Mindfulness for Managing Chronic Pain

Chronic pain can make it difficult to get through a day productively. Chronic pain takes a physical toll on the body, increases emotional stress, and can interfere with relationships and intimacy. One strategy for dealing with chronic pain is harnessing the power of the mind to generate moments of pause, rest, and relief from chronic pain. Mindfulness exercises such as guided imagery, conscious breathing, and generating focus on pain relief can be powerful tools.

Here we share a guided meditation to create a moment of pause and rest from the pain one may be feeling today through self-compassion:

Today, may I give myself a moment of relief from pain. May my body rest for a moment in stillness. May I sense a part of my body where there is peace and calm. Let me tune into this peace and calm. May I pause now to feel the stillness of my thoughts and the quiet of my beating heart. May this moment of rest generate peace that reverberates to all those around me. May all beings in pain feel a moment of relief, rest, and pause from their pain. May the thoughts, words, and actions of this moment I have created contribute to peace and calm in the lives of all those suffering today.

Neurological Symptoms of Depression

Depression can cause a wide range of neurological symptoms. These include tingling, sense of weakness, fatigue, tremor, numbness, memory problems, problems concentrating, sleep difficulties, dizziness, blurred vision, sensation of near-fainting, ringing in the ears, difficulty swallowing, dry mouth, neck and back pains, headaches, body aches and myalgias, urinary symptoms, impotence, and lack of balance.

Recent studies suggest that the increased level of stress associated with depression may raise levels of glucocorticoid. This steroid can have harmful effects on the nervous system, damaging the hippocampus which is crucial for creating long-term memories.

One study shows that having depression may nearly double the risk of developing dementia later in life.

Depression is often comorbid with neulogical conditions as well. Estimates of the prevalence of depression after stroke range from 20% to 72%. In Parkinson’s disease, estimates are 40–50% and 19–54% for multiple sclerosis. In epilepsy, the prevalence is estimated at up to 55%.

The Pain of Binge Eating and the Relief of Compassion

Binge eating can be both physically and emotionally painful. The physical pain involves eating to the point of great discomfort. For some binge eater who purge multiple times a day, their throats can become burned. The emotional pain of being out of control, anxious, and feeling utterly alone with this condition is debilitating and frightening.

My patients have experienced moments of relief either before the urge to engage in a binge episode, or after a binge episode when repeating these healing words. Repetition of these healing words daily, multiple times a day, for an extended period of time has shifted their relationship with their bodies and food. And, their relationship with all those around them.
[Think of a living being you know who is in pain and say these words while thinking of them. This living being can be yourself, a loved one, a stranger, an animal, a forest, the universe]
You are sacred. I am warm, glowing energy. I hold you in my protection. I am your comfort. I am your relief. I am your  calm.  I am warm, glowing energy.  I hold you in my protection. You are sacred. 

What is Huntington’s Disease?

More than 15,000 Americans have Huntington’s Disease (HD). At least 150,000 others have a 50 percent risk of developing the disease and thousands more of their relatives live with the possibility that they, too, might develop HD.

What causes HD?
HD results from the genetically programmed degeneration of neurons. It is a familial disease, passed from parent to child through a mutation in the normal gene. The genetic defect responsible for HD is a small sequence of DNA on chromosome 4.  Each child of an HD parent has a 50-50 chance of inheriting the HD gene. If a child does not inherit the HD gene, he or she will not develop the disease and cannot pass it to subsequent generations. A person who inherits the HD gene, and survives long enough, will sooner or later develop the disease. In some families, all the children may inherit the HD gene; in others, none do. Whether one child inherits the gene has no bearing on whether others will or will not share the same fate.

Signs of Huntington’s Disease
The degeneration of neurons in HD causes uncontrolled movements, loss of intellectual faculties, and emotional disturbances. Some signs of HD may include:

  • Chorea—sudden involuntary or jerky movements that can occur throughout the body
  • Major balance and coordination problems
  • Rapid, jerky movements in the eyes
  • Slurred, hesitant or halted speech
  • Problems swallowing
  • Dementia

What kind of treatment is available for Huntingon’s Disease?
While there is no treatment for curing HD, a combination of medication, psychotherapy, family therapy, physical therapy, and occupational therapy can help to lessen and improve HD symptoms.

Medications for movement disorders
Drugs to treat movement disorders associated with HD include:

  • Tetrabenazine (Xenazine) is specifically approved by the Food and Drug Administration to suppress the involuntary jerking and writhing movements associated with Huntington’s disease (chorea). A serious side effect is the risk of worsening or triggering depression or other psychiatric conditions. Other possible side effects include insomnia, drowsiness, nausea and restlessness.
  • Antipsychotic drugs, such as haloperidol (Haldol) and clozapine (Clozaril), have a side effect of suppressing movements. Therefore, they may be beneficial in treating chorea. These drugs may, however, worsen involuntary contractions (dystonia) and muscle rigidity.

Medications for psychiatric disorders
Medications to treat psychiatric disorders will vary depending on the disorders and symptoms. Possible treatments include the following:

  • Antidepressants include such drugs as escitalopram (Lexapro), fluoxetine (Prozac, Sarafem) and sertraline (Zoloft). These drugs may also have some effect on treating obsessive-compulsive disorder. Side effects may include nausea, diarrhea, insomnia, and sexual problems.
  • Antipsychotic drugs may suppress violent outbursts, agitation and other symptoms of mood disorders or psychosis.
  • Mood-stabilizing drugs that can help prevent the highs and lows associated with bipolar disorder include lithium (Lithobid) and anticonvulsants, such as valproic acid (Depakene), divalproex (Depakote) and lamotrigine (Lamictal). Common side effects include weight gain, tremor and gastrointestinal problems. Periodic blood tests are required for lithium use because it can cause thyroid and kidney problems.

Family Therapy and psychotherapy
A psychotherapist — a psychiatrist, psychologist, and clinical social worker— can provide talk therapy to help a person manage behavioral problems, develop coping strategies, manage expectations during progression of the disease. A family therapist can help to facilitate effective communication among family members and cope through the disease stages together as a family.

Speech therapy
Huntington’s disease can significantly impair control of muscles of the mouth and throat that are essential for speech, eating and swallowing. A speech therapist can help improve your ability to speak clearly or teach you to use communication devices — such as a board covered with pictures of everyday items and activities. Speech therapists can also address difficulties with muscles used in eating and swallowing.

Physical therapy
A physical therapist can teach you appropriate and safe exercises that enhance strength, flexibility, balance and coordination. These exercises can help maintain mobility as long as possible and may reduce the risk of falls.

When the use of a walker or wheelchair is required, the physical therapist can provide instruction on appropriate use of the device and posture. Also, exercise regimens can be adapted to suit the new level of mobility.

Occupational therapy
An occupational therapist can assist the person with Huntington’s disease, family members and caregivers on the use of assistive devices that improve functional abilities. These strategies may include handrails at home, assistive devices for activities such as bathing and dressing, and eating and drinking utensils adapted for people with limited fine motor skills.

Source:  Mayo Clinic – http://www.mayoclinic.com/health/huntingtons-disease/DS00401

Migraine and Epilepsy are often comorbid conditions

Migraine and epilepsy are episodic neurological disorders. They are linked by their symptomatology and comorbidity. Migraine is common in patients with epilepsy, while epilepsy is less common in migraine sufferers. In addition, a number of migraine symptoms can be confused with epilepsy. The presence of one disorder increases the likelihood the other is also present.  The diagnosis and treatment of each disorder must take into account the potential presence of the other.

Differential diagnosis of epilepsy and migraine

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Because migraine and epilepsy are associated, clinicians should be aware that individuals with one disorder are more likely to have the other. The migrainous symptoms of patients with a diagnosis of epilepsy may be overlooked or attributed to the seizure disorder, particularly since a number of epileptic syndromes may mimic migraine.When developing a treatment plan for a patient with both  epilepsy  and migraine, the comorbidity should be considered. Tricyclic antidepressants and neuroleptic drugs are often used to treat migraine. Antimigraine anticonvulsants should be considered as a simultaneous treatment for both disorders.Valproate or divalproex, topiramate, and gabapentin have demonstrated efficacy in double-blind controlled trials, although, thus far, only divalproex is FDA-approved as a migraine preventive agent. Anti-epileptic drugs such as zonisamide and levetiracetam may also be useful in migraine prevention.

Family therapy can help with the psychosocial treatment and management  of both epilepsy and migraine. These neurological disorders can disrupt family functioning and healthy family dynamics. Family members can develop affect and mood disorders as well. Family therapy is especially indicated when family members want to learn how to cope with these neurological conditions as a family unit and share in the management of these diseases together.

Migraine and PTSD often occur together

We’ve known for some time now that migraine disease and major depressive disorder (MDD) tend to be comorbid conditions. Research is showing a similar connection to post-traumatic stress disorder (PTSD). A Drexel University study, led by Dr. B. Lee Peterlin in 2009, looked at approximately 600 migraine patients and found that 30 percent of chronic daily sufferers also had PTSD symptoms. PTSD symtomotology was found in 22 percent of ‘episodic’ migraine sufferers. Migraine sufferers are considerably more likely to be PTSD sufferers.  This study suggests that treating post traumatic stress in migraine sufferers can be an important aspect of migraine treatment.

Sources:

B. Lee Peterlin, DO; Gretchen E. Tietjen, MD; Jan L. Brandes, MD; Susan M. Rubin, MD; Ellen Drexler, MD; Jeffrey R. Lidicker, MSc; Sarah Meng, DO. “Posttraumatic Stress Disorder in Migraine.” Headache 2009;49:541-551.

James L. Griffith, MD. “Posttraumatic Stress Disorder in Headache Patients: Implications for Treatment.” Headache 2009;49:554-554.

How does migraine impact the family?

Migraine sufferers report a variety of family issues related to their migraines. In one study, many respondents reported that they were less able to communicate and more likely to argue with their children, felt less involved with home and school and spent less time with the children. Almost half felt they could be better parents if they did not have migraine.  Many also felt less able to communicate and more likely to argue with their partners, and that they could be a better partner if they did not have headaches. Migraine can disrupt family life significantly.

Source: Lipton RB, Bigal ME, Kolodner K, Stewart WF, Liberman JN, Steiner TJ. The family impact of migraine: population-based studies in the USA and UK. Cephalalgia 2003; 23:  429–440.