Thursday, January 15, 2015


Today is the best day of your life. Although you may still feel the heavy baggage of yesterday, it is nothing more than a memory. Yesterday does not exist anymore. Although you may worry about tomorrow, it is just a concept that your mind has made up. Tomorrow is not real right now. The only real day is today. When you face the wall of depression and think that you cannot go on any more, remind yourself of this reality: Today is the only real day and in this day, there are millions of people that would trade their spot on this planet with you in a split second if they could. So this is the best day of your life, the only real day, TODAY.

Wednesday, January 14, 2015


Pain medications are important tools in controlling pain. Their effects are different from one to another as they belong to different classes. However, they have different side effects as well. Each individual medication my have a side effect and once we take different ones together, their side effects may add up. Added to the pain medications, many of us are on multiple other medications for other conditions like blood pressure, anxiety, depression, asthma, etc. Each of those medications also have effects and side effects. Many of us see different physicians for different conditions and many times these doctors are not aware of each other's prescriptions. Each of these prescriptions have specific instructions from physicians about the doses and duration of prescription.
The only place that has a pool of information about who we saw, what was prescribed to us, how much and for how long, is the pharmacy. Many times it is the pharmacy that can prevent life threatening drug interactions between different medications. There are some legal regulations about many medications, especially narcotics that would not allow early releases, double doctoring or multiple pharmacies for narcotic medications. Principally these regulations are not made to give us hard time. They are supposed to protect us and our pharmacists have to follow these regulations. In today's age of technology many things are done automatically. For example if we show up for the refill of a narcotic medication earlier than the doctor's instruction or if we have prescription from different doctors for narcotic medications the system would red flag our file. 
This is why sometimes we feel our pharmacists are giving us hard time. I am not saying there re not some bad apples out there. Bad apples are everywhere, patients, doctors or pharmacists can be among them. But we need to know the facts before we pass the judgment on anyone.

Tuesday, January 13, 2015

I am not lazy, I have Chronic Fatigue

It is very common that chronic pain patients complain of fatigue. Many pain patients are not able to carry on with their activities of daily life that many others conduct as a simple routine. These patients are often miss judged as lazy or inactive. They have to listen to lectures from all who may mean well about how they should be more active. It is very frustrating to be misunderstood. If you have chronic pain you would not be able to move well, you can't have a restful sleep and you are more likely than not, depressed. These are not different unrelated conditions. Each one feeds into another and the total sum will lead into less and less energy.
Many of chronic fatigue conditions can start independent of pain by sources like a viral infection by EBV or a parasitic infestation of Lyme disease, etc. However once the fatigue settles in, most of the times chronic pain follows to appear due to mobility problems and body deconditioning. We lose muscles and develop poor posture when we are fatigued and inactive. Sleep, mood, hormonal and immune system disturbances can follow. One thing leads to another and make the clinical picture more and more complicated.
The other aspect of this story is that many doctors do not know much about chronic fatigue, chronic pain and the inter play among them. We call them co-morbid conditions to give them a fancy name and ease the anxiety of unknown a bit, but most of us feel intimidated by the fact that we can't solve the problem we are facing.
There are many conditions that we can cure, and some others that we can't cure but attempt to manage. No matter what the condition may be, dismissing and labeling the conditions as fake and patients as lazy are the worst ways of managing any condition. This does not mean that we should stop motivating patients to be as active as they can. Educating pain and fatigue patients about ways of exercise therapy for better self management outcomes is very helpful to them. Calling them lazy and dismissing their condition as unreal is not helpful at all.

Sunday, December 7, 2014


The narcotic medications, especially the morphine family are commonly used for pain management. They are very useful tools if used appropriately. However they can harm you if not used carefully. Morphine like medications called opioids have some common side effects. Constipation, nausea, itchiness, drowsiness and cognitive decline, are among the common side effects of all opioids in short term use. Respiratory depression or slowing down, or even in high doses stopping the breathing is the most dangerous side effect. Each year there are numerous patients that lose their lives because of this side effect. We all may think this is overdose and it will never happen to us because we never take too much of our medications. However the problem is the possibility of drug drug interaction or use of alcohol with opioids which can cause the breathing to stop.
In long term use opioids can become less effective. we build tolerance to it. It is because of different mechanisms. One of them is that the hook or receptor on the cells that opioids link with can move into the inside of cells and make the connection less effective, it is called receptor internalization. As a result we may end up using more of opioids to get the same or less effects with more side effects. The irony is that in some cases using this family of pain medications can actually make our pain worse. We may get into this circle of having pain, needing to use more, on and on. In many cases if we stop increasing and slowly bring the dose of opioids down the pain control improves.

Sunday, November 30, 2014


I am a pain patient, What do you want me to do? I am tired of the expectations of others. I am tired of not being understood and be expected to understand. I am sick of not being believed by anyone and be expected to believe all that I am told. Family, friends and society expectations and their disappointments on me mount up to mountains, but what do you want me to do? More importantly, how do you want me to do it? I have tried everything I could but nothing has panned out. I am just too tired to explain myself anymore.
why don't you for once try to understand me?
The story of every single one of us!