Back to my occasional series of writing about self-care, and today's topic is pain.

That's a big topic, I know. Huge. I have way more to say than I can possibly fit in this post (I did in fact write a book on this topic 3 years ago), so here I'm just going to be focusing on the highlights. This includes things I think that most people can safely try at home, things for those with chronic pain to be aware of, and other ideas that I'm commonly discussing with patients that I don't really put into the, "needs to be monitored by a healthcare professional" category.
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First up, what are we dealing with here?

Many of my patients seek me out because they want to further investigate and figure out their pain. Often my "job" at the first visit is to assess what has been imaged, tested, and treated, and understand what that past workup can tell us in terms of someone's potential diagnosis and the cause of their pain, so we both can figure out how to move forward.

Just a few common sources of pain in my practice include:

• Osteoarthritis (commonly just called arthritis), or Degenerative Joint Disease
• Hypermobility (injury, localized hypermobility, generalized hypermobility that includes Ehlers-Danlos Syndrome)
• Tendonitis
• Muscle spasms
• Trigger points (in muscles) - I differentiate them from muscle spasms as our treatment approach differs
• Ligament and joint injury, weakness, laxity (loss of elasticity in the tissue), instability
• Spinal injuries and degeneration, leading to disc disease, nerve impingements, and spinal joint arthritis
• Other types of autoimmune or inflammatory conditions that also can affect joint and musculoskeletal pain
• And of course there are so many other areas of chronic pain in the body, such as nerves, digestive tract, bladder, reproductive organs, and more.

Many, many more. So I'm mostly focusing on the musculoskeletal system here. As each condition has its own triggers, risk factors, and how it affects us, our pain, ability to function, investigation and treatment course options are individualized for each person.

But with that being said, I would like to share a few self-care ideas that can help a variety of common underlying sources of pain…

Moving your body

"Water Aerobic Tools" by leyla.a is licensed under CC BY-SA 2.0.

Sorry, but you knew that exercise was going to be on this list, didn't you?

Instead of me giving each patient a standard recommendation for the type of exercise, number of days per week and minutes that everyone should be doing, I want this to be individualized, too.

First up, are you moving your body regularly?
If not, start with moving it in a way that feels good, and that you enjoy.

Forcing yourself to do exercise that you hate because a healthcare professional told you you "should" do it is a recipe for reinforcing negative thought patterns when it comes to natural body movement.

Instead, move in a way you enjoy.
Let's all start there.

If you are not moving, then choose a way to gently reintroduce movement (I say reintroduce as nearly all of us were more active in our younger years).

For some, that is water aerobics.
Or chair yoga.
Or tai chi or other meditative practices may be a good fit, particularly if gentle movement and improved balance are goals.

Some enjoy jogging. I do not. But some think that Zumba sounds like the worst punishment possible, and I find it really fun.

Good thing there are endless ways we can express physical movement in our lives.

And here's just a few more specific ideas on this topic:

Controlled Articular Rotation (CARs) is a great introduction to improving mobilization all over, especially in those joints that are painful, stiff and limited in their range of motion, without introducing too much resistance and strain.
Here's one explanation and guide on this topic.
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Stretching can be a great self-care tool at home, just be aware of how your body responds. Some tight muscles feel great after a stretch.
But in areas of joint pain, hypermobility, muscle spasms, and trigger points, sometimes stretching can put undue stress on joints and muscles that are already struggling to heal and recover. Run your exercise program by the expert you trust the most in this field.

And sometimes, less movement is the key.

Health conditions that include high cortisol, stress, anxiety, fatigue, and insomnia are sometimes worsened by too much high-intensity or aerobic exercise. Stressed-out bodies often don't respond well to exercise that can stress them out more.

In these cases, yin yoga or other slower-paced exercise is a great addition.

For tight, spasmodic muscles, sometimes intentional relaxation of those muscles is more beneficial than stretching - especially as stretching can sometimes be too aggressive.

Finding a position of maximal release involves identifying the points in the body where the muscle attaches, and bringing those sites closer together. By relaxing and breathing slowly over 1-2 minutes, the muscle is given the opportunity to find a lower "set point" of tension.

Here is just one style in this video, to release the piriformis muscle in the pelvis region (this video was recently passed to me by a patient).

There are many styles of muscle release techniques, please ask your chiropractor, physical therapist, or myself for ideas specific to the muscles you are seeking to release.

Myofascial care at home

Myofascial treatment is a very broad term that encompasses hands-on care that you can receive from an acupuncturist (gua sha, cupping), chiropractor (Graston or IASTM), physical therapist and others.

A common aspect of all these types of treatments is breaking up any fascial adhesions that can build up in the superficial and deep connective tissue layers of the body, which can cause pain and limited range of motion.

An additional benefit is these therapies (either performed by someone else, or as self-care) also tend to improve circulation, movement of nutrition and oxygen to the areas of chronic pain.

A few common at-home tools to aid in this include foam rollers, dense rubber balls (Lacrosse balls or Melt balls), and other roller massage home tools.

Working out fascial adhesions can be sore, even a bit painful or tender. When doing this at home, it is good to know precisely which muscles you are intending to treat, so that you don't inadvertently painfully compress a nerve instead of the fascial layers you are trying to release. Sometimes pain is no gain, so be aware of your anatomy.

Here's a few home exercises on self myofascial release you can try.
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Supplementation: what I commonly use, and what I commonly recommend to avoid
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"Turmeric Supplement Capsules and Bottle" by formulatehealth is licensed under CC BY 2.0.

Supplements are just that, a supplementation to an otherwise comprehensive approach. I don't use them in a vacuum as all the other more foundational aspects are really key.

My book has all the research and backstory on supplements, so here we'll just hit the highlights, plus what new I have learned over the last three years since its publication.

Glucosamine is still one of my go-to supplements, because it supports connective tissue regeneration processes - which is often supportive in cases of arthritis, tendonitis, sprains, injuries and more.

It's generally a good approach to try one new thing at a time. That way you can assess how you believe it works for you. The same is often helpful with supplements. For that reason, plain glucosamine (sulfate or HCl) is preferable over the "joint support" blends that might have 5-10 ingredients. If that combo supplement doesn't seem to do much, you won't really know if just one or two of the ingredients may have been the better fit for you.

A few brands hit the 500-750 mg per capsule dosage (Thorne and Vital Nutrients are the ones I most commonly use), which is then easy to aim for the 1500 mg daily dose that has most commonly been researched.

Turmeric/curcumin is another supplement where I focus on the minor details. Taking a bioavailable form (may say Meriva or phospholipid bound on the label) means that a lot more of that supplement is being absorbed through your digestive tract and making it to your joints (or wherever else you're using this common antiinflammatory supplement).

A couple of good quality brands (Thorne and Pure Encapsulations) make capsules in the 500-750 mg range to hit the daily 1500 mg that is most commonly shown in research to be as effective as over the counter antiinflammatories, and in some studies even as effective as prescription antiinflammatories and low-dose opioid painkillers.

You can find these and similar brands in many locations: in health food stores, my Salem office has an inventory managed by an office-mate there, and many places online. If you are supplement shopping on sites available to the public, just be sure to buy directly from that manufacturer (such as directly from the Thorne "store" on Amazon). There is a scary and unfortunate amount of fraud that happens in the supplement sales world out there.

The prescription platform I use in the office, FullScript, gets their supplements directly from the manufacturer, so I feel safe and secure when I'm ordering my own personal supplements there.

Ursolic acid is a new one for me. Let me introduce you to this compound.

I just found out about this really interesting botanical extract from a colleague Dr. Jeff Clark last year. After trying to find additional treatment options for neurologic inflammatory conditions, he read up on the research on this compound. Ultimately he started making a concentrated ursolic acid product from rosemary extract, in topical and oral forms, which he calls Bear cream and Bear capsules.

After speaking with him and reviewing the information he's collected on ursolic acid, I did my own multi-hour deep-dive into the research. And I found a whole lot more interesting applications than just nerve anti inflammatory support (though that is interesting in and of itself). I found many studies on maintaining muscle mass, preserving nerve function, improving osteoarthritis and rheumatoid arthritis joint pain, and even reducing uric acid levels.

Then I decided I wanted to try it out on as many patients as were interested, so I've been stocking the topical application Bear cream in my office for the last few months, and trying it out on patients when it seems it might help.

Because the Bear cream contains DMSO, it absorbs within a few minutes, so during an office visit I can try it out with a patient and they can report back what they think in real time.

My very non-scientific guesstimate is that about half of patients with joint pain notice a difference, and at least 75% with tendonitis and ligament pain notice a difference.

Though no treatment will be the 100% effective magic bullet for everyone, I have found it to be another useful tool in my Chronic Pain Toolbox, as one more additional non-pharmaceutical option to be tried for arthritic, tendon, and ligament pain.

For some it provides palliative pain relief so that they can sleep, exercise, work, or otherwise function a little more comfortably while we're doing all we can to help figure out and/or treat the more underlying causes of the pain.

And after trying it on myself, friends, family and a few dozen patients over these last few months, I am just now starting to carry it in the office (in addition to it being available directly from Dr. Clark via the above link). It's on the shelves at my Salem office, and will soon be at my Portland office as well.

If you are interested in trying a sample, please ask during your next office visit with me! I'd love to collect even more information on how I can use and recommend this in my work with patients.

And of course, I want to think about all those other background factors and triggers of chronic pain

Most of you know that I like to dive deep into investigating all the metabolic, hormonal, inflammatory, and immune influences in chronic pain. So don't be surprised when I seem to be getting off topic talking about insulin, testosterone or uric acid, when all you wanted was to know what I think about cortisone injections :)

It's all connected. I just can't help but dive down all the rabbit holes.

(Oh and if you did want to know, I'm not nearly as opposed to cortisone as many patients presume. I just think they are overused with little to no thought being given as to why the arthritic pain is there in the first place. And too many of my patients have been "fired" when the cortisone injection didn't work and they weren't a surgical candidate or did not want to pursue surgery. Or worse, were a "failed surgery" patient - has a worse medical phrase ever existed?!)

So stay cool, stay hydrated, go have a little fun while you're moving your body, and let me know when you need more support keeping it all moving and going,
Dr. Angela Cortal

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