Exercise to Treat Chronic Pain

There are millions of Americans who suffer from chronic pain and/or chronic fatigue.  If you are one of them, exercise is very likely the best solution to improve, or better manage, your symptoms.  Wouldn't it be great to be able to do all of your normal daily activities and not have to worry so much about pain and fatigue?  Or maybe you would just like to have a little energy left over to enjoy some recreational activity.  There have been several recent research studies that have shown that the right exercise program can be the most beneficial treatment option available.

What is a pain cycle?

Pain cycles begin when you make specific adjustments to your activity to avoid pain.  This leads to an inactive lifestyle.  Being inactive leads to deconditioning, in which your muscles get weaker, and your joints get stiffer.  Then when you try to be physically active, you have even more pain and fatigue, so you become even less physically active.  This cycle can lead to very significant weakness, fatigue, pain, and even further injuries.  This can be very debilitating.  Exercise is the first step to breaking this cycle.

What should you do if you suffer from chronic pain?

Your body has probably already adapted to this pain cycle.  The idea of exercising may seem like the last thing that you want to do.  In fact, breaking out of this pain cycle can be very difficult, especially if this has been going on for a long time.  Some people feel like when they exercise, they will only get a flare up of pain, or fatigue, so it just feels better to avoid activity.

The latest research shows that more rest is not the best way to treat your pain.  Just the opposite is true!  Research shows that patients with chronic fatigue syndrome or fibromyalgia report decreased fatigue, decreased pain, as well as decreased stress and other symptoms after starting a program of regular moderate exercise.  At the same time, it improved their perception of their health, physical function, and their overall aerobic fitness.

Even though it may cause some discomfort in the beginning, re-training and re-conditioning your body can improve pain and fatigue in the long run.  Even people who don't suffer from chronic pain or fatigue have some pain or muscle soreness when they begin an exercise routine.

I remember several times in my life when I had to be inactive for several weeks for various reasons.  Even after just a few weeks, starting back on my usual exercise routine caused significant muscle soreness that lasted for the first week, then it all started to get better, and I was able to increase my activity to get back into my regular exercise routine.

The first step is to start a gradually increasing program of aerobic exercise, such as walking or pool exercises.  Even low intensity exercise can lead to less muscle and joint pain, as well as more energy.  As your fitness improves, you can increase your level of exercise.

How do you get started in an exercise program?

First make sure that you contact your doctor to make sure that you are healthy enough for exercise.
Start by just gradually increasing your usual daily activities.  For instance, park further away from the grocery store entrance, take the stairs whenever you can, get up more often to do activities around the house, or maybe walk leisurely around at the local mall.

Then start a more formal exercise routine, such as walking specifically for exercise, or maybe doing some pool exercises or ride a stationary bike.  Tai chi is a great way to start if you have been very inactive.  Start with one or two days a week, even as little as 5-10 minutes each time.  From there you can gradually build up to three, then four days a week.  Then start adding time to your exercise.  Go up to 15 minutes, then increase by five minute increments every week or two, up to 30 minutes or more.  If you're doing well with that, then try to do five days a week or even every day if you can.  It won't be long before you are exercising 30 minutes a day, and feeling so much better.

Be sure to listen to your body and be gentle with yourself.  Avoid increasing the time or intensity of your work out too quickly.  If you overdo, you may not feel up to exercising the next time.  The consistency of exercise is more important than the intensity of the exercise, especially in the beginning.

There are lots of exercise programs that cater to people with arthritis or other painful conditions.  Some hospitals do a community water aerobics class in their therapy pool, and community centers often have Tai Chi classes or other group exercise classes geared toward beginners or specifically for people with arthritis.  Exercising with a group can make the activity much more enjoyable.  Just check in your local community to see what they have to offer.

If you have any questions about exercising for chronic pain, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor

Poison Ivy

We may not typically think of poison ivy this time of year.  It really seems like more of a summer worry.  However, it's the time in which we are usually doing a lot of yard clean up.  You can be exposed to poison ivy raking leaves, picking up brush, stacking firewood, or even bringing firewood in for a fire.  I thought this was a good time to talk about poison ivy.  When you are not really thinking about it, you are more likely to be exposed.
 

What is a poison ivy rash?
 

A poison ivy rash is caused by an allergic reaction to an oily substance called urushiol.  This reaction is called contact dermatitis.  This oil is in the leaves, stems, and even the roots of poison ivy, as well as poison oak, and poison sumac.  This is the most common allergic reaction in the U.S., with at least 85% of Americans being allergic to this oil to some degree, and about 10-15% of people being extremely allergic to it.  The rash affects approximately 50 million Americans each year.  You can also develop an allergy to this oil at any time in your life, so just because you have not broken out from poison ivy in the past, does not mean that you will not have a reaction the next time you come in contact with it.

The rash has a very classic appearance, with redness initially, followed by swelling, then blisters.  The rash is associated with severe itching.  The rash can range from mild to severe, depending on how much of the oil gets on your skin and how allergic you are.

How do you recognize that a plant is poison ivy, oak, or sumac?
 

You have probably heard the saying "leaves of three, let it be."  Poison ivy and poison oak both typically have three leaves.  However, poison sumac typically has five or seven leaves.  Poison ivy is a vine with a fuzzy appearance to the vine itself, but poison oak and sumac are shrubs.  These plants grow everywhere in the United States, except Hawaii, Alaska, and some deserts in Nevada.  They change colors in the fall, just like other leaves do, so they may not look the way you expect this time of year.  Follow this link to see some pictures of the plants:  https://poisonivy.aesir.com/view/welcome.html

How do you get a poison ivy rash?
 

If you come into contact with the urushiol oil, you can develop the allergic skin reaction.  The oil is colorless and odorless, so you don't really notice that you have anything on you.  It is sticky though, not sticky enough to make you feel sticky, but it really sticks to your skin.  This oil is also very potent.  The amount contained on the head of a pin can cause 500 people to have a rash!

Here are the different ways that you may come into contact with the oil.

• Direct contact - Touching the stems, leaves, roots, or berries of the plants
• Touching an object contaminated with the oil - It may be on your shoes after a walk, on the sleeve of your shirt or jacket, on the fur of your dog or cat, on tools that you used in the yard, on wood that was cut and stacked for the fireplace.  The oil can stay active on a surface for several years without losing its potency.  
• Inhaling smoke from burning plants - This can irritate or even cause damage to your nasal passages or lungs.

Is poison ivy contagious?
 

The poison ivy rash is NOT contagious.  If you have a rash from poison ivy, the rash itself is not contagious.  The fluid in the blisters does not contain the urushiol oil and it will not spread the rash.  Just remember that it can be spread if you touch a person's skin when they still have the oil from the plant on their skin, or if you touch their clothing before it has been adequately washed.

Next week we'll talk about ways to prevent and treat the poison ivy rash.

If you have any questions about poison ivy, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor

When Should You Get Your Flu Shot?

Last week, public health officials urged Americans to get their flu shot early this year.  Let's talk about the reason for the warning, and whether you should get a flu shot.

You may not realize that influenza viruses are constantly mutating and changing.  Because of this, the strain of influenza virus that is common this year, may be very different from the strain that was common during last year's flu season.  This is why a new influenza vaccine, or flu shot, is necessary each year.

How is the flu shot designed or selected each year?

More than 100 influenza centers in over 100 countries conduct year-round surveillance for influenza.  This involves testing thousands of influenza virus samples from patients all over the world.  The laboratories then send representative viruses to five World Health Organization (WHO) laboratories, one of which is the Centers for Disease Control and Prevention in Atlanta, Georgia.

The flu vaccine is then designed to protect against the three or four influenza viruses that research indicates are most likely to cause illness during the upcoming flu season.  In the United States, the FDA makes the final decision about which strains are included in the flu shots that are given in the U.S., with consideration given to recommendations made by the WHO, based on worldwide research.

Why are officials recommending early flu shots this year?

It may be no surprise that the Southern Hemisphere's flu season is about 6 months earlier than our flu season in the Northern Hemisphere.  Influenza season is typically during fall and winter.  Because the Southern Hemisphere experiences their fall and winter, and their flu season, during our spring and summer, we often look at the trends seen in Australia's flu season, to help us plan for our own.

While their flu season does not always predict the severity of our own, it can certainly provide an indication of what's to come for us.  This year, Australia's flu season started early, and is considered to be one of the worst influenza seasons that they have ever seen.

This makes our public health officials worry about our upcoming flu season.  In fact, there have already been some U.S. locations reporting scattered cases of influenza as early as September, which is considered early for our flu season.  There have even been 2 reported deaths from influenza recently.

Why does it matter if you get your flu shot?

Although the flu vaccine is not 100% effective at preventing influenza, there is research showing that the vaccine reduces the severe and sometimes even deadly complications from the flu, and can protect newborns whose mothers received the flu vaccine while pregnant.  The effectiveness at preventing disease varies from year to year, depending on how accurate the predictions were for the strains of flu virus expected.  So even though it may not prevent every case of the flu, it does prevent a number of infections, it does decrease the severity of the disease, and it will save lives.

Although last year's season, 2018-2019 was not too bad, in the 2017-2018 flu season in the U.S., the flu killed at least 80,000 people.

Who should get a flu shot?

The CDC recommends everyone ages 6 months and older get a flu shot every flu season, including people with chronic health conditions as well as healthy people.  It is especially important for some people to get vaccinated, namely people who are at risk of developing serious complications, like pneumonia, if they get sick with the flu. This includes:

• People who have certain medical conditions including asthma, diabetes, and chronic heart or lung disease, and the people who live with or care for them.
• Pregnant women
• People 65 years and older

Who should NOT get a flu shot?

• Children younger than 6 months of age
• People with severe, life-threatening allergies to any component of the flu vaccine
• Some people should not be vaccinated without first consulting a doctor, including
  • Those with an allergy to eggs
  • Anyone who had Guillain-Barre Syndrome within 6 weeks of getting the flu vaccine previously
  • Anyone who has a moderate to severe illness with a fever should likely wait until they recover before getting the shot

When should you get your flu shot?

I usually recommend a flu shot by November 1st, but this year we should all get our flu shots early.  I would talk with your doctor or pharmacist about getting your flu shot as soon as you can.

If you have any questions about flu shots, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor