Tag Archives: chronic pain

Getting Your Pain Treated in the ER in the Midst of an Opiate Epidemic

September 29, 2018General Health and Wellness844-SMA-TALK, American Chronic Pain Association, American College of Emergency Physicians, Behind the Curtain, chronic pain, narcotics, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Both the American College of Emergency Physicians and the American Chronic Pain Association have worked diligently to offer information and recommendations to protect patient interests and prevent inappropriate emergency room utilization while respecting the needs of chronic pain patients experiencing acute exacerbations.
In a word, it’s about expectations. Learning to understand what’s reasonable and not so much in an emergency room setting is important in helping patients to avoid disappointment.
Here are some tips to help your emergency room team help you.

If you don’t prepare for an emergency room visit, you’re the one who’s going to end up disappointed.

You should be able to tell the staff the name of the condition from which you suffer.
You should know the name and the contact information of your primary physician and any pain management specialist you see.
You should know the names of your medications, including over the counter and herbal preparations.
You should know any medical allergies you have. (A word about this. There is a difference between a medical allergy and an adverse reaction to a medication. Just because a medicine upsets you stomach or isn’t as effective as another doesn’t mean you’re allergic to it. It’s insulting to your physician to insist that you have an allergy when you don’t. You can assume that taking this posture starts the relationship off poorly because the physician will often know better and in many cases can check or test you for true allergies. It’s ok to be honest about your concerns, including medications that seem to work better than others. Your physicians will work with you and will do so more willingly when you are completely honest.)

At the ER
If you’re dealing with chronic pain, you’re going to end up in an emergency room at some point. The experience doesn’t have to be unpleasant. Emergency physicians are quite aware that pain is woefully under-treated and really do want to address it when it exists. That said, it’s important to be aware that physicians’ first charge is to “Do No Harm,” and if the situation is such that it could lead to inappropriate treatment, other and possible greater concerns than your immediate pain may take priority in the mind of the physician. It’s not that this applies to you, but this is what we have to protect against:

Here are other things to appreciate when you come to visit:

Your presence doesn’t change the reality that life-threatening conditions may be present at the same time in the emergency room. Be patient. You’re not being ignored.
Your physicians are going to treat your pain, but they’re even more interested in finding and treating any disease that exists. Be patient.
Your physicians are going to attempt to coordinate your care with your primary physicians and/or your pain management physicians.
You can’t just come to the emergency room and start demanding narcotics, even if it’s what is eventually going to happen. I shouldn’t have to explain that.

You can’t come to the emergency room and claim medical allergies to every medication except for a specific pain cocktail. Your physician understands that your body doesn’t work that way.
You shouldn’t expect an emergency physician to immediately be able to make a diagnosis of your condition that has eluded other physicians who have been evaluating you for months or years.
You shouldn’t expect an emergency physician to provide you with more than a few days of pain medication (or any without a discussion with one of your physicians).
You should expect to receive a thorough evaluation of your condition and to be treated with respect.
You should expect to receive treatment based on the evaluation performed in the emergency room.

Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!

Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.

Chronic Pain – What You and Your Physicians Can Do To Really Help

September 27, 2018General Health and Wellness, Neurology, Health Prevention844-SMA-TALK, acupuncture, Behind the Curtain, brain stimulation therapy, chronic fatigue syndrome, chronic pain, chronic pain syndrome, Cognitive behavioral therapy, endometriosis, fibromyalgia, Inflammatory bowel disease, Interstitial cystitis, local electrical stimulation, occupational therapy, osteopathic manipulation therapy, pain awareness month, psychotherapy, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Temporomandibular joint dysfunction, There are 72 Hours in a Day, TMJ, VulvodyniaJeffrey Sterling, MD

The notion of a pain awareness month is an odd thing; probably even more so to those suffering from chronic pain. Typically the idea with these periods of recognizing diseases and conditions is to create sensitivity among the general public toward one’s condition. In this and the next Straight, No Chaser, we will not only do that but will build upon that and provide those sufferers of chronic pain some better tools to make those emergency room visits more productive.

I’d begin by asking you to get more in touch with your “you sensitivity” and learn to differentiate between different types of pain. It’s important for you to know the difference.

Clearly there’s acute pain from injury. You break a jaw or twist an ankle, you’re going to hurt.
There’s acute exacerbations of pain from disease. You have sickle cell anemia? Cancer? Lupus? Sciatica or other low back pain? Arthritis? Migraines? You will have acute flare ups.

Then there’s chronic pain. Remember, sometimes pain happens without injury or disease. Pain is simply a signal communicated from your body to you through your brain. Acute pain is normal and is meant to alert you to somehow protect yourself or get help. Chronic pain is different. Those signals coming from your nervous system can be sporadic or haphazard, and they may be more reflective of dysfunction within the nervous system than a disease or injury. It can even be psychogenic (due to matters of your mind). Regardless of the cause, chronic pain is well, a pain.

There are many established conditions that cause chronic pain, such as the following:

Chronic fatigue syndrome
Endometriosis
Fibromyalgia
Inflammatory bowel disease
Interstitial cystitis
Temporomandibular joint dysfunction (TMJ syndrome)
Vulvodynia

Many patients with chronic pain suffer horrible outcomes because they become desensitized to pain, learn to ignore it, and misinterpret a new, unrelated pain condition (maybe with a few similarities), failing to get evaluated before it is too late.

If you suffer from chronic pain, it’s key to know the things you can do to improve your quality of life. Strengthening your mind to reduce stress and avoid fixating on your medical condition is very important. Learning to relax actually is treatment; your body has pain-reducing chemicals, including those that directly treat pain and promote healing, and others that prevent release of internal pain producers. Find someone with whom you can discuss relaxation and stress reduction.

Engage the fight to get better within your physical limitations.

Exercise remains key. Depending on your situation, walking, running, biking and/or swimming can dramatically improve your situation. Be advised that the extremes (not exercising at all or doing so too much) can actually worsen the situation.
Stretching and strengthening similarly produce benefits to those with chronic pain. This should sound like a good reason to become involved with a personal trainer or have a physical therapist.
Regular sleep and avoidance of nicotine (stop smoking!) will also help.

Your physician may discuss multiple other possible treatment modalities, such as the following:

Acupuncture
Behavioral therapy can reduce your pain and decrease your stress through methods that help you relax, such as meditation, tai chi, and yoga. Give it a try. It works for many people.
Brain stimulation therapy
Local electrical stimulation
Occupational therapy teaches you how to perform routine activities of daily living in a way that reduces your pain and/or avoids reinjuring yourself.
Osteopathic manipulation therapy (OMT)
Psychotherapy

The pain, mental duress and reduction in quality of life associated with chronic pain can be lessened with you learning how to approach and understand your pain, taking appropriate steps to reduce things you do to exacerbate the pain, increasing the things you do to lessen the pain, and working with your health care team to provide you with appropriate support and treatment.

Fibromyalgia – Facts and Controversies

September 26, 2018General Health and Wellness, Mental Health, Neurology844-SMA-TALK, Behind the Curtain, chronic fatigue syndrome, chronic pain, Conditions and Diseases, fibromyalgia, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Previously, Straight, No Chaser has discussed the frustration of uncertainty some patients have with having symptoms and not being given a diagnosis (much less a cure). Imagine if that uncertainty arose in the context of excruciating pain lasting for what seems like all day. There was a time when this was the case to a much greater extent, and then several medical conditions gained recognition and/or prominence. Some of these include chronic pain syndrome, chronic fatigue syndrome, temporomandibular joint syndrome (TMJ syndrome), endometriosis, inflammatory bowel disorder, vaginismus, vulvodynia and still other conditions. Today we will address one such condition, fibromyalgia.

The symptoms of fibromyalgia include muscle pain and fatigue. This pain may take one of several typical forms, including headaches, painful menstrual periods and – most interestingly – “tender points.” Tender points are specific places on the body that hurt when you apply pressure. These can occur most anywhere but usually involve the extremities, neck, back, hips and shoulders. Other symptoms include numbness and tingling in your hands and feet, difficulty sleeping and morning stiffness. In some cases a condition called “fibro fog” occurs, in which clouding of thinking and memory occurs. It shouldn’t be a surprise that these other symptoms often result in clinical depression.

Unfortunately, fibromyalgia is a condition, not a disease that we can attach to a specific cause. However, there are several diseases to which fibromyalgia has been linked. In short, many stressful life conditions and events can serve as triggers for this disorder. Some of the more notable conditions and triggers include ankylosing spondylitis (aka spinal arthritis), motor vehicle crashes, rheumatoid arthritis and systemic lupus erythematosus (aka lupus). So many such triggers exists that now over 5 million Americans have been labeled with the diagnosis. Interesting, 80-90% of those so diagnosed are women, most during middle age.

Given the absence of an identified cause, treatment is mostly symptomatic, attempting to address the pain and other things that disrupt one’s activities of daily living. More importantly, once affected, you need to implement the lifestyle changes that have been shown to help, including improving diet, exercise, getting enough sleep, changing one’s work and home environments, and taking medications as prescribed.

I would be remiss if I didn’t address the controversies surrounding fibromyalgia. Given the absence of a defined cause, many patients suffering from fibromyalgia and similar disorders are often perceived to be drug seeking, particularly in emergency departments. It is very frustrating for physicians to care for patients they can’t “fix.” Although drug seeking patients do exist, multiple medical studies have shown that inadequate treatment of pain remains one of the great faux pas of medicine. It is an equal disservice to give in to a patient’s request for pain medication as a routine matter without the benefit of a full evaluation. There are many defined medical conditions that present with pain. More deliberate and vigorous evaluations can not only put a more definitive name to the pain but can lead to better outcomes for those patients.

Straight, No Chaser: Getting Your Pain Treated at the Emergency Room

September 16, 2017General Health and Wellness844-SMA-TALK, American Chronic Pain Association, American College of Emergency Physicians, Behind the Curtain, chronic pain, narcotics, Sterling Medical Advice, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

You should be able to tell the staff the name of the condition from which you suffer.
You should know the name and the contact information of your primary physician and any pain management specialist you see.
You should know the names of your medications, including over the counter and herbal preparations.
You should know any medical allergies you have. (A word about this. There is a difference between a medical allergy and an adverse reaction to a medication. Just because a medicine upsets you stomach or isn’t as effective as another doesn’t mean you’re allergic to it. It’s insulting to your physician to insist that you have an allergy when you don’t. You can assume that taking this posture starts the relationship off poorly because the physician will often know better and in many cases can check or test you for true allergies. It’s ok to be honest about your concerns, including medications that seem to work better than others. Your physicians will work with you and will do so more willingly when you are completely honest.)

Here are other things to appreciate when you come to visit:

Your presence doesn’t change the reality that life-threatening conditions may be present at the same time in the emergency room. Be patient. You’re not being ignored.
Your physicians are going to treat your pain, but they’re even more interested in finding and treating any disease that exists. Be patient.
Your physicians are going to attempt to coordinate your care with your primary physicians and/or your pain management physicians.
You can’t just come to the emergency room and start demanding narcotics, even if it’s what is eventually going to happen. I shouldn’t have to explain that.

You can’t come to the emergency room and claim medical allergies to every medication except for a specific pain cocktail. Your physician understands that your body doesn’t work that way.
You shouldn’t expect an emergency physician to immediately be able to make a diagnosis of your condition that has eluded other physicians who have been evaluating you for months or years.
You shouldn’t expect an emergency physician to provide you with more than a few days of pain medication (or any without a discussion with one of your physicians).
You should expect to receive a thorough evaluation of your condition and to be treated with respect.
You should expect to receive treatment based on the evaluation performed in the emergency room.

Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2017 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Chronic Pain

September 13, 2017General Health and Wellness, Neurology, Health Prevention844-SMA-TALK, acupuncture, Behind the Curtain, brain stimulation therapy, chronic fatigue syndrome, chronic pain, Cognitive behavioral therapy, endometriosis, fibromyalgia, Inflammatory bowel disease, Interstitial cystitis, local electrical stimulation, occupational therapy, osteopathic manipulation therapy, pain awareness month, psychotherapy, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Temporomandibular joint dysfunction, There are 72 Hours in a Day, TMJ syndrome, VulvodyniaJeffrey Sterling, MD

Clearly there’s acute pain from injury. You break a jaw or twist an ankle, you’re going to hurt.
There’s acute exacerbations of pain from disease. You have sickle cell anemia? Cancer? Lupus? Sciatica or other low back pain? Arthritis? Migraines? You will have acute flare ups.

Chronic fatigue syndrome
Endometriosis
Fibromyalgia
Inflammatory bowel disease
Interstitial cystitis
Temporomandibular joint dysfunction (TMJ syndrome)
Vulvodynia

Maybe the point of this post isn’t to tell those of you who suffer from chronic pain things you don’t already know as much as it is to organize your thoughts and approach to your pain. After all, it’s not like there are cures for chronic pain besides eliminating the underlying condition (which reminds me to remind you not to fall for the many medical scams promising instant and permanent relief to these medical conditions). The first step really is to help you appreciate the need for becoming better sensitized to your condition. Many patients with chronic pain suffer horrible outcomes because they become desensitized to pain, learn to ignore it, and misinterpret a new, unrelated pain condition (maybe with a few similarities), failing to get evaluated before it is too late.
If you suffer from chronic pain, it’s key to know the things you can do to improve your quality of life. Strengthening your mind to reduce stress and avoid fixating on your medical condition is very important. Learning to relax actually is treatment; your body has pain-reducing chemicals, including those that directly treat pain and promote healing, and others that prevent release of internal pain producers. Find someone with whom you can discuss relaxation and stress reduction.

Engage the fight to get better within your physical limitations.

Exercise remains key. Depending on your situation, walking, running, biking and/or swimming can dramatically improve your situation. Be advised that the extremes (not exercising at all or doing so too much) can actually worsen the situation.
Stretching and strengthening similarly produce benefits to those with chronic pain. This should sound like a good reason to become involved with a personal trainer or have a physical therapist.
Regular sleep and avoidance of nicotine (stop smoking!) will also help.

Your physician may discuss multiple other possible treatment modalities, such as the following:

Acupuncture
Behavioral therapy can reduce your pain and decrease your stress through methods that help you relax, such as meditation, tai chi, and yoga. Give it a try. It works for many people.
Brain stimulation therapy
Local electrical stimulation
Occupational therapy teaches you how to perform routine activities of daily living in a way that reduces your pain and/or avoids reinjuring yourself.
Osteopathic manipulation therapy (OMT)
Psychotherapy

Regarding medication, for many people use of medication (especially narcotics) becomes a crutch and a slippery slope. Over the counter medications such as acetaminophen and ibuprofen are quite effective for many causes of pain. Use of narcotics should be measured and part of an overall plan, not a tool for a quick fix or to get you out of your doctor’s face. It is part of reality that even if you are not a drug-seeking patient, with enough exposure to narcotics you will develop tolerance (less effectiveness at the same dose) and become addicted. You should want to avoid this fate.
The pain, mental duress and reduction in quality of life associated with chronic pain can be lessened with you learning how to approach and understand your pain, taking appropriate steps to reduce things you do to exacerbate the pain, increasing the things you do to lessen the pain, and working with your health care team to provide you with appropriate support and treatment.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2017 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Getting Your Pain Treated at the Emergency Room

September 11, 2016General Health and Wellness844-SMA-TALK, American Chronic Pain Association, American College of Emergency Physicians, Behind the Curtain, chronic pain, narcotics, Sterling Medical Advice, Straight No ChaserJeffrey Sterling, MD

You should be able to tell the staff the name of the condition from which you suffer.
You should know the name and the contact information of your primary physician and any pain management specialist you see.
You should know the names of your medications, including over the counter and herbal preparations.
You should know any medical allergies you have. (A word about this. There is a difference between a medical allergy and an adverse reaction to a medication. Just because a medicine upsets you stomach or isn’t as effective as another doesn’t mean you’re allergic to it. It’s insulting to your physician to insist that you have an allergy when you don’t. You can assume that taking this posture starts the relationship off poorly because the physician will often know better and in many cases can check or test you for true allergies. It’s ok to be honest about your concerns, including medications that seem to work better than others. Your physicians will work with you and will do so more willingly when you are completely honest.)

Here are other things to appreciate when you come to visit:

Your presence doesn’t change the reality that life-threatening conditions may be present at the same time in the emergency room. Be patient. You’re not being ignored.
Your physicians are going to treat your pain, but they’re even more interested in finding and treating any disease that exists. Be patient.
Your physicians are going to attempt to coordinate your care with your primary physicians and/or your pain management physicians.
You can’t just come to the emergency room and start demanding narcotics, even if it’s what is eventually going to happen. I shouldn’t have to explain that.

You can’t come to the emergency room and claim medical allergies to every medication except for a specific pain cocktail. Your physician understands that your body doesn’t work that way.
You shouldn’t expect an emergency physician to immediately be able to make a diagnosis of your condition that has eluded other physicians who have been evaluating you for months or years.
You shouldn’t expect an emergency physician to provide you with more than a few days of pain medication (or any without a discussion with one of your physicians).
You should expect to receive a thorough evaluation of your condition and to be treated with respect.
You should expect to receive treatment based on the evaluation performed in the emergency room.

You have a role to play in the treatment of your pain in an emergency room. The more prepared you are and better able you are to discuss your current situation in the context of your long-term care, the more likely you are to have a successful interaction and treatment experience. Although you never know when pain will strike, taking the time to organize the information described above will work to your advantage.
Feel free to ask any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2016 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Chronic Pain

September 10, 2016General Health and Wellness, Neurology, Health Prevention844-SMA-TALK, acupuncture, Behind the Curtain, brain stimulation therapy, chronic fatigue syndrome, chronic pain, Cognitive behavioral therapy, endometriosis, fibromyalgia, Inflammatory bowel disease, Interstitial cystitis, local electrical stimulation, occupational therapy, osteopathic manipulation therapy, pain awareness month, psychotherapy, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Temporomandibular joint dysfunction, TMJ syndrome, VulvodyniaJeffrey Sterling, MD

I’d begin by asking you to get more in touch with your “you sensitivity” and learn to differentiate between different types of pain. It’s important for you to know the difference.

Clearly there’s acute pain from injury. You break a jaw or twist an ankle, you’re going to hurt.
There’s acute exacerbations of pain from disease. You have sickle cell anemia? Cancer? Lupus? Sciatica or other low back pain? Arthritis? Migraines? You will have acute flare ups.

Chronic fatigue syndrome
Endometriosis
Fibromyalgia
Inflammatory bowel disease
Interstitial cystitis
Temporomandibular joint dysfunction (TMJ syndrome)
Vulvodynia

Engage the fight to get better within your physical limitations.

Exercise remains key. Depending on your situation, walking, running, biking and/or swimming can dramatically improve your situation. Be advised that the extremes (not exercising at all or doing so too much) can actually worsen the situation.
Stretching and strengthening similarly produce benefits to those with chronic pain. This should sound like a good reason to become involved with a personal trainer or have a physical therapist.
Regular sleep and avoidance of nicotine (stop smoking!) will also help.

Your physician may discuss multiple other possible treatment modalities, such as the following:

Acupuncture
Behavioral therapy can reduce your pain and decrease your stress through methods that help you relax, such as meditation, tai chi, and yoga. Give it a try. It works for many people.
Brain stimulation therapy
Local electrical stimulation
Occupational therapy teaches you how to perform routine activities of daily living in a way that reduces your pain and/or avoids reinjuring yourself.
Osteopathic manipulation therapy (OMT)
Psychotherapy

Regarding medication, for many people use of medication (especially narcotics) becomes a crutch and a slippery slope. Over the counter medications such as acetaminophen and ibuprofen are quite effective for many causes of pain. Use of narcotics should be measured and part of an overall plan, not a tool for a quick fix or to get you out of your doctor’s face. It is part of reality that even if you are not a drug-seeking patient, with enough exposure to narcotics you will develop tolerance (less effectiveness at the same dose) and become addicted. You should want to avoid this fate.
The pain, mental duress and reduction in quality of life associated with chronic pain can be lessened with you learning how to approach and understand your pain, taking appropriate steps to reduce things you do to exacerbate the pain, increasing the things you do to lessen the pain, and working with your health care team to provide you with appropriate support and treatment.
Feel free to ask any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2016 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Getting Your Pain Treated at the Emergency Room

September 25, 2015General Health and Wellness844-SMA-TALK, American Chronic Pain Association, American College of Emergency Physicians, Behind the Curtain, chronic pain, narcotics, Sterling Medical Advice, Straight No ChaserJeffrey Sterling, MD

You should be able to tell the staff the name of the condition from which you suffer.
You should know the name and the contact information of your primary physician and any pain management specialist you see.
You should know the names of your medications, including over the counter and herbal preparations.
You should know any medical allergies you have. (A word about this. There is a difference between a medical allergy and an adverse reaction to a medication. Just because a medicine upsets you stomach or isn’t as effective as another doesn’t mean you’re allergic to it. It’s insulting to your physician to insist that you have an allergy when you don’t. You can assume that taking this posture starts the relationship off poorly because the physician will often know better and in many cases can check or test you for true allergies. It’s ok to be honest about your concerns, including medications that seem to work better than others. Your physicians will work with you and will do so more willingly when you are completely honest.)

Here are other things to appreciate when you come to visit:

Your presence doesn’t change the reality that life-threatening conditions may be present at the same time in the emergency room. Be patient. You’re not being ignored.
Your physicians are going to treat your pain, but they’re even more interested in finding and treating any disease that exists. Be patient.
Your physicians are going to attempt to coordinate your care with your primary physicians and/or your pain management physicians.
You can’t just come to the emergency room and start demanding narcotics, even if it’s what is eventually going to happen. I shouldn’t have to explain that.

You can’t come to the emergency room and claim medical allergies to every medication except for a specific pain cocktail. Your physician understands that your body doesn’t work that way.
You shouldn’t expect an emergency physician to immediately be able to make a diagnosis of your condition that has eluded other physicians who have been evaluating you for months or years.
You shouldn’t expect an emergency physician to provide you with more than a few days of pain medication (or any without a discussion with one of your physicians).
You should expect to receive a thorough evaluation of your condition and to be treated with respect.
You should expect to receive treatment based on the evaluation performed in the emergency room.

You have a role to play in the treatment of your pain in an emergency room. The more prepared you are and better able you are to discuss your current situation in the context of your long-term care, the more likely you are to have a successful interaction and treatment experience. Although you never know when pain will strike, taking the time to organize the information described above will work to your advantage.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright, Sterling Initiatives, LLC. 2013-2015

Straight, No Chaser: Pain Awareness Month and Your Chronic Pain

September 24, 2015General Health and Wellness844-SMA-TALK, acupuncture, Behind the Curtain, brain stimulation therapy, chronic fatigue syndrome, chronic pain, Cognitive behavioral therapy, endometriosis, fibromyalgia, Inflammatory bowel disease, Interstitial cystitis, local electrical stimulation, occupational therapy, osteopathic manipulation therapy, pain awareness month, psychotherapy, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Temporomandibular joint dysfunction, TMJ syndrome, VulvodyniaJeffrey Sterling, MD

I’d begin by asking you to get more in touch with your “you sensitivity” and learn to differentiate between different types of pain. It’s important for you to know the difference.

Clearly there’s acute pain from injury. You break a jaw or twist an ankle, you’re going to hurt.
There’s acute exacerbations of pain from disease. You have sickle cell anemia? Cancer? Lupus? Sciatica or other low back pain? Arthritis? Migraines? You will have acute flare ups.

Chronic fatigue syndrome
Endometriosis
Fibromyalgia
Inflammatory bowel disease
Interstitial cystitis
Temporomandibular joint dysfunction (TMJ syndrome)
Vulvodynia

Engage the fight to get better within your physical limitations.

Exercise remains key. Depending on your situation, walking, running, biking and/or swimming can dramatically improve your situation. Be advised that the extremes (not exercising at all or doing so too much) can actually worsen the situation.
Stretching and strengthening similarly produce benefits to those with chronic pain. This should sound like a good reason to become involved with a personal trainer or have a physical therapist.
Regular sleep and avoidance of nicotine (stop smoking!) will also help.

Your physician may discuss multiple other possible treatment modalities, such as the following:

Acupuncture
Behavioral therapy can reduce your pain and decrease your stress through methods that help you relax, such as meditation, tai chi, and yoga. Give it a try. It works for many people.
Brain stimulation therapy
Local electrical stimulation
Occupational therapy teaches you how to perform routine activities of daily living in a way that reduces your pain and/or avoids reinjuring yourself.
Osteopathic manipulation therapy (OMT)
Psychotherapy

Regarding medication, for many people use of medication (especially narcotics) becomes a crutch and a slippery slope. Over the counter medications such as acetaminophen and ibuprofen are quite effective for many causes of pain. Use of narcotics should be measured and part of an overall plan, not a tool for a quick fix or to get you out of your doctor’s face. It is part of reality that even if you are not a drug-seeking patient, with enough exposure to narcotics you will develop tolerance (less effectiveness at the same dose) and become addicted. You should want to avoid this fate.
The pain, mental duress and reduction in quality of life associated with chronic pain can be lessened with you learning how to approach and understand your pain, taking appropriate steps to reduce things you do to exacerbate the pain, increasing the things you do to lessen the pain, and working with your health care team to provide you with appropriate support and treatment.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright, Sterling Initiatives, LLC. 2013-2015

Straight, No Chaser: Would You Consider Acupuncture?

March 16, 2015General Health and Wellness844-SMA-TALK, acupuncture, acupuncturist, chronic pain, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

I will start by saying this about Western medicine. It’s presumption is not that complementary and alternative methods of treatment engaged around world, such as herbals, are ineffective. The premise is that any treatment measure needs thorough research, testing and analysis before approval and adoption. The scientific method simply asks for proof to be established prior to recommending a course of treatment. This approach is taken for your safety. If you appreciate that sentiment, you should understand how and why the practice of complementary and alternative medicine (CAM) is allowed but not necessarily recommended as a first line treatment. Physicians have no stakes in pharmaceutical companies’ profit aspirations; in fact, we’re quite aware of them.
Acupuncture is among the oldest treatment modalities in the world, having been practiced in several Asian countries for thousands of years (most notably China). It’s obvious effectiveness in the Far East has generated a call for it to be subjected to the scientific method to better define how to integrate its use into Western medicine.
Here are some frequently asked questions on acupuncture.

What is acupuncture?
Acupuncture is a series of procedures that stimulate various anatomical points of the body. To accomplish that, the skin is penetrated with thin metallic needles. Alternatively, electric stimulation may be used. Theoretically, this stimulation releases internal pain-reducing hormones and other chemicals we use to heal ourselves.

Why is it used?
The treatment of pain is a pretty big reason for the use of acupuncture, including the following conditions:

persistent acute lower back pain
headache and migraine
chronic pain, particularly neck and back pain
joint pain
dental pain
post-operative pain

Some acupuncturists use acupuncture to treat additional considerations not related to pain, including the following conditions:

post-operative nausea and vomiting
allergies, including hay fever and eczema
fatigue
depression and anxiety
digestive disorders, including irritable bowel syndrome (IBS)
infertility and menstrual disorders
insomnia

Is it safe?
In the hands of a qualified practitioner, acupuncture is associated with relatively few side effects. However, there are multiple potentially serious consequences if not performed properly, including infections and rupture of organs through puncture. To that end, the U.S. Food and Drug Administration (FDA) requires acupuncture needles to be sterile, nontoxic, and labeled for single use by qualified practitioners.
Is it being used in the U.S.?
According to the National Institutes of Health and a National Health Interview Survey conducted in 2007, over 3 million adults and 150,000 children had used acupuncture in the previous year. That’s one of every 100 people!
How does it work?
This is the answer being sought by current research efforts. Research is investigating methods of actions, appropriate medical indications and performance of different instruments used in the process.
What should I expect from a visit to a qualified acupuncturist?

You should expect to provide a picture of your overall health.
You should not expect much pain. These needles are hair-thin.
You should expect to feel energized or relaxed.
You should not expect a medical diagnosis. Acupuncturists are therapists, not physicians.

Most treatments require at least a few weeks of sessions. If you’re a sufferer from chronic pain and are at wit’s end, consider acupuncture. I prefer you did that than become a chronic and habitual user of narcotics.
Feel free to contact your Personal Healthcare Consulltant with any questions you have on this topic.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what 844-SMA-TALK and http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress. We are also on Facebook at SterlingMedicalAdvice.com and Twitter at @asksterlingmd.

Straight, No Chaser: Getting Your Pain Treated at the Emergency Room

September 30, 2014General Health and Wellness, Medical Treatment844-SMA-TALK, chronic pain, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

You should be able to tell the staff the name of the condition from which you suffer.
You should know the name and the contact information of your primary physician and any pain management specialist you see.
You should know the names of your medications, including over the counter and herbal preparations.
You should know any medical allergies you have. (A word about this. There is a difference between a medical allergy and an adverse reaction to a medication. Just because a medicine upsets you stomach or isn’t as effective as another doesn’t mean you’re allergic to it. It’s insulting to your physician to insist that you have an allergy when you don’t. You can assume that taking this posture starts the relationship off poorly because the physician will often know better and in many cases can check or test you for true allergies. It’s ok to be honest about your concerns, including medications that seem to work better than others. Your physicians will work with you and will do so more willingly when you are completely honest.)

Here are other things to appreciate when you come to visit:

Your presence doesn’t change the reality that life-threatening conditions may be present at the same time in the emergency room. Be patient. You’re not being ignored.
Your physicians are going to treat your pain, but they’re even more interested in finding and treating any disease that exists. Be patient.
Your physicians are going to attempt to coordinate your care with your primary physicians and/or your pain management physicians.
You can’t just come to the emergency room and start demanding narcotics, even if it’s what is eventually going to happen. I shouldn’t have to explain that.

You can’t come to the emergency room and claim medical allergies to every medication except for a specific pain cocktail. Your physician understands that your body doesn’t work that way.
You shouldn’t expect an emergency physician to immediately be able to make a diagnosis of your condition that has eluded other physicians who have been evaluating you for months or years.
You shouldn’t expect an emergency physician to provide you with more than a few days of pain medication (or any without a discussion with one of your physicians).
You should expect to receive a thorough evaluation of your condition and to be treated with respect.
You should expect to receive treatment based on the evaluation performed in the emergency room.

Straight, No Chaser: Pain Awareness Month and Your Chronic Pain

September 29, 2014General Health and Wellness844-SMA-TALK, chronic fatigue syndrome, chronic pain, chronic pain syndrome, Conditions and Diseases, endometriosis, fibromyalgia, health, Inflammatory bowel disease, Interstitial cystitis, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Temporomandibular joint dysfunction, TMJ syndrome, VulvodyniaJeffrey Sterling, MD

Clearly there’s acute pain from injury. You break a jaw or twist an ankle, you’re going to hurt.
There’s acute exacerbations of pain from disease. You have sickle cell anemia? Cancer? Lupus? Sciatica or other low back pain? Arthritis? Migraines? You will have acute flare ups.

Chronic fatigue syndrome
Endometriosis
Fibromyalgia
Inflammatory bowel disease
Interstitial cystitis
Temporomandibular joint dysfunction (TMJ syndrome)
Vulvodynia

Exercise remains key. Depending on your situation, walking, running, biking and/or swimming can dramatically improve your situation. Be advised that the extremes (not exercising at all or doing so too much) can actually worsen the situation.
Stretching and strengthening similarly produce benefits to those with chronic pain. This should sound like a good reason to become involved with a personal trainer or have a physical therapist.
Regular sleep and avoidance of nicotine (stop smoking!) will also help.

Your physician may discuss multiple other possible treatment modalities, such as the following:

Acupuncture
Behavioral therapy can reduce your pain and decrease your stress through methods that help you relax, such as meditation, tai chi, and yoga. Give it a try. It works for many people.
Brain stimulation therapy
Local electrical stimulation
Occupational therapy teaches you how to perform routine activities of daily living in a way that reduces your pain and/or avoids reinjuring yourself.
Osteopathic manipulation therapy (OMT)
Psychotherapy

Straight, No Chaser: Chronic Pain

July 2, 2014General Health and Wellness, Neurology, Musculoskeletal System844-SMA-TALK, chronic fatigue syndrome, chronic pain, chronic pain syndrome, Conditions and Diseases, endometriosis, fibromyalgia, health, Inflammatory bowel disease, Interstitial cystitis, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Temporomandibular joint dysfunction, TMJ syndrome, VulvodyniaJeffrey Sterling, MD

If I could talk to you about pain (oh wait, I can), I’d begin by asking you to get more in touch with your “you sensitivity” and learn to differentiate between different types of pain. It’s important for you to know the difference.

Clearly there’s acute pain from injury. You break a jaw or twist an ankle, you’re going to hurt.
There’s acute exacerbations of pain from disease. You have sickle cell anemia? Cancer? Lupus? Sciatica or other low back pain? Arthritis? Migraines? You will have acute flare ups.

Chronic fatigue syndrome
Endometriosis
Fibromyalgia
Inflammatory bowel disease
Interstitial cystitis
Temporomandibular joint dysfunction (TMJ syndrome)
Vulvodynia

Engage the fight to get better within your physical limitations.

Exercise remains key. Depending on your situation, walking, running, biking and/or swimming can dramatically improve your situation. Be advised that the extremes (not exercising at all or doing so too much) can actually worsen the situation.
Stretching and strengthening similarly produce benefits to those with chronic pain. This should sound like a good reason to become involved with a personal training or have a physical therapist.
Regular sleep and avoidance of nicotine (stop smoking!) will also help.

Your physician may discuss multiple other possible treatment modalities, such as the following:

Acupuncture
Behavioral therapy can reduce your pain and decrease your stress through methods that help you relax, such as meditation, tai chi, and yoga. Give it a try. It works for many people.
Brain stimulation therapy
Local electrical stimulation
Occupational therapy teaches you how to perform routine activities of daily living in a way that reduces your pain and/or avoids reinjuring yourself.
Osteopathic manipulation therapy (OMT)
Psychotherapy

Straight, No Chaser: Would You Consider Acupuncture?

March 1, 2014General Health and Wellness, Neurology844-SMA-TALK, acupuncture, acupuncturist, chronic pain, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

I will start by saying this about Western medicine. The presumption is not that complementary and alternative methods of treatment engaged around world, such as herbals, are ineffective. The premise is that any treatment measure needs thorough research, testing and analysis before approval and adoption. The scientific method simply asks for proof to be established prior to recommending a course of treatment. This approach is taken for your safety. If you appreciate that sentiment, you should understand how and why the practice of complementary and alternative medicine (CAM) is allowed but not necessarily recommended as a first line treatment. Physicians have no stakes in pharmaceutical companies’ profit aspirations; in fact, we’re quite aware of them.
Acupuncture is among the oldest treatment modalities in the world, having been practiced in several Asian countries for thousands of years (most notably China). It’s obvious effectiveness in the Far East has generated a call for it to be subjected to the scientific method to better define how to integrate its use into Western medicine.
Here are some frequently asked questions on acupuncture.

Why is it used?
The treatment of pain is a pretty big reason for the use of acupuncture, including the following conditions:

persistent acute lower back pain
headache and migraine
chronic pain, particularly neck and back pain
joint pain
dental pain
post-operative pain

Some acupuncturists use acupuncture to treat additional considerations not related to pain, including the following conditions:

post-operative nausea and vomiting
allergies, including hay fever and eczema
fatigue
depression and anxiety
digestive disorders, including irritable bowel syndrome (IBS)
infertility and menstrual disorders
insomnia

You should expect to provide a picture of your overall health.
You should not expect much pain. These needles are hair-thin.
You should expect to feel energized or relaxed.
You should not expect a medical diagnosis. Acupuncturists are therapists, not physicians.

Most treatments require at least a few weeks of sessions. If you’re a sufferer from chronic pain and are at wit’s end, consider acupuncture. I prefer you did that than become a chronic and habitual user of narcotics.
Feel free to contact your Personal Healthcare Consulltant with any questions you have on this topic.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress, Facebook @ SterlingMedicalAdvice.com and Twitter at @asksterlingmd.
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