Managing Pain & Inflammation by Karthik

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Managing Pain & Inflammation Rheumatoid Arthritis Is Painful — This Invisible Symptom Is Often Worse

ileen Davidson, known as Chronic Eileen, lives with rheumatoid arthritis and common comorbidities that come with the painful autoimmune disease. While pain is often debilitating, fatigue can often take the spotlight as the most complicated symptom to deal with on a daily basis. Chronic fatigue is a whole-body feeling that impairs your ability to function and is invisible to all but the person experiencing it. Medications and comorbidities like fibromyalgia, depression, anxiety, and vitamin and mineral deficiencies are what cause Eileen’s fatigue. However, with the right self-management skills, which she has developed after a decade with RA , Eileen has made life a little easier with this pesky symptom.

Here are five of Eileen’s best tips for combating debilitating chronic fatigue: Motion is lotion

The CSA Empowers People Living With Spondyloarthritis to Live Their Best Lives Mechanical back pain from strain, injury, or overuse is common, but persistent inflammatory pain could signal an autoimmune condition like spondyloarthritis. Dr. Elie Karam Chair of the Board, Canadian Spondylitis Association

Think you could have SpA? Visit spondylitis.ca to take the CSA’s spondylitis questionnaire. This article was sponsored by the Canadian Spondylitis Association.

Anne Papmehl

pondyloarthritis (SpA) is a form of inflammatory arthritis affecting people mostly between the ages of 25 and 30. The journey to diagnosis and proper treatment can be slow. Dr. Elie Karam, 35, knows this only too well. In April of 2016, while doing his residency in orthopedic surgery, he started having pain in his back and later in his shoulders. “Some days I would wake up totally normal and other days I couldn’t do basic things like dressing,” he says. While SpA was suspected, it took two years to get a diagnosis. “It’s ironic because here I was surrounded by experts in the musculoskeletal field and doing my residency in orthopedic surgery, yet we all missed it,” says Dr. Karam.

Negative tests don't rule out the condition Part of the problem was that the X-rays, lumbar MRI, and typical HLA-B27 inflammatory marker test all came back negative. “About 10 percent

of people with SpA have a negative B27 marker,” says Dr. Karam. Thankfully, his wife, also a physician, had a gut feeling it might be SpA. Deciding to trust her judgment, Dr. Karam requested a new MRI centred on sacroiliac joints, which confirmed the diagnosis. It took another year to get the right treatment of biologics, but Dr. Karam finally has his life back. He’s now Chair of the Board of the Canadian Spondylitis Association (CSA), hoping to help others with SpA get earlier diagnoses. “We spend years going to the doctor, getting negative tests, and worrying that people think we’re faking it. But we’re not faking being sick, we’re faking being well," he says. Dr. Karam advises others who have inflammatory pain onset before age 45 for more than three months to talk to their doctor. And don’t be afraid to ask for help. “The CSA is here to support and empower you to live better with the disease,” he says.

To learn more about arthritis research currently underway or how you can participate in arthritis research, visit arthritisresearch.ca. This article was made possible with support from Arthritis Research Canada.

Sticking with a healthy diet full of fresh fruits, vegetables, whole grains, fatty fish, and lean proteins can help contribute to increased energy compared to a diet with processed foods or foods high in sugar and saturated fat. Maintaining adequate hydration can help more than grabbing another coffee.

Remember to rest and pace yourself

Pushing yourself and overdoing it is a major trigger for pesky fatigue. It's incredibly important to prioritize rest and to pace yourself each day to not trigger unrelenting fatigue that can leave you in a slump for a few days. Complete big tasks during your best hours.

Find the right medications and treatments

When pain and inflammation are under control, it can help with fatigue. But your physical health isn’t the only cause of increased fatigue. Ensuring that your mental health is supported as much as your physical health is key in fighting draining fatigue. Ask your health care providers how they can help you manage your fatigue and mental health.

Patti Nakatsu, Director of Development, Arthritis Research Canada

Maintaining a healthy diet and hydration

Arthritis Is Serious; Research Changes Lives ver 350 million people worldwide, including more than six million Canadians of all ages, live with pain and inflammation caused by arthritis. At Arthritis Research Canada, research teams are working to find solutions to help those people deal with the challenges caused by this debilitating disease. Arthritis is the most common health reason why Canadians stop working. We’ve developed a unique, online program, called Making it Work™, to help them remain employed. Arthritis inflammation can cause complications like heart attacks, strokes, and blood clots. We’re finding ways to prevent these serious, life-threatening conditions. We’re also evaluating the long-term impact of virtual appointments on patients, and deter-

mining the safety and effectiveness of COVID-19 vaccines. And these are only a few examples.

More than aches and pains Arthritis costs the Canadian economy an estimated $33 billion per year. Arthritis research is the only way to fi nd answers and save the lives of millions struggling with the over 100 types of arthritis. With four centres across Canada, Arthritis Research Canada is the largest clinical arthritis research centre in North America, conducting research to explore every possible avenue of discovery aimed at arthritis prevention, early diagnosis, new and better treatment, and improved quality of life.

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Seek out communication and support

Chronic fatigue is a challenge to live with but those around you can help you by better understanding how fatigue impacts your daily life and how they can best support you. If you know someone with fatigue, remember to be kind and supportive as they're climbing an invisible mountain.

Publisher: Rayan Hassan Business Development Manager: Melanie Kosev Country Manager: Nina Theodorlis Content & Production Manager: Raymond Fan Designer: Kylie Armishaw Content & Web Editor: Karthik Talwar All images are from Getty Images unless otherwise credited. This section was created by Mediaplanet and did not involve The Toronto Star or its editorial departments. Send all inquiries to ca.editorial@mediaplanet.com.

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Fatigue often causes people to become more sedentary, causing more pain and more fatigue. While it doesn’t work straight away and at first can be difficult due to lack of energy, exercise is a critical step in Eileen’s fight against arthritis and in improving her overall well-being. Her advice is to start small with low-impact exercises you enjoy and slowly build your way up to more. Moving a little each day can be one of your best tools for chronic fatigue.

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Better Cardiovascular Health Improves Rheumatoid Arthritis Exercise and mindfulness can help people with rheumatoid arthritis manage their disease and improve heart health. Abigail Cukier

Dr. Yan Yeung Rheumatologist, Waterloo Rheumatology

arrie Barnes has always been active. She used to play volleyball regularly and jog up to 10 kilometres a day. When she developed rheumatoid arthritis (RA), Barnes had to find other activities that weren't as hard on her most affected joints. She has played in a ball hockey league, trained for and participated in several extreme trail runs, walks or bikes to work, and logs hundreds of kilometres a year of cross-country skiing and hiking. “When you're diagnosed with a chronic illness, it can be quite overwhelming,” says Barnes. “What helps me is being active, eating well, and having strong relationships with the people around me. This helps me remember that I'm so much more than the fact that I have RA.” While these habits help Barnes feel better in her daily life, they're also beneficial for her long-term health, says Dr. Yan Yeung, a rheumatologist in Waterloo, Ont.

RA increases your risk of heart attack

Speak with your health care team for more information.

“Managing cardiovascular health is crucial in patients with RA. RA increases your risk of heart attack, perhaps to the same degree as having diabetes,” Dr. Yeung says. “The best way to avoid that higher risk is to take your medication, because that controls the added inflammation, But we also have to address lifestyle factors to improve cardiovascular health and RA.” RA is an autoimmune disease in which the body’s immune system mistakenly attacks the lining of the joints. It's an inflammatory disease that can affect multiple joints in the body. The same inflammation that causes pain, stiffness, swelling, and joint damage also increases the risk of heart disease. This risk increases further in people with RA who smoke, are overweight or have high blood pressure.

Dr. Yeung recommends that people with RA eat a diet rich in fruits, vegetables, whole grains, beans, nuts, and seeds — for example, a Mediterranean diet, which may improve cardiovascular health. He also suggests practising meditation or taking short mindfulness breaks. "It's about learning to just stop and take a breath or a moment to reflect," he says. “This can reduce stress.” Smoking cessation is also important for improving your cardiovascular health. “There's also higher risk of lung cancer in RA and there are connections between smoking and RA,” Dr. Yeung says. “Smoking has been shown to possibly increase your risk of getting RA and once you get it, smoking can make it more difficult to control your disease.” Dr. Yeung also recommends regular exercise. If new to exercise, he suggests starting with short walks a few days a week. “In addition to cardiovascular health, exercise has benefits for RA,” he says. “Strength training can improve the structures around the joints, so that they're not so easily strained. Walking or cycling can enhance cartilage integrity. Mobility exercise, like tai chi and yoga, can improve the range of motion of your joints.”

“The fact that I keep moving keeps me moving” Barnes, who has completed several 100 Mile Wilderness challenges, says people sometimes worry that so much activity might make her RA worse.

What helps me, Carrie Barnes is being active, RA Patient eating well, and having strong relationships with the people around me. This helps me remember that I'm so much more than the fact that I have RA. “I tell them, the fact that I keep moving keeps me moving,” she says. “It maintains the strength around my joints and improves my stability. It keeps my weight down and it keeps my heart healthy.” Dr. Yeung says lifestyle changes can be difficult. “It requires a lot of persistence, but my patients who make these changes seem to be happier,” he says. “ They're more active and live with less pain. There is less missed work and they can do more things around the house and more activities with friends and family. Medications are important, but lifestyle changes help improve overall function, happiness, and quality of life.”

This article was sponsored by one of Canada's leading research-based pharmaceutical companies.

New Innovative Cream Taps Into Plant-Based Ingredients for Pain Relief A Canadian company has introduced a unique topical product designed to tackle acute and chronic pain naturally, without drugs. Michele Sponagle

Plant-derived medicinal ingredients offer relief Approved by Health Canada as a natural health product, Awaye has been clinically tested and confirmed to be safe and effective. Its unique formula combines two plant-sourced natural ingredients: capsaicin, derived from cayenne pepper, and β-caryophyllene. Capsaicin activates the transient receptor potential vanilloid 1 (TRPV1) channel, a receptor involved in pain transmission. Meanwhile, β-caryophyllene is a natural terpene (an aromatic compound found in plants) made from the stems and flowers of Syzygium aromaticum (clove), and also found in rosemary and hops. It triggers

PHOTOS COURTESY OF AWAYE

n estimated 7.63 million Canadians aged 15 and up are living with chronic pain, according to the 2020 Canadian Pain Task Force Report. It’s a condition with a significant impact on physical and mental health, family and community life, society, and the economy. When it comes to seeking solutions, many people are looking for natural, drugfree options. Fortunately, there are a growing number of choices available. One of the newest therapeutic products to be introduced onto the market is Awaye Pain Relief Cream. Developed by Lumiera Health Inc. (NHP.V), a Canadian company based in Saint-Hubert, Que., it's indicated for those suffering from painful strains and sprains (involving muscles, tendons, or ligaments), lumbago, simple backaches, chronic low back pain, and arthritis. Launched in April 2021, it’s a ground-breaking product — the fi rst specially designed to leverage the body's own pain-defence mechanism, known as the endocannabinoid system (ECS).

the receptors in the ECS. Specifically, β-caryophyllene activates the cannabinoid type 2 (CB2) receptors to help provide fast, effective pain relief. Awaye is indicative of the kind of natural approach to health that has been embraced by many people. Health Canada data shows that 71 percent of Canadians have used natural health products. Their appeal is multi-faceted. Most of all, they represent alternatives to prescription medications, which can come with side effects, impair daily functioning, and cause drowsiness and addiction.

Getting back to everyday life pain-free The bottom line for many people with chronic pain is that they want something that will allow them to enjoy everyday life, whether it’s playing sports, driving, working, or doing household chores. “No matter the exertion, it’s always good to follow up rigorous exercise like snow shovelling with a topical remedy to ease muscle tenderness,” says Dr.

Maher Obeid, a chiropractor from the Healing Path Chiropractic and Wellness Centre in Burlington, Ont. For those seeking safe and effective relief from acute or chronic pain caused by a variety of conditions, Awaye is a lowodour, non-greasy, non-staining, and non-habit-forming solution that can also complement existing pain treatments and therapies. It comes in an easyto-use, convenient pump. For maximum effectiveness, apply two pumps to the affected area three to four times a day. Awaye comes recommended by health care professionals, like Dr. Obeid. “I like to use a topical cream like Awaye, which works with the body’s ECS to relieve soreness and acute pain,” he says. Discover a natural, drug-free way to help manage acute and chronic pain with Awaye, available online without a prescription. And coming soon, it will be sold over the counter through select pharmacy and natural health store channels.

Discover a natural, drug-free way to help manage acute and chronic pain with Awaye, available online at awaye.ca and amazon.ca without a prescription. This article was sponsored by Lumiera Health Inc.

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Are You or a Loved One in Pain? You Need a Magic Bag The Original Magic Bag®, Canada’s best-selling hot/cold compress, offers all-natural pain relief for the whole family. Tania Amardeil

I Tyler is one of 24,000 kids in Canada living in pain due to juvenile arthritis. For his efforts to raise funds and awareness, he was named one of two National Youth Leaders by Cassie and Friends in 2021.

March is Juvenile Arthritis Awareness Month. To learn more and make a donation, visit cassieand friends.ca. This article was sponsored by Cassie + Friends.

Teen Joins Race to a Pain-Free Future for Kids with Arthritis Jennifer Wilson

n February 2020, Tyler Mah, then 11 years old, suddenly couldn’t sleep at night because of excruciating pain in his hip. The cause turned out to be a rare form of juvenile arthritis (JA) called chronic recurrent multifocal osteomyelitis (CRMO). JA affects approximately 24,000 kids in Canada; CRMO is one in a million. “I worried I wouldn’t be able to play sports,” says Tyler, who after a challenging year of tests and medications was still in pain. In March 2021, a full-body MRI at the Hospital for Sick Children showed lesions in the ligaments and joints that connect his bones, resulting in another diagnosis: enthesitis-related arthritis. Tyler now receives infusions of Remicade, a drug that allows him to play basketball and volleyball again. To make sense of his experience, Tyler created a website for a school project to share his journey with pain and medications and to raise awareness. He also fundraised and joined the Toronto run/walk organized by Cassie and Friends, a national charity working to advance JA research and care so kids like Tyler can have the pain-free futures they deserve. “We felt so alone and terrified at the beginning, and worried about the future,” says Tyler’s mom, Cindy. “We’re so thankful for Cassie and Friends because they’re doing so much for families like ours by sharing information and personal experiences, hosting educational webinars, connecting families across Canada, and working toward a cure.” “I hope no other kid has to go through what I did,” says Tyler. “My advice to others is to stay strong, keep your joints moving, and don’t be afraid to tell others about your experience.”

All-natural pain relief at the ready As warm compresses, Magic Bags offer moist heat to help relieve menstrual cramps and abdominal pain, arthritic pain, rheumatism, bursitis, stiffness, stress, and body chills. As cold compresses, Magic Bags can help reduce inflammation, relieve muscle spasms, and provide relief from sprains, strains, bruises, minor burns, and headaches. “The heat brings more blood to the area where it’s applied, which helps relieve stiffness and cramping, while the cold tends to slow down the blood flow to that area, offering a numbing effect and reducing inflammation and muscle spasms,” explains Neveu. Magic Bags are family-tested, family-approved. “My husband told me that the heat from the Magic Bag was better than most medications prescribed for pain,” writes one verified user. “It’s definitely something that I will recommend to those who are in all kinds of pain,” says another.

Learn more about Magic Bags at magicbag.com. This article was sponsored by Magic Bag.

PHOTO COURTESY OF MAGIC BAG

PHOTO COURTESY OF TYLER MAH

f you or someone you love is dealing with acute or chronic pain, hot and cold compresses may be the answer. Canadians seeking all-natural, non-invasive pain relief can turn to the Original Magic Bag® by Masdel Inc., a proudly Canadian company that has been making and selling Magic Bags — registered Class 1 medical devices with Health Canada — for 30 years. “Magic Bags are made in Canada, which we’re really proud of,” says Jennifer Neveu, Product Development and Marketing Director at Masdel. “We cut, sew, and fill the product locally with organic, Canadian-sourced grains, which can be composted after 100 uses, contributing to an eco-friendly afterlife.”

Learn How Physiotherapy Can Help With Inflammation Dr. Charlotte Anderson, MSc PT., PhD

PHOTOS COURTESY OF WEBBER NATURALS

Natural Supplements Are Effective in Supporting Joint Health Dr. Joyce Johnson Naturopathic Doctor

To learn more, visit webber naturals.com. This article was sponsored by Webber Naturals.

Living life fully means supporting healthy joints and managing pain with supplements like turmeric and glucosamine chondroitin. Michele Sponagle

aintaining joint health should be a top priority for Canadians. Pain due to conditions like osteoarthritis can seriously impair our mobility. Fortunately, natural supplements can play a key role in managing joint pain and supporting overall joint health. Natural, drug-free alternatives have become very popular in Canada. “If someone is experiencing joint pain, they often seek safer alternatives,” says naturopathic doctor Dr. Joyce Johnson. “Taking pain medication long-term may cause issues.” Turmeric and glucosamine chondroitin have been clinically tested and shown to be effective for managing joint health. Turmeric has been used for centuries in Ayurvedic and traditional Chinese medicine. It helps to decrease pain naturally and ease inflammation. Glucosamine chondroitin supplements combine two different and complementary elements to relieve osteoarthritic joint pain and help rebuild existing cartilage. It can be confusing to know which supplements are safe and effective. Dr. Johnson suggests purchasing from a trusted and reputable brand. Webber Naturals is a family-run, Canadian company based in British Columbia and founded in 1948. It has a proven track record of producing safe, natural, and effective supplements formulated to exceed Health Canada and international regulations. The company goes a step further by embracing a sustainable, planet-friendly approach to formulating and manufacturing supplements. Its products are free from pesticides, fungicides, herbicides, and solvents. They're also non-GMO compliant and don't contain artificial flavours, colours, or preservatives. In addition, Webber Naturals has partnered with Carbonzero to become carbon-neutral and mitigate climate change.

nflammation is how the body’s immune system responds to harmful stimuli. These stimuli can range from pathogens, damaged cells, toxic compounds, or foreign substances, and inflammation acts to remove the stimuli and initiate the healing process. Inflammation can occur at any site in the body, depending on the injury, surgery, or trigger. Over time, chronic inflammation can trigger the immune system to attack healthy tissue and organs in the body. When left untreated, prolonged chronic inflammation can increase the risk for diseases like diabetes, heart disease, cancer, and rheumatoid arthritis. Physiotherapy can help — both in acute and chronic inflammatory conditions and in preventing inflammation from occurring. Physiotherapists are trained in returning a body to function after injury, disease, or illness. In acute inflammatory conditions, physiotherapists are trained to use different modalities, manual techniques, and treatments to reduce inflammation and prevent it from reoccurring. Similarly, in chronic inflammatory states, a physical therapist can be an educator on the reduction of risk and lifestyle modifications. • Physical exercise: Energy expenditure through exercise has been shown to lower multiple pro-inflammatory molecules and cytokines independently of weight loss. • Avoid smoking, limit alcohol consumption, and reduce stress levels. • A variety of foods have anti-inflammatory properties. These include foods that are high in antioxidants and polyphenols such as olive oil; leafy greens, such as kale and spinach; tomatoes; fatty fish, such as salmon, sardines, and mackerel; nuts; fruits, especially cherries, blueberries, and oranges. • Certain supplements may help reduce inflammation. Fish oil, lipoic acid, and curcumin are all linked to a decrease in inflammation associated with diseases such as cancer and heart disease. Several spices may also help with chronic inflammation and inflammatory disease, including ginger, garlic, and cayenne. ALPHA Health Services provides physiotherapy and supporting services. Practitioners are experienced, thorough, and knowledgeable in managing chronic and acute inflammatory conditions.

Dr. Charlotte Anderson MSc PT., PhD, Alpha Health Services

Learn more at alphahealth services.ca This article was sponsored by Alpha Health Services.