When pain is discussed, medications are often brought forth as the primary means of management. The focus of Dr. McSweeneyís presentation to the SLE Workshop honors the contribution of traditional medical approaches to pain management, while offering information on complementary and alternative therapies for pain. Many people with lupus have discussed medical treatments for pain with their doctors. For a variety of reasons, they may want to explore what non-pharmaceutical options exist. This is an opportunity to learn about what can be done that has the potential to offer additional relief.
Although the therapies presented here are grouped together as both complementary and alternative, it is more accurate to say that they are complementary. It is not advisable to replace a prescribed regimen of medication, especially without consulting a doctor. Instead, complementary therapies can be added to a pain management plan in order to provide an extra measure of relief. At times, people are able to reduce the dose of their medications due to the added effects. Another benefit is the ability to proactively do something on oneís own to assist with the plan laid out by the doctors. It can be helpful to know that there are methods other than medication that can be effective.
When discussing pain in lupus, it is important to look at the whole picture created by lupus. Many members of The SLE Workshop have identified pain as one of the major components of their lupus. Because pain plays such a major role for so many people, it is important that people with lupus have a variety of tools for managing pain.
With a simple pain condition, such as banging your finger, there is a source you can identify. There is also a clear course of action that resolves the pain. Pain experienced with lupus is different. It is part of the systemic condition and is not as easily resolved. To deal with the pain, the cause of the pain may not always be addressed, but rather the ways the body expresses the pain, such as inflammation. Interventions such as anti-inflammatory medications reduce the pain, even if they donít change the lupus itself.
Stress can also contribute to pain. This is the point where most complementary treatments can be of assistance. Even though the cause of the pain itself is not being directly addressed, reducing stress can often help to reduce pain, or at least help to deal more effectively with the pain.
Another point where pain can be addressed is with the immune system imbalance. Prednisone, for example, works to decrease the activity of an overactive immune system. Some complementary therapies aim to assist with immune system imbalance. This does not mean that complementary therapies are a cure for lupus, and thatís not the case. Some therapies can, however, have an impact on the immune system.
There are five categories. Some therapies cross over the categories.
1. Mind-Body: techniques for using your thoughts to have an impact on your body. Also, body therapies that target how the use of the body can have an impact on your emotions. Generally you can learn these and then do them yourself.
Examples of mind-body therapies:
Reasons for using Mind Body Therapies:
The Gate Control Theory states that we have pain because there are messages going from the site of pain through the spinal cord to the brain where it registers that you have pain. The brain then signals back to the body. With chronic pain, however, nerves may fire continuously, even though there may not be any increase at a pain site. If we can shut off some of the pain messages in the spinal cord going up, or if the brain can actually send out different chemicals such as endorphins, than you can feel less pain and interrupt the chronic pain cycle. Itís not that your lupus condition is getting better and suddenly everything is fine, but that the brain and spinal cord are moderating some of the pain sensation. When practicing a mind body therapy such as guided imagery, your brain is calm and relaxed and therefore not processing, as much pain and you feel better.
2. Alternative treatments. This category is referred to as treatments because you would seek the help of a practitioner.
*Acupuncture can be helpful for pain and can have a beneficial effect on the immune system, but will not stop the lupus. Traditionally, 8-10 treatments are conducted by a practitioner. The treatments begin in a schedule of 2-3 times a week, reducing down to once a week. Acupuncture does not work for everyone. If you are not finding any relief by the 8th session, itís probably not something thatís going to work for you.
Massage can be helpful and relaxing. It might be helpful to find a practitioner who is aware of lupus. The pressure used by a masseuse may be too great and cause more pain if the practitioner is unaware of the needs of a person with lupus.
3. Movement Therapies. These therapies use physical movement to help with both pain, and with calming the mind. These therapies tend to be very mind body focused. By calming the mind, the body is less sensitive to pain.
Some examples of movement therapies are Tai Chi, Yoga, and Qigong. Qigong may have a balancing effect on the immune system. With the eastern therapies the goal is to achieve balance in the mind-body system. Itís not something that will cure but that can help. Itís a matter of trying the different therapies and coming up with what works for you. Some classes are geared to people who suffer from pain, and one of those would be the best to take. It is also important to keep in mind that movement therapies are active and may not be helpful during a lupus flare.
4. Alternative remedies. These are different substances that you would take:
The Arthritis Foundation has put together a useful supplement guide. See also their information regarding this on their website, www.arthritis.org. Two of the most popular supplements for lupus are fish oil (omega 3 fatty acid) which targets inflammation, and DHEA, which has been thought to be helpful for lupus, but there are still some concerns about the side effects. It is a hormone. The ones at the health store are too low in dosage to make a difference, so if youíre serious about trying DHEA, you would want to talk to a doctor who could prescribe it at a higher dose. Again, you want to be careful about putting hormones into your body.
Homeopathy is a very gentle noninvasive remedy. Individuals report variations in helpfulness. Itís a complicated treatment where a practitioner will spend over an hour assessing your lifestyle and recommend treatments that are personalized. Practitioner visits tend to be expensive, although treatment generally involves very few visits. The remedies themselves are inexpensive.
5. Energy Medicine. These therapies address the energy fields of the body.
Reiki is similar to therapeutic touch where you barely touch a person in order to balance out the energy field on the body, smoothing out the energy. It can be very calming and can target specific points on the body such as the throat or the abdomen.
Aroma Therapy: Some people say it works on the energy system, others think it responds to specific sensory receptors. Aromatherapy may help decrease pain by promoting relaxation. Too many or too strong scents can be overwhelming and not helpful. Some scents are over stimulating. Lavender, chamomile, and peppermint are calming, which is the goal.
During flare-ups, lupus symptoms should be addressed differently. This includes the use of complementary and alternative therapies. Pain can occur both during and between flare-ups. Strenuous activities should be avoided during a flare. Even something like meditation can be difficult to practice during a flare, since it can be difficult to concentrate. Anything that causes physical or mental stress should be avoided during a flare-up. Therapies marked with an asterisk (*) are considered mild enough to use during a flare, and can help decrease pain at these times. As with any change in lupus treatment plans, pain management or otherwise, it is important to discuss changes with your doctor before they are made., a free support and education group held monthly as HSS.
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Summary of a presentation given at The SLE Workshop, a free support and education group held monthly for people with lupus and their families/friends Summary prepared by Olivia Ivey, MSW