Managing Chronic Pain After A Hepatitis C Diagnosis

Chronic pain can be difficult to manage. Unfortunately, chronic pain and its treatment may also have accompanying stigma that makes this issue even more frustrating to navigate. The nature of pain being an invisible ailment, along with the rise of the opioid crisis in America, has transformed many aspects of this complex issue in recent years. Invisible conditions and stigma Unlike a broken leg in a cast, pain is invisible to the outside observer. This makes it hard for others to truly understand how severe pain may be. It’s possible for individuals in chronic pain to be stigmatized, or unfairly or incorrectly judged, for their experiences with pain. Common examples of stigma when it comes to chronic pain include labeling an individual as a complainer, attention-seeker, or lazy (if is perceived that they are lying about their pain to get out of work or other responsibilities). Coping with these unfair judgements and labels can make navigating life quite challenging for those in pain.1 The rise of stigma around pain medication In recent years, a new kind of stigma has arisen along with the opioid epidemic. This perception is that individuals with chronic pain may be drug-seekers looking for opioid medications. This frustrating judgment can be held by friends, family members, and even healthcare providers. When healthcare providers are the ones making this judgement, it can impact the way an individual in pain is medically treated, and limit their access to certain pain-relieving therapies.2 Most healthcare providers will consider the risks of addiction and other opioid-related side-effects before prescribing opioids, especially if an individual has a past history of addiction. The opioid crisis refers to the increasing prevalence of opioid-related overdoses and deaths since their introduction in the 1990s. Opioids include legally prescribed pain medications like oxycodone and morphine, as well as illegal substances like heroine and illegally-produced fentanyl. Roughly 115 Americans die each day due to an opioid-related overdose, and 350,000 individuals have died between 1999-2016 as a result of an opioid-related overdose.3 These numbers have become so severe, that the prescribing of opioids has decreased dramatically. Many states have regulations on opioid prescriptions, and research into alternative pain relief methods and treatment for those struggling with addiction is growing. Stigma and worsening health outcomes As mentioned, research into chronic pain management has been increasing in recent years, especially since the opioid epidemic has reached new heights. In addition to finding alternate methods of pain relief to replace opioids, many studies are looking at the impact of chronic pain on emotional, physical, and mental health. Coping with the stress and frustration of not feeling validated or believed can be a significant challenge faced by some with chronic pain. This struggle has been linked to increased emotional distress, issues with self-perception and self-identity, depression, anger, a decrease in pain control, and feelings of isolation, among other negative health impacts.4,5 Battling stigma through support Finding the right sources of support may help an individual cope with the stress of chronic pain and the stigma that comes along with it. Assistance can often be found through support groups that contain individuals who are going through similar experiences or who are also navigating life with pain. These support groups are often of varying sizes, and can be found in person or online. It’s important to remember that if you or a loved one is experiencing mental health distress as a result of chronic pain or its stigma, there are sources of additional support available. Mental health professionals, like counselors or therapists, may help an individual mentally and emotional cope with the stressors of life with chronic pain. [native] [lead_gen showIfLoggedIn="0" campaign="shortcode" source="site" title="Sign up for emails from {{site-name}}:"] I tried ignoring those needle-like stings and aching bones. It’s hard for me to admit that neuropathy from hepatitis C treatment is a part of my life. Just like many of you, I took long term Interferon and Ribavirin with the protease inhibitors. If you're having problems with hands, legs or feet pain, this blog can provide some help. The symptoms range from feeling a little bee sting on your foot all the way to complete numbness. There are many ways to find relief. I say to try them all in coordination with your doctors advice. Tips for managing neuropathy after hepatitis C Work it out Mild forms of exercise like yoga, walking, or stretching can help. If you are able to gain muscular strength and flexibility, you may have less pain. Try for 30 minutes 3 times a week. Live a clean lifestyle Eat clean whole foods with reduced sugar and fat. Get plenty of vegetables and low fat meats. That plus grains and plant based protein can help you get the vitamins and minerals you need. Stop or cut back on smoking and alcohol Stopping smoking or drinking alcohol can be tough, especially when managing large life changes like clearing hep C. If you need support, consider joining a group to help build coping skills to deal with addictions. Protect your feet and hands What supportive shoes. Use loose gloves and socks. Check for calluses and cuts after bathing. Apply lotion to both feet and hands. Eat a good diet Foods that include amino acids, fish oil, Vitamin B12, and alpha lipoid acid have proven benefits. Always ask your doctor before taking a supplement. Medications Talk to your doctor about prescription and over-the-counter medications. There are prescription creams that can be prescribed. Some doctors will offer a special blend that is mixed at a compounding pharmacy. Anti-inflammatory drugs can reduce pain. If it’s too severe, your doctor may prescribe a prescription pain killer. That should be a last resort for those of us with liver disease. We don’t need to burden our liver or our mental stability with a dependence on opioids. Anti-seizure medicine are usually the first line of prescription tried. The ones used to treat epilepsy may also relieve nerve pain. The problems is that it can include side effects like drowsiness and dizziness. There is a over the counter cream I have tried called Capsaicin. I began using it post transplant. It’s actually made of hot peppers. It totally worked! My cousin would rub in in and the heat was wonderful. Then there was the day she rubbed her eyes and it got a little wild. She did a little dance and splashed a lot of water! Antidepressants are occasionally used to block the chemical messages that is sent to your brain. It is like interrupting the pain. [native] TENS Transcutaneous electrical nerve stimulation is also used with a lot of success. It quickly became a fave last year. You put sticky patch electrodes on and it pulses a gentle electric current. I start the day with it and end with it also. It is a miracle. Physical therapy May be needed if you are unable to walk or move around. You may need to learn how to use a walker or cane. Legs, hands, and feet pain need to be addressed. Pushing the pain aside can create mental distress. If you have taken long term hepatitis C medicine, work with your doctor about ways to relieve the pain of neuropathy. [lead_gen showIfLoggedIn="0" campaign="shortcode" source="site" title="Sign up for emails from {{site-name}}:"] Many people with hepatitis C experience chronic pain, and therefore need to seek out ways to manage it. According to the Hepatitis C In America 2017 survey, pain impacts both those living with hep C and those who have been cured. Of those currently living with hep C, 53% currently experience joint pain and 51% experience muscle aches. Among those who have been cured, 63% currently experience joint pain and 62% experience muscle aches. While doctors may prescribe pain medications, not everyone wants to take these prescriptions long-term, and some people don’t like the side effects or risk of addiction with pain medications. Fortunately, there are many alternative options to manage chronic pain. What are some of the alternative approaches for managing pain? No one solution works for everyone, but there are many different approaches and strategies for managing pain. Exercise When you’re in pain, it may seem like exercise is the last thing you want to do, but limiting your activity can make pain worse, as muscles weaken from lack of exercise and can compound joint problems. Activity has actually been shown to reduce pain, as well as prevent additional chronic pain. Gentle stretching and low-impact activities like walking or swimming can generally be done in a safe manner. If you’ve been inactive for a while or have restricted movement due to your pain, talk to your doctor or a physical therapist about therapeutic exercises.1,2 Biofeedback With biofeedback, you learn how to control your bodily functions, like heartrate, blood pressure, and muscle tension. Biofeedback can be helpful for reducing pain, and it provides you with techniques to use your mind to influence your physical functioning. There are different biofeedback methods and devices available, including some for home use. Others are used in a physical therapy clinic or medical center.3 Mindfulness practices Mindfulness practices include a variety of meditation and relaxation strategies that aim to relax the body and allow the mind to observe what is happening in a detached, calm manner. Many mindfulness strategies begin with breathing exercises, in which the individual learns how focusing on and controlling the inhalation and exhalation of the breath leads to more relaxation and less stress. Studies have found that mindfulness can improve pain and depression symptoms.4,5 Acupuncture Acupuncture is a part of traditional Chinese medicine and involves the use of thin needles placed in specific areas on the body to balance the energy in the body, known as chi or qi. Acupuncture can have positive effects on many aspects of wellbeing, such as mood, anxiety, sleep problems, and pain. Not everyone experiences a benefit with acupuncture, but it has been shown to be safe, well-tolerated, and effective for many who suffer with chronic pain.6 Anti-inflammatory diet The idea behind the anti-inflammatory diet is that some foods increase inflammation in the diet, while others reduce inflammation. Since chronic inflammation itself can cause pain in the body, taking steps to reduce the inflammation can reduce pain. Generally, foods that increase inflammation include dairy, sugars, and grains, while eating a variety of vegetables can help reduce inflammation.7 Sleep Sleep is one of the most important things you can do to reduce and manage chronic pain. When you don’t get enough sleep, it can make your body more sensitive to pain, as well as increasing symptoms of depression, which can further compound pain symptoms. To increase your quality of sleep, experts recommend following good sleep hygiene practices, including going to bed at the same time each day, avoiding long naps, not exercising at least four hours before bedtime, limiting liquids to reduce the chance of needing to urinate at night, following bedtime rituals, and avoiding caffeine, nicotine, and alcohol (especially late in the day).8 Heat/cold The application of heat and cold treatments are two of the simplest approaches for joint pain. Heat, whether from heating pads or warm baths, can increase circulation and soothe muscles and joints, while cold applications can ease acute pain by reducing swelling and numbing nerve endings.9 Who can I talk to about my pain? Pain management specialists are physicians who have special training in treating all kinds of pain, including acute pain, chronic pain, and even pain due to cancer. Since many types of pain require a combination of approaches, it can be helpful to consult with someone like a pain management specialist who understands the different options and can suggest a multidisciplinary approach. You may need a referral to a pain management specialist from your primary doctor.10 [lead_gen showIfLoggedIn="0" campaign="shortcode" source="site" title="Sign up for emails from {{site-name}}:"] The United States is currently in an epidemic that is often referred to as the “opioid crisis.” This has led to a change in the availability and access of opioid-containing pain medications to individuals battling chronic pain. What are opioids? The term opioid refers to a class of drugs that act on opioid receptors in the body. These receptors help control pain and often produce pleasure. This is why opioids can be addictive. Opioids can be legal and prescribed by a doctor, such as oxycodone, codeine, morphine, and hydrocodone. Other opioids, including heroin, are illegal. The drug fentanyl is a synthetic (or man-made) opioid drug.1 Fentanyl can be prescribed and regulated by medical professionals, however, it can also be illegally made and manufactured. Illegally produced fentanyl can be extremely potent, and very small amounts can lead to an overdose. Illegally created fentanyl can also be laced or put into other illicit drugs, which can make them even more dangerous.1,2 What is the opioid crisis? According to the Centers for Disease Control and Prevention (CDC), in 2016 alone, nearly 12 million Americans aged 12 and older said they had misused an opioid within the last 12 months.3 In addition, it has been estimated that around 115 Americans die each day due to an opioid-related overdose, and 350,000 individuals have died between 1999-2016 as a result of an opioid-related overdose.4,5 These numbers are several of the many statistics that have led experts to believe that opioid misuse is currently a national health crisis. The opioid crisis is thought to have grown in three waves. The first was in the 1990s with the introduction of opioids to the market, and a lack of awareness on their addictive properties. The second and third waves came in 2010 and 2013, as heroin and illegally-made fentanyl gained popularity as street drugs.2,4,5 In order to combat the opioid crisis, many national, state, and local organizations have created programs designed to help those who are addicted, educate others on addiction, fund research into alternative pain relief options and addiction medicine, and set stronger regulations on opioid prescribing. How is the opioid crisis changing access to medications? As mentioned, many regulations and organizations are being created in the United States to help fight the opioid crisis. As of late 2018, the SUPPORT (Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment) for Patients and Communities Act has been passed that will provide resources to expand research, regulation, and support for those affected by the opioid epidemic, and to prevent its further spread.6 However, aside from this national act, the majority of regulations around opioid prescribing are at the state level. Some states have well developed and strict regulations for who can prescribe opioids and in what context, while other states have none. If you live in a state with strict regulations, it may be harder to gain access to these medications. In order to create a more standardized method of prescribing opioids, the CDC has created a set of guidelines for providers to use when considering a potential opioid-containing treatment plan for an individual in pain. There are 12 guidelines in total, and include recommendations such as checking the PDMP (prescription drug monitoring program) database to check an individual’s current prescriptions across their area, starting with the lowest dosage of opioids possible when starting treatment, and maintaining a close follow-up schedule to determine if the harms of treatment are ever outweighing the benefits.7 Due to the opioid crisis, many providers will try to find alternative methods of long-term pain relief before creating a plan that includes opioids. Non-opioid pain relief options As mentioned, opioids are not meant to be the first option for pain management. If this is the first time you and your provider are working together to create a pain management plan, it’s possible that they may first suggest starting with non-opioid pain relief alternatives, or using non-opioid pain relief options in addition to opioid therapy. Some of these options include, but are not limited to:8 Acetaminophen NSAIDs (nonsteroidal anti-inflammatory drugs: aspirin, ibuprofen, naproxen) Gabapentin/pregabalin Antidepressants (tricyclic antidepressants and serotonin/norepinephrine reuptake inhibitors) Topical agents (lidocaine) Acupuncture Yoga Meditation Massage [lead_gen showIfLoggedIn="0" campaign="shortcode" source="site" title="Sign up for emails from {{site-name}}:"]

Managing Chronic Pain After A Hepatitis C Diagnosis

The Stigma Around Pain and Medications

Neuropathy After Hepatitis C Treatment

Community Poll

Alternative Options for Managing Chronic Pain

Access to Medications in an Opioid-Crisis Era

Current Regulations Around Opioid Prescribing

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Cutting Off Pain Meds