Im In Pain But I Dont Want To Take Carbidopa/levodopa Yet Because My Doctor Says It Will Only Work For Five Years Any Advice
It is true that as time passes and your disease progresses, you will have to take higher doses to replace the dopamine your body can no longer produce. However, the rate of dopamine loss is different for everyone. What your doctor may be telling you is that after taking carbidopa/levodopa for some time, you may begin to experience side effects like dyskinesia. It is important to understand that while you may experience this unwanted side effect, for example, you still benefit from the carbidopa/levodopa. If you believe your pain is Parkinson’s-related, and you have already tried other medications and complementary therapies without relief, it is probably time to try carbidopa/levodopa.
Fact: Fibromyalgia Is A Neurological Disease Affecting A Person’s Sensory Processing System
Fibromyalgia does not involve inflammation or damage to joints. Brain imaging and studies have shown that fibromyalgia is a disorder of the central nervous system.
“It’s a neurological disease driven by the central nervous system,” says Clauw. “The brain and spinal cord in people with fibromyalgia process pain signals differently than in other people so that they have heightened sensitivity to pain.”
Other sensory reactions — response to light and noise, for instance — are amplified as well, says Clauw, noting that brain imaging has helped cement such observations: “The brain regions that are more active in people with fibromyalgia are the multisensory areas” — those that respond to pain, heat, pressure.
Fact: Although Fibromyalgia Is More Common Among Women It Affects Men And Children As Well
Twice as many women as men suffer from the condition. No one knows exactly why.
“Women are more likely to develop chronic illnesses that overlap like migraines, irritable bowel syndrome and pain disorders,” says Goldenberg. Researchers suspect that estrogen and other hormones may play a part, but so far no one has found clear biological reasons why women may be more susceptible. “We do know that women are more likely to complain of conditions and to go to physicians earlier than men do,” he says.
Among children, it turns out, what used to be thought of as “growing pains” may in fact be undiagnosed fibromyalgia.
Interested In Parkinsons Disease Research Check Out Our Forums And Join The Conversation
The team searched the Clalit Health Services database between the years 2000 and 2015 for people diagnosed with Parkinson’s and fibromyalgia. Researchers identified Parkinson’s patients through the application of a medication tracer algorithm, and those with fibromyalgia based on medical records.
During this 15-year period, 2,606 people were diagnosed with Parkinson’s and 60 of them also had fibromyalgia .
The majority of those with both the neurodegenerative and rheumatic disorders were women diagnosed at a mean age of 63.95 for Parkinson’s, while their age at fibromyalgia diagnosis varied from 51.68 to 76.22 years. A majority — 77% — also received a fibromyalgia diagnosis after that of Parkinson’s disease.
This particular patient population also had a higher prevalence of depression, anxiety, dementia, hypertension, and heart failure.
Compared to those with Parkinson’s, patients with both conditions used different analgesics at higher rates as well as more antidepressants.
“This FLISPAD subgroup of patients are mostly female, younger at PD diagnosis with a higher rate of cigarette smoking, anxiety, and depression,” the researchers wrote. And they “consume more analgesic drugs, both over-the-counter and prescription medications, including opioids.”
A diagnosis of depression or use of antidepressants tended to come a mean 3.5 years before a fibromyalgia diagnosis.
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What Are The Different Types Of Pain Experienced By People With Parkinsons
Five main types of pain are common for people with Parkinson’s. Multiple types may be present simultaneously or occur at different points throughout a person’s path with Parkinson’s. Recognizing which kind of pain is present can help you optimize treatment, as can paying attention to what activities or times of day make your pain better or worse.
Musculoskeletal pain that affects muscles, bones, tendons, ligaments, and/or nerves. The pain can be localized or generalized and can fade or intensify at different times. Existing musculoskeletal pain can be exacerbated by Parkinson’s.
Rather than being caused by a physical injury, this type of pain is caused by damage to the somatosensory nervous system or a disease affecting the somatosensory nervous system, which responds to external stimuli like touch, temperature, and vibration. It tends to be fairly consistent throughout the day and is present no matter what activity you’re doing. Unlike the aching you may feel when you’re doing a strenuous physical activity, neuropathic pain feels more like a tingly, crawly, uncomfortable sensation.
Dystonia, the movement disorder in which involuntary muscle contractions cause repetitive or twisting motions, is often very painful. Many people with Parkinson’s experience dystonia as a motor symptom, whether it’s localized , in multiple nearby body parts , or all over .
Fibromyalgia Vs Lupus: Complications Mortality Hospitalization And Costs
Over the period between 1979 and 1998, the Centers for Disease Control and Prevention reported approximately 23 annual deaths from fibromyalgia. Mortality among fibromyalgia patients is usually on par with the general population, but suicide rates and injuries are higher among fibromyalgia patients.
In 1997, fibromyalgia hospitalizations accounted for 7,440 patients and annually fibromyalgia costs each person $3,400 to $3,600.
During the same time period, lupus mortality accounted for 879 to 1,406 deaths annually, with rates rising. Estimations of lupus-related hospitalizations were 39,400 in 2010, and an average cost to the U.S. healthcare system was estimated to be $13.3 billion.
Fibromyalgia complications result from lack of sleep, which can interfere with daily function as being tired can impair memory, focus, and increase the risk of injury. Other complications may include depression and anxiety, and the disease is still very much misunderstood.
Complications of lupus include severe kidney damage, damage to the brain and central nervous system, problems with the blood and blood vessels, inflammation of the lungs and chest cavity, inflammation of the heart, increased risk of infection, cancer, bone tissue death, and pregnancy complications.
Fibromyalgia Vs Lupus Differences In Symptoms Pain Causes And Treatment
Fibromyalgia and lupus are two conditions that can cause pain, but it’s important to recognize the many significant differences between the two. Systemic lupus erythematosus , or lupus, is an autoimmune systemic disorder, which affects the joints, skin, and practically any organ in the body. Fibromyalgia affects the muscles causing pain, tender points, and extreme fatigue, and can contribute to anxiety or depression.
Both lupus and fibromyalgia are difficult to diagnose, and many patients with fibromyalgia are often wrongly diagnosed with lupus and vice versa. Furthermore, the two diseases can actually overlap one another, and there is a higher risk of rheumatic disease in fibromyalgia patients.
Fibromyalgia affects roughly two percent of the population and women are more likely to develop fibromyalgia than men. Estimates of lupus cases in the U.S. are 161,000 with definite lupus and 322,000 with definite or probable lupus. Like fibromyalgia, lupus often affects women more than men, too.
Fact: Fibromyalgia Does Not Damage Muscles Joints And Connective Tissue
Rheumatologists consider fibromyalgia to be a musculoskeletal disease because of the discomfort in the muscles and joints, says Don Goldenberg, M.D., director of the Arthritis-Fibromyalgia Center, Newton Wellesley Hospital, Newton, Mass., and a medical adviser to the Arthritis Foundation. “But there is no specific disease in those areas. Evidence suggests that most of the pain has to do with changes in pain processing.”
Towards An Understanding Of The Concept Of Comorbid Fibromyalgia
There are three scenarios that should be taken into consideration when FM associates with some other medical condition. Firstly, FM may have predated the disease, but it is unknown whether pre-existing FM specifically affects disease expression. However, to borrow from the legal tradition, a ‘thin-skull’ diathesis does suggest a particular fragility that may influence the impact of a new disease. The effect may simply be additive of the individual components of each disease, or may even be an exaggerated effect that compounds the overall burden of suffering.
Secondly, the individual may possess a pain prone phenotype with any pain able to initiate sensitization resulting in amplification of pain intensity and location. For example, persons with OA localized pain exhibit hyperalgesia even at sites distant from the OA site, indicating widespread multimodality changes in the nociceptive system . ‘Remaining pain’ in RA, reported to occur for about 60% of patients with well-controlled inflammatory disease, may also reflect this pain prone phenotype . Although reports of remaining pain have not specifically invoked FM, the hypothesized mechanism of peripheral nerve sensitization represents a pathogenesis similar to FM.
Innovative Treatment Modalities For Managing Pain In Parkinson’s
Non-dopaminergic pharmacotherapy may benefit patients with PD-related pain. Botulinum toxin , both A and B derivatives, should be considered in patients who do not respond to dopaminergic treatment optimization.1,8 Botulinum toxin injection provides localized treatment by blocking the release of acetylcholine at the neuromuscular junction.4 Local injections of BTX type A or B can be effective for persistent dystonia-related pain and central pain, based on its neuromuscular action in movement disorders plus analgesic mechanism.
A randomized, double-blind, crossover, placebo-controlled trial concluded that BTX-A in patients with PD is safe and potentially useful in treating limb pain.29 The study was conducted in patients with PD over the age of 30 years with painful limbs not responding to the optimization of anti-Parkinsonian medications. Patients were randomized to receive BTX-A injection or placebo, followed by the other treatment per the crossover design. Depending on the location of pain, patients received up to 200 units in upper limbs or up to 300 units in lower limbs. Patients experienced a significant reduction in their self-reported numerical pain score 4 weeks after the BTX-A injection , but not with placebo . There was no difference between the change with BTX-A compared to placebo . This study demonstrated that targeted BTX-A injections are safe in patients with PD.
Can Emotional Stress Cause Symptoms That Resemble Transient Pd
Sayings such as ‘shaking in fear’, ‘staring in disbelief’ or ‘frozen with fear’ exist in many languages and suggest that acute emotional stress can mimic some features of PD.
Dramatic examples of reversible parkinsonism were frequently reported among the casualties of ‘shell shock’ and ‘war neurosis’ that in Germany were referred to as ‘Kriegszitterer’ . In the surviving cine films, most of these handicaps resembled a psychogenic movement disorder and suggestion therapy led to an improvement in most cases.27
A few cases, however, closely resembled PD and neurologists described some World War I soldiers as follows: “The eyes were wide open and had a pained vacant stare. He cannot move his legs, which are rigid. As in many of these patients the sole of the foot is shuffled along the ground. Another form of tremor which is coarser and less rapid than the preceding, viz. 5–6 per sec, is that which resembles paralysis agitans.”28 Others observed similar findings reporting “balance is maintained with difficulty since the trunk is flexed anteriorly and the legs are partially bent at the knees. The arms hang low and stiffly at the sides, giving a simian appearance to the whole posture. Coarse tremors develop in the hands and legs , the facies are mask-like without expression.”29
Same patient without any dopaminergic therapy showed significant improvement in handwriting after chronic stress has been resolved.
Fact: Treatment Involves Antidepressants And Antiseizure Drugs
The notion that people with fibromyalgia have a predisposition to both pain and depression led to the idea that antidepressants might help. Antiseizure drugs are thought to improve brain neurotransmitter issues in fibromyalgia, Goldenberg says.
But opioids don’t work, says Clauw: “The body’s opioid system may be driving part of the underlying of the disease, so giving patients opioids may make their fibromyalgia worse.” In a 2013 Stanford study, when 31 women with fibromyalgia took low doses of naltrexone, a drug which blocks the body’s opioids, they saw a 29 percent reduction in pain compared with an 18 percent reduction in those that took a placebo.
Fact: People With Fibromyalgia Need Exercise But Not Too Much
“Exercise is the most effective ‘drug’ for fibromyalgia,” Clauw says. “It works like the drugs for fibromyalgia, raising chemicals in the body that are connected to feeling good. But as with drugs, if you ‘take’ too much exercise, your fibromyalgia symptoms may become worse. Start at a low level of exercise and increase slowly.”
Clauw’s not suggesting that you sign up for sweating sessions in the gym. “Just get up and move, walk, take the stairs instead of the elevator. It will improve all your symptoms — pain, fatigue, sleeplessness — in part because it alters the levels of neurotransmitters that affect pain and mood.”
Dorothy Foltz-Gray is a freelance writer.
Does Taking Certain Medications Risk Lowering Dopamine Levels
Neuroleptic medications typically lower dopamine levels. If you’re taking any of them, check with your doctor about any symptoms you may have that could be due to low dopamine levels. You’ll want to work with your doctor to balance benefits and side effects of these medications. Common medications in this class include:??
Supplements believed to help raise dopamine levels include:??
- Rhodiola rosea, an herb sometimes called golden root or Arctic root
- L-theanine, also known as suntheanine, an amino acid derived from tea leaves
Study Reveals Syndrome Combining Parkinsons And Fibromyalgia
An Israeli research study found that some people with Parkinson’s disease, also referred to as PD, also have fibromyalgia, or FM, creating a unique syndrome. Many of these patients are women who also have depression or anxiety. This group tends to use more pain medication and more antidepressants as well as smoke cigarettes at a higher rate than people with PD only.
Researchers have dubbed the PD-FM syndrome FLISPAD or “fibromyalgia-like syndrome associated with Parkinson’s disease.” Patients with FLISPAD generally are diagnosed with FM at a later age than are those with FM alone.
We have previously as many of our disability clients suffer from the debilitating disease, which causes ongoing, severe pain in several areas of the body and other symptoms. Parkinson’s is a “progressive nervous system disorder that affects movement tremors … stiffness or slowing of movement,” explains the Mayo Clinic.
According to Parkinson’s News Today, PD and FM have overlapping symptoms that include:
- Pelvic discomfort
- Muscle stiffness
Those with this dual diagnosis were at greater risk of heart failure, depression, anxiety, hypertension and dementia. The researchers found that 88.3% of those in a 15-year period sampled who had the dual diagnosis were female, with about three-quarters of them having had the FM diagnosed after the PD. PD was more resistant to treatment in patients with a dual diagnosis than in patients with PD alone.
SSDI and SSI claimants with FLISPAD
Clinical Overlap Between Functional Somatic Symptoms And Non
There is a striking overlap between the symptoms of chronic fatigue syndrome, fibromyalgia and irritable bowel syndrome, all classed as functional somatic syndromes and the spectrum of non-motor symptoms seen in PD.
Mental fatigue, a typical feature of patients with chronic fatigue syndrome, can be found in up to 70% of PD patients at some stage of the illness.42
Conversely, symptoms commonly reported in PD have been found in patients with somatic syndromes. Over 75% of patients with chronic fatigue complain of ‘slow thinking’,51 which can be an early feature of PD often referred to as bradyphrenia. Reduction in stride length, slowness of movements, impairment of flexing and bending knees and hips and trouble keeping up on treadmills can occur in patients with chronic fatigue syndrome.52
However, we do not suggest that chronic fatigue syndrome is a variant of PD, although there may be some overlap at a neural level in the mechanism of symptom expression. In contrast to PD, which is a chronic progressive degenerative disease with neuronal cell loss, chronic fatigue syndrome can be reversible with treatments such as cognitive behavioural therapy.53,54
Links between dopaminergic dysfunction and medically unexplained symptoms have been described .
Parkinson’s Disease Caused By Stroke: Vascular Parkinsonism
A stroke involving the substantia nigra or basal ganglia is called vascular Parkinsonism. Similar to other strokes, damage is caused primarily by a lack of blood supply to these regions of the brain. Generally, the strokes associated with Parkinsonism are termed small vessel strokes as they aren’t normally catastrophic. Diagnosis of small vessel strokes can be confirmed with diagnostic tests such as CT or MRI of the brain.
It typically takes several small strokes to produce the symptoms of vascular Parkinsonism. In some cases, small vessel strokes can also produce a type of dementia called vascular dementia. As such, it is not unusual for people who have vascular Parkinsonism to also have vascular dementia.
Your Fibromyalgia May Be The Cause Of Occiptal Neuralgia
- Buchwald, D., Goldenberg, D. L., Sullivan, J. L., & Komaroff, A. L. . The ‘chronic, active epstein-barr virus infection’ syndrome and primary fibromyalgia. Arthritis & Rheumatism, 30, 1132. doi:10.1002/art.1780301007
- Does Herpes Cause Fibromyalgia? via utmb Health
- Hedberg, N. R. . EPSTEIN-BARR VIRUS & AUTOIMMUNE DISEASE: THE INFECTION CONNECTION. Original Internist, 20, 18-19.
- The Devil Is In The Details – A Herpes Simplex Virus Inquiry For Fibromyalgia and Chronic Fatigue Syndrome via Health Rising
For support and discussion join the group with 35,000+ member “Living with fibromyalgia and Chronic illness”
Fibromyalgia Awareness Store: With so many people across the world affected by the pain, fatigue and brain fog of fibro, it is critical we raise awareness of the condition.Along with speaking, lets spread out fibromyalgia awareness with some others means, let the things speak out it self. Like you can have customized T-Shirts, Mugs, Stickers, Pants, Mobile Covers, Socks, Wall Tapestry.
Fibromyalgia Vs Lupus: Difference In Symptoms And Causes
The above chart outlined many symptoms that lupus and fibromyalgia share which could contribute to the misdiagnosis of both diseases. It is the key differences, though, that help solidify a proper diagnosis and distinguish the two diseases.
First and foremost, lupus and fibromyalgia have very different causes. Lupus is an autoimmune systemic disorder in which the immune system mistakenly attacks its own healthy cells. Fibromyalgia does have some genetic predisposition, but generally it is triggered by unmanaged emotional stress, anxiety, and emotional trauma. The exact cause of fibromyalgia is still unknown.
Lupus can affect any system in the body. The symptoms that can help conclude a definite diagnosis include arthritis, photosensitivity, malar rash, protein in urine, oral ulcers, and lower white blood cell count.
Fibromyalgia is a muscular disease, so symptoms include muscles pain and fatigue, disturbed sleep, and all-over body aches with specific tender points.
Fact: Diagnosis Involves Assessment Of Symptom Severity
No blood test or imaging can confirm fibromyalgia; a detailed assessment of symptoms is all doctors and patients have to make a diagnosis.
In 2010, the American College of Rheumatology came up with new criteria for diagnosing fibromyalgia. Doctors, through a patient survey, assess first how widespread pain is in 19 areas of the body, says Clauw. The more widespread the pain, the more likely it stems from the way the brain is processing pain messages, not from a specific peripheral injury. Patients also rate levels of fatigue, memory and sleep disturbance, depression, headache and other physical symptoms.
Learning To Deal With Fibromyalgia And Muscle Tremors
Similar to the sensation of “internal shaking,” fibromyalgia can also cause general muscle tremors that are more noticeable and easier to pinpoint than the internal fluttering sensation discussed above.
It is fairly easy to tell the difference between these two conditions, as while the former is difficult to place and explain, the latter is a full physical “attack” that can be highly distracting, painful, or disturbing.
According to Suzanne Elvidge, BSc, MSc, muscle tremors can vary in degree of severity, from a simple eye twitch to a full-on bout of restless leg syndrome.
These tremors can also manifest as full muscle spasms, where your arm or leg might suddenly twist or move of its own accord, which can also develop into muscle cramps. Cramping muscles induce a great deal of pain and can make movement difficult if not impossible.
Restless leg syndrome has been increasingly linked to fibromyalgia, to the point where individuals with fibromyalgia are considered 11 times more likely to develop restless leg syndrome that those without fibromyalgia, explains Hiyaguha Cohen of the Baseline of Health Foundation.
Restless leg syndrome is a neurological disorder that is accompanied by the feeling of a crawling or tingling sensation under the skin of the legs that inevitably makes you feel as if your legs have to move.
Chronic Pain Emotions Addiction And The Basal Ganglia
The neurons in the nucleus accumbens in the basal ganglia are activated by drugs such as opiates that produce euphoria or by participating in rewarding experiences such as sex, exercise, etc. The connection to the mesolimbic pathway – which is highly activated in addiction suggested to the researchers that the brain can become hardwired or addicted to producing pain. One asserted that the results indicate that chronic pain cannot be viewed as a purely sensory phenomenon but instead is closely related to emotions.
That’s no surprise. It’s clear that the anticipation of pain, for instance, results in increased pain. Anticipating pain could be viewed as the opposite of anticipating reward.
Miller’s ME/CFS study found that basal ganglia inactivity and reduced reward was associated with increased fatigue in ME/CFS. Reward is clearly a complex phenomenon that integrates emotions and motor activity. High reward states may be synonymous with increased motor activation and vice versa.
Fibromyalgia Likely The Result Of Autoimmune Problems
New research from the Institute of Psychiatry, Psychology & Neuroscience at King’s College London, in collaboration with the University of Liverpool and the Karolinska Institute, has shown that many of the symptoms in fibromyalgia syndrome are caused by antibodies that increase the activity of pain-sensing nerves throughout the body.
The results show that fibromyalgia is a disease of the immune system, rather than the currently held view that it originates in the brain.
The study, published today in the Journal of Clinical Investigation, demonstrates that the increased pain sensitivity, muscle weakness, reduced movement, and reduced number of small nerve-fibers in the skin that are typical of FMS, are all a consequence of patient antibodies.
The researchers injected mice with antibodies from people living with FMS and observed that the mice rapidly developed an increased sensitivity to pressure and cold, as well as displaying reduced movement grip strength. In contrast, mice that were injected with antibodies from healthy people were unaffected, demonstrating that patient antibodies cause, or at least are a major contributor to the disease.
Current estimates suggest that at least 1 in 40 people are affected by FMS worldwide and is commonly characterized by widespread pain throughout the body, as well as fatigue and emotional distress. It most commonly develops between the ages of 25 and 55, although children can also get it.
What Drug Treatments Are Commonly Prescribed For Pain
Dopamine agonists are often the neurologist’s first weapon to alleviate Parkinson’s-related pain. Levodopa is used to treat many types of pain due to Parkinson’s because it treats the motor symptoms such as rigidity and dystonia that are causing them. Other medicines called analgesics can also be used to treat pain. When talking with your doctor, it is critical to let her know about all of the medications you are taking– including over the counter drugs, herbs, vitamins and mineral supplements. Without complete information, your doctor may prescribe a drug that could have serious adverse effects.
Upper Cervical Specific Chiropractic And Fibromyalgia
For these reasons, it makes sense that upper cervical specific chiropractors have found success in helping fibromyalgia patients. In some case studies, patients have even become symptom-free. Whether you are dealing with chronic pain, fatigue, eye problems, migraines, headaches, sensory sensitivities, or any other fibromyalgia symptoms, this may be the natural solution you’ve been looking for.
If you are living with fibromyalgia, especially if you have a history of head or neck injuries that may have caused a misalignment, please contact an upper cervical practitioner in your area. Remember that the accident does not have to be recent because these small subluxations can work under the surface for years to cause symptoms. The search feature on this website can help you to locate one of our preferred doctors in your area. We hope this is the first step that puts you on the path to better overall health and well-being.
to schedule a consultation today.
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People With Fibromyalgia Score Worse On Balance Test
The study involved only middle-aged people in order to preclude older age as a culprit in patients’ falls, Jones says.
To find out whether balance problems could be to blame, the researchers employed computerized balance platform testing. “It tests the three components of balance — visual, vestibular and somatosensory,” Jones says.
The test involves standing on a platform while watching a visual target. Pressure gauges under the platform record shifts in body sway as a person is subjected to conditions that are designed to make the person lose balance.
“How much you sway gives you information about balance,” she says.
People with fibromyalgia scored worse on all three parts of the test than their healthy counterparts.
On the visual aspect of the balance test, the fibromyalgia group scored an average 0.68 while the healthy group scored an average of 0.87. In all three parts, 1 represents a perfect score.
On the spatial part of the test, the fibromyalgia group scored an average 0.41 vs. an average 0.67 in the healthy group. On the somatosensory part, scores were 0.91 and 0.98, respectively.
“The average 50-year old with fibromyalgia has scores on all the tests that are worse than you would expect in a healthy 70- to 80-year-old,” Jones says.
The study also showed there was no relationship between the number of medications fibromyalgia patients took and their balance scores.
Fact: Fibromyalgia Is Not A Psychological Condition
“Depression and anxiety are about four to five times more common in people with fibromyalgia than in normal, healthy people,” says Goldenberg. “But that doesn’t mean that depression and anxiety are the same thing as fibromyalgia. Almost all pain disorders have links to depression and anxiety.”
People with a genetic disposition to fibromyalgia likely have a predisposition to disorders such as depression as well, he adds.
What Can I Do On A Regular Basis To Manage My Pain
Remember, you’re your best advocate as you understands how your pain feels. Understanding and communicating the kind of pain you’re experiencing can greatly inform your treatment plan and will allow your doctors to address the type and severity of your specific pain. Keep your care team informed about activities that cause pain or the times of day your pain is worst so they can help fine-tune your care plan. Do you notice the pain starting to creep in at a certain point after you take your medication? Do you feel fine when you bike but experience pain when you jog? Did you start experiencing this pain before or after your Parkinson’s diagnosis? Taking stock of these sorts of questions can be helpful as you work with your care team to effectively treat your pain.
Incorporating approved medications and following the pain ladder can also help you find the right pain management solution, as can taking steps in your everyday life to be an active participant in your own pain management. Regular stretching, heat and cold treatments, exercise, yoga, and dance can all help reduce your pain, and they are all steps that you can take on your own. Making adjustments to your home and workspace, such as minimizing places where fall risks are likely, using an ergonomically designed desk, sleeping in a comfortable bed, and wearing clothes and shoes that don’t exacerbate pain, can help you establish a more pain-free daily routine.