Central Sensitization, Favorites, Inspiration, Interesting Articles, My Story, Nervous System, Pain Science, Treatment Approaches

What I really want you to know

I never know quite what to call the posts in which I share a video.

Every title I think of sounds either click-baity or boring.  Like for this one: “Mayo Clinic doctor explains central sensitization.”  “Awesome video on central sensitization,” etc. etc.

In this day and age… what do you call something that truly is a “must-watch?”  The term is so overused.

But I really, really want everyone to watch this.

***

Have you ever held something in for so long that, when someone finally validates the way you feel, you end up crying?

That was kind of how it was for me, with this.  This video was so great it actually made me cry.

I know a lot about central sensitization, but, honestly, most of that is from my own research.  (You can check out the articles and researchers I cite in my Resources section, particularly under “Scientific Articles”).

Of course, I’m grateful to have access to these articles, and of course, to the scientists who wrote them.  (Not to mention the education that allows me to understand them– big shout out to my neuroscience professor!).

But when it comes to understanding central sensitization as a scientific concept, there have been many times when I’ve felt pretty alone.

Maybe I shouldn’t feel this way, because, largely, I’ve found the answers I need– my life is so much better since I discovered pain neurophysiology education and the work of Neil Pearson (thank you again, Neil!).

But what I’m talking about is the emotional aftermath of what I went through in all the years before; all the time I spent feeling misunderstood.  All the conflicts and arguments with friends and family over the “weird” symptoms no one could understand… I have sometimes felt very, very alone in trying to articulate exactly what’s happened to me.

***

That’s a big part of why this video blew me out of the water.

Here, Dr. Christopher Sletten, who runs the Pain Rehabilitation Center at the Mayo Clinic in Florida, describes, in patient-friendly language, exactly how central sensitization can happen, and the myriad ways it can affect a person.

***

On my blog, I talk mainly about pain.  That’s been my main symptom, and in some ways it’s the clearest and easiest to write about.

But central sensitization can cause all sorts of bodily sensations to become amplified.

As Dr. Sletten explains, it can make lights seem brighter, and sounds seem louder.  It can make you dizzy.  It can cause digestive upset.

It can really affect all of the sensory input that is meant to help you protect your body and guide you through the world.

And this, of course, will make you look crazy to those who don’t understand.  It can even make you look crazy to yourself.

***

So I love, love, LOVED the part around the 7:20 mark where Dr. Sletten asks, “So how much of this is psychological?  NONE.”  Bam.

“The emotions are a symptom, not a cause.”  YES.

How I wish the people in my life had believed this, all the times I tried to explain it to them ten years ago.

I knew I wasn’t crazy; knew it wasn’t all “in my head.”  But I could never find the right words to convey my reality; to convince people who’d already made up their minds.

It doesn’t mean they didn’t care.  But there’s a difference between knowing you’re cared about, and feeling truly believed and understood.  There’s quite a big difference, actually, and it can hurt to never get that second part from the people you love.  To know they’re tolerating your “craziness,” instead of seeing you for who you really are.

***

I wasn’t really planning on writing such a personal post today.  I seriously LOVE the science behind this stuff, so I was planning to take some notes on important concepts and get more into the nitty-gritty.

But I guess this is the part of my story that I needed to tell today.  More of the nitty gritty will have to come later on.

***

The one sciencey thought I wanted to leave you with right now is that this video provides some great insight into how central sensitization can lead to what are called central sensitivity syndromes.

After all, it’s not just pain.  It’s never just any one thing.  It’s the fact that the sensory information that’s supposed to give your brain cues as to how to respond to your environment is coming in way too “loud.”

This can create all sorts of different symptoms and sensations in different people.  It can lead to chronic pain; some people call it fibromyalgia.  It can cause phantom limb pain; it can cause Complex Regional Pain Syndrome (CRPS).

It can cause lead to diagnoses whose names imply more of a specific focus: chronic pelvic pain.  Temporo-mandibular joint disorder.  Irritable bowel syndrome; other digestive issues.

But they all fall under this umbrella term: central sensitivity syndromes.   Despite having seemingly very different symptoms on the surface, all of these conditions can share a common cause, at the level of the nervous system.

***

So that’s all for now.  I hope you get as much out of this video as I did.  (And if you do, I hope you spread it around– I seriously want everyone in the world to watch it!).

As always, if you have any thoughts or questions for me, you can leave a comment below or email me!

 

 

Central Sensitization, Interesting Articles, My Story, Pain Neurophysiology Education, Pain Science, Treatment Approaches

Shedding light on central sensitization

Hi everyone!  Hope you’re all having a great summer.

I just wanted to let you know that I recently added a new section to my blog, to focus on central sensitization.

When I began this blog in late 2012, I started out writing about the topics of chronic pain and fibromyalgia, terms which most of my readers are more familiar with.

However, over time, it became more and more important to me to focus on some of the scientific research that’s been shedding light on the nervous system phenomena behind chronic, persistent pain.

Central sensitization has had a huge impact on my own life, one that’s stretched far beyond the initial injuries that caused me to develop it in the first place.  (Basically, central sensitization occurs as a response to some sort of trauma to the body, leaving the person with a heightened sensitivity to pain long after any physical injuries have healed).

I’ve recently begun to tell the story of “How I developed central sensitization.”  It’s a series posts about how, after years of abusing my body as a high school athlete with an eating disorder, I finally stretched my nervous system to the breaking point.

I’ve also written a series on my experience with pain neurophysiology education, an approach to physical therapy that taught me to better manage my condition.

These stories are incredibly personal to me, yet I really believe that central sensitization is an under-recognized problem, and I’m determined to raise awareness.  It took me years of suffering before I even knew the name of my condition (or was able to get help treating it), and it shouldn’t have to be that way.

So on my blog, I’ll be telling stories from my own personal experience, well as highlighting some of the articles, research and researchers that I find inspiring and noteworthy.

I’ll still be writing about chronic pain and fibromyalgia, recognizing that there are many factors that contribute to each patient’s experience with these conditions.

Ultimately, I believe that the more we know as patients, the better we can advocate for ourselves.  That is why I believe so strongly in raising awareness of this issue, both in terms of the scientific discoveries being made, as well as sharing the impact it’s had on my own life.

Here are some of the posts I’ve written on central sensitization so far:

What is central sensitization?

The nervous system and chronic pain

How I developed central sensitization: Part 1

How I developed central sensitization: Part 2

How Clifford Woolf discovered central sensitization (and why you shouldn’t blame yourself for chronic pain)

Central Sensitivity Syndromes

Todd Hargrove: Seven Things You Should Know About about Pain Science

Let’s give this a whirl: explaining a scientific article in plain English

All of these, of course, are listed on my new “Central Sensitization” page.

Other great links:

Central sensitization in chronic pain (from Paul Ingraham at PainScience.com)

Dr. Sean Mackey: An Update on Fibromyalgia (really interesting talk from a Stanford researcher on the role of central sensitization in fibromyalgia).

and a lot more within my “Resources” section (if you haven’t swung by in a while, I’ve been adding a lot to it).

***

I hope the things I write and link to are helpful to you.  As always, you’re welcome to contact me with any comments or questions.   (You can comment below or send me an email!).  Happy reading!

Central Sensitization, Interesting Articles

Can music block pain signals? Music-induced analgesia

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I, personally, have known for a long time that music could help reduce my pain levels.  It’s just something that I always knew intuitively. Listen to music (good music, of course) –> feel better.

That’s why I was so intrigued when I found the following post from my friend Jo Malby on some of the science behind how music can lessen our experience of pain.  (I’m sharing it here with her permission, of course!).

Jo writes:

“The joy we derive from listening to music we love, much like anything that brings us joy, is always beneficial in helping us cope with chronic illness and pain. According to ongoing studies, researchers have found that there are many reasons for pain patients to listen to music they love.

Outside of the times when pain is too fierce or your body too sensitized and flared-up for sound or vibration, music can be a useful coping tool, though not only for the joy and escape music brings you.

With real physiological changes in the brain, listening to your favourite music can have a significant, positive impact on perception of chronic pain, as well as the pain itself, with some studies even finding music resulted in less intense pain levels.

Music also reduces anxiety and depression, both often natural consequences of unpredictable debilitating chronic illness and pain, and both difficult to manage and treat. Though it’s often under used as an natural anti-depressant.

Research has drawn its theories on how nerve impulses in the central nervous system are affected by music. Anything that distracts us from pain may reduce the extent to which we focus on it; music helps us shift our attention from the pain but it’s also emotionally engaging, especially if the piece has memories or associations.

With even the rarest of tunes now online — from YouTube to Spotify to Soundcloud to more exclusive sites — search for some of your favourite sounds or create playlists with songs that specifically help you through particularly difficult times or when pain is especially severe, and you need to calm it and your state of mind.

Personally, nothing gives my mood a lift like a little Billy Holiday, Dusty Springfield or Aretha; if feeling frustrated, Chavela Vegas (anger’s better in Spanish). More recently, Mozart’s been on repeat. I love music. (Almost) every genre. Find what you love. Play it. See if it helps you cope, lifts your mood, or offers a momentary sonic escape from the complexities that come with pain and chronic illness.

Scientists now know that listening to music involves a huge portion of the brain — auditory areas, of course, but also motor (movement) areas, the limbic system (involved in emotions), and areas of the brain believed to be responsible for increased creative thought.

Anything that lights up areas in the brain other than pain may also be helpful to reduce that pain.  ((Sidenote from Christy: this reminds me of some of the really cool resources I’ve linked to from Neil Pearson!)).

These effects may not be powerful enough in isolation but added to your pain management toolkit, using music when you are feeling frustrated or sad, depressed or angry, lost or alone, all can help you cope, feel better emotionally, and even lessen a tiny bit of pain.

A study conducted by Peter Vuust, of the Center for Functionally Integrative Neuroscience (CFIN) at Aarhus University, Denmark, found that fibromyalgia patients experienced less chronic pain after listening to their favourite music.

Additionally, recent studies on music therapy and chronic pain conditions found that music reduces anxiety, depression and pain— just from listening to music.

The effect is often referred to as ‘music-induced analgesia‘, and though that analgesia may be more subtle than profound, anything that helps you must be embraced.”

Some additional links:

Science Nordic: Music can relieve chronic pain

The Conversation: How music can relieve chronic pain

BBC News: How music can reduce chronic pain

Prevention.com: More music, less pain?

Study: Emotional valence contributes to music-induced analgesia

Body in Mind: Music modulation of pain perception

And for more from Jo:

Jo Malby is an amazing writer living with and sharing her experience of complex regional pain syndrome (CRPS) on her site The Princess in the Tower.

She also runs the site Inspire Portal, where she shares resources to provide creative inspiration to writers (and other artists!).

Definitely check out more of what she has to say!

Favorites, Inspiration, Interesting Articles, mindfulness

Amy Cuddy on Personal Power, Posture, & Body Language

Here is an amazing talk, given by social psychologist Amy Cuddy, on how the way we feel about ourselves can affect our physical experience of our bodies.   I first stumbled upon it a few years ago, and every time I watch it, I find it’s still relevant to my own life.

Dr. Cuddy’s main argument is that our sense of self directly influences both our body language and our internal biochemistry.   When we feel powerful, we tend to carry our bodies in a way that signals to others that we are in-control and confident.  We stand up tall; we make eye contact.

Conversely, when we don’t feel powerful– when instead, we are experiencing self-doubt– we try to shrink.  We hunch forward, cross our arms, and look down at the floor.

Dr. Cuddy explains that these non-verbal cues send powerful messages to others about how we are feeling, and can directly influence the judgements they make about us.

While that probably won’t come as much of a surprise to most of my readers, what’s really surprising is that, as Dr. Cuddy explains, our own body language can also have a direct affect on how we see ourselves.

Basically, when we hunch over, trying to make ourselves small, our brains recognizes that we are feeling powerless, and our internal chemical state then matches that feeling.  (To get into the nitty-gritty, this means that our brains release more of the stress hormone cortisol).

Conversely, when we take on what Dr. Cuddy refers to as a “power pose,” our brains (male and female) release more testosterone– the “power” hormone.

So, Dr. Cuddy explains, we can actually directly affect our brain chemistry with our own body language.   If we are feeling scared and powerless, we can give ourselves a confidence boost by taking on a power pose.  By assuming the body language of someone who is confident and strong, we send the signal to our brain that it should create an internal chemical state to match that body language.

Of course, it isn’t a magic bullet– nothing ever is– but I’ve tried this out myself, many times, and I do find that “power posing” can have an effect.

***

While Dr. Cuddy’s talk is aimed at a general audience, I find an additional layer of relevance within it to my own experience with chronic pain.

Many of the same physical cues we exhibit when we are feeling fearful are also a response to pain and illness.  When I am in pain, or feeling nauseous due to my digestive issues, what do I do?  I hunch over; I round my shoulders forward.  Every classic marker of bad posture becomes exaggerated when I don’t feel well.

Although for me the cycle of “powerless” body language starts as a response to not feeling well. I have to wonder if it becomes part of a self-perpetuating cycle.  I don’t feel well, so I hunch over, which in turn sends the signal to my brain that I’m not feeling great about myself or my abilities.  In general, I tend to feel pretty good about myself, and confident in my ability to accomplish things, but when I am in a lot of pain, that all (temporarily) goes out the window.

***

Since first discovering Dr. Cuddy’s talk, I pay way more attention to my posture.  Am I standing up straight, or am I hunching over?  And, if my posture isn’t great– am I in pain?  Or is something in this situation making me uncomfortable?

It’s kind of like the chicken and the egg– there are a lot of factors that can influence our experience of pain, and our posture; how we carry our bodies, what our alignment is like.

But paying attention to our own feelings of power vs. powerlessness can be one piece of the puzzle.   Even if our hunched-over, low-power poses are caused by physical factors such as muscle weakness/spending too much time slumped over our desks/being out of shape/being in pain, there’s no reason why paying attention to our own sense of power can’t contribute to our healing.

Now, when I’m in the locker room at the gym, I stop and check out my posture in the mirror before heading out to exercise.  Am I standing up tall, or and am I slumped?

And I just take a minute to check in with myself, and my goals.  Why am I here right now?  What are my goals; what is motivating me?

I find that just remembering to pause and re-center myself can make a big difference.  I might have a lot of issues going on with my back that I haven’t quite sorted out yet, but not having a sense of confidence doesn’t have to be one of them.

***

P.S. For my other absolute favorite TED talk– Kelly McGonigal on Stress and Chasing Meaning, click here!

Favorites, Interesting Articles, Neil Pearson, Pain Science

Neil Pearson: Blending Optimism and Scientific Evidence

One of the things I really admire about Neil Pearson’s approach to chronic pain treatment is his optimism about our ability to re-train our nervous systems, once they’ve become sensitized to pain.

Chronic pain is obviously not a cheerful topic. Those of us who’ve struggled with it know what it’s like to come home from the doctor’s office feeling totally hopeless (or worse, insulted).

Then, on the other end of the spectrum, are the people who promise things that are too good to be true. In the six years I struggled with chronic pain before discovering Neil Pearson’s work, I tried just about everything under the sun. Over time, I came to find that the more optimistic someone was about their ability to “cure” my pain for good, the less their treatments actually helped in the end.

Neil’s approach is totally different, because while he has a very optimistic view on our ability to change our pain, his work is very much grounded in science, thanks to his training as a physiotherapist.

(By the way: if you’re new to my blog and don’t know who Neil Pearson is, or why I’m writing about him, you should probably start here!).

Recently, I’ve been looking through some of Neil’s older, open-access materials, which are now available under the “Resources” section of my blog (thank you, Neil!). Although I’ve been familiar with Neil’s work for a while now, I hadn’t yet seen these. I found them really interesting, because they provide a window into the thought process behind his unique perspective.

In particular, his article on the “Optimistic Scientific Recovery Model,” laid out a few key points that I felt like I’d sometimes struggled to articulate to people, so I thought I’d share them with you now.

Basically, Neil’s work is about helping people find a way to get past the limits of what they, or their doctors, had thought their recovery from pain might be.

His work is not meant to take the place of other medical interventions. Instead, it’s geared toward patients who have fully pursued all of their treatment options, and are still in pain. In other words, it’s for the patients whose doctors say there’s nothing else that can be done.

Neil’s point is that something else can be done. And in my own personal experience, that something else can be life-changing.

It’s all based on the concept of neuroplasticity– the idea that, with enough practice, we can begin to change the way our nervous systems function.

***

There are many different aspects to how we can begin to try to change our nervous systems.  I’ve written about pain neurophysiology education before– the idea that when we learn more about how pain works, as well as what’s happening in our bodies overall, it can begin to diminish some of the emotional effect that that fear has on us.

However, as I read through Neil’s articles, I’m reminded that there are many other different angles to exploring chronic pain/neuroplasticity. For example, in the “Optimistic Scientific Recovery Model,” he also writes about the importance of mindfulness and body awareness; learning to relax our bodies instead of remaining tense, which only increases pain. It’s not just about exercises to increase strength; it’s about learning to move mindfully, in beneficial ways (something I know I personally could work on!).

He also talks about the idea that we can distract the nervous system from focusing pain by giving it other information to process. Things like breathing exercises, meditation, and visualizations can all help accomplishing this, as can rhythmic movements such as gum chewing. (I first wrote about this a few weeks ago, and it still blows my mind!  For more about the gum-chewing study, click here).

***

I really think that Neil’s approach has the potential to help a lot of people– which is, of course, why I’m always talking about it on this blog.

Since I started working on this blog a few years ago, I have met so many great, interesting people who have been suffering from pain for a long time, and are taking matters into their own hands by doing their own research.  Open-access articles like these can be a great jumping-off point.  Some of them are geared more towards other medical professionals than to patients, but hey: information is power.  I think there are a lot of great ideas contained within these articles, which is why I’m so happy to share them with you.

For more articles like this, check out:

Key messages of understanding pain

Pain management strategies

Understanding pain basics

and many others to be found under the Resource section of my blog!

And, of course, Neil’s website is www.lifeisnow.ca. He has updated it recently with a lot of really great new resources for both chronic pain patients and medical professionals– you should absolutely check it out!

Happy researching!

Favorites, Inspiration, Interesting Articles, Neil Pearson, Pain Science

Neil Pearson on Building Hope and Recovery

I know I may have mentioned this once or twice before on my blog (or in like every post), but in case you missed it: Neil Pearson‘s work changed my life.

It all started when I met a physical therapist who had studied with Neil. This physical therapist opened my eyes to a relatively new approach to chronic pain treatment, called pain neurophysiology education. Ultimately, I was so inspired by what I learned that I began to consider physical therapy as a career.

I have written a lot on these experiences, and I always urge people to watch the three online lectures, given by Neil himself, that my physical therapist insisted I watch when I first began treatment with him.

For me, these lectures have always been a springboard– I come away wanting to know more.

Well, I was poking around on the Internet last night, and stumbled across this amazing webinar, Building Hope: The way through pain to self-management and recovery.  In this Neil Pearson discusses some new ideas and approaches to treatment that I hadn’t heard before.

The webinar itself is hosted by the Canadian Institute for the Relief of Pain and Disability, a really cool organization that’s worth checking out in its own right. They have a lot of great resources, and I love their compassionate, actively pro-patient stance. (Obviously, every organization tries to be “pro-patient,” but CIRPD really seems to get it right).

Here are some of the key points I’m taking away from this webinar:

1) Neuroplasticity means the nervous system can be changed, and if it can be changed one way (as in the case of chronic pain/central sensitization), it’s also possible to change it back.

2) Even just visualizing movement can help the nervous system inhibit its own pain signals. Research has established that exercise is a great way to stimulate your body’s own internal pain controls, but when the movement itself creates more pain, it can be counterproductive.

That is the beauty of just visualizing movement. As far as your brain is concerned, visualizing a movement is very, very similar to actually performing it.

As Neil explains at the 17:10 mark, visualization can actually help to stimulate the nervous system to inhibit pain. Over time, after you let your nervous system “practice” moving through visualization, you may find you have less pain when you actually go to move.

I think this is seriously SO cool. I can’t even find the words. It’s things like this that really inspire me to become a PT, and help people living with pain. (My takeaway: I want more information on this right now!!!).

3) You can help the nervous system block out pain signals by distracting it and giving it other information to process. You can use touch, or movement– even if it’s very very small movement.

4) Repetitive, rhythmic movements in particular can help to calm the nervous system by giving it something else to focus on other than pain. Rhythmic movements such as walking, breathing or even rhythmic gum chewing (what?!) have been shown to release more serotonin and help control pain.

***

I just honestly can’t even tell you how inspiring I find all this stuff.

I am fortunate that, right now, I am mostly able to move without significant pain. (Due to my SI joint concerns, I do have to be cautious).

But it’s nothing like the place I used to be in. I can remember a time in my own life when even thinking about moving was terrifying. I just felt truly stuck– like my body was a jail.

I can also think of people I’ve met– through blogging, reading stories, as well as the patients I’ve met while shadowing physical therapists– who are in equally as much pain, and seem to be trapped within their bodies.

These are people who, through no fault of their own, are in too much pain to move. It’s not that they’re lazy; it’s not that they’re depressed. It’s not that they don’t want to get better.

It’s just the way the deck was stacked; the way the cookie crumbled.

They are in too much pain; their injuries are too great; their nervous systems too sensitized. Perhaps they are obese; perhaps there are multiple health conditions going on.

Whatever the reason– it is so amazing to know that there is a way to begin to help them, without requiring them to move before they are ready.

I want to help those people. I want to be that physical therapist that comes in and helps the hard cases, the ones other medical professionals may have secretly labeled impossible. I want to sit with those people, and look them in the eye, and tell them that there is a way out of this.

***

I hope that you enjoy the video, and that you will also check out more from CIRPD and Neil Pearson. The webinar was also co-sponsored by the Canadian Pain Coalition and Pain BC— two additional groups with a lot to offer (why does Canada have all the cool organizations?). I could say more about how cool they are… but that will have to wait for another post.

I hope you are as inspired as I am! As always, don’t hesitate to let me know what you think!

Interesting Articles, Uncategorized

Violins and enhanced sensory maps

Sunlight in Winter

violin player

I recently learned about a fascinating study that I had to share with you all.  Researchers took two groups of people– professional violinists and regular, everyday people off the street– and pricked everyone’s index finger with a pin.  The violinists reported feeling much more pain than the non-violinists, even though everyone’s finger was pricked in the exact same way.

I thought this was so interesting.  This article on Optimum Sports Performance sums it up quite well (scroll down to the “Influence Psychology” section.  The author writes, “The enhanced sensory map and awareness of their hands that a professional violinist has makes them hypervigilant to anything that may be remotely threatening.”

I love this phrase “enhanced sensory map.”  They say practice makes perfect– well, all those hours and hours of practicing has given that violinist a very well-developed communication pathway between hand, spinal cord, and brain.  He or she is…

View original post 435 more words

Interesting Articles

Introducing the Sunlight in Winter Youtube Channel

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Ever have one of those days where you want to keep working/thinking/being productive, but your body just wants you to lie down with a heating pad?

That, unfortunately, has been happening to me quite a bit recently.   I’ve been wanting to sit at my computer and either study or work on my blog, but my neck and shoulders have just not been on board.

Trying to look on the bright side, I remembered that there were a ton of pain science-related videos on Youtube that I’ve been meaning to check out.  So I decided to use my “lying-down” time to catch up.  I started saving my favorites to playlists, so that I could just lie down and listen, and not have to worry about getting up and selecting the next video.

And then it occurred to me—maybe other people would enjoy these playlists too.   It’s a lot more relaxing to just start a playlist and let it run, instead of having to get up and go to the computer every time you want to start a new video.   It also makes taking a break a lot less frustrating, since you can keep your mind going with something productive.

So, check out my channel!  So far I’ve broken things down into a few separate playlists, some based on topic and some by speaker.  I’ll be adding to it as time goes by.  Let me know if you have any comments or recommendations for videos I should add.

To go directly to some of my favorite videos:

Lorimer Moseley: Why things hurt

Elliot Krane: The mystery of chronic pain

The evidence for physical therapy for chronic pain

Hope you enjoy!

Photo credit: Dan Barbus

Healthcare, Interesting Articles

New York Times: The Heart Perils of Pain Relievers

An interesting look at the risks that come from taking anti-inflammatory medications.

http://well.blogs.nytimes.com/2013/06/17/the-heart-perils-of-pain-relievers/?_r=0

The article quotes one doctor as saying, “If these drugs are making your life a lot better, that may be worth the risks.  But a lot of people will tell you, ‘I can’t tell if they’re doing anything, I just take them every day anyway.'”

I think a lot of people with chronic pain are told by their doctors to take these medications.  They are considered by most doctors to be a lot safer than some of the alternatives, which carry a risk of dependency and have a potential for abuse.

But NSAIDS have never really done much for me.  They help if I’ve  strained a muscle in a very acute manner, or when I’ve had a specific injury such as an ankle sprain.  But for ongoing, chronic pain where the original injury happened a long time ago, NSAIDS don’t seem to do much.

Don’t take NSAIDS just because your doctor recommended them.  Make sure they are actually producing a reduction in pain before subjecting yourself to the risks.