To medicate or not to medicate

A friend of mine passed on an interesting article from the New York Times about migraines. (I’m posting it as a “special weekend edition,” as I don’t know how long the article will be freely accessible online. With the newspaper industry the way it is, I think the NY Times charges for older articles.)

“Some early data suggests that if you let headache pain go without treatment it can lower your threshold for pain down the line,” Dr. Saper said. In other words, untreated headaches can make you more vulnerable to pain.

On the other hand, if you are taking over-the-counter or prescription painkillers two to three days a week for months on end, the medications you are taking to dull pain could worsen your condition. You may then start to experience medication-overuse headaches — a risk for migraine sufferers.

I think this is one of the really tricky things about medications. Not only do you have to find the right medication that works for your body, you also have to figure out the right dosage. How much medication is too much? Am I able to lower my dosage safely, or will I have renewed symptoms?

There is also a lot of controversy – particularly in alternative medicine settings – about taking prescription medications at all. I know many people are uncomfortable with taking medications, often particularly with taking painkillers. I can understand this, and yet many people also don’t have a choice about whether or not to take their medications. For example, someone with HIV/AIDS should not go off their anti-retrovirals.

It’s particularly interesting to see this article’s mention of the positive/negative effects of medication on chronic pain. Pain is such a nebulous thing anyway. Different people have different pain thresholds, and chronic pain takes the issue to a whole new level.

How do we treat pain in our society? I think it’s certainly telling that we have medications called “painkillers.” Yet untreated pain, as mentioned in the article, can negatively affect a person’s quality of life. Certainly, having pain all the time – particularly with no effective coping strategies or pain management – is really, really terrible.

Researchers are learning that pain and the medications used to treat pain can potentially change the biology of the brain.

Receiving good treatment can help you function more effectively, and will probably also save you money over the long term. And if you have health insurance, it should cover most of the relevant medical evaluations and treatments.

The question of universal health care aside, I think the key thing this article mentions is “good treatment.” The article continues by talking about effective strategies for talking to your health care provider about migraines/chronic headaches, as well as some supplements migraine sufferers may find helpful if they’re going the “alternative” route.

I’m glad that researchers are studying the effects of medication, unmanaged/untreated pain, and treatment strategies on migraines. I’m interested to see what further studies reveal. I feel like the study and article raise a lot more questions than they answer.

Mind-body connection

I read an article, “Is it All in My Head?”, from Psychology Today recently, and I really feel like it has a lot of good content about the role of the mind-body connection in chronic pain syndromes.

“Capping her frustration, Howard cannot be sure to this day why she became ill. But her best guess is that the self-imposed stress of her ambitious lifestyle played a role….Howard’s suspicions are confirmed by many researchers, who are coming to believe that psychological factors play a crucial role in perpetuating many physical illnesses, particularly a subset of chronic ailments that defy logic, diagnosis or a cure. It seems that the way you think about your illness can actually affect how sick you get.

These “multi-symptom illnesses”—which include chronic fatigue syndrome, fibromyalgia and potentially others such as Gulf War syndrome, irritable bowel syndrome and the condition known as multiple chemical sensitivity—have provoked intense controversy. Because they have no obvious biological cause, some doctors and researchers dismissed them in the past as hysteria or the “yuppie flu.”

Many patients, in response, became equally determined to prove that their disease was just as real and as biologically legitimate as heart disease or breast cancer….

However, the war between doubters and advocates has waned. The consensus is that these illnesses are truly mind-body diseases, in which biological and psychological causes and dysfunctions are inseparably intertwined. The mind seems to play a key role in kick-starting and perpetuating illness—but it’s not that sufferers are simply malingerers. Their bodies are sick, and their reaction to the illness often makes it worse.” [emphasis mine]

I definitely would have had a hard time hearing this when I was first diagnosed. I was in the “camp” trying so hard to justify my pain to people who didn’t seem to understand. Heck, I even had a “Fibromyalgia is Real” awareness bracelet.

That mindset didn’t help me get better. I just stayed trapped in what Buddhists would call dukkha, or suffering.

Allowing myself to feel pain – but not dwell in pain – is probably the single most important lesson I have learned from my experiences with fibromyalgia, if not my life.