Author Topic: Pain Management  (Read 1621 times)

partgypsy

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Re: Pain Management
« Reply #50 on: May 03, 2021, 09:57:58 AM »
yes. I've had chronic neck/shoulder aches as well, exacerbated by me stupidly injuring one shoulder a few years ago. While I did get a consultation, only now that I am post surgery/radiation for breast cancer, they can sneak in a PT referral on that pretext. Whatever it is I'll take it. Still wish therapeutic massage was covered by insurance.

Malcat

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Re: Pain Management
« Reply #51 on: May 03, 2021, 10:17:21 AM »
That sounds nuts to me.

So is physio just not that common then? Where I live, there's a physio on almost every block, and you would never have to wait more than a few days for an appointment. I had an emergency recently and was even able to see a specialized neurogical physiotherapist the same day.
Physio (or PT in 'murican) is common, but the process of getting it can be complicated. The primary care doctor generally has to prescribe PT for it to be covered by insurance. In my case, my doctor wouldn't prescribe it until I had an Xray (cheap) and an MRI (almost $500). So it took me 4 appointments, 2 months and about $700 to get into PT for shoulder tendinitis.

Yeah, a lot of insurance companies here require a referral from an MD, but because medicine is publicly funded, they don't do x-rays or MRIs unless they absolutely have to. So they'll much sooner refer for physio than for an MRI.

Do MDs make money off of imaging there?

LifeHappens

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Re: Pain Management
« Reply #52 on: May 03, 2021, 10:28:21 AM »
Do MDs make money off of imaging there?
In my case, the MD didn't have their own imaging equipment, so I don't think there was a financial incentive. The main thing seems to be 1) managing risk of malpractice and 2) managing risk of my insurance denying coverage for PT.

Malcat

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Re: Pain Management
« Reply #53 on: May 03, 2021, 10:45:43 AM »
Do MDs make money off of imaging there?
In my case, the MD didn't have their own imaging equipment, so I don't think there was a financial incentive. The main thing seems to be 1) managing risk of malpractice and 2) managing risk of my insurance denying coverage for PT.

Ahhh...makes sense.

Yeah, I've worked with some American surgeons who really struggled with the Canadian system because there's no much less ass-covering and they were kind of shit-their-pants scared because patients here can just as readily sue. They just don't.

jeninco

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Re: Pain Management
« Reply #54 on: May 03, 2021, 11:22:49 AM »
And that explanation above there is why I just pay out of pocket (out of an HSA, so pre-tax dollars, to complicate the situation) to see a PT (which I think is the same as "physio" in Canadian). It means I get to see people who practice modalities that are immediately effective for me (although, ouch, manual cross-friction massaging on connective tissue is painful, it gets'er'done so I can go back to my regularly scheduled activities) without arguing with doctors about "just take off 6 weeks" which is what I tend to get around here. (Yes, I live in a place full of professional athletes. Yes, "rest it for 6 weeks" is still advice I get. )

"Money well spent" -- make it better, so I can go back to living my life rather than chasing around doctor's appointments.

TrMama

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Re: Pain Management
« Reply #55 on: May 03, 2021, 12:12:10 PM »
That sounds nuts to me.

So is physio just not that common then? Where I live, there's a physio on almost every block, and you would never have to wait more than a few days for an appointment. I had an emergency recently and was even able to see a specialized neurogical physiotherapist the same day.
Physio (or PT in 'murican) is common, but the process of getting it can be complicated. The primary care doctor generally has to prescribe PT for it to be covered by insurance. In my case, my doctor wouldn't prescribe it until I had an Xray (cheap) and an MRI (almost $500). So it took me 4 appointments, 2 months and about $700 to get into PT for shoulder tendinitis.

That sounds nuts. It also means you had to wait 2 months to actually start treating the injury.

I'm also Canadian and some extended health insurance plans here also require doctor referral. However, once you have the referral you can go to any licensed PT. Our family is covered by 2 different extended health plans, one requires referral and the other doesn't. My workaround is to have my GP write me (and anyone else in the family who I think may need it) a generic prescription for each service once a year (insurance requires each script to be no more than 1 year old). Works great because the insurance company either doesn't care or isn't allowed to ask what exactly was done at the PT appointment. Now that telehealth is so prevalent getting the referral is stupidly easy. I don't even have to go in person to collect my piece of paper. Although it still feels like a total waste of effort on everyone's part. Note that there's also a dollar limit on how much physio, massage, psychotherapy, etc insurance will pay for so their liability is pretty limited.

achvfi

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Re: Pain Management
« Reply #56 on: May 03, 2021, 01:53:11 PM »
First , Just to be clear unless someone is an actual Doctor anything suggested should be considered as just an opinion and nothing else. Any decision should be made on your own and probably even if from a Doctor.
While there is a lot of woo out there, there is also lot to gain to look for advice beyond doctors. Kudos.

I dont have much advice for pain medication but two things worked for me are Nutrition and Physical therapy. Most doctors don't know about nutrition and its effect on body. They are not taught more than few sessions in school about nutrition. They usually focus on treating symptoms of what they can treat with medicine and ignore the root cause.

Just like MMM forum where people do of financial hacking there are communities for health hacking, I would recommend educating yourself on nutrition and ancestral way of eating (I do not recommend Vegan).

Nutrition: Try low carb diet. Give up on processed food. No grains, no flour, no sugar, no sweeteners, no alcohol, no vegetable oils. These are all highly inflammatory over time  result in degeneration of body at cellular level. They interfere with normal function of your body, your hormone balance and also deplete vital vitamins and minerals.

Eat lots of meat (beef is health food!), try bone broth and some greens and vegetables you like or tolerate. Basically eat food that doesn't come with list of ingredients. Focus on nutrient dense food. When you give your body the nutrition it requires it will heal itself what it can.

For me nutrition changes and combining it with physical therapy helped overcome my knee and ankle joint pain from years of sports and abuse. Beyond that I lost all my excess weight and now I am in best shape of my life. Every time I see myself in the mirror, I see me minus 10 years of aging and a toned body

Avoid regular high impact activities like running and replace wit low impact activities such as elliptical, swimming, biking/spinning.

I know this is a tall order but your body is worth it. Good luck.




Malcat

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Re: Pain Management
« Reply #57 on: May 03, 2021, 03:21:57 PM »
^Although I don't necessarily agree with your diet advice, the advice of beef as a universal recommendation, I do totally agree that diet as a modulator of inflammation is important. This is well recognized in the medical world.

It's just tricky to develop into an evidence based treatment recommendation because it varies so much by person, which makes it difficult to study and difficult to implement. That, and doctors are not the professionals to oversee that kind of lifestyle stuff.

I will also TOTALLY agree with you that an aversion to woo should not equal a dependence on doctors alone. Doctors tend to be HORRIBLE at treating pain. They can be experts at treating issues that cause pain, but if, and only if the problem can be readily identified and is actually treatable.

I've had severe pain my entire life and I've seen dozens and dozens of doctors, and only the ones trained in pain management knew anything about managing pain properly.

The only doctors who have ever successfully resolved pain for me were the surgeons who took out my infected appendix, and the doctor who gave me a puffer when I had an asthma attack.

Otherwise I've been given a giant pile of prescriptions, which sometimes help in a pinch, but come with side effects, especially if taken long term.

Then there's all of the other shit. What works, what's woo? Who should you trust? Who's full of shit???

Well the key to navigating the world of non-doctor treatment is to give up on the need for explanations, and to generally ignore any explanations given.

Acupuncture works for some people for some reason. We have no idea why, we have theories, but no actual facts. Many chiros and naturopaths and whatever will give detailed explanations as to why they work...they don't know, but in the end, it doesn't matter.

If it works for you, then great. Don't question it, just do it.

It's the same with taping, cupping, and even massage therapy. The RMTs are taught detailed rationals for why what they do works and how it should be done. Meanwhile, it's all just a theory, but it works! Consistently! For almost everyone! Yay!

Truthfully medicine isn't any different. Doctors don't know why most of their drugs work. The difference is that they aren't usually taught bullshit reasons to explain it. They're doctors, they don't need PR to justify what they do.

These allied health folks, fitness folks, whoever, aren't at fault. This is what they're taught. They're taught theory as fact and they repeat it as if it's fact. That's where woo is a problem.

It's hard to sell people on alternative treatments if the sales pitch is "fucked if I know how it works, but you might as well spend a couple hundred bucks and see if it helps". So the industry doesn't promote that narrative. Plus what people in pain usually want even more than relief is answers.

I've "helped" countless pain patients just by being able to explain to them why they're in constant pain. Honestly this alone accounts for 99% of my patients satisfaction. Actually reducing their pain is usually just a bonus in terms of how much they value my service and its cost, even though it fails to help a lot of people. These industries know that, it's why they focus on giving clients answers.

Do bee stings help with chronic conditions? I don't know, maybe. But if they do, I guarantee no one else knows why either, especially not the chiropractor with pages and pages of explanation as to how it interacts with the body.

There's no question that a certain diet, a certain exercise, and a certain combo of treatments will probably help anyone who experiences pain. It's just very very hard to figure out which combo, because there's no reliable scientific way to determine which body will uniquely respond to what. And each type of provider only has evaluation techniques that allow them to say if their treatment MIGHT help, and the answer is almost always 100% "yes it might".

So that's really the best way to approach any ongoing bodily issue. Get the doctors to check if there is an objectively solvable problem, or if there's a problem that could get worse without intervention.

Beyond that, sure, read about options and the various theories as to why certain approaches might work, but take any and all explanations with a grain of salt. That doesn't mean these treatments or diets aren't powerfully effective for some people, just learn to have a healthy respect for how mysterious the human body is.

Respect that no one has answers, but a lot of people have options to offer, and the vast majority of options that can help you with chronic pain will not come from an MD.

It's trial and error. And if it works great, but don't kid yourself that you have much of an idea why something works. Just keep doing it as long as it works. And just because your woo-y alt medicine provider is probably entirely full of shit as to why they're recommending certain treatments, doesn't mean that full-of-shit woo huckster can't help you. Statistically, they can probably help you with pain more than the MD who is less full of shit but also has no good options for you.
« Last Edit: May 03, 2021, 03:32:10 PM by Malcat »

achvfi

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Re: Pain Management
« Reply #58 on: May 04, 2021, 09:09:46 AM »
^Although I don't necessarily agree with your diet advice, the advice of beef as a universal recommendation, I do totally agree that diet as a modulator of inflammation is important. This is well recognized in the medical world.

I mentioned beef on purpose because there is widely accepted myth among Nutritional, Medical community and general public that red meat and saturated fat will clog your arteries, cause cancer and kill you. But in fact that belief is based on poorly conducted epidemiological observational studies in 60s and 70s. In fact all this is outdated information that still persists in the mainstream.

These beliefs continue to be promoted by people with agendas beyond nutrition. Food, Pharma, animal welfare and religious so on, that control medical advice, nutritional guidelines and academic research. There is lots of confusion and misrepresentation of data that mainstream media picks up.

In fact beef if one of the most nutritious foods you can eat for both macro and micro nutrition perspective. Also nutrition it provides is bio available that the body can actually absorb and use compared to so much of plant based foods.

There are communities that are benefiting from meat based diets to resolve various conditions including pains that people used to accept as incurable or have to live with for their life.

I know this is all hard to accept after decades of marketing-brainwashing we have all been through.

Check out following YouTube channel where many people eating just meat that are thriving compared to their previous lifestyles. I am not recommending to eat just meat BTW.

https://www.youtube.com/channel/UC99hyfVlVP17XOic3K1_IvQ

Malcat

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Re: Pain Management
« Reply #59 on: May 04, 2021, 09:29:49 AM »
^Although I don't necessarily agree with your diet advice, the advice of beef as a universal recommendation, I do totally agree that diet as a modulator of inflammation is important. This is well recognized in the medical world.

I mentioned beef on purpose because there is widely accepted myth among Nutritional, Medical community and general public that red meat and saturated fat will clog your arteries, cause cancer and kill you. But in fact that belief is based on poorly conducted epidemiological observational studies in 60s and 70s. In fact all this is outdated information that still persists in the mainstream.

These beliefs continue to be promoted by people with agendas beyond nutrition. Food, Pharma, animal welfare and religious so on, that control medical advice, nutritional guidelines and academic research. There is lots of confusion and misrepresentation of data that mainstream media picks up.

In fact beef if one of the most nutritious foods you can eat for both macro and micro nutrition perspective. Also nutrition it provides is bio available that the body can actually absorb and use compared to so much of plant based foods.

There are communities that are benefiting from meat based diets to resolve various conditions including pains that people used to accept as incurable or have to live with for their life.

I know this is all hard to accept after decades of marketing-brainwashing we have all been through.

Check out following YouTube channel where many people eating just meat that are thriving compared to their previous lifestyles. I am not recommending to eat just meat BTW.

https://www.youtube.com/channel/UC99hyfVlVP17XOic3K1_IvQ

All I said was that I don't agree with beef as a universal recommendation for everyone. I don't react well to beef for example, so I'm not about to have a beef heavy diet. I'm absolutely fine with dairy though, which my sister reacts to (we're not genetically related).

My point was that different bodies are different. Each person needs to figure out what their body responds best to. I've done multiple elimination diets, and I respond best to vegetarian with dairy and eggs.

I'm all for discounting historical diet bullshit, but I don't agree with pushing any one diet on everyone. Every person responds to everything differently. To say otherwise is 100% bullshit.

The science around nutrition is all over the place, so anyone claiming to know "the truth" when it comes to nutrition is guaranteed to be stretching the applicability of research.

The only absolute truth that we can conclude about most diets is that what works for the individual is highly dependent on the individual and for the most part, we have no solid idea as to why.

achvfi

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Re: Pain Management
« Reply #60 on: May 04, 2021, 11:49:36 AM »
All I said was that I don't agree with beef as a universal recommendation for everyone. I don't react well to beef for example, so I'm not about to have a beef heavy diet. I'm absolutely fine with dairy though, which my sister reacts to (we're not genetically related).
I am not sure why you keep writing about universal recommendation. I am giving an option that people can try, they may not be aware of or not usually ready to accept generally that worked very well for me. I am not pushing universal truths here.

You can almost recommend nothing universally, its meaningless. That doesn't mean you cant recommend something. Yes, it is individual and also what an individual is capable of mentally and physically overtime.

My point was that different bodies are different. Each person needs to figure out what their body responds best to. I've done multiple elimination diets, and I respond best to vegetarian with dairy and eggs.
That is awesome that you figured out what works for you after trying different ideas.

Malcat

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Re: Pain Management
« Reply #61 on: May 04, 2021, 12:00:43 PM »
All I said was that I don't agree with beef as a universal recommendation for everyone. I don't react well to beef for example, so I'm not about to have a beef heavy diet. I'm absolutely fine with dairy though, which my sister reacts to (we're not genetically related).
I am not sure why you keep writing about universal recommendation. I am giving an option that people can try, they may not be aware of or not usually ready to accept generally that worked very well for me. I am not pushing universal truths here.

You can almost recommend nothing universally, its meaningless. That doesn't mean you cant recommend something. Yes, it is individual and also what an individual is capable of mentally and physically overtime.

My point was that different bodies are different. Each person needs to figure out what their body responds best to. I've done multiple elimination diets, and I respond best to vegetarian with dairy and eggs.
That is awesome that you figured out what works for you after trying different ideas.

Sorry if I misinterpreted. The way I read your post seems to be saying that everyone should be eating beef.

lexde

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Re: Pain Management
« Reply #62 on: May 05, 2021, 08:13:14 AM »
Iím 31, so Iím not sure how well this will hold up, but cutting way back on alcohol and coffee, drinking tons of water/tea, consuming lots of anti-inflammatory food (turmeric for one), and stretching/yoga helps me. I have a bad back, and this keeps everything manageable without other meds.

Malcat

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Re: Pain Management
« Reply #63 on: May 05, 2021, 08:54:56 AM »
Iím 31, so Iím not sure how well this will hold up, but cutting way back on alcohol and coffee, drinking tons of water/tea, consuming lots of anti-inflammatory food (turmeric for one), and stretching/yoga helps me. I have a bad back, and this keeps everything manageable without other meds.

Yeah alcohol is a big one, a lot of people self medicate pain with alcohol because it is reasonably effective for pain in the short term, but it's horrible for making pain worse overall on multiple fronts, both directly and indirectly by seriously damaging reparative sleep, although no one knows how sleep works or what it even goes, but we do know that disrupting sleep cycles is horrible.