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    Lisa Bywaters
    02/Jul/2020
    Health InformationMSK articles

    Masks – revisited

    This article was written a week before Melbourne and Mitchell Shire in Victoria resumed Stage 3 restrictions from 11.59pm 8 July 2020.

    We’ve updated it as information has changed for different parts of Australia. Latest update 30 July 2020

    Another week, another edit.

    “The advice from the Victorian Department of Health and Human Services has been updated. People living in metropolitan Melbourne and Mitchell Shire and will now be required to wear a face covering when leaving home for one of the four reasons, following a concerning increase in coronavirus cases in recent days. To give people time to purchase or make a face covering, this new rule won’t be enforced until after 11.59pm on Wednesday 22 July – but for those who can, please start wearing yours immediately. The fine for not wearing a face covering will be $200.”(1) 

    • All people in regional Victoria will be required to wear a face covering from 11.59 Sunday 2 August 2020.
    • NSW now recommends people wear a mask when physical distancing can’t be guaranteed.(8)

     

    Just as restrictions began easing across Australia, Victoria started recording outbreaks of COVID cases. For more than two weeks the number of Victorians infected has been in the double-digits. And on Wednesday many suburbs in Victoria were locked down to stop the spread of the virus.

    So if you’re immunosuppressed and feeling really vulnerable no one can blame you. This is a scary time, and having a condition or taking medication that makes you more at risk of getting ill from any contagion or infection, adds another level to this.

    Although, we’re being advised to stay at home as much as possible, sometimes we just have to go outside the house. Some of us can’t work from home, or we have an appointment that can’t be done online or via video chat, or we have to use public transport.

    So how do we protect ourselves when we have to go out?

    Three months ago we wrote a blog about face masks. We thought it was timely to revisit this blog in light of the latest evidence, and advice from the Federal and Victorian Governments.

    The advice from the Federal Government

    This information is general advice about the use of face masks in Australia. It’s important to note that the advice from your local state or territory health department supersedes any general advice about face masks and coverings.

    “In Australia the routine use of face masks in the community is currently not recommended, while the rate of community transmission of COVID-19 is low.” (2)

    “However, some members of the public may choose to wear a mask in situations where it is not feasible to maintain physical distancing e.g. on public transport and/or if they are at increased risk of severe illness if infected (e.g. because of their age or a chronic medical condition). This may provide some additional protection in these circumstances.” (3)

    This advice takes into account the fact that restrictions are easing, and people are going out more. And with the opening up of our communities, the risk of coming into contact with people who have the virus, whether they appear to have it or not, is increased.

    The advice also reinforces the message that masks aren’t a substitute for all the other things we’ve been doing: staying at home as much as possible, physical distancing, washing/disinfecting our hands regularly, not touching our face, coughing/sneezing into our elbow and staying home when we’re sick.

    The advice from the Victorian Government

    Parts of Victoria are currently experiencing significant outbreaks of COVID-19. For that reason the recommendations about face masks have changed.

    The Victorian Premier Daniel Andrews and Chief Health Officer Brett Sutton have advised that it will be mandatory from 11.59pm on Wednesday 22 July 2020 that people living in metropolitan Melbourne and Mitchell Shire must wear a face covering when leaving home for one of the four reasons, following a concerning increase in coronavirus cases in recent days.

    People in regional Victoria will be required to wear a face covering from 11.59 Sunday 2 August 2020. That means that it will mandatory for ALL Victorians to wear a face covering when they go outside of their homes from next Monday.

    What type of face covering?
    If you haven’t been able to get a surgical or cloth mask, Premier Andrews has said: “It need not be a hospital-grade mask. It need not be one of the handmade masks … it can be a scarf, it can be a homemade mask.” He admits “nothing is perfect” and a “face covering is just as good”. (4)

    What else do you need to know? 

    • Wearing a face covering protects you and your community by providing an additional physical barrier to COVID-19.
    • Keeping 1.5 metres between yourself and others and washing your hands are still the best defences against COVID-19.
    • There will be some reasons not to wear a face covering. For example, those who have a medical reason, kids under 12 years of age, those who have a professional reason or if it’s just not practical, like when running. However you’ll still be expected to carry your face covering at all times to wear when you can.
    • The fine for not wearing a face covering will be $200.
    • Face coverings in regional Victoria continue to be recommended in situations where maintaining 1.5 metres distance is not possible – however regional Victorians will have to wear a mask when visiting metropolitan Melbourne or Mitchell Shire for one of the permitted reasons. (4)
    • Read the full Department of Health and Human Services update.

    The advice from the New South Wales Government

    The NSW Government now recommends wearing a mask if it’s difficult to stay 1.5 metres away from other people. For example, on public transport, when caring for vulnerable people or when indoors.

    Find out more on the NSW Government website.

    The evidence for using face masks

    Up until recently the evidence for the use of face masks to protect against COVID-19 has been conflicting. But over the last several months the evolving evidence has come down firmly on the side of wearing masks.

    Many people cite an article published in The Lancet in June 2020 as the turning point in the debate for wearing masks in public. It provided robust evidence for the benefits of face masks. It reported on a systematic review and meta-analysis that investigated a range of measures used to prevent person-to-person virus transmission. It looked at physical distancing, eye protection and the use of face masks.

    Researchers analysed hundreds of studies involving SARS-CoV2 (the virus that causes COVID-19), as well as SARS (severe acute respiratory syndrome) and MERS (Middle East respiratory syndrome), across 16 countries in healthcare and non-healthcare settings, including more than 25,000 people.

    They conclude that “wearing face masks protects people (both healthcare workers and the general public) against infection by these coronaviruses”. (5)

    However the authors also state that “none of these interventions offers complete protection and other basic protective measures (such as hand hygiene) are essential to reduce transmission.” (6)

    While there were several limitations with this study, it does provide good evidence for the use of masks by the general public.

    So if you choose (or are required) to wear a mask there are some things to keep in mind:

    • Follow the latest guidelines from your state/territory health department. There’s no ‘one size fits all’ when it comes to face masks or coverings in Australia.
    • Don’t let wearing a mask give you a false sense of security. Masks will provide some level of protection – depending on what they’re made of, how porous the fabric is, how well you use them – but they’re not a magical, virus-repelling shield (though how cool would that be?)
    • Use masks correctly:
      • Wash or sanitise your hands thoroughly before you put a mask on and when you take it off.
      • Only touch the mask by the straps.
      • Make sure it covers your nose and mouth and fits snugly under your chin, over the bridge of your nose and against the sides of your face.
      • Don’t touch the front of the mask when you wear it. That means no pulling it down to talk to someone, to eat or drink or to smoke a cigarette.
      • And don’t touch the front of the mask when you remove it. If you do accidentally touch it, wash or sanitise your hands immediately.
        Basically imagine the front of your mask is covered in something messy or gross – like paint or a virus (!) – that you don’t want to get all over yourself and the things you touch (e.g. your phone, your kids).
    • If it’s a disposable, single use mask, only use it once and then dispose of it properly.
    • If it’s a cloth mask, wash it thoroughly in warm, soapy water and allow it to dry properly before you use it again.
    • Don’t wear a mask if you have breathing difficulties or when you’re exercising strenuously.
    • Don’t put a mask on a baby or small child.
    • Replace the mask if it gets damp or wet, or if you sneeze inside it.

    The World Health Organization (WHO) has some great videos to help you learn how to use a mask correctly.

    And finally, remember to keep doing all the other important things: stay home when you can, wash your hands regularly and thoroughly, use hand sanitiser when you don’t have access to soap and water, physically distance yourself from others, cough and sneeze into your elbow and stay at home and get tested if you feel even the slightest bit unwell.

    Stay safe and be kind.

    Contact our free national Help Line

    If you have questions about things like COVID-19, your musculoskeletal condition, treatment options, telehealth, managing your pain 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

    References

    (1, 5)  Face coverings mandatory for Melbourne and Mitchell Shire
    Victorian Department of Health and Human Services, 19 July 2020

    (2-3) Use of masks by the public in the community
    Australian Government Department of Health, updated 11 June 2020

    (4) Face masks will be mandatory in Melbourne and Mitchell Shire to combat coronavirus. What about regional Victoria? Do children need to wear them?
    ABC News, 19 July 2020

    (6-7) Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis
    The Lancet, 1 June 2020

    (8) Face masks
    NSW Government, 28 July 2020

     

    Photo by visuals on Unsplash

    CONTINUE READING
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    Lisa Bywaters
    02/Jul/2020
    Health InformationMSK articles

    Losing the COVID kilos

    An article in the news this week caught my eye and really struck a chord. I don’t know about you, but the period of isolation has seen me gain a little more weight than I’m happy with

    Having more time to cook and create, stress eating, the return of Masterchef (Go Poh!) and not being as physically active as we were before COVID…not to mention the snacking, cocktail hour and a whole bunch of other factors has caused many of us to gain weight during iso.

    Apart from the many health issues associated with being overweight (e.g. heart disease, diabetes, high blood pressure) it’s also linked to increased pain and joint damage due to the increased stress on your joints. It can also affect your ability to be as active as you’d like, which can lead to more pain, musculoskeletal issues and weight gain. We also know that fat releases molecules that increase inflammation throughout your body.

    Clearly maintaining a healthy weight is important.

    So if, like me, you want to lose some of the weight you’ve gained during the last few months, we can do it! We can turn this around. It may be a challenge and take some time, but we can lose the COVID kilos.

    • Start with a goal. It really does help if you have a clear goal in mind. Just the idea of losing weight isn’t a goal, but a specific, measurable plan – for example – losing 5 kilos in 8 weeks is. So make sure your goal is SMART – specific, measureable, achievable, realistic and has a timeframe. Read our blog on setting goals for more info. When you’ve created a goal that suits your specific wants and needs, write it down and put it somewhere prominent. It’s a great visual to help you stay on track, and remind you of why you started.
    • Keep track. It’s helpful when you’re trying to get back into a healthy routine to write down what you’re eating. You can use a simple notepad or download an app. Whatever format you choose, make sure you use it. Add every little thing you eat and drink, how much you’re consuming and when. Keeping track of your food intake really helps you see if your diet is balanced and it can help you spot any trends as far as snacking, serving sizes etc. That’ll help you adjust things if you need to.
    • Eat a balanced diet that includes a colourful variety of foods, such as fruits, vegetables, whole grains, dairy products, proteins and healthy fats. This gives your body the energy and nutrients it needs to work properly, helps you maintain a healthy weight, helps protect you against other health conditions and is vital for a healthy immune system.
    • (Re)Establish a routine. If you had a healthy diet and exercise routine pre-COVID, reestablish it. It may not be exactly the same, but if you had it once, you can do it again. Look at what’s changed for you over these last few months, how it’s affected your diet and exercise, and what things you need to do to get things working again for you in this new world. If you didn’t have a good routine before COVID, now’s the perfect time to get one. Think about your typical weekday (weekends will have a slightly different routine), what you need to fit into your day including your family, work and other commitments. Write it all down and think about how you can establish a routine that works for you. Think about when you’ll work on creating healthy meal plans, when you’ll shop for ingredients, when you’ll cook, and when you’ll exercise. If you break it down into the small tasks, it makes it easier to fit into your schedule. This may take some trial and error, but it’s worth the effort.
    • Get the family involved. Whether you have family living with you, or they’re in another location, get them involved. They’ll be your cheer squad, but they may also benefit from a little TLC when it comes to their diet and exercise. You can support each other, work through problems together, share recipes and ideas.
    • Exercise. Obviously. Make sure exercise is part of your everyday routine. It’s important to help manage your musculoskeletal condition, pain, mental health, weight, sleep – and so many others things.
    • Get a good night’s sleep. Research has shown a clear link between not getting enough sleep and weight gain. Poor sleep is also linked to difficulties losing weight. As many people with musculoskeletal conditions struggle with sleep, this is yet another reason to really look at how you can improve your sleep quality and quantity. And if you need help, talk with your doctor.
    • Eat mindfully. This involves taking the time to be aware of what you’re cooking and eating – savour the tastes, the smells, the textures. Be present while you eat, and try not to be distracted by things like the work, TV and other devices. Don’t hurry, eat small bites, take your time and enjoy.
    • Distract yourself. Sometimes we eat not because we’re hungry, but because we’re bored, sad, lonely or upset. Before you eat something outside of meal times, ask yourself why you’re reaching for that food. Do you actually feel hungry? Or is there another reason? If you’re not hungry, distract yourself with a walk, call a friend, drink a glass of water (not wine! – many of us are overdoing that too – see below).
    • Choose snacks wisely. I’m not a chocoholic, but somehow it’s been finding its way into my cupboard on a regular basis. It’s easy for this sort of thing to become a habit, so be mindful of what you’re snacking on and how often. If you’re snacking on less healthy options like high fat, high sugar or high salt treats, substitute them for healthy options such as fruit, vegetables, nuts, yoghurt. But be aware of the serving size and the frequency. You can have too much of a good thing! And save the treats for when you can really savour them. When you only eat them occasionally you’ll enjoy them even more.
    • Acknowledge that you’re not perfect and you may eat some things that aren’t part of your healthy eating plan. That’s OK, you’ll get back on track. Don’t let it trip you up, or allow the negative self-talk to sabotage your weight loss. Go back to your goal, remind yourself why you’re doing this, and move on.
    • Don’t deprive yourself but don’t ‘treat’ yourself too often either. Find that balance of enjoying your food, but don’t use it as a reward or to make yourself feel better if you’re feeling down or stressed.
    • Get help. If you’re struggling with your weight and you need professional help, talk with your doctor or dietitian. They can help you with practical information and strategies that are specifically tailored to you.
    • Be careful with alcohol. Reports are showing that many of us are drinking more during these stressful times. If that sounds familiar, cut back on your alcohol intake. Substitute other drinks that you enjoy instead of alcohol, though be careful of drinks high in sugar. Try different teas and infusions, add lemon and other fruits to your water, give kombucha a go (maybe? It can be an acquired taste), make a mocktail (again be careful of the sugar content).

    Contact our free national Help Line

    If you have questions about things like COVID-19, your musculoskeletal condition, treatment options, telehealth, managing your pain 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

    Photo by Heather Ford on Unsplash

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    Lisa Bywaters
    25/Jun/2020
    Health InformationMSK articles

    COVID-19 outbreaks

    The last week has seen a large number of new cases of COVID-19, particularly in Victoria. With this large increase in the number of active cases, should we be worried?

    Well – yes and no. Let’s explore some of the issues.

    We’re dropping our guard

    SARS-CoV-2 (the virus that causes COVID-19) is like a mythical beast. It’s caused so much damage and devastation – both here and globally – but most of us haven’t faced it. It’s hard to stay vigilant against something that seems so elusive.

    So we drop our guards and our standards along with them.

    It’s absolutely understandable – it’s been a long road so far, we’re sick of being isolated, we want life to go back to normal.

    “I wish it need not have happened in my time,” said Frodo.
    “So do I,” said Gandalf, “and so do all who live to see such times. But that is not for them to decide. All we have to decide is that to do with the time that is given us.”
    J.R.R Tolkien – The Fellowship of the Ring

    But because most of us haven’t been exposed to the virus, we’re still susceptible. And some people are more at risk than others of becoming very ill if they develop COVID-19, including people with immune issues and certain other health conditions.

    So we need to maintain our vigilance.

    Community transmission

    Most of the new cases can be linked to people returning from overseas and specific clusters where the origin of the virus transmission is known.

    However there are some cases where we have absolutely no idea how/when/where a person became infected. This is known as ‘community transmission’ – a person becomes infected with the virus but they’ve had no contact with a known case.

    They may have been in contact with someone who’s asymptomatic (infected but don’t feel unwell or show any symptoms) or someone who’s pre-symptomatic (infected but not yet showing symptoms). Or they may have come into contact with someone who thinks they have a bit of a cold, or even someone who suspects they have the virus but isn’t self-isolating.

    The issue of community transmission is why we need to remain on guard against this virus. Just because restrictions have been easing doesn’t mean we can ease up on our physical (social) distancing, washing our hands as often as possible, using hand sanitiser if there’s no access to soap and water, sneezing and coughing into the elbow, staying home when we’re sick and getting tested if/when we develop symptoms, however mild.

    Remember, symptoms of COVID-19 are:

    • fever
    • chills or sweats
    • cough
    • sore throat
    • shortness of breath
    • runny nose
    • loss of sense of smell.

    For more information about symptoms and to see if you or someone you care for may have the virus, use the healthdirect Coronavirus (COVID-19) Symptom Checker. Answer a few simple questions to find out if you need to seek medical help or be tested. Or call the National Coronavirus Helpline on 1800 020 080, 24 hours a day, seven days a week.

    Winter is here

    And for most of Australia there’s is a bit (or a lot) of chill in the air. Which means we’re staying indoors, huddling close together to stay warm, keeping the windows closed to keep the cold out and the warm in. Unfortunately all of these things make it easier for germs to spread. We’re close together and there’s little ventilation. Perfect to help the little buggers move from person to person.

    Along with the cold weather, we’re seeing more people gather together as restrictions ease and as boredom well and truly sets in. This’s a big problem. On a recent trip to the local shopping centre I was shocked by how many people I saw –most weren’t allowing 1.5 metres between themselves and others, people were hugging, coughing into their hands, not using hand sanitiser when entering stores…all of these things allow germs to spread through the community. Needless to say I hightailed it to the closest exit and went home.

    It’s cold and flu season

    This pandemic is overlapping with our flu season. Yay! Currently flu numbers in Australia are low due to our physical distancing measures. However, this may change for the same reasons we’ve seen increases in COVID-19 cases.

    There’s also the potential that people may become infected with the flu and COVID-19 at the same time, which, to put it mildly, isn’t ideal. While we don’t know if this leads to more severe cases of both infections, the immune system will be weakened by fighting two infections. And if a person’s immune system is already weak due to another health issue, this has the potential for very serious outcomes.

    Finally if flu numbers do increase as we continue through our flu season, it will have an impact on our healthcare system, which is already working overtime because of the pandemic. It seems like so long ago, but the 2019 flu season was our worst flu season on record.

    So for all of these reasons we’re being urged to get our flu vaccination this year.

    This is also a time of year when many of us succumb to colds. Coughing, a runny nose or sore throat may be symptoms of cold, allergies, the flu or COVID-19. If you experience these symptoms, don’t just assume it’s a cold or your allergies flaring up. The same goes with muscle soreness and a fever. For some people with musculoskeletal conditions, this may be a symptom of a flare. Or it may be your body displaying signs of COVID-19. The best thing you can do is stay home and contact your doctor – and if recommended – get tested.

    So should we be worried about these COVID outbreaks?

    We should be concerned because most of us are still susceptible to the virus, and some of us are at risk of becoming seriously ill if we become infected with COVID-19.

    So stay at home if you’re unwell, know the symptoms of COVID-19, wash your hands often and thoroughly, cough/sneeze into your elbow, maintain physical distancing measures and continue to follow the advice of our health officers.

    But we shouldn’t become so worried that we don’t get out (safely and responsibly), that we don’t live our lives. We were able to keep the numbers down for months. We can do it again.

    Contact our free national Help Line

    If you have questions about things like COVID-19, your musculoskeletal condition, treatment options, telehealth, managing your pain 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.

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    Lisa Bywaters
    25/Jun/2020
    Health InformationMSK articles

    Rediscovering small joys

    This strange time we’re living through has forced us to live smaller. SARS-CoV-2 is going to hang around for quite some time, so our way of living will likely remain on the small scale for the foreseeable future.

    And as we’ve seen with the spike in active cases in Victoria, restrictions can be eased and they can be tightened again. Trips overseas are out and trips interstate are dependent on state borders being open. Even travelling across our own state may be subject to restrictions if outbreaks continue.

    It’s easy to feel a little despondent about the whole situation. It’s been a hard slog with no end in sight.

    So it’s important we take some time to sit back and take stock. We’ve adapted to isolation and the massive changes in our world. We’ve been creative and done things that we couldn’t even imagine we would’ve done this time last year. We should give ourselves credit for that and continue to discover the small joys in life.

    Like having a jigsaw on the go on the kitchen or coffee table that everyone adds to as they walk past. I can’t tell you how many people have told me they’ve been doing this…and how much satisfaction they get when they complete a tricky 1,000 piece puzzle.

    Or discovering the parks, paths and until now unexplored areas in our neighbourhoods. Foot power and pedal power has us discovering many hidden treasures we never knew existed before COVID.

    We’ve enjoyed cooking and creating meals together. Discovering an interesting recipe, trying new ingredients, and taking time to sit down together and talk, laugh and have fun. With the change in our routines, and the lack of social/sporting/school/work gatherings, we have a little more time to break away from the mundane meals of the past, at least occasionally. Turn the TV off, put some music on, enjoy the company and the meal.

    We’ve hauled the dusty board games out of the back of cupboards and spent hours playing and enjoying time together…unless it’s Monopoly. It always seems to start well, then ends in tears. We’re reading, planting vegie gardens, catching up on new TV shows, enjoying a cup of tea in the garden, doing the crossword together – basically living much more simply.

    We’re catching up with friends and family with long phone calls and video chats. I think this’s been one of the best things that has come out of the pandemic. Without the distractions of work, social obligations, kids sports and the busyness of pre-COVID life, we have a bit more time to catch up and really talk. This has been wonderful.

    And for those of us with a chronic condition, being able to stay home has allowed us to feel safe from the virus, but has also given us the time to reevaluate how we’re travelling. For example, how’s our pain management? Do we need to tweak something, try something new? Are we looking after our mental health? Should we try some mind-body techniques such as mindfulness or guided imagery? This pandemic has paused the world in some ways, but it’s given us an opportunity to check our health and wellbeing.

    This time will pass. It’s going to take a while, but we can adapt. We’ve been doing it for months, and we can continue to do it. And rediscovering the small joys in our world will help us get through.

    Contact our free national Help Line

    If you have questions about things like COVID-19, your musculoskeletal condition, treatment options, telehealth, managing your pain 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.

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    Lisa Bywaters
    18/Jun/2020
    Health InformationMSK articles

    Vitamin D for healthy bones – and for COVID-19?

    Most of us know that vitamin D is important. It’s like the other things we ‘know’ – when to use the word literally, which fork goes with which course, and what Pi is. We sort of know vitamin D is good for us, but maybe not as much as we’d like. So let’s do a quick vitamin D refresher.

    It’s important for our health. Among its many benefits vitamin D:

    • regulates the amount of calcium and phosphate in our body, necessary for healthy bones, teeth and muscles
    • helps protect us against osteoporosis, a condition that causes bones to become weak and lose their strength, making them break more easily than normal bones
    • supports our immune system
    • can reduce the risk of falls, important for all of us, but especially those with fragile bones or another musculoskeletal condition.

    There are two types of vitamin D:

    • D3 (cholecalciferol) – formed in the skin by the action of ultraviolet (UV) light
    • D2 (ergocalciferol) – produced by UV light on plants and obtained through our diet.

    In Australia our main source of vitamin D is sunlight. It’s important to expose our hands, face and arms to the sun every day. The amount of time needed to do this depends on where you live, the time of the year and the complexion of your skin. Because we also need to be careful that our sun exposure is safe and we don’t risk skin cancer, Osteoporosis Australia and the Cancer Council have developed a useful chart to help you work this out.

    Vitamin D can also be found in small quantities in foods such as fatty fish (salmon, herring, mackerel), liver, eggs and fortified foods such as low fat milks and margarine. For most us though, it’s unlikely we’ll get enough vitamin D through diet alone.

    Vitamin D – whether it’s from sunlight, food or supplements – is stored in our fat cells until it’s needed.

    Why should we care about vitamin D?

    First, for the reasons we mentioned above. And second, in case you haven’t felt it, it’s getting cold. Winter is upon us and we’re not exposing as much of our skin to the sun in most parts of Australia as we did earlier in the year – at least not without risking frostbite.

    So we need to make sure we’re doing everything we can to get enough vitamin D during these colder months.

    Most people, through every day exposure to the sun in the warmer months, will have created enough vitamin D to make it through the winter without becoming deficient. Yay!

    For others however, it may take a more concerted effort to get enough vitamin D during winter. The best way to do this is to be active outdoors – e.g. going for a walk, working in the garden. You can also include foods that contain vitamin D in your diet. A dietitian can help you with this. They can also ensure your diet is healthy so that you get all the other nutrients you need.

    Finally there are some people who aren’t able to get enough vitamin D through sunlight or diet, which puts them at risk of vitamin D deficiency. This includes:

    • elderly people – especially those who are housebound or in residential care
    • people who wear concealing clothing for religious or cultural reasons
    • people with certain health or medical conditions who need to avoid the sun
    • people with dark skin as their skin contains higher amounts of melanin, which inhibits the creation of vitamin D
    • people in occupations where they have limited exposure to natural sunlight throughout the day – e.g. taxi drivers, factory workers, office workers and nightshift workers
    • people with diseases that make it difficult to absorb enough vitamin D – e.g. cystic fibrosis, coeliac disease and renal disease.

    If you‘re concerned that you may be deficient in vitamin D, it’s important to discuss this with your doctor. They can do a simple blood test to check your vitamin D levels. If you are deficient, it may be necessary to take vitamin D supplements for a period of time.

    It’s important to note that if you’re not vitamin D deficient, there’s no reason to take vitamin D supplements. It’s possible to have too much vitamin D, so only use these supplements as prescribed by your doctor.

    What does vitamin D have to do with COVID-19?

    There have been reports that vitamin D may be useful in our fight against COVID-19, however the results of these studies haven’t been conclusive.

    We know that vitamin D plays an important role in supporting our immune system. And in some recent studies people who’ve developed COVID-19 have been found to be vitamin D deficient. However these studies involved literature searches, analysis and observational studies – which are useful and provide valuable information – but can’t say with any certainty that vitamin D can help prevent people who are vitamin D deficient from catching COVID-19.

    That’s because they can’t eliminate other important risk factors such as age, obesity and socioeconomic status (e.g. level of income, education, access to healthcare, housing).

    However when researchers looked at the data of half a million people from the UK Biobank and adjusted for variables such as age, race, socioeconomic status and obesity, they found that ‘people with lower vitamin D have a higher risk of COVID infection, but it looks like this is explained by other risk factors and not by the vitamin D itself…our findings do not support a link between vitamin D concentration and the risk of COVID-19 infection.’ (1)

    Professor Mark Morgan, Chair of the Royal Australian College of General Practitioners Expert Committee – Quality Care (REC–QC), has also been quoted as saying ‘at the moment, I’ve not seen any evidence that using vitamin D could prevent or treat COVID-19…I know that there’s a number of controlled trials that are being commenced to look into that, but we’ll have to wait for the results of those trials before we have any information.’ (2)

    So at the moment, it’s a watch and wait situation when it comes to vitamin D and COVID-19. We need more information from randomised controlled trials that are able to tell us conclusively if vitamin D can protect at risk people from catching it.

    And remember if you’re concerned about your vitamin D levels, discuss this with your doctor. Don’t start taking a supplement without their expert advice.

    Contact our free national Help Line

    If you have questions about things like COVID-19, your musculoskeletal condition, treatment options, telehealth, managing your pain 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

    References

    1. Exploring the links between coronavirus and vitamin D
      The New York Times, 10 June 2020
    2. Do vitamin D levels affect risk of infection and severity of COVID-19?
      newsGP 15 May 2020

    Photo by Michele Blackwell on Unsplash

    CONTINUE READING
    garden-gnome.jpg
    Lisa Bywaters
    18/Jun/2020
    Health InformationMSK articles

    Can we get rid of this virus once and for all?

    With our neighbours across the ditch resuming life in an almost pre-COVID normal – abandoning physical distancing and restrictions on gatherings – it’s hard not to feel a little envious. They’ve recorded zero new cases of COVID-19 in more than two weeks. That’s longer than the incubation period of the virus, so they’re feeling pretty confident that SARS-CoV-2 (the virus that causes COVID-19) has been eliminated in New Zealand.

    In Australia some of our states and territories have also recorded zero new cases in over two weeks or are getting close to this magical number. So can we expect Australia to follow in NZs footsteps and lose all restrictions any time soon? And does this mean we can get rid of this virus once and for all?

    To explore this issue we need to understand some of the terminology that’s being used when we talk about getting rid of the virus – suppression, elimination and eradication. They’re sometimes used interchangeably in the media, but they’re quite different.

    Suppression requires everyone in the community to physically (or socially) distance themselves. It also requires people who have COVID-19, and the people they live with, to socially isolate themselves from the community – that is, stay at home and don’t go out – until they’re COVID-free.

    This is what we’ve been doing in Australia. It aims to flatten the curve so that our health system isn’t overwhelmed and we minimise the spread of the SARS-CoV-2 until a vaccine is developed.

    On the 12 June 2020, a media statement from the PMs office stated that “National Cabinet recommitted to a strategy of suppression of COVID-19”. (1) This means that we’ll be continuing as we have up until now – testing and tracing, controlling outbreaks as they occur and slowly easing restrictions as active case numbers drop.

    Elimination means that there are no cases in a specific area – e.g. a state/territory/country – for a specific period. The aim is to reduce any chance the virus can spread from person to person. NZ achieved this by putting in place strict lockdown measures for about 5 weeks early on in the pandemic, and gradually relaxing restrictions when active cases greatly decreased.

    The incubation period – or the time from when you’re exposed to the virus to the time you start showing symptoms – is two weeks for SARS-CoV-2. NZ declared they had eliminated the virus after there were no new cases in 17 days.

    It’s important to note that elimination doesn’t mean everything’s back to normal. The borders will still remain closed to overseas travel and testing and surveillance will continue to occur so that the virus hopefully doesn’t gain a foothold in the community again.

    It also means that after a vaccine is developed for SARS-CoV-2 we’ll need to vaccinate people regularly, as we do with other infectious diseases such as measles or the seasonal flu. We don’t know yet if people who are exposed to this virus remain immune. We just don’t have the long-term data on this new virus. So we may need a national vaccination program (as we do with measles) or an annual vaccination (as with the flu) and continue to monitor for any emerging cases.

    Finally, eradication means there are no cases anywhere in the world. This is what happened with smallpox. It took a worldwide effort to identify ALL smallpox cases, then vaccinate everyone who could have been exposed to it. It took many years but in 1980 the World Health Organization declared smallpox to be eradicated.

    However eradicating COVID-19 may not be possible.

    As Adrian Esterman, Professor of Biostatistics, at the University of SA wrote recently, “to be eradicated, a disease needs to be both preventable and treatable. At the moment, we neither have anything to prevent COVID-19 (such as a vaccine) nor any proven treatments (such as antivirals).” (2)

    He also went on to say that “even if a vaccine does become available, SARS-CoV-2…easily mutates. So we would be in a situation like we are with influenza, where we need annual vaccinations targeting the circulating strains. The other factor making COVID-19 very difficult if not impossible to eradicate is the fact many infected people have few or no symptoms, and people could still be infectious even with no symptoms. This makes case detection very difficult… So while we may well be on the path to elimination in Australia and New Zealand, eradication is a different ball game.” (2)

    Contact our free national Help Line

    If you have questions about things like COVID-19, your musculoskeletal condition, treatment options, telehealth, managing your pain 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

    References

    Photo by John Bussell on Unsplash

    CONTINUE READING
    connections-lego-figures.jpg
    Lisa Bywaters
    18/Jun/2020
    MSK articles

    Our connections are now more important than ever

    As a species we’re social creatures. We need our tribe – whether it’s a large extended family group and lots of friends, a small intimate group of nearest and dearest, or somewhere in between. We need our connections.

    I think that’s one of the hardest things we’ve had to deal with during this pandemic. We’ve been forced to change how we connect with others. We kept away from our people for months, and now that we can gather, we’re told to keep a distance, don’t touch, hug or shake hands. It feels so unnatural.

    That’s the insidiousness of this virus. It’s infiltrated our world and affected the very fabric of our connectedness.

    I need to make a confession – I’m incredibly sad as I write this blog. My aunt died today. She was a beloved mother, sister, grandmother, aunt and – like me – a crazy cat lady. She’s been unwell for quite some time, and I haven’t been able to see her for months. With isolation and the very real risk of spreading the virus to someone who was already so unwell, it was not a risk we could take.

    And so she died, this wonderful, kind, most incredibly well-read woman. Without all of her family around her. And I’m so very sad.

    I know I’m not unique in this situation. So many people have died during this pandemic – due to COVID-19 as well as the many other reasons people leave our world every single day. But sitting at home on a cold Sunday afternoon, I can’t help but reflect on how terribly sad this whole situation is.

    We’ve missed, and will continue to miss, our celebrations and milestones. Weddings have been postponed. Babies have been born with far less fanfare than would normally happen. Special birthdays have been and gone without the usual fuss. Students have finished courses, aced exams or have mastered a difficult skill without the jubilant gathering of family and friends to celebrate. And funerals have occurred with only a small number of mourners allowed to attend in person.

    And it’s not only the milestones and celebrations we’re missing. It’s the small events, the little encounters that go to the very heart of who we are. The big events are important, but the small things, the everyday incidental stuff with workmates, neighbours, friends, family – they’re the things that make our lives rich.

    So we need to find ways to ensure our milestones, gatherings, phone calls, video chats and every day encounters carry as much joy, love, sadness, real emotion and connection as they possibly can.

    Celebrate and bask in the little things. Share your day – the highs and lows with your partner/kids/closest friend – and really listen as they do the same. Take time to sit and reflect on what’s been happening in your life and those close to you. Even though it may feel like life is moving slowly at the moment, it’s moving quickly – can you believe it’s almost the end of June? – and so much can happen in a day, a week, a month. Don’t let these moments pass you by.

    Tell those close to you how much they mean to you. Extend that support and kindness beyond your own bubble to those you encounter at the supermarket, when you’re driving, talking with your child’s teacher, or when you’re in a work meeting. We’re all dealing with all kinds of stuff – big and small – so let’s discard the petty annoyances and frustrations.

    We’re still some way from finding a vaccine or treatment for this virus. It’s vital we continue to support and care for each other in this new normal we live in.

    Life is short, and although it’s changed so dramatically, we have so much to be thankful for.

    Contact our free national Help Line

    If you have questions about things like COVID-19, your musculoskeletal condition, treatment options, telehealth, managing your pain 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.

    Crisis support

    If this article has raised some issues with you or you feel like you need help during this stressful time, there’s help available. Contact Lifeline Australia on 13 11 14 for 24-hour crisis support and suicide prevention.

    More to explore

    It’s okay to feel sad
    Better Health Channel

    Photo by Hello I’m Nik on Unsplash

    CONTINUE READING
    immunity.jpg
    Lisa Bywaters
    11/Jun/2020
    Health InformationMSK articles

    Our amazing immune system

    Every day we’re exposed to millions of microscopic germs – bacteria, viruses, fungi, parasites. Our immune system protects us from them so that we don’t get sick.

    But sometimes a germ (or pathogen) is able to get into our system – through a cut, from breathing in droplets from someone’s cough, or if our immune system has become weakened.

    When this happens, our body launches an attack.

    It starts with the white blood cells (or leukocytes). They’re our germ fighting cells. They patrol the body looking for foreign bodies like viruses. When they come across one, they immediately start to multiply. While they do this, they’re also sending signals to other immune cells to saddle up and get ready for battle.

    There are two types of white blood cells: phagocytes and lymphocytes.

    Phagocytes are hungry little buggers that eat pathogens for breakfast. They do this by surrounding the cell and absorbing it. When they do this they receive information from the proteins on the surface of the pathogen. These proteins are called antigens (or antibody generators). Phagocytes then send this info to the lymphocytes.

    There are several types of phagocytes including neutrophils, monocytes, macrophages and mast cells. They all play important roles in the immune system.

    Lymphocytes can be divided into B cells (they’re created in Bone marrow) and T cells (they’re created when they travel from the bone marrow to the Thymus).

    B cells create antibodies. Antibodies neutralise the antigen by binding to it and disabling it. The antigen and antibody fit together like a key in a lock. As with a specific key working for a specific lock, there’s only one antibody that can fit each type of antigen.

    T cells kill any of your infected cells. There are different types of T cells who have specific jobs in the immune response: Helper T cells and Killer T cells.

    Helper T cells help…they send instructions to the other immune cells to help them get coordinated. They tell the B cells to create antibodies. They tell the Killer T cells to do what they do best – kill or destroy the cells infected by the pathogen. And they tell the phagocytes (specifically the macrophages) to join the party for a tasty pathogen feast.

    When the battle is done and dusted, your body will keep copies of the antibody it created against this pathogen. That way if you encounter it again, you have a defence against it.

    That’s your immune system in the very briefest of nutshells. It’s a highly complex, involved system that includes a lot of other cells, organs and body parts. Check out the More to Explore section for more info about the immune system.

    Giving the immune system a head start – vaccines

    Vaccines work by introducing your immune system to a virus or bacteria. This allows it to learn how to protect you from the pathogen before you meet it out in the world. A vaccine is a weakened or inactivated version of the pathogen. It causes your body to create antibodies. We have many vaccines at our disposal for diseases that cause people to get seriously ill – including measles, flu, tetanus, typhoid and polio.

    There are currently more than 100 labs around the world researching and developing a vaccine for COVID-19. Read our blog to find out more.

    When things go wrong – autoimmunity

    Sometimes the immune system gets it wrong. Instead of attacking something foreign, like a virus or bacteria, it attacks healthy cells and tissues in the body. This is called autoimmunity. The attack causes inflammation and damage to the cells.

    We don’t know why the immune system attacks its own body, but it’s thought that it may be the result of genetic factors (or things you’ve inherited) and something from the environment (e.g. a bacteria, virus or some medications).

    There are many autoimmune conditions that are the result of a malfunctioning immune system. They include rheumatoid arthritis, lupus, ankylosing spondylitis, juvenile arthritis, Sjögren’s syndrome, coeliac disease and type 1 diabetes.

    Stopping the spread of disease – herd immunity

    There’s been a lot of talk recently about herd immunity – especially around COVID-19. But what does it mean?

    Simply put herd immunity means that a large proportion of the population (or the herd) is immune to the disease. This can happen if they’ve been vaccinated or they’ve had the disease and are now immune to it. When most of us are immune to a disease, the disease isn’t able to spread as easily from person to person. The people who are immune create a buffer between the disease and those who can’t be vaccinated.

    By building up this herd immunity, we not only look after ourselves (if we’re able to be vaccinated) but we help protect those who are vulnerable to infectious diseases – including babies, people with compromised or suppressed immune systems and older people.

    The number of people we need to be immune to a disease to achieve herd immunity – the herd immunity threshold – varies from disease to disease. It depends on how easily transmissible and how infectious a pathogen is. For example, in the case of measles we need 92-95% of the population to be vaccinated because it’s incredibly infectious and the virus can survive outside the body for up to two hours. So even if you’re not in the room with an infected person, if you touch a surface that they’ve coughed or sneezed on, you can become infected if you’re not immune to the measles virus.

    We don’t at this stage know what the herd immunity threshold will be for COVID-19. Estimates currently suggest around 60%. However we also don’t know if people remain immune to COVID-19 after they’ve recovered from an infection. So it may be that we only truly reach herd immunity if/when a vaccine is created and administered to the majority of us.

    As with so much to do with this virus, we’re still learning and gathering data.

    Contact our free national Help Line

    If you have questions about things like COVID-19, your musculoskeletal condition, treatment options, telehealth, managing your pain 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

    CONTINUE READING
    computer-on-couch.jpg
    Lisa Bywaters
    11/Jun/2020
    Health InformationMSK articles

    Iso aches and pains

    Sore neck? Back? Knees? Feel like you’ve aged 20 years with all the niggles, twinges and outright pain you’re feeling lately? You’re not alone. Many of us, even those who don’t live with a musculoskeletal condition, are feeling the physical effects of months of isolation, changes to our routine and living more sedentary lives than usual.

    There are many reasons for this, and the good news is there’s lots you can do to deal with these annoying aches and pains.

    Working or studying from home

    When many of us first started working from home, it felt strange but also pretty cool. No dreaded peak hour commute. Yay! Instead we moved a bit more leisurely, lingered over coffee and our slippers stayed on all day. But after months of sitting at makeshift desks, or using laptops for hours on end, or struggling with tech issues and video calls, the cool phase is well and truly gone.

    You may notice that you’re getting a sore neck more often, or your back aches, or you’re really tight across your shoulder blades. Or when you stand up your knees and/or hips let you know quite emphatically that you’ve been sitting in one place for a loooong time.

    The problem is most of us don’t have a dedicated working space that’s set up as well as the one we had in the office. And since we’re likely to be working from home for quite some time, we need to deal with these issues rather than continuing to put up with them and the resulting aches and pains. Some simple things you can do include:

    • Have a routine – and stick to it. Find what works best for you and your specific situation. Whether you’re home schooling your kids, sharing your work space and equipment with your partner, or keeping your pets off your laptop, all of these things will factor into your routine. For me, internet access is really poor during the late afternoon, so starting work earlier and finishing earlier meant I could work more productively and with much less frustration. We’ll all have different solutions to suit our unique situations. So work out what’s best for you and stick with it. And don’t forget to talk with your employer if your new routine affects how/when you work.
    • Check out your work space. Is it helping or hindering you? Are you putting up with an uncomfortable space because you’re not sure what else to do? If so Safe Work Australia has a guide to help you set up your workstation and ABC News also has some practical hacks to take some of the pain out of working from home.
    • Move. When you’re working from home it’s easy for time to get away from you. We don’t have our usual cues to move such as getting up to go to the copier or attending a meeting in another room or just going to chat with a workmate. We’re sitting more and moving less. So you need to schedule time to get up, move around, stretch, go outside. Set up regular alerts on your phone/computer/watch – whatever works for you – and make sure you move. You’ll really notice a big difference at the end of your day.
    • Talk with your employer. If you need to adjust your hours, or you’re having issues with equipment or tech, or you’re having other issues working from home, discuss this with your manager or with HR. Together you should be able to come up with some solutions to ease these issues.

    Managing stress

    We’re living through a worldwide pandemic. Even after several months it feels surreal to say that. It’s important to acknowledge that it’s a really stressful time. Apart from worrying about getting sick, we’re also stressed about work, making sure the kids don’t fall behind at school, managing our chronic conditions, our finances, our family, and concern about the future. Add in the current unrest across the globe and it’s amazing we’re not all hiding under the bed.

    But stress can cause physical aches and pains. It can also affect the quality of our sleep, our pain levels and can trigger a flare. So it’s important we find ways to manage stress effectively.

    Many of the practical strategies we use to manage pain can be used to manage stress. These include: deep breathing, exercising, pacing, talking with a friend, mindfulness, guided imagery, progressive muscle relaxation and doing something you enjoy (e.g. reading, gardening, walking your dog, playing music).

    But if you’re finding it difficult to manage your stress, talk with a professional such as your doctor or psychologist. There’s help available. And remember you can access them via telehealth if you prefer.

    Spending more time at home

    Even though isolation is easing we’re still meant to stay at home as much as we can. And with the weather getting really chilly, we’re getting cosy on the couch with the doona and the remote, as we binge lots of TV (or is that just me). There’s just so much to watch!

    Hanging out on the couch and binge watching TV is ok occasionally, but we don’t want to get into the habit of doing it too often. Slouching on the couch and not moving for long periods can aggravate our existing musculoskeletal conditions. And if we’re not moving and being active regularly it can also make it difficult to manage our weight.

    So make sure you get up and move. Take a break. Go for a walk or do some exercises or stretches.

    Break up your day with a mix of activities – both physically active (e.g. walking, gardening, tidying) and more passive (e.g. reading, watching TV, sitting at a computer).

    Be aware of your posture

    Bad posture can sneak up on us. Working at a computer, sitting on the couch reading a book, standing around watching the kids in the playground, lifting shopping out of the boot of your car – if you’re not paying attention to your posture, it’s easy to slouch, hunch over or strain.

    As I’m typing this I’m literally straightening up from the curled position I was in, hunched over my laptop. And wow – it feels amazing when you sit up straight. It’s the same when you’ve been sitting on the couch for a while – when you stand up, stretching feels soooo good.

    So be aware of your posture as you’re sitting and standing. For more info read our tips for good posture.

    Increase your incidental exercise

    Because we’re more sedentary than usual, and don’t have many of our usual outlets for exercise, we need to find ways to become more active. Increasing our incidental exercise is one way to do this. Incidental exercise is the little bits and pieces you do over the course of your day such as walking to a letterbox to post a letter, playing with the grandkids, cleaning the house. It’s not a part of your structured exercise plan, but it is important. There are many ways you can increase your incidental exercise without too much effort or disruption to your day. Read our blog to find out more. Before you know it you’ll be feeling more energised and noticing a difference with your pain levels, sleep quality and mood.

    Dress appropriately

    It’s getting really cold and many of us are a little stressed at the thought of high energy bills as we stay home and use the heater more. It’s tempting to keep the heat down, but that can cause your muscles to become tense, aggravating your musculoskeletal condition. So it’s important to keep warm. One of the simplest things you can do to stay warm is to dress for the weather. Let’s face it we’re not going anywhere, so wear the thick socks, the cuddly jumper and the daggiest track pants. Whatever keeps you warm.

    We also need to be mindful of our footwear. Although it’s tempting to stay in our slippers all day, our feet and ankles need proper support. Wear the right footwear for whatever you’re doing. Going for a walk? Put on your sneakers. Working at home? Wear your casual shoes/boots that support your feet and keep you warm. And lounging around in the evening? Get those slippers on.

    Be careful of trips and falls

    Hands up if you’ve tripped over cables, laptop bags, files, excited dogs, folders, exercise equipment, books, and other stuff that’s suddenly cluttering your home? With all of the other things going on at home at the moment, school, work, exercise, entertainment…we’ve had to make space for all sorts of things in order to be get by. Which means our risk of tripping or falling has suddenly increased, especially if you’ve got nowhere to put these things and they’re constantly in the living area. So be careful as you move around your home – don’t rush, put things away if you can and tie or tape down cables. Preventing a fall, especially if you have a musculoskeletal condition, is easier than dealing with the significant injuries a fall can cause. So please be careful.

    Treating pain

    Even when you’ve done everything you can to prevent joint pain and muscle strain, you may still find you’re a bit sore. Depending on how severe this pain is, you may be able to treat it simply with heat and cold, massage, short term use of medication, distraction and many other strategies. Check out our A-Z guide for managing pain for more hints and tips.
    However if the pain is severe, it’s affecting your day to day activities, your ability to sleep, or it’s lasted for some time with no relief, it’s a good idea to talk with your doctor about it. Together you can find out what’s causing the pain, and the most effective ways to treat it. Don’t simply put up with it.

    Contact our free national Help Line

    If you have questions about things like COVID-19, your musculoskeletal condition, treatment options, telehealth, managing your pain 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.

    CONTINUE READING
    poppy_web.jpg
    Lisa Bywaters
    04/Jun/2020
    Health InformationMSK articles

    More changes to opioid access

    The opium poppy is such a pretty, delicate looking flower. And humans have been actively growing them and enjoying their medicinal benefits since at least 3,400 B.C. The Sumerians referred to it as Hul Gil or the “joy plant.”

    It’s from these delicate plants we get opioids, a group of medications with which we have a long and complex relationship. They can provide great pain relief, but can also cause great harm.

    That’s why on 1 June 2020 the Australian Government introduced some changes which affect how we use and access opioids. So let’s look at what opioids are, how they work, and why these changes have been brought in.

    What are opioids?

    Opioids are pain relieving medications that come in a variety of formulations, dosages and strengths. They include: tramadol, codeine, morphine, oxycodone and fentanyl. You need a prescription from your doctor to buy any medications containing opioids.

    Opioids may be:

    • natural – created using the milky substance found inside the pods of the opium poppy, or
    • synthetic – created in a lab to have a chemical structure similar to natural opioids.

    How do they work?

    Opioids attach to opioid receptors in brain cells and dull our perception of pain. The pain isn’t gone, nor is the cause of the pain. It’s simply been dampened so that we can function with less discomfort. They also cause the brain to release the hormone dopamine, which can make us feel happy or relaxed.

    Opioids are used to treat severe pain associated with cancer or for acute pain – e.g. following surgery.

    They’ve also been used for many years to help people with severe, persistent non-cancer pain, like the pain associated with musculoskeletal conditions. However their long-term benefit is controversial for persistent pain or chronic pain. This is mainly due to the large body of evidence that shows that opioids have a limited effect on this type of pain. In addition they can also have serious side effects particularly with long term use, including breathing difficulties, addiction, overdose and death.

    We also know that our body adapts to opioids when we use them long-term. We have to increase the dosage to get the same effect, and an increased dose brings an increased risk of harm.

    Every day in Australia there are nearly 150 hospitalisations and 14 emergency department admissions due to opioid use, and three people die from drug-induced deaths involving opioids. (1)

    Because of these alarming statistics the Australian government has been changing the way we access opioids. Last year we saw all opioids, even the lowest dose available, requiring a prescription from your doctor. You can no longer buy them over-the-counter.

    The latest changes are a continuation of this plan to reduce the harm that opioids can do, and ensure that we use them cautiously and safely.

    What’s changing?

    From 1 June 2020 changes include:

    • smaller medication packs containing fewer opioids will be provided for short-term opioid use – for example after surgery or an injury,
    • improvements in medication information so people are better informed about the potential risks of opioids and how to reduce them, and doctors are following best-practise when prescribing opioids,
    • updating prescribing ‘indications’ (or when they’re used) to ensure opioids are only prescribed where the benefits outweigh the risks. (2)

    Can I still use them for my musculoskeletal pain?

    If you’re using opioids to manage the pain associated with your musculoskeletal condition, continue taking them as prescribed and talk to your doctor.

    We do know some people experience pain relief using opioids for persistent pain, so if they’re proving to be clinically effective for managing your pain, your doctor will be able to continue to prescribe them. However these new changes will require your doctor to weigh the risks and benefits of these medications, and to explore possible alternatives with you, including enrolling in a pain management program. Also, where opioid use exceeds twelve months or is expected to exceed this time, a second opinion will be required to renew ongoing prescriptions.

    Opioids aren’t a magic bullet and should be used in conjunction with other pain management therapies such as physiotherapy, exercise, weight management, cognitive behavioural therapy and mindfulness.

    What now?

    Living with persistent pain is exhausting. And the possibility of changing your medication can be stressful, especially if you feel like you’re managing your condition and your pain effectively. If you’re worried about these changes, talk with your doctor. Be honest about how you feel, but also be open to the possibility of trying new things to manage your pain. The aim is to keep your pain at a level that allows you to live your life and do the things you want and need to do. Opioids may be part of that, or they may be something that you’ll be able to phase out. It’s something that you and your doctor will need to discuss so that you get the best and safest outcomes.

    Contact our free national Help Line

    If you have questions about things like COVID-19, your musculoskeletal condition, treatment options, telehealth, managing your pain 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

    References

    (1) Prescription opioids: What changes are being made and why
    Therapeutic Goods Administration, 29 May 2020 

    (2) Prescription opioids: Information for consumers, patients and carers
    Therapeutic Goods Administration, 29 May 2020 

    CONTINUE READING

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