially and then not so good if you have a few glasses, or more. You can also become dependent on it too, and yes, it can be abused.

So, say you have a few glasses of alcohol, how do you feel while you are consuming it and shortly after?

This is for the average person, but most people would feel a little warm and tingling and feel quite good wouldn’t they?

But, even with a few glasses, would you necessarily wake up OK the next morning?

Some people might wake up semi OK, some might feel a little less than OK?

For some, a few are nothing because they are used to having way more. Some of these people may in fact be dependent and actually have an alcohol dependency.

So, say you have more than a few glasses of alcohol, how might you feel the next morning?

More than likely you may feel a little dusty, or for some, you may in fact have what we all know to be a hangover… is that correct?

You might feel really tired, irritable, nauseas, sore, have a headache, or a really bad head that feels like it might explode, and all the senses are just a little on hyper-drive and you would feel a little off??

Now that we are clear that alcohol can give you a hangover and make you a bit sick and that alcohol is in fact a drug, let me ask you this?

If alcohol is a drug and it can give you a hangover, even after one night of taking it, and taking just a few glasses of it, then why would not a medication, that can produce all the initial effects of alcohol, then not cause you a “Hangover Effect” the next day as well????

Just have a think about that for one second and let it really sink in.

Hmmmm, what are you thinking now?

Well, I am sure this is where we get some people going “But, but, but!”

Well there are no “But’s”. This is the hard but honest truth. Any drug, being prescription, over the counter, off the street and illegal, can cause you a withdrawal and hangover effect. Also, the longer you take those drugs, the more you take them etc, the more you need to take and the more dependent you become on them.

This doesn’t mean I don’t get why people take these medications. I do get it and I get all the reasons behind it too. This is just to explain everything logically and properly to people so that they also get that they may not be managed properly and that they may also be dependent on medications, which are actually in the long term, making all their symptoms worse, or actually causing the ones they have now.

Just so people don’t forget, please go back to points 1 and point 2 in the ground rules I set before. I have lived with pain and I have loved ones who are in pain and yes, I have taken pain medications and so have my loved ones.

Ok, so we are now all on the same page and are clear here, yes, many of the medications that people are taking daily, or periodically, or once off, or chugging down by the packet load, or are actually causing them rebound symptoms and withdrawal symptoms, when those drugs wear off.

We also need to recognise that some people are only taking medications every so often, when they need them too and this is more for people who are medication daily, or frequently. But even still, people do need to be away of rebound symptoms from taking medications, even periodically.

When we talk about “withdrawal” and “rebound symptoms”, let’s all go back to the alcohol story. We know that the hangover symptoms occur because of a rebound and withdrawal affect from the alcohol messing with the symptom, causing dehydration, causing inflammation and then causing all manner of symptoms from nausea, headaches, tiredness and even muscle and joint pain. The same goes for when you take any pain medications, especially those that are opiates, or contain codeine, or convert to morphine in the body.

Are we all getting this yet??

Right, then lets move on.

Now, the longer you take a medication the more your body gets used to it and the more that you may have to take to get that same therapeutic affect on the body and the pain that you are trying to manage. But, the more you have to take, the more dependent you become on that medication and the more worse you are going to feel when the medication wears off and tries to leave the body. Then it is going to take longer to ween off the medication, when you finally realise that you are dependent and that you need to so something about it. That is if you have that realisation, or finally admit there may be an issue.

One of the things that I have mentioned many times before, is that sometimes the body has been in pain that long, that the body doesn’t realise that it isn’t in pain any longer, that you also need to turn that response off, because it has actually become a habit, rather than the body actually still being in pain.

The other issue is that the pain medications may in fact now be what are causing the pain, through rebound symptoms and withdrawal.  This one is a bit tricky to explain to people, but in essence what we need to do is actually tell the body it isn’t in pain any longer, so that it switches off that response in the brain. To do that we need to detox an individual and then see what pain really does exist still and then manage those remaining symptoms. I will talk about proper medical detox further in the post.

Now let’s look at how pain medications, opiates and some elicit drugs work

Pain medications, Opiates and other pain relieving drugs, all change the way the brain responds to pain and they can also produce a “high” feeling by disrupting the reward and pleasure centres in the brain. This is why they can make you feel a bit stoned, or a bit light headed and why you should not drive, or operate machinery etc, while you are taking them.

They can dehydrate and constipate you too, so this is why you should only take as directed and also make sure you drink enough water, take some electrolytes and take it easy too. Let’s not forget the serious side effects of medications that can put overload on your liver and other vital organs and actually shut them down, if taken for long enough, or in a super high dose.

The central nervous system, which includes the brain, cardiovascular and respiratory systems, has opioid and pain medication receptors that receive opiate drugs and other pain medications, and these drugs bring a variety of physical and emotional effects. Your heart rate, respiration, blood pressure, and body temperature are usually all lowered while pleasant feelings are increased. It can cause the opposite effect too, where some people get hyper-activated responses too.

Repeated use, or abuse, of pain medications, or an opioid drug, can actually change the way an individual’s brain chemistry works and then lead to physical and psychological dependence. The body may not feel “normal” anymore without the drug’s interaction, and withdrawal symptoms may start in between doses or when an individual stops taking the pain medication, or drug they are on.

What Are Pain Medication, Drugs and Opiate Withdrawal Symptoms?

Certain over the counter medications (such as codeine based meds), prescription painkillers, Opiates and heroin, can produce withdrawal symptoms just hours after the last dose, and the symptoms can last for a week or more. Sometimes these symptoms can be minor, but many times they can cause all manner of symptoms, which I will list below in detail.

Some symptoms can be major and unassisted withdrawal may, or may not be life-threatening. When someone doesn’t withdraw properly it can also lead to relapse and further dependence on a medication, or drug. Medications and therapy, accessed in medical detox, may make relapse less likely. I’ll talk about why it is necessary to do a proper medical detox first, before seeing practitioners outside the medical detox model.

What Are Pain Medication ad Drug Dependency Symptoms?

Pain medication and drug withdrawal symptoms can last about a week, or even longer for some, and may include:

  • Irritability
  • Agitation
  • Depression
  • Muscles aches
  • Insomnia
  • Thoughts of suicide
  • Anxiety
  • Inability to concentrate
  • Diarrhoea
  • Bowel Pain and Rectal Pressure
  • Severe bloating
  • Fluid Retention
  • Sweating
  • Body aches
  • Runny nose
  • Headaches
  • High blood pressure
  • Irregular heartbeat
  • Many other symptoms not mentioned here
Detox and Withdrawal Duration

Withdrawal is the collection of side effects that occur when a drug is removed from the brain and body of someone who is dependent on it, while detox is the actual removal of the drug itself.

Withdrawal symptoms can last anywhere from a couple of days to up to a week or longer. For most pain medications and prescription opiates, withdrawal symptoms take shape 8-12 hours after the last dose and it peaks in the first 72 hours. The time within the withdrawal period depends on the medication, or drug taken. This is where rebound symptoms can occur.

The first week of withdrawal is typically the worst, but some symptoms may actually last longer. Symptoms typically last up to one month, but can linger for several months. Some effects can be permanent if there is a genuine abuse of a medication. Symptoms that can last longer than one week include tiredness, muscles aches and tiredness, depression, anxiety, and trouble with sleeping.

This diagram shows the withdrawal of these medications and time frames of side effects from withdrawal after the last dose is taken.

Medical Detox

Detox may begin before withdrawal symptoms start and while the drug is still active in the body. This way the drug can be safely removed. During medical detox, individuals are monitored around the clock for 5-7 days, vital signs are continually checked, and medications may be used to control more difficult withdrawal symptoms.

If an individual is heavily dependent on pain medications, opiates, or took large amounts of the drug for a long time, or has a family or personal history of addiction, medical detox may last up to 10 days. Medical detox ensures that an individual is stable before moving on with a comprehensive substance dependence treatment and management program.

Relapse after a proper detox can increase the risk for a potentially life-threatening overdose since the brain and body may not be used to the same amount of drugs that was used before. Each year around 30,000 people worldwide die each year as the result of a prescription pain reliever overdose.

Each year around 500,000 people worldwide seek emergency department treatment for a reaction to the abuse, or dependency of pain medications or drugs to help with pain. By decreasing pain medication side effects and dependency on these medications as drugs, an individual may be less prone to seek out these same pain medications and drugs again after detox. Medical detox can help sustain abstinence and potentially prevent a tragic, relapse-related consequence.

While there are non-medical forms of detox, I wouldn’t recommend someone doing these until a proper medical detox is done. Proper support and around the clock care is needed in the initial stages of a proper detox and this really cannot be provided out in private practice, or by complementary medicine practitioners during this initial stage.

I am all for people seeing natural medicine practitioners and using natural medicines but this needs to be done after the initial medical detox. That first phase needs 24-hour care, medicines, psychological care and so many things that would be really hard to find out in a non-medical environment. There are some specialised centres that use a multimodality approach, using medical science and complementary medicines, but these are few and not always cheap to access either.

Sure, after the initial medical side of things, go your hardest and you should be seeking natural alternatives to pain medications and looking and diet and lifestyle choices to help deal with pain. You should also be seeking alternatives to pain medications and seeking therapies that can help manage your pain, such as acupuncture, herbal medicines, pilates, yoga, counselling etc.

All these things are important for ongoing care and helping deal with disease states and ongoing pain. But if you have reached the point where you are dependent on a medication, or drug, you are going to need lots of help and you will need help with proper detox first. Please, do not think that those packet over the counter detoxes from a chemist etc, are a proper detox. They are just a herbal laxative that cleans out your bowel. Always speak to a qualified professional to get proper advice about detox and microbiome restore.

Having lived with pain and having actually properly detoxed off meds years ago, it wasn’t until I was off all meds and things managed properly while detoxing, that I realised that some of my daily pain, was actually withdrawal effect of my pain meds. I don’t think many people realise that this happens and all the nausea and migraines and headaches and increased pain, is actually withdrawal.

Only once pain is managed well, a proper medical detox done and then a plan put in place, do people realise how much the meds were actually part of their daily struggle and it was all withdrawal. Then you can use proper pain management strategies and alternatives for pain and also preventative strategies too.

I hope this has given you all a better insight into pain, pain medications and withdrawal symptoms and if you aren’t being managed properly for your pain and pain condition, then you need to talk to your healthcare professional about this. Everyone’s pain and pain symptoms are going to be different, even if they have the same disease state, or inflammatory condition. This is why individual treatment plans are much more effective than a treating the masses approach.

I’ll do a separate post of some alternative to pain medications and drugs shortly, as it is whole post in itself. I will be collaborating with integrative medicine practitioner and mindfulness expert Rosa Bunn on this topic. 

In the meantime have a read of my post about me knowing what it is like to live with pain

https://drandreworr.com.au/knowing-all-too-well-what-it-is-like-to-live-with-pain/

I have written quite a few articles on pain and pain management and I urge you all to have a read of them all, so that it gives you some understanding of where I am coming from and also some helpful pain management strategies

  1. https://drandreworr.com.au/getting-a-handle-on-pain-with-proper-pain-management/
  2. https://drandreworr.com.au/stop-telling-women-that-period-pain-is-normal/
  3. https://drandreworr.com.au/early-intervention-early-management-is-vital-for-gynaecological-conditions-menstrual-issues/
  4. https://drandreworr.com.au/period-pain-is-not-normal-and-doctors-in-australia-and-the-rest-of-the-world-need-to-start-listening/
  5. https://drandreworr.com.au/asking-the-right-questions-about-period-pain-gynaecological-issues/
  6. https://www.sciencedaily.com/releases/2017/06/170618103517.htm
  7. https://www.medicalnewstoday.com/articles/318532.php

Take care and if you do need help and assistance with pain and pain management  you can always come and see me and book in a proper consultation and I can help you and point you in the right direction too.

Sometimes we all need a little help in the right direction and sometimes the first step is admitting you have a problem in the first place. Oh, yes, I also get that many of you have been missed and dismissed also and this is why you are where you are now.

Telling it how it is and keeping it real. I get it and I understand.

Regards

Andrew Orr

-No Stone Left Unturned

-Women’s and Men’s Health Advocate