MSK articles - Musculoskeletal Australia (MSK)

16/Nov/2023

Or how to manage fatigue

We all get tired. We overdo things and feel physically exhausted. It happens to us all. Usually after a night or two of good quality sleep the tiredness goes away and we’re back to our old selves.

But fatigue is different.

It’s an almost overwhelming physical and/or mental tiredness. And it usually takes more than a night’s sleep to resolve. It generally requires multiple strategies, working together, to help you get it under control.

Many people living with a musculoskeletal condition struggle with fatigue. It may be caused by a chronic lack of sleep, your medications, depression, your actual condition (e.g. rheumatoid arthritis, lupus, fibromyalgia) or just the very fact that you live with persistent pain.

Fatigue can make everyday activities difficult, and can get in the way of you doing the things you enjoy. The good news is there are many things you can do to manage fatigue and get on with life.

Exercise and being active. While this may sound like the last thing you should do when you’re feeling fatigued, exercise can actually boost your energy levels, help you sleep better, improve your mood, and it can help you manage your pain. If you’re starting an exercise program, start slowly, listen to your body and seek advice from qualified professionals. Gradually increase the amount and intensity of activity over time.

Take time out for you. Relaxation – both physical and mental – can help you manage your fatigue. I’m not just talking about finishing work and plonking down in front of the TV – though that may be one way you relax and wind down. I’m specifically referring to the deliberate letting go of the tension in your muscles and mind. There are so many ways to relax including deep breathing, visualisation, gardening, progressive muscle relaxation, listening to music, guided imagery, reading a book, taking a warm bubble bath, meditating, going for a walk. Choose whatever works for you. Now set aside a specific time every day to relax – and choose a time when you’re unlikely to be interrupted or distracted. Put it in your calendar – as you would any other important event – and practise, practise, practise. Surprisingly it takes time to become really good at relaxing, but it’s totally worth the effort. By using relaxation techniques, you can reduce stress and anxiety (which can make you feel fatigued), and feel more energised.

Eat a well-balanced diet. A healthy diet gives your body the energy and nutrients it needs to work properly, helps you maintain a healthy weight, protects you against other health conditions and is vital for a healthy immune system. Make sure you drink enough water, and try and limit the amount of caffeine and alcohol you consume.

And take a note out of the Scout’s handbook and ‘be prepared’. Consider making some healthy meals that you can freeze for the days when you’re not feeling so hot. You’ll then have some healthy options you can quickly plate up to ensure you’re eating well without having to use a lot of energy.

Get a good night’s sleep. Good quality sleep makes such a difference when you live with pain and fatigue. It can sometimes be difficult to achieve, but there are many things you can do to sleep well, that will decrease your fatigue and make you feel human again. Check out our blog on painsomnia for more info and tips.

Pace yourself. It’s an easy trap to fall into. On the days you feel great you do as much as possible – you push on and on and overdo it. Other days you avoid doing stuff because fatigue has sapped away all of your energy. By pacing yourself you can do the things you want to do by finding the right balance between rest and activity. Some tips for pacing yourself: plan your day, prioritise your activities (not everything is super important or has to be done immediately), break your jobs into smaller tasks, alternate physical jobs with less active ones, and ask for help if you need it.

Write lists and create habits. When you’re fatigued, remembering what you need at the shops, where you left your keys, if you’ve taken your meds or what your name is, can be a challenge. And when you’re constantly forgetting stuff, it can make you stress and worry about all the things you can’t remember. Meh – it’s a terrible cycle. So write it down. Write down the things you need at the supermarket as soon as you think of it –a notepad on the fridge is a really easy way to do this. Create habits around your everyday tasks – for example always put your keys in a bowl by the door or straight into your bag, put your meds in a pill organiser.

Be kind to yourself. Managing fatigue and developing new ways to pace yourself is a challenge. Like any new behaviour it takes time, effort and lots of practice. So be kind to yourself and be patient. You’ll get there. It may take some time, and there may be some stumbles along the way, but you will become an expert at listening to your body, pacing yourself and managing fatigue.

Talk with your doctor. Sometimes fatigue may be caused by medications you’re taking to manage your musculoskeletal condition. If you think your medications are the issue, talk with your doctor about alternatives that may be available.

Fatigue may also be caused by another health condition – including anaemia (not having enough healthy red blood cells to carry oxygen around your body), diabetes, high blood pressure, fibromyalgia and being overweight. If you’re not having any success getting your fatigue under control, your doctor may suggest looking into other potential causes.

So that’s fatigue…it can be difficult to live with, but there are lots of ways you can learn to manage it.

Tell us how you manage. We’d love to hear your top tips for dealing with fatigue.

FIRST WRITTEN AND PUBLISHED BY LISA BYWATERS IN OCTOBER 2020

Call our Help Line

If you have questions about things like managing your pain, COVID-19, your musculoskeletal condition, treatment options, telehealth, or accessing services be sure to call our nurses. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

More to explore

I’m a “spoonie.” Here’s what I wish more people knew about chronic illness
healthline
A great way to describe what it’s like to have limited energy to family and friends who want to understand.
Fatigue
Better Health Channel
Fatigue and arthritis
Arthritis Society (Canada)
Managing fatigue
Versus Arthritis (UK)

Lisa Bywaters

16/Nov/2023

Anti-inflammatory diets have been around for some time. There are many websites, books and blogs promoting the benefits of eating anti-inflammatory foods.

This type of diet sounds tempting, not only because of the foods they promote – which are all delicious – but because the idea that we can fight inflammation with the foods we eat sounds so attractive and natural!

So what is an anti-inflammatory diet, what are they supposed to do and what’s the evidence (if any) behind them?

First – the what

The theory behind these diets is that certain foods have anti-inflammatory properties, while others cause inflammation. So if we incorporate more of the anti-inflammatory foods and less of the pro-inflammatory foods in our diets, it may help lower levels of inflammation for people who have arthritis, psoriasis and other inflammatory conditions.

Sounds logical, right? Maybe??

Next – the evidence

OK, so this is where it gets a little murky. There’s really not a lot of conclusive evidence to support these claims. Studying the effects of diet is a tricky business, as this article in VOX explains. When we look at treating chronic diseases, research “involves looking holistically at diets and other lifestyle behaviors, trying to tease out the risk factors that lead to illness. Nutrition science [is therefore] a lot more imprecise. It’s filled with contradictory studies that are each rife with flaws and limitations. The messiness of this field is a big reason why nutrition advice can be confusing.” (1)

So we often have to use things like observational studies, self-reporting or information gleaned from studying the effects of dietary changes on lab animals.

Which means the data we obtain is often contradictory and isn’t conclusive. For more information read: The messy facts about diet and inflammation by Scientific American.

Does this matter?

Maybe not. Two popular anti-inflammatory diets are the Mediterranean diet and the DASH (Dietary Approaches to Stop Hypertension) diet.

Both diets have a heavy emphasis on eating:

foods that are as unprocessed as possible,
a rainbow of fresh whole fruits and vegetables (not juices),
whole grains such as brown rice, quinoa, oats, whole grain breads and pasta,
beans, lentils, chick peas and other legumes,
nuts and seeds,
fish, seafood and poultry,
healthy oils such as olive, vegetable, canola.

They both recommend people eat less:

red meat,
foods high in sugar, salt and fat,
highly processed foods.

So if we look at this type of diet, it’s actually a healthy, well-balanced diet. Eating a variety of different foods, in a range of different colours means that we’re giving our body a wide range of important vitamins and nutrients.

In the end, whether you call it an anti-inflammatory diet, a Mediterranean diet or DASH diet, it doesn’t really matter. And whether it has an effect on inflammation, only time and further research will tell.

But if you eat a nutritious, well-balanced diet you’ll certainly feel better overall. Eating well helps us maintain a healthy weight, is important for our physical and mental health, can help us sleep better, be more active, reduce our risk of developing other health conditions, and just generally makes us feel good.

Tips to change your diet

If you want to make your diet more like the anti-inflammatory style of diet, here are our top tips:

Talk with your doctor and seek advice from an accredited practising dietitian.
Start small. You don’t have to change your entire diet at once if that seems overwhelming. Make small changes such as reducing the amount of processed foods you eat, eating more fruits and vegies each day, swap red meat for fish, lean chicken (skin-off), beans or lentils.
Get adventurous. There are a lot of websites that provide easy recipes that follow this type of eating plan. We’ve listed some in the More to Explore section.
Portion size is still important. Many of the plates we use, especially for dinner, are far too big. And we tend to fill them. The simple solution is to use a smaller plate. When dishing up your meals, imagine your plate is divided into quarters. Aim to fill two of those quarters (or half the plate) with colourful vegies or salad, one quarter with protein (fish, legumes, tofu, meat) and the last quarter with carbohydrate foods such as rice, noodles, potato or bread roll.
Exercise is also important. A healthy diet doesn’t work on its own. We also need to be active every day to maintain our weight, control our pain, improve our sleep and improve our mood and mental health.
Reduce your intake of:
o Sweet foods such as cakes and biscuits. Swap them for fresh, in-season fruit.
o Refined grains such as white rice and white bread. Swap them for whole grains.
o Trans-fats and saturated fats.
o Ultra-processed foods. These are foods that have gone through a LOT of processing and are far from their original state. They generally have salt, sugar, fat, additives, preservatives and/or artificial colours added.

Final words

At the end of the day, these diets are all about eating a variety of healthy foods. And as we come into warmer weather, these are the sorts of foods that make us happy, feel lighter and more energetic. So – if you’re not already – why not give it a go?

FIRST WRITTEN AND PUBLISHED BY LISA BYWATERS IN SEPT 2020

Call our Help Line

More to explore

Find an Accredited Practising Dietitian
Dietitians Australia
Anti-inflammatory diet do’s and don’ts
Arthritis Foundation (USA)
Health effects of a low-inflammatory diet in adults with arthritis: a systematic review and meta-analysis
Journal of Nutritional Science, 2020
How can changing my diet help my arthritis?
Versus Arthritis (UK)
Mediterranean diet recipes
Taste.com.au
The Mediterranean diet
Queensland Health
The messy facts about diet and inflammation
Scientific American, 2018
What’s the DASH diet?
Sanitarium

Reference

(1) I asked 8 researchers why the science of nutrition is so messy. Here’s what they said.
Vox, 2016

Lisa Bywaters

25/Oct/2023

Gardening, pain and musculoskeletal conditions

Gardening’s a wonderful way to get out in the fresh air and sunshine. It can also be extremely relaxing, and it’s often a good workout.

But if your condition sometimes impacts on your ability to garden, there are many things you can do so that you can still get into your garden and enjoy yourself.

Pace yourself – don’t try to do too much in one go. And take regular breaks. This’s a good opportunity to rest – but also to sit back and admire your work, contemplate what to do next, and imagine future gardening projects.
Contain it – use pots and other containers for small, manageable gardens. You can use regular garden pots or containers, or be creative and use other containers you have lying around – e.g. old wheelbarrows, teapots, colanders, tyres, boots. Check out Pinterest for some great ideas.
Create raised garden beds – this will take a bit more planning and work, but by raising your garden beds you can access them with less bending or kneeling. Perfect if you have a sore back, hips or knees.
Use thick handled tools – there are a wide range of thicker handled garden tools that are great if you have painful hands or difficulty gripping. You can also buy thick rubber or foam tubing from the hardware store, cut it to length and fit it over the handles of your existing gardening tools.
Use cushioned knee supports – knees pads, kneeling mats, or even gardening stools can help cushion and protect your knees and help you get up and down off the ground.
Get some help – whether it’s family, friends, or a local handyman or gardener, get some help if you have some big jobs that need doing – e.g. creating raised garden beds, pruning trees, mowing lawns. You don’t have to do everything yourself.
Keep hydrated – make sure you drink plenty of fluids. Gardening can be hot, strenuous work, so don’t let yourself become dehydrated. Keep a water bottle close by.
Talk with an OT – an occupational therapist can help you find ways to modify your activities to reduce joint pain and fatigue and save energy. They can also give you tips and ideas about different aids and equipment available.

These are just a few things you can do to stay active in the garden, so that you can get out in the fresh air and enjoy getting your hands dirty. If you love to garden, and have suggestions or tips for others, please let us know. We’d love to hear from you.

Originally written and published by Lisa Bywaters in May 2018.

Lisa Bywaters

24/Oct/2023

You know what it’s like. It’s 3.00am and you’ve just woken up. Again. You glance at your clock and do the maths – only 4 hours until it’s time to get up. This is really taking a toll on you – your mood, your performance at work, and your pain levels.

So what can you do?

Avoid using technology in bed. The blue light from laptops, tablets and smartphones suppresses the hormone melatonin, which makes us sleepy at night. So be sure to stop screen use at least one hour before bed.
Get out of bed. Don’t lie in bed tossing and turning. Have a warm drink (e.g. milk, no caffeine), do some gentle stretches or breathing exercises and go back to bed when you feel more comfortable.
Develop a sleep routine. There’s a reason we do this with babies and small children – it works! As often as possible, go to bed and get up at the same time each day. Your body will become used to this routine and you’ll find it’s easier to fall asleep and stay asleep.
Don’t look at the clock. Constantly checking the time can make you anxious, which makes it hard to sleep. Try removing your clock from the bedside, or cover it up at night.
Try some relaxation techniques. There are as many ways to relax as there are stars in the night sky (well, almost) so there’s bound to be something that suits you. Consider trying mindfulness, visualisation, deep breathing or a warm bath before bed. These techniques will help you become more relaxed and may help you manage your pain better so that when you go to sleep, you sleep well.
Be active during the day. As well as the many other benefits of regular exercise, it’ll help you fall asleep and stay asleep longer.
Seek help. If pain is constantly keeping you awake at night, talk with your doctor about other things you can do to manage your pain and get some decent sleep.

And check out our A-Z guide to managing pain. It’s full of tips and strategies to help you manage your pain.

First written and published by Lisa Bywaters in June 2018

Lisa Bywaters

24/Oct/2023

Medicinal cannabis and you

Marijuana, dope, pot, grass, weed, Mary Jane, doobie, bud, ganja, hashish, hash, wacky tobaccy…they’re just some of the common names for cannabis.

Whatever you call it, it’s been used for medicinal purposes for thousands of years, until it became a banned or controlled substance in most parts of the world.

But for decades there’s been renewed interest in its use in healthcare, with many countries – including Australia in 2016 – decriminalising it for medicinal use.

Last year alone the Therapeutic Goods Administration (TGA) granted over 25,000 applications from doctors to prescribe cannabis, mostly in the form of an oil.

So let’s weed out some of the facts and explore the use of medicinal cannabis for pain and musculoskeletal conditions.

Is it marijuana or cannabis?

It’s both. They’re just different names for the same plant – marijuana is the commonly used name, cannabis is the scientific name. The preferred name for its use in healthcare is medicinal cannabis, to draw the distinction between medicinal use of cannabis and the illegal, recreational use of marijuana.

The tongue twisters – cannabinoids

It’s a tough word to say – far harder than musculoskeletal! – but an important one when we talk about the properties of cannabis. Cannabinoids are the chemicals found in the cannabis plant. They bind onto specific receptors (CB1 and CB2) on the outside of our cells and can affect things like our mood, appetite, memory and pain sensation.

Cannabis has more than 140 cannabinoids. The two major ones are tetrahydrocannabinol (THC) and cannabidiol (CBD). THC is the cannabinoid linked with the sensation of feeling ‘high’ that’s associated with recreational marijuana use.

Cannabinoids also occur naturally in our body (endocannabinoids) and can also be created artificially (synthetic cannabinoids).

How’s it taken?

Medicinal cannabis, both plant-based and synthetic, comes in many forms including oils, capsules, oral sprays and vapours. Smoking isn’t an approved preparation as it can cause damage to the lungs and airways.

Does it work?

At the moment, evidence for its use to treat pain associated with arthritis and musculoskeletal conditions is lacking.

Cannabis has been illegal for so long that we don’t have the thorough, scientific evidence we need about: side effects, which cannabinoids (e.g. THC, CBD or a combination) may be effective, dosages, the best form to use (e.g. oil, capsules etc), the long-term effects, or the health conditions or symptoms it may be beneficial for. Research is emerging, but we need a lot more.

Because of this lack of research, the Australian Rheumatology Association doesn’t support the use of medicinal cannabis for musculoskeletal conditions. Their concern is that we don’t have enough info to ensure cannabis is safe and effective for people with musculoskeletal conditions.

The Therapeutic Goods Administration (TGA) has also stated that there’s “not enough information to tell whether medicinal cannabis is effective in treating pain associated with arthritis and fibromyalgia”.

Possible side effects

As with any medication – and medicinal cannabis is a medication – it can have side effects. They include: dizziness, confusion, changes in appetite, problems with balance and difficulties concentrating or thinking.

The extent of side effects can vary between people and with the type of medicinal cannabis product being used.

How do I access it?

Unfortunately it’s a complicated process. We aren’t at the stage where a doctor can just write a prescription that you can fill at any chemist. Medicinal cannabis is an unregistered medicine, which means your doctor must be an Authorised Prescriber or must apply for you to have access to it through the TGA’s Special Access Scheme.

But if it’s something you’d like to try, talk with your doctor about whether it’s a possible option for you. Together you can weigh up the risks and benefits for your specific situation.

You need to be aware that medicinal cannabis is not on the Pharmaceutical Benefits Scheme (PBS), so if you can access it, you’ll likely have to pay significant costs.

Another option for gaining access to medicinal cannabis is to consult a doctor at a specialised cannabis clinic. This also comes at a price, however it may be an option if your doctor isn’t an authorised prescriber or they’re not well-informed in the use and prescribing of medicinal cannabis.

Driving and medicinal cannabis

If you’re using medicinal cannabis it’s important that you know exactly what’s in it. If you’re taking a product that you’ve obtained through legal prescribers that only contains CBD, you can drive. However if you’re using a product that has any THC in it, whether on its own or in combination with CBD, you can’t drive. It’s currently a criminal offence to drive with any THC in your system.

Talk with your doctor and/or pharmacist for more information.

Interactions with other medications

As with any substance you ingest, there’s the potential for medicinal cannabis to interact with other medications and supplements you’re taking. So before prescribing medicinal cannabis, your doctor will review your current medications to reduce the risk of any negative effects.

However if while using medicinal cannabis you experience any unusual symptoms, discuss these with your doctor.

Finally

For many people the use of medicinal cannabis could be a long way off. And unlike the way it’s often portrayed in the media, it’s unlikely to be a panacea or magic bullet that will cure all ills.

It also won’t work in isolation – you’ll still need to do all of the other things you do to manage your condition and pain, including exercise, managing your weight, mindfulness, managing stress, pacing etc.

The important thing is to be as educated as you can and be open in your discussions with your doctor.

And be aware that cannabis for non-medicinal purposes is still illegal in Australia.

First written and published by Lisa Bywaters, Dec 2020.

For more detailed information about medical cannabis in Australia watch our webinar

Medicinal cannabis in Australia: Weeding out the facts
Dr Richard di Natale, outgoing Senator and former leader of the Australian Greens, and Prof Iain McGregor, Lambert Initiative for Cannabinoid Therapeutics, University of Sydney discuss the use of medicinal cannabis in Australia – what it is, available forms, access issues in Australia and the current evidence for use.

Call our Help Line

If you have questions about things like managing your pain, your musculoskeletal condition, treatment options, COVID-19, telehealth, or accessing services be sure to call our nurses. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

More to explore

Medicinal cannabis to manage chronic pain? We don’t have evidence it works
The Conversation, 23 March 2021
Current barriers to patient access to medicinal cannabis in Australia
Australian Government, March 2020
Medicinal cannabis products: Information for consumers
Therapeutic Goods Administration, September 2020
Medicinal cannabis explained
National Prescribing Service
Lambert Initiative for Cannabinoid Therapeutics
The University of Sydney
Medicinal cannabis
Alcohol and Drug Foundation, October 2020
ARA Position Statement on the use of medicinal cannabis for musculoskeletal pain
Australian Rheumatology Association, November 2016

Lisa Bywaters

04/Oct/2023

If you’ve been experiencing persistent joint or muscle pain, stiffness and/or inflammation that you can’t explain (e.g. from a fall or strenuous physical activity), you should discuss your symptoms with your general practitioner (GP).

Many conditions can cause these symptoms, so to work out what’s causing your symptoms, your GP will:

Take your medical history. They’ll ask you about your symptoms, when they started, how they affect you, your family medical history and other health issues you may have.
Do a physical examination. They’ll look for redness and swelling in and around the joint and test your joint’s range of movement. They may also look for rashes, check your eyes and throat, and take your temperature.
Order scans and other tests. Depending on the condition your GP thinks you might have, they may send you for tests to check for levels of inflammation in your blood or specific genetic markers. You may also have scans such as x-rays, ultrasound or CT (computed tomography) to get a clearer picture of what’s happening inside your body.

When your GP has gathered all of this information, they may refer you to a rheumatologist.

Rheumatologists are doctors who specialise in diagnosing and treating problems with joints, muscles, bones and the immune system. You need a referral from your GP to see a rheumatologist, whether they’re in private practice or a public hospital outpatient clinic.

Your GP may refer you to a rheumatologist if:

they think you have, or they’ve diagnosed you with, an inflammatory type of arthritis such as rheumatoid arthritis or ankylosing spondylitis, so that treatment can be started as soon as possible
your symptoms improve with treatment but come back when you stop taking medicine
your symptoms don’t respond to treatment or get worse over time
you develop unexpected complications, such as a fever, rash, or fatigue
you have unusual test results.

Preparing for your first consultation

When you make an appointment to see a rheumatologist, you should ask them some questions so that you’re prepared. This may include:

What do I need to bring with me?
How much will my out-of-pocket expenses be?
How long will my appointment be?
Is there parking available, or accessible public transport?

Armed with this information, you can be proactive and prepare for your consultation.

It can be helpful to make notes about your symptoms – when you first noticed they appeared, how they affect you day-to-day – as well as other health conditions you have, medicines or supplements you take regularly and information about your family medical history.

It’s also helpful to write down questions you want to ask your rheumatologist. Put them in order of the most important first, in case you don’t get through your entire list.

Your consultation

Seeing a specialist can sometimes be overwhelming, especially if you’re feeling unwell or anxious. There can also be a lot of information to absorb. That’s why it can be helpful to bring a family member or a friend to your appointment. They can provide emotional support, help you ask questions or write down any important information. They can also be a second set of ears to hear what the specialist says and help you recall this information later. It can be hard to remember everything, especially when you’re feeling anxious.

Wear comfortable clothing that can be easily adjusted or removed if necessary, so that the rheumatologist can examine you.

And don’t forget your referral, x-rays, scans and other test results, your list of questions and any other bits and pieces you were asked to bring!

Your first consultation with your rheumatologist will be more thorough than your consultation with your GP. They’ll:

review your medical history
ask lots of questions about your symptoms, such as when you’re most stiff or sore, and how long you’ve had pain and symptoms
do a comprehensive examination of your joints, including counting the number of tender and swollen joints
refer you for further blood tests and imaging if required.

It’s important to know that there are many different types of musculoskeletal conditions, and many have similar symptoms. So it can take time to get a diagnosis. Your rheumatologist may provide you with a prescription for medicines and suggest some self-care options that you can do while you wait for your diagnosis.

Follow-up consultations

Once your diagnosis has been made, your rheumatologist will provide you with information about your condition and a treatment plan.

Your treatment plan will fit your specific symptoms, needs and preferences. However, it will usually involve a combination of:

self-care and lifestyle changes, such as regular exercise, weight management, improving sleep and quitting smoking.
medicines to reduce inflammation, control pain, and prevent joint damage.

Depending on your diagnosis, you may need regular consultations with your rheumatologist.

How often they occur will depend on your condition, how well it’s responding to treatment and the medicines you’re taking, as some specialised medicines can only be prescribed by a rheumatologist. Some people see a rheumatologist regularly, while others are mainly treated by their GP, with the rheumatologist on hand for specialist advice. Some consultations with a rheumatologist may be done via telehealth.

Follow-up consultations are generally shorter than your initial one. Your rheumatologist will talk with you about how you’ve been doing since you began treatment. They’ll assess how well you’re responding to treatment and if you need to change your medicines or add additional ones. They’ll also do a physical exam and order any further blood tests or imaging if required.

Your rheumatologist will also talk with you about your self-care and other things you can do to manage your condition.

It’s important to take an active role in these consultations. Ask questions, and if you don’t understand the answers, ask them to explain further or for more information. Talk with your rheumatologist about your goals for treatment – they may be things like reducing pain and fatigue, but also more personal goals such as getting back to playing golf regularly or planning an overseas trip. Together you can ensure your treatment plan supports your goals.

Ongoing care

The aim of treatment for musculoskeletal conditions is low or no disease activity. This is called remission. It doesn’t mean your condition has been cured, but your treatments keep it under control.

With the significant advancements we’ve had in medicines in the past few decades and targeted treatments for many types of musculoskeletal conditions, achieving remission can be a real possibility.

If you achieve remission, your rheumatologist may reduce the dosage and/or frequency of the medicines you’re taking. They’ll monitor you to see how you’re doing and make changes as required. And you won’t need to see them as often.

If you haven’t achieved remission, the aim will be to control your condition and its effects on your body and life as much as possible. This will determine how often you need to see your rheumatologist in the future.

Costs

The cost to see a rheumatologist varies. Part of the cost is subsidised by Medicare, but there is usually a gap payment that you’ll need to make. When making an appointment, ask about out-of-pocket costs.

If you have a Medicare card, you may be able to attend a rheumatology clinic at a public hospital if you cannot afford out-of-pocket expenses to see a rheumatologist privately. Talk with your GP about your options.

Contact our free national Help Line

Call our nurses if you have questions about managing your pain, musculoskeletal condition, treatment options, mental health issues, COVID-19, telehealth, or accessing services. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

More to explore

3 tips to make the most of your first rheumatology appointment
Cleveland Clinic
How to prepare for your next rheumatologist visit
HealthLine
What is a rheumatologist?
American College of Rheumatology
Your rheumatology healthcare team
Australian Rheumatology Association

First written and published by Lisa Bywaters in May, 2022.

Lisa Bywaters

04/Oct/2023

We talk about inflammation a lot. But what is it? What’s happening in your body when you have inflammation?

Acute and chronic inflammation

There are two types of inflammation – acute and chronic.

Acute inflammation

Acute inflammation is your body’s reaction to things such as an infection (e.g. a cold or infected wound) or an injury (e.g. a sprained ankle or bee sting).

Symptoms associated with acute inflammation are:

pain
redness
swelling
heat
loss of function (e.g. difficulty moving a swollen ankle after spraining it or difficulty breathing through your nose when you have a cold).

What’s happening in your body with acute inflammation?

When you sprain your ankle, or get an infection, your immune system automatically springs into action.

Cells close to the source of the injury or infection release chemicals known as inflammatory mediators (e.g. histamine). They increase blood flow to the area, widening blood vessels and allowing more blood to reach the injured tissue. As a result, the area becomes red and feels hot.

The extra blood to the area enables more immune cells to reach the injured tissue. This includes white blood cells, or leukocytes, whose role it is to defend your body against infections and disease and start the healing process.

Depending on the cause, acute inflammation can occur quickly and generally goes away quickly.

Chronic inflammation

Chronic inflammation is persistent, low-level inflammation that lasts for months or years. With chronic inflammation, the inflammatory process often begins when there’s no injury or illness present; and it doesn’t end when it should. When this happens, white blood cells may target and damage nearby healthy tissues and organs.

We don’t really know why chronic inflammation occurs. It doesn’t seem to serve a protective purpose as acute inflammation does.

However researchers have identified factors that increase your risk of developing chronic inflammation, including:

chronic infections
physical inactivity
poor diet
obesity
imbalance of gut bacteria
disturbed sleep
smoking
stress
ageing.

Many people don’t know they have chronic inflammation, but they may feel symptoms such as:

body and joint pain
fatigue and insomnia
weight gain or loss
frequent infections
depression, anxiety and mood disorders
digestive problems (e.g. constipation, diarrhoea, acid reflux)
skin rashes.

Chronic inflammation is associated with many diseases, such as rheumatoid arthritis, lupus, heart disease, diabetes, cancer, and bowel diseases like Crohn’s disease and ulcerative colitis.

If you’re concerned about chronic inflammation and have symptoms like those above that have been troubling you for some time, see your doctor . They’ll talk with you about your symptoms, do a physical exam, and may decide that blood tests are necessary to look for signs of inflammation.

The blood test will look for elevated C-reactive protein (CRP), which rises in response to inflammation.

Inflammation is helpful until it’s not

It’s important to remember that inflammation isn’t inherently bad. Acute inflammation serves a vital role in our health and survival. It helps us recover from injury and infection. However, when it’s chronic, it can negatively affect our health.

Always talk with your doctor if you have symptoms that are distressing you or making you feel unwell.

Contact our free national Help Line

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This article was first written and published by Lisa Bywaters in April, 2022.

Lisa Bywaters

02/Oct/2023

It occurred to me today that I really don’t understand as much about my condition as I should. I see my doctor regularly, I take my meds, exercise and manage my pain as best as I can.

But I actually don’t understand exactly what’s happening to my body at the basic level. How my condition works, progresses, and the nitty gritty of potential causes.

Don’t get me wrong, I don’t want to know the cellular level stuff – though some of you may want to know that – I just think I should know more, so that I can make informed decisions and play a more active role in the management of my health.

So where to start?

There’s information everywhere and it can be overwhelming. It can sometimes be difficult to work out what information is good and helpful, and what information is wrong, misleading and even dangerous.

As a general rule, libraries, your health professionals, peer support groups, reputable websites/social media sites and peak organisations like Musculoskeletal Australia can give you great information to help you learn about, and understand, your condition.

And the information they provide will help in different situations. For example, your doctor can provide evidence-based information about your condition and treatment options, whereas members of a peer support group can give you practical information about the experience of living with a chronic condition.

I also find that asking lots of questions and being sceptical is key. The information you get – from any source – could potentially affect your health, so you should be cautious.

Some questions I ask when looking at new health information:

Who wrote/gave me the information? Do they have the proper qualifications?
Where does the information come from? Does it have the scientific evidence to support it?
Is the information balanced? Does it give me a variety of options, or provide only one?
Does the information provide links to scientific evidence? Or does it only use personal anecdotes from satisfied customers or celebrity endorsements?
Is the information up-to-date?
Is the information regularly reviewed and updated?

Information is power. So use it to take control over your health and your body.

And if you get confused about any information you find, talk with your doctor. You can also contact our National Arthritis and Back Pain+ Help Line on 1800 263 265 for information and support.

“Information can bring you choices and choices bring power – educate yourself about your options and choices. Never remain in the dark of ignorance.” – Joy Page

Originally written and published by Lisa Bywaters in 2018

Karla Wignall

06/Sep/2023

Let’s take advantage of the warmer days and and look at how we can sweep away the winter cobwebs and make ourselves sparkle this spring!

Unplug. We’re always connected these days, immersed in the news, social media, video chats, work/school, and phone calls. We’re never far away from a phone, tablet or computer – and we need to step away. Schedule time to put it all aside: perhaps after dinner, or for an hour during your day, or for your entire Sunday. Whatever works for you and your commitments. Just make sure you take some time away from the digital world, step outside and breathe in the fresh, sweet-smelling spring air.
Say no. We’re wired to want to please others, so we often find it difficult to say no. But that can make us become overwhelmed and stressed with the number of commitments we have. That’s why we need to look after ourselves and start saying no. The next time someone asks you to do something, give yourself a moment. Don’t answer immediately with an automatic ‘yes’. Ask yourself if this is something you want to do. Are you able to do it – physically and mentally? Do you have the time to do it? Will it bring you happiness? If you answered no to these questions, then you should say no to the request. You may disappoint some people, and they may be a little unhappy with you. But you need to be true to who you are and stand firm. And don’t feel the need to give detailed reasons for saying no. Saying no is really hard, but it will become easier.
Change your routine. Do you feel like you’re stuck in a rut? I know it feels like Groundhog Day at times! So look at your routine. What can you change? Take your work/school commitments out of the equation for now. Do you spend your evenings on the couch? Or weekends doing the same old things? Stop and really think about what you would actually ‘like’ to do with your free time. Go for a bike ride? Take up painting? Visit a new place each week? Find things that you enjoy, and fill you with anticipation and happiness, and do them. Now think about your work routine. There may not be things you can change about work – but why not put on your favourite outfit/earrings/shoes/lipstick – even if you’re working from home. Or use some new stationary or bit of tech. It’s amazing how these small changes give us a mental boost.
Focus on the basics – eat well, move, sleep – repeat. This time of the year we have access to amazing fresh produce that’s just crying out to be made into delicious salads and stir fries. The days are getting longer and warmer so we can get outside more for our exercise. We can shed the heavy blankets and adjust our sleep habits. There’s never been a better time than now to focus on these basics and make improvements if needed. And finally, make sure you’re staying hydrated by drinking enough water each day.
Surround yourself with positive, upbeat people. Positivity and happiness is contagious. These people will inspire you, make you feel good about yourself and the world in general. Too much contact with negative people (in person and via social media) does the opposite and makes the world a gloomy place. So seek out the happy, positive people and enjoy their company. And if you can, ditch the negative people.
Take some time out to relax. Try strategies like mindfulness, visualisation and guided imagery. Or read a book, listen to music, walk the dog, create something, play a computer game, have a bubble bath or massage. Whatever relaxes you. And make sure you do these things on a regular basis. They’re not an indulgence – they’re a necessity and vital to our overall happiness and wellbeing.
Let’s get serious – sugar, fats, alcohol and drugs. Many of us seek comfort in sugary and/or fatty foods more than we’d like. Or we’ve been using alcohol and/or drugs to make us feel better. Over time this becomes an unhealthy habit. So it’s time to get serious. Ask yourself if your intake of these things has changed or increased? If it has – what do you need to do to fix this? Can you decrease their use by yourself? Or do you need help from your family, doctor or other health professional? The sooner you acknowledge there’s a problem, the sooner you can deal with it.
Nurture your relationships. It’s easy to take the people around us for granted, but these people support and care for us day in and day out. They deserve focused time and attention from us. So sit down and talk with your kids about their day. Make time for a date night with your partner and cook a special meal to share together. Call or visit your parents and see how they’re really doing. Reminisce with your siblings about childhood antics and holidays. Our relationships are the glue that holds everything together for us – so put in the effort. You’ll all feel so much better for it.
Quit being so mean to yourself. You’re valued and loved. But sometimes we forget that. And the negative thoughts take over. “I’m fat”, “I’m hopeless”, “I’m lazy”, “I’m a burden”. If you wouldn’t say these things to another person, then why are you saying them to yourself? Ask yourself why you even think these things? And how can you reframe these thoughts? If, for example, you tell yourself you’re fat – are you actually overweight or are you comparing yourself to the unrealistic media image of how a person should look? And if you do know you need to lose weight, and want to make that happen, put those steps in motion. Talk with your doctor for some guidance and help. And congratulate yourself for taking action. And as you make these changes be kind to yourself along the journey. There will be stumbles, but that’s expected. You can pick yourself up and move on. Kindly.
Throw away the ‘should’s. This is similar to the negative self-talk…we need to stop should-ing ourselves to death. This often happens after we’ve been on social media and seen someone’s ‘amazing’ life. You start thinking “I should be better at X”, “I should be doing X”, “I should be earning X”, “I should look like X”. Remember that most people only put their best images on social media, so everyone’s life looks wonderful. But you’re just seeing the superficial, filtered person, not the whole, and they probably have just as many insecurities as the rest of us. Instead of thinking “I should…”, be grateful for who you are and what you have.
Be thankful and grateful. You exist! And yes, the world is a strange and sometimes frightening place at the moment, but you’re here to see it. People love and care for you. Focus on the people in your life and the things you’re grateful to have in your life. Celebrating these things – both big and small – reminds us why we’re here. To bring joy and happiness to those around us, and to make the world a better place.

(Originally written and published by Lisa Bywaters 2020).

Call our Help Line

If you have questions about things like managing your pain, your musculoskeletal condition, treatment options, telehealth, or accessing services be sure to call our nurses. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

More to explore

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Karla Wignall

06/Sep/2023

Neck pain is a common problem many of us will experience at least once in our lives. The good news is that most cases of neck pain get better within a few days.

So what is neck pain? What causes it, and how can you manage it and get on with life?

Let’s start with a look at your spine

It helps to know how your spine works to understand some of the potential causes of neck pain.

Your spine (or backbone) is made up of bones called vertebrae, stacked on top of each other to form a loose ‘S’-shaped column.

Your spinal cord transports messages to and from your brain and the rest of your body. It passes through a hole in each of the vertebrae, where it’s protected from damage. It runs through the length of your spinal column.

Each vertebra is cushioned by spongy tissue called intervertebral discs. These discs act as shock absorbers. Vertebrae are joined together by small joints (facet joints), which allow the vertebrae to slide against each other, enabling you to twist and turn. Tough, flexible bands of soft tissue (ligaments) also hold the spine in position.

Layers of muscle provide structural support and help you move. They’re joined to bone by strong tissue (tendons).

Your spine is divided into five sections: 7 cervical or neck vertebrae, 12 thoracic vertebrae, 5 lumbar vertebrae, 5 fused vertebrae in your sacrum and 4 fused vertebrae in your tailbone (or coccyx) at the base of your spine.

So what’s causing the pain?

It’s important to know that most people with neck pain don’t have any significant damage to their spine. The pain they’re experiencing often comes from the soft tissues such as muscles and ligaments.

Some common causes of neck pain are:

muscle strain or tension – caused by things such as poor posture for long periods (e.g. hunching over while using a computer/smartphone or while reading), poor neck support while sleeping, jerking or straining your neck during exercise or work activities, anxiety and stress.
cervical spondylosis – this arthritis of the neck is related to ageing. As you age, your intervertebral discs lose moisture and some of their cushioning effect. The space between your vertebrae becomes narrower, and your vertebrae may begin to rub together. Your body tries to repair this damage by creating bony growths (bone spurs). Most people with this condition don’t have any symptoms; however, when they do occur, the most common symptoms are neck pain and stiffness. Some people may experience other symptoms such as tingling or numbness in their arms and legs if bone spurs press against nerves. There can also be a narrowing of the spinal canal (stenosis).
other musculoskeletal conditions such as osteoarthritis, rheumatoid arthritis, fibromyalgia, osteoporosis.
herniated disc (also called a slipped or ruptured disc). This occurs when the tough outside layer of a disc tears or ruptures, and the soft jelly-like inside bulges out and presses on the nerves in your spine.
whiplash – this is a form of neck sprain caused when the neck is suddenly whipped backward and then forward. This stretches the neck muscles and ligaments more than normal, causing a sprain. Whiplash most commonly occurs following a car accident and may occur days after the accident.

Symptoms

The symptoms you experience will depend on what’s causing your neck pain but may include:

pain and/or stiffness in the neck and shoulders
pain when moving
difficulty turning your head
headache.

In most cases, neck pain goes away in a few days. But if your pain doesn’t get better, or you develop other symptoms, you should see your doctor.

Or you can answer a few questions in the neck pain and stiffness symptom checker by healthdirect to find out if you need medical care. Simply click on ‘N’ and select ‘neck pain and stiffness’.

Seeing your doctor

If you need to see your doctor because of your neck pain, you can expect a discussion about potential causes or triggers of your pain, whether you’ve had neck pain before, things that make your pain worse, things that make it better. Your doctor will also conduct a thorough physical exam.

This discussion and examination by your doctor will decide whether more investigations (e.g. x-rays, CT or MRI scans) are appropriate for you. However, these tests are generally unhelpful to find a cause of the pain unless there’s an obvious injury or problem (e.g. following an accident or fall). It‘s also important to know that many investigations show ‘changes’ to your spine that represent the normal passage of time, not damage to your spine.

Often it’s not possible to find a cause for neck pain. However, it’s good to know that you can still treat it effectively without knowing the cause.

For more information about questions to ask your doctor before getting any test, treatment or procedure, visit the Choosing Wisely Australia website.

Dealing with neck pain

Most cases of neck pain will get better within a few days without you needing to see your doctor. During this time, try to keep active and carry on with your normal activities as much as possible.

The following may help relieve your symptoms and speed up your recovery:

Use heat or cold – they can help relieve pain and stiffness. Some people prefer heat (e.g. heat packs, heat rubs, warm shower, hot water bottle), others prefer cold (e.g. ice packs, a bag of frozen peas, cold gels). Always wrap them in a towel or cloth to help protect your skin from burns and tissue damage. Don’t use for longer than 10 to 15 minutes at a time, and wait for your skin temperature to return to normal before reapplying.

Rest (temporarily) and then move. When you first develop neck pain, you might find it helps to rest your neck, but don’t rest it for too long. Too much rest can stiffen your neck muscles and make your pain last longer. Try gentle exercises and stretches to loosen the muscles and ligaments as soon as possible. If in doubt, talk with your doctor.

Sleep on a low, firm pillow – too many pillows will cause your neck to bend unnaturally, and pillows that are too soft won’t provide your neck with adequate support.

Be aware of your posture – poor posture for extended periods, for example, bent over your smartphone, can cause neck pain or worsen existing pain. This puts stress on your neck muscles and makes them work harder than they need to. So whether you’re standing or sitting, make a conscious effort to be aware of your posture and adjust it if necessary, or do some gentle stretches.

Massage your pain away – massage can help you deal with your physical pain, and it also helps relieve stress and muscle tension. You can give yourself a massage, see a qualified therapist or ask a family member or friend to give you a gentle massage.

Take time to relax – try some relaxation exercises (e.g. mindfulness, visualisation, progressive muscle relaxation) to help reduce muscle tension in your neck and shoulders.

Try an anti-inflammatory or analgesic cream or gel – they may provide temporary pain relief. Talk with your doctor or pharmacist for advice.

Use medication for temporary pain relief – always follow the instructions and talk to your doctor about alternatives if you find they don’t help.

Treating ongoing neck pain

Sometimes neck pain lasts longer than a few days, and you may have ongoing neck pain. There are things you can do to manage this:

See your doctor if the pain is worse or if you have other symptoms in addition to your neck pain such as numbness, pins and needles, fever or any difficulty with your bladder or bowel.
See a physiotherapist or exercise physiologist – they can provide you with stretching and strengthening exercises to help relieve your neck pain and stiffness.
Injections – some people with persistent neck pain may benefit from a long-acting steroid injection into the affected area. Talk with your doctor about whether this is right for you.
Surgery – is rarely needed for neck pain. However, it may be required in cases where severe pain interferes with daily activities, or the spinal cord or nerves are affected.

(Originally written and published by Lisa Bywaters 2022)

Contact our free national Help Line

If you have questions about managing your pain, your musculoskeletal condition, treatment options, mental health issues, COVID-19, telehealth, or accessing services be sure to call our nurses. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

More to explore

Neck pain
healthdirect
Neck pain
Versus Arthritis
Patient education: Neck pain (The Basics)
UpToDate
Patient education: Neck pain (Beyond the Basics)
UpToDate
Neck pain or spasms: self-care
MedlinePlus

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