The need for new research

Two factors are increasing the study of non-medication-based treatments for pain:

1. Increased understanding of the impact of chronic pain because of new research
   • ⅔ people with chronic pain reported decreased ability to exercise, sleep, perform household chores, or drive a car
   • “The financial cost of chronic pain is roughly the same as cancer or cardiovascular disease.”
2. Overdose and death from opioids has become a major health crisis
   • “Every day, more than 130 people in the United States die after overdosing on opioids.”

New prescribing guidelines aiming to reduce opioid use disorder can also make it challenging for people with chronic pain to get treatments

Mindfulness-based stress reduction research

A January 2019 published meta-analysis in Evidence-Based Mental Health explored the effectiveness of alternative chronic pain treatments. The researchers analyzed 21 randomized controlled trials (12 of which met subsequent quality standards) on mindfulness-based stress reduction, cognitive behavioral therapy (CBT), and chronic pain.

Chronic pain as a result of MS was not specifically studied. Chronic pain sources included musculoskeletal pain, fibromyalgia, chronic lower back pain, rheumatoid arthritis, and others. 

Mindfulness-based stress reduction and CBT showed “clinically important advantages relative to control” for physical functioning, pain intensity, depression. This is particularly fascinating as control participants in some study arms received standard-of-care pain management, including medications.

 

What is mindfulness-based stress reduction?

As the name suggests, mindfulness-based stress reductions are interventions that help reduce stress by cultivating an awareness of the current moment (mindfulness). Meditation, breathing exercises, and yoga are 3 examples of mindful exercises.

The goal of these exercises is to encourage a body awareness and bring the focus to the present. These strategies make it easier to recognize body sensations, emotions, and thoughts and then to let them go.

In the research paper discussed above, the mindfulness exercises were administered by certified MBSR teachers or other trained professionals.

How to practice 4-7-8 breathing

You can try these strategies out for yourself! A good one to start with is mindful breathing, also known as diaphragmatic breathing or abdominal breathing. The goal of this exercise is to pace your breaths and generate a calm feeling. 

 

Quick tips:

• Sit with your back straight
• Try to keep your tongue touching your gums just above your front teeth during the cycle. When you exhale with your mouth open, you will breathe around your tongue

 

Steps:

1. Exhale completely through your mouth — make a whoosh sound
2. Close your mouth and inhale through your nose. Count to 4 in your head
3. Hold your breath and count to 7
4. Exhale completely through your mouth, making a whoosh sound, and count to 8
5. Repeat until you complete the cycle 4 times

 

First, try to complete the exercise twice per day. As you continue, you can add daily repetitions or increase the number of breaths that you take. 

Looking for other mindfulness exercises? Check out these 22 individual and group strategies

Chronic pain and medications

Medications will still continue to be an important part of the toolkit in the battle against chronic pain. It is not always possible to cure chronic pain. Work with your lupus treatment team to establish a safe and effective regimen. Even over-the-counter pain medications can be dangerous when taken at high doses or when taken in conjunction with other medications. Before starting any new medication, talk to your rheumatologist.

 

Prescription-strength medications, including opioids, are used in cases of severe pain. While opioids are strong pain relievers, they also come with a high risk of dependence and addiction. 

 

Opioid overdose risks are increased for people with reduced kidney or liver function. Be sure to check out these resources if you or a loved one is using an opioid for pain management.

• Safe Use, Storage, and Disposal of Opioid Drugs — by the American Academy of Family Physicians
• Opioid Overdose — by the U.S. National Library of Medicine

Over-the-counter (OTC) medications

OTC medications are available without a prescription, though they may still come in a variety of dosages. Be sure to read the labels in order to ensure you are taking a safe dose for your body weight. Also, it’s a good idea to bring up all new medications with your MS treatment team.

There are 2 main types of OTC pain relievers:

1. Acetaminophen
   1. Tylenol
   2. Ofirmev
   3. Mapap
2. Nonsteroidal anti-inflammatory drugs (NSAIDs)
   1. Aspirin
   2. Ibuprofen (Advil; Motrin)
   3. Naproxen (Aleve)

Mediation & Mediator Variables

When designing research studies, it is necessary to consider what will be measured. And, part of that process is defining the independent and dependent variables.

Independent variables are the variables that are changed intentionally by the researchers (different medication dosages, etc.) or are standard variables like age or time. The measurement of these variables does not change as a result of some other variable.

Dependent variables, on the other hand, are variables that are being studied and measured. A hypothesis is a guess at the change in the dependent variable based on the presentation of some independent variable.

Mediation models are another type of study which include mediator variables. Mediator variables are used to clarify the understanding between an independent variable and a dependent variable. In this way, mediator variables attempt to describe chains of action that may be influenced.

Sleep Strategies

Looking for ways to get to sleep faster and stay asleep? These may help:

1. Avoid blue light (cellphone screens, television, computers, etc.) 30 minutes before bed
2. Wake up at the same time everyday (weekends, too!)
3. Ban pets from your bedroom if they wake you up in the middle of the night
4. Keep your room slightly cooler than normal
5. Exercise daily — but try not to work out too close to bedtime
6. Limit naps. Try to schedule naps and aim for consistency of schedule
7. Watch your caffeine intake
8. Do not use alcohol to help you fall asleep. It decreases sleep quality and can lead to dependence issues