Committing to regular massages is a great tool for pain management. Your therapist can focus in on specific problem areas, as well as stiff muscles, and gradually loosen them with increasing blood circulation.
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CHRONIC PAIN-
Mind-Body Approaches to Coping With Pain.
Pain treatment can be optimized by involving mind and body.
Reviewed by Davia Sills

KEY POINTS-
Chronic pain can wear you down emotionally and mentally.
Focusing only on the physical element of pain is one of the factors in many cases of narcotic overuse, with serious consequences.
An anti-inflammatory diet that includes whole grains, healthy fats, lean protein, and berries can reduce inflammation and help decrease pain.
Neuroscience research tells us that becoming mindful for less than an hour during your day can help ease symptoms.

If you’ve ever stubbed your toe or touched a hot stove, you’ve experienced acute pain. An injury or natural process can cause this type of pain, but it goes away relatively quickly.

If your pain lasts three months or more, most healthcare providers agree on calling it chronic pain. It’s something you live with for a while and doesn’t go away. This experience can wear you down emotionally and mentally. Many common conditions, such as arthritis, migraine, fibromyalgia, and cancer, involve chronic pain.

Pain’s mental and emotional toll
A sudden injury can be scary. You may experience shock or even post-traumatic stress.1 Living with chronic pain can create anxiety, depression, and overuse problems with medication, alcohol, and other substances.

Experiencing pain affects our thinking and emotions. In turn, these responses can affect your healing. When Dave, a firefighter, strained his back at work, a doctor prescribed pain medications and time off. On leave, Dave filled the hours by catching up with his favorite sports teams and drinking a few microbrews to relax.

Then his mother died suddenly. Dave began drinking more and more. His back pain was intensified by the stress of grief and sorting out his mom’s affairs, and he requested more pain medication.

Fortunately, Dave’s doctor practiced whole-person health. “What’s going on?” he asked. Dave was otherwise healthy, and his physical therapist had reported the injury was healing well.

That simple question was enough. Dave broke down in the office talking about his mom. Then he and his doctor created a mind-body approach to his physical and emotional pain. It included returning to work on light duty and scheduling some sessions with a counselor who was experienced in helping people with loss and grief.

Finally, Dave talked with his younger sister about how sad he was. As the older sibling, he had always filled the role of protector, never admitting to weakness. Talking with his sister allowed her to offer support for a change. Together, Dave and his sister worked on clearing out their mother’s home and preparing it for sale.

We can easily imagine a different path. Focusing only on the physical element of pain—Dave’s back—is one of the factors in many cases of narcotic overuse, with serious consequences.

Optimize pain treatment with mind-body approaches.
If you burn your hand on a hot stove, your first impulse is probably to cool the burn. You may wave your hand through the air to create a cooling draft or stick it under cool water. Then, you may try to distract yourself from the pain by watching a favorite show or talking with a friend. Using these mind-body approaches can calm your mind and relax your body.

The strategies we naturally adopt with acute pain can help with chronic pain as well. If you have been in pain for three months or longer, ask yourself, “How is my treatment working?” Communicate with your healthcare provider about what the options are.

Aaliyah, who has chronic migraine, used this approach. She scheduled a video visit to ask her doctor about her prescribed medication and ask about other options. She also asked about her use of non-prescription medications, which can lead to a condition called rebound headache.

Next, Aaliyah advocated for a mind-body approach. Using a migraine app to track her headaches showed that she tended to get one after being around a particular coworker, in a pattern often called the “let-down” headache.

Talking with coworkers about the problem helped her relieve some of the tension of working with her stressful colleague. She adjusted her workstation so she could stand and move around during meetings with this coworker, releasing stress.

Aaliyah planned to take a short walk after the meetings that typically made her tense up. She also spent a few minutes outdoors to get some sun and relax in nature. Eventually, she took the practical step of transferring to another team.

Aaliyah still has the occasional migraine and keeps her new migraine medication on hand. But the mind-body approach she took works far better for pain than medication alone.

Find the pain management that works for you.
A whole person approach is ideal for managing pain. Here are some evidence-based strategies to try.

Consider your biology.
Biological women have more chronic pain than biological men.2, 3 Research has shown several reasons for this, including hormone shifts over time, being victims of trauma and abuse, and tending to prioritize the needs of others ahead of their own.

Avoid foods that cause inflammation.
Inflammation in the body can worsen pain. On the other hand, an anti-inflammatory diet that includes plenty of whole grains, healthy fats, lean protein and berries—and yes, small amounts of chocolate and red wine—can reduce inflammation and thus help decrease pain.

Try a short meditation.
You may think you don’t have time to meditate. But neuroscience research tells us that becoming mindful for less than an hour during your day can help ease symptoms. In one study, patients who practiced mindfulness-based meditation or had cognitive behavioral therapy had less pain than those who did not add a mind-based practice to their treatment.4

Try a free, relaxing mindfulness meditation. Bonus: it includes a gorgeous nature video to help you reset mentally. You can use it for acute or chronic pain.

Be careful with tech.
The technology that surrounds us can cause pain. Have you ever experienced “text neck” or strained your arms, wrists, or fingers by typing too much? Erik Peper, Ph.D., is the author of Tech Stress: How Technology is Hijacking Our Lives. The book includes strategies for using technology without causing pain, including ergonomics that can help.

Taking control of your pain
No matter what type of pain you have, taking a whole-person approach can help you feel better. As we saw in Dave and Aaliyah’s stories, pain is much more than physical. Having a compassionate provider you can talk with about what else is going on in your life, as Dave did, and advocating for yourself, as Aaliyah did, can make an enormous difference in reducing or eliminating pain and creating the best health possible.

KETAMINE-
Update on Ketamine via Telemedicine Delivery.
A breakthrough treatment for depression or a risky precedent? Here’s the latest.
Reviewed by Tyler Woods

In 2020, the federal government changed the rules to make it easier for providers to treat patients via telemedicine. One rule change allowed providers to prescribe controlled substances like ketamine without first seeing the patient in person.

The thinking was that, because the pandemic was raging, it was too dangerous for people to go to doctor’s offices for visits and to get their prescriptions.

Since that time, the number of people receiving ketamine via telemedicine has soared. The reason is clear. Several studies, as well as anecdotal evidence, in the last few years have shown ketamine to be highly effective for some people with treatment-resistant depression (TRD). It is also showing efficacy for bipolar disorder, PTSD, and certain other mental illnesses.

But depression seems to be the sweet spot. Many who have been suffering from debilitating TRD for years, and who have tried other medications with no success, are finally seeing their symptoms improve with ketamine. Some see a dramatic improvement over a period of days or even hours.

Another positive development? Ketamine obtained in this way—it usually gets sent in the mail in lozenge or tablet form when the prescription is filled—often costs far less than when a person receives the medication in person at a clinic.

So far, so good. However.
The risks of ketamine via telemedicine delivery
There are several serious downsides to this development. For one, when ketamine is taken chronically in high doses (which can happen when it’s taken at home in an unsupervised manner), it can cause severe bladder damage. In some cases, the damage requires surgical reconstruction of the bladder.

Ketamine can also be highly addictive for some individuals, and you can overdose on it. It can also dramatically raise heart rate and blood pressure when you take it, and it’s risky for those who live with certain kinds of psychiatric illnesses.

Maybe the biggest downside of all is that there is virtually no data on the long-term health effects of taking ketamine daily or every other day, as many who get it delivered via telemedicine do. (Many people receive their monthly dose of lozenges or tablets, take more of the medication each day than is prescribed, and run out early.)

Compare that lack of oversight to ketamine’s FDA-approved nasal spray form, called esketamine or Spravato. This is normally taken in a controlled clinical setting only once or twice a week for a set number of weeks under medical supervision.

Given all these upsides and downsides, what’s the best way forward with ketamine? Let’s start with the basics.

What is ketamine?
A synthetic substance, ketamine (pronounced “KEH-ta-meen”) was developed in the early 1960s as an anesthesia treatment to keep people from feeling pain from injury or during surgery. It’s still used today and is especially common in veterinary hospitals.

Classified as an anesthetic, ketamine causes feelings of dissociation and sedation in higher doses. It gained notoriety in the 90s as a club drug—people inject it, snort it, or add it to marijuana or cigarettes. Nicknames include "K," "Special K," and "Super K." Ketamine has also shown benefits in pain management for both chronic pain and acute pain in emergency room settings.

When taken to combat depression and other mental illnesses, ketamine can produce hallucinatory effects, visual and sensory distortions, out-of-body experiences, and euphoria or a “buzzed” state. Often, a ketamine “trip” lasts about two hours, though occasional side effects, such as unconsciousness and high blood pressure can be severe.

Many ketamine patients say that their sessions with the drug can act as a reset button for the brain. The drug allows them to detach from themselves, and many report profoundly pleasant thoughts and visualizations. Afterward, your daily problems can feel less oppressive, and the improved mood can last for weeks or longer.

A few cautionary words on telemedicine as a delivery method
As an addiction treatment clinician, I am wary of working remotely with patients, prescribing medications to them via telemedicine, and monitoring their progress and recoveries via videoconference. Why? Because it’s harder to do all those things remotely than if you’re seeing someone in person and can assess body language, attitude, hygiene, and other behaviors. It’s also easier for patients and providers to abuse the “virtual” delivery system.

So yes, in a perfect world where quality in-person care was available to everyone, that delivery method would win every time. But that’s not the reality. To extend our health and medical reach to those who otherwise wouldn’t access it, telehealth is vital, and it’s here to stay. On balance, that’s a great thing.

Telemedicine and ketamine
Here’s my take: Telehealth-based care (usually via video) works well for physical ailments like strep, skin rashes, or sinus infections. But things get more difficult with mental health because there are fewer physical symptoms to guide you. It gets dicier still when the medication that is prescribed for the illness is itself risky, as is the case with ketamine, because it’s harder to monitor remotely.

That said, the answer isn’t to shut down this delivery method for ketamine. Rather, we need to create regulations and safeguards that allow for the medication to be prescribed and monitored by a certified provider in a safe manner.

With that goal in mind, I offer the following.
4 recommendations on ketamine
Put clear, enforceable rules around that first visit with the provider. If the government doesn’t require a return to an in-person visit before prescribing controlled substances like ketamine, that first virtual visit must be comprehensive, recorded, and trackable by an oversight body. I hear all the time that these initial visits are as short as 30 minutes, and I can say with certainty that it is impossible to do a thorough mental health assessment with a patient in that amount of time.
Require certification of all providers and companies that offer ketamine via telemedicine delivery. This is how it works now with clinics that offer in-person FDA-approved Spravato nasal spray. Similar regulations need to be in place for the new providers offering ketamine via telemedicine.

Require addiction screening for all patients. Because ketamine can be addictive, providers and patients are playing with fire if patients aren’t thoroughly screened (this takes more than 30 minutes!) for addiction use past or present. This needs to happen, no exceptions. My recommendation is that a patient must be sober from drugs or alcohol for at least six months, if not a year, before a ketamine prescription is considered.
Make it mandatory that providers do frequent video checkups with their patients who take ketamine. This oversight is vital. Providers need to see how the patient is doing in order to make dosage adjustments. Video chats also allow for visual evidence to be shared, for example, the provider can ask to see a patient’s remaining dosages.

Key advice for patients
Always advocate for yourself, and remain vigilant about fraudulent or suspicious activity by your provider.

Remember, providers are not infallible. They sometimes make mistakes in judgment—or worse. There’s money to be made in this new-frontier area of medicine at the moment, which means you’re always going to get some bad characters involved.

If something smells fishy about the way medications are being prescribed by your provider, ask about it. Push back. Ask direct questions. Make inquiries. Do your due diligence. Google your provider to check on their credentials.

Bottom line: Be careful. Hold your provider to the highest possible standard. This is your (or a loved one’s) mental health we’re talking about, and there’s nothing more important than that.

7 Psychological Factors Affecting Pain Perception.
Why do people experience pain differently?
Reviewed by Tyler Woods

KEY POINTS-
Not everyone hurts the same way; pain tolerance varies greatly among individuals.
Our expectations, mood and perspective on pain powerfully influence our sensitivity to pain.
Our mental state can dramatically affect pain perception.
Pain has a protective role. A primary role of acute pain is to protect us from further harm. For example, a painful blister on your foot can motivate you to stop walking or to wear more comfortable shoes.

People might experience pain differently depending on various emotional and cognitive factors (belief, anxiety, and expectations) (Lumley, 2011). These factors can substantially shape the experience of pain. They function as a kind of volume control for pain, and they play a major role in any pain management (Corns, 2017).

1. Attention
Pain disrupts the person’s attention and forces them to focus on their body. The pain is then judged as a threat, which makes them more aware and urges them toward addressing the injury. Paying close attention to the pain sensations may increase pain intensity. Attention distraction from pain is one of the most used strategies for managing pain. Because you can only attend to only one thing at a time. This explains why athletes can continue to play and soldiers can continue to fight when injured. They often don’t notice their injury until the action stops.

2. Interpretation
Some people may perceive a pain problem as devastating to one’s well-being whereas others may perceive the same pain problem as an inconvenience that can be tolerated and managed. It is the meaning of how pain influences life activities and the future that fuels much of the pain-related emotions (i.e., suffering). For example, the emotional aspect of cancer pain is quite different from labor pain. The positive emotional consequences of labor pain may offset, to some degree, the unpleasantness of pain.

3. Attitudes toward pain
Cultural factors influence beliefs, perceptions, and emotions. Culture can influence how an individual communicates pain, pain tolerance, and pain catastrophizing. Some cultural groups expect an excessive display of emotion in the presence of pain, while others value stoicism, restraint, and playing down the pain, or accepting pain as a natural part of life. For example, in some Asian cultures, there is a tendency to avoid talking about one’s own pain.

4. Catastrophic thinking
Catastrophic thinking can be defined as imagining the worst possible result that could happen. Catastrophizing may worsen pain by making a person focus and attach additional emotion to it. Catastrophic thinking can also be viewed as a coping strategy used to draw support from others, such as showing an excessive display of pain in the hope of gaining better support. The social reinforcements of exaggerated illness behavior can serve to sustain it.

5. Sense of agency
Having control over an unpleasant stimulus can make it feel less painful. Evidence has shown that patient-controlled analgesia allows a patient experiencing pain to self-administer analgesics to be effective for acute pain management. Patients clearly feel better as their sense of control increases. Pain is no longer a threat when we know we are not entirely at its mercy.

6. Expectations
The subjective experience of pain is largely shaped by our expectations. When people expect to have more pain, they have more pain, and vice versa. Expectations are a fundamental component of the placebo effect. The placebo effect means that when someone expects that a treatment will work, it tends to work better than if the person expects that it will not work. The placebos are effective because people believe in them. In fact, a placebo is an effective pain therapy without any side effects.

7. Anxiety
Anxiety is well known to increase pain. Anxious people seem to have a lower pain threshold. Some people (mostly men) even shy away from seeing doctors because they fear receiving bad news. Some deny their pain through pills, narcotics, alcohol, etc. In contrast to the effects of anxiety in intensifying pain, positive emotional states (such as could arise when listening to pleasant music), generally, reduce pain. For example, research shows that pain is reduced when partners hold hands.

In sum, psychological factors play a huge role in pain perception. The mind and emotions can powerfully exaggerate or dimmish the perception of pain. Pain is not a purely sensory experience reflecting underlying tissue damage. Emotions, beliefs, and actions are vital parts of the human pain experience (Morris, 1991).