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    opioids.jpg
    Lisa Bywaters
    24/Mar/2022
    Health InformationMSK articles

    Opioids and musculoskeletal pain

    We have a long and complex relationship with opioids. Humans have been actively growing poppies and enjoying their medicinal benefits since at least 3,400 B.C. The Sumerians referred to it as Hul Gil or the ‘joy plant’.

    However, we now know that while these medicines can provide significant pain relief when used appropriately, they can also cause great harm.

    Did you know that every day in Australia, nearly 150 people are hospitalised, and 3 people die due to issues related to opioid use? (1)

    That’s why in 2020, the Australian Government made changes to how we use and access opioids.

    What are opioids?

    Opioids are pain-relieving medicines that come in various formulations, dosages and strengths. They include tramadol, codeine, morphine, oxycodone and fentanyl.

    There are two groups of opioids:

    • opiates – created using the milky substance found inside the pods of the opium poppy, and
    • synthetic or man-made opiods – created in a laboratory using chemicals.

    Opioids can be taken as tablets, injections or patches on the skin.

    How do they work?

    Opioids attach to opioid receptors in the nervous system and slow down the messages between the body and brain, including pain messages. This dulls your perception of pain – it’s not gone, nor is the cause of the pain. It’s simply been dampened so that you can function with less discomfort. They also cause the brain to release the hormone dopamine, making you feel happy or relaxed.

    However, opioids can also slow your heart rate and breathing.

    Opioids are used to treat severe pain associated with cancer or acute pain, for example 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, extensive research now shows that opioids don’t provide ‘clinically important improvement in pain or function compared with other treatments’ for most people with persistent pain or chronic pain.(2) This research, combined with our knowledge of the serious side effects of opioid medicines, particularly with long-term use, mean that these medicines should be used with caution.

    Side effects

    All medicines have side effects, so it’s important to know what they are. Side effects of opioids include sleepiness, constipation and nausea. More serious side effects include shallow breathing, slowed heart rate and loss of consciousness. These serious side effects may be due to too many opioid medicines being taken (an overdose). This can be life-threatening, so you need to ensure that you know when and how to take your medicines to prevent an accidental overdose.

    Addiction is also a possible side effect of opioids.

    Opioids, when taken long-term, can also make you feel more pain. This is called opioid-induced hyperalgesia. It happens because opioids make the brain and nerves more sensitive to pain.

    Tolerance, dependence and withdrawal

    Your body adapts to opioids when you use them long-term. This is called tolerance. To get the same pain relief, you need to increase the dosage. However, it’s not safe or sustainable to continue to increase the dosage of opioid medicines because of the serious risk of harm associated with their long-term, high-dosage use.

    Dependence is when your body requires a specific dose of the medicine to avoid withdrawal symptoms when the dose is reduced or stopped. Symptoms of withdrawal can include: disturbed sleep, hot and cold flushes, sweating, feeling anxious or irritable, cravings for opioids, nausea, vomiting, diarrhoea, lack of appetite and tremors.(3) You’re more likely to experience withdrawal symptoms if you’ve been taking opioids for a long time and/or taking high doses.

    Your doctor will slowly reduce your dosage to lessen your risk of withdrawal symptoms. This is called tapering.

    Using opioids safely

    Because of the risks associated with their use, opioids aren’t a first-line treatment for managing pain associated with musculoskeletal conditions. Instead, your doctor may suggest strategies such as exercise, maintaining a healthy weight, cognitive behavioural therapy (CBT), heat and cold packs, distraction, and short-term use of medicines such as paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs).

    If you are prescribed opioids, it’s important that you:

    • take them as prescribed
    • don’t drink alcohol while you’re taking them
    • don’t change the dosage or stop taking them without discussing this with your doctor – you may need to reduce your dosage gradually
    • talk with your doctor about other medicines or supplements you’re taking – some may not be able to be used at the same time you’re taking opioids
    • let your doctor know about any side effects you experience
    • discuss other options you can use to help manage your pain with your doctor – for example, gentle exercise, CBT, heat and cold.

    While using opioid medicines, you should also monitor whether or not they’re working for you. If you’re still experiencing severe pain that’s affecting your quality of life and ability to do daily activities, discuss this with your doctor. Together you can look at alternative treatment options.

    Finally – it’s important to understand that opioids reduce our perception of pain. They don’t ‘kill it’, because there’s no such thing as a ‘pain killer’. Medicines and other strategies such as heat and cold, exercise, distraction and CBT can help you reduce pain to levels that enable you to live a healthy and happy life.

    Contact our free national Help Line

    If you have questions about managing your pain, musculoskeletal condition, treatment options, mental health issues, COVID-19, telehealth, or accessing services, 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 
    2. Prescription opioids: Information for consumers, patients and carers
      Therapeutic Goods Administration 
    3. Opioid withdrawal symptoms
      Healthdirect
    CONTINUE READING
    morning-coffee.jpg
    Lisa Bywaters
    24/Mar/2022
    Health InformationMSK articles

    Rise and shine! Developing a morning routine

    Do you get to the end of your day and wonder where all your time went? Between work, family commitments, random phone calls, catching up with friends, walking the dog, feeding the cat and endlessly scrolling through socials, your day has flown by, your to-do list has barely been touched, and you still need to scrounge up something for dinner?

    If this sounds familiar, I’m right there with you 🙃. Adjusting to our ‘new normal’ is taking a bit of getting used to. Finding the right balance between work and home life, commuting to the office (or moving from my couch to my desk 😉) is challenging. And my routine, once the foundation of my day, is in tatters and needs some help.

    Why do we need routine?

    When so much is out of our control, developing a morning routine can help you gain some control so you can do the things you need to do in your day. This boosts your confidence, makes you feel more positive and reduces feelings of stress.

    Having a morning routine allows you to plan and prioritise activities so that if things go pear-shaped – as they sometimes do – your most important activities have (hopefully) been accomplished. And having a regular routine means you’re less likely to forget something, which is especially helpful if you’re feeling a bit ‘foggy’.

    So how can you create (or update) your morning routine?

    First, let’s start with the foundation of your morning routine – getting a good night’s sleep. We all know what it’s like when we haven’t slept well. We drag ourselves through the day, bleary-eyed and unfocused. But we also know that getting a good night’s sleep can sometimes be tough when you live with a musculoskeletal condition and persistent pain. Fortunately, there are many things you can do to improve your sleep quality and quantity, and wake up feeling refreshed. Read our article on sleep for info and tips.

    The next step is planning. For your morning routine to be effective and have a positive flow-on effect for the rest of your day, you need to be prepared and have a plan. This may include:

    • Getting things ready the night before. Do whatever you can at the end of your day so that your mornings are less hectic. For example, check the weather and decide what you want to wear the following day; prep healthy breakfasts/lunches/snacks so you can just grab them as you head out the door in the morning.
    • Make a list of the things you need to do in the day and prioritise them to know what absolutely needs to be done. Include appointments, exercise, work/school/family/social commitments and recreation.

    Now it’s time to get moving.

    • When the alarm goes off, it’s tempting to hit the snooze button, but resist the urge! Endlessly hitting snooze will make you lose valuable time, and it could also affect your health. Find out how.
    • Build extra time into your morning routine in case you wake up feeling blah. The extra time will also make you feel less rushed and stressed.
    • Do some gentle stretches while in bed to warm up and loosen stiff muscles and joints.
    • Have a warm shower for the same reason. It’ll also help clear your head and wake you up fully.
    • Sit down and eat a healthy breakfast and drink some water.
    • Take your medications (if required).
    • Do some exercise. Take your dog for a walk, do some yoga, hit the gym, go for a swim. Whatever exercise you enjoy and you’re committed to doing, do it. Not only will it help you manage your condition and health overall, exercising in the morning improves your concentration, energy levels and mood.
    • Do something nice for yourself. Try mindfulness meditation, deep breathing, practising gratitude, listening to upbeat music, hug your partner/kids/pet. Choose something that makes you happy and puts a smile on your face as you start a new day.
    • Review your day ahead so you know what to expect, what you need to do, what things to take with you etc.
    • Set up alerts or alarms on your phone or computer to help you stay on track with your day.

    Making your routine stick

    Once you’ve established your routine, you need to be consistent and stick to it. That way, it’ll become second nature.

    And be flexible. Sticking to your morning routine as often as possible is great, but you’ll also need to learn to be flexible if something unexpected happens.

    When it’s all said and done, routines may sound boring, but they’re a great way to stay on top of your commitments and get to the end of the day feeling accomplished and relaxed. So if you struggle to achieve all of the things you set out to do each day, why not try a couple of these strategies to see if they can help? You’ve got nothing to lose and so much to gain.

    Contact our free national Help Line

    If you have questions about managing your pain, musculoskeletal condition, treatment options, mental health issues, COVID-19, telehealth, or accessing services, 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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    neck-pain.jpg
    Lisa Bywaters
    03/Mar/2022
    Health InformationMSK articles

    What a pain in the neck!

    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.

    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.

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    Lisa Bywaters
    03/Mar/2022
    Health InformationMSK articles

    Understanding food labels

    Are you like me and automatically select the same items when buying groceries? That specific yoghurt, brand of orange juice, yummy cheese 😉?

    There’s nothing wrong with that. We’re creatures of habit and know what we like. Also, we often want to shop as quickly as possible and get it over with 😄.

    But every now and again, it’s a good idea to compare that yoghurt, orange juice, cheese or whatever, to other similar items available.

    The ingredients list and nutrition labels can help you do this. They pack a lot of useful info into a tiny space. By reading this information you can see if the product you buy really is the best or healthiest choice for you.

    For example, if you have high blood pressure, making sure the product you buy is low in salt is important. If you’re trying to lose weight, comparing the kilojoules, fats and sugars in different brands of foods will help you make a better choice. Or if you have an allergy or intolerance to an ingredient or food additive, you can avoid buying a product that contains that item.

    In Australia, all manufactured food must provide nutrition and safety information on their labels.

    This includes:

    • the name of the product and an accurate description of what it is
    • the brand’s name
    • an ingredients list (in order from largest to smallest by weight)
    • nutritional information (e.g. energy, fat, protein, sugars and salt)
    • use-by or best-before date
    • manufacturer details
    • weight
    • food allergy information
    • list of food additives
    • directions for use and storage
    • country in which the food was produced.

    Obviously you’re not going to take the time to look at every one of these items every time you shop! But it’s helpful to look at the ingredients list and nutrition panel when looking at new products, and occasionally compare your trusty favourite with other similar items.

    Ingredients list

    All ingredients must be listed in order by weight, from largest to smallest. They also need to show the percentage of the key ingredient if it’s mentioned in the description. For example, a tomato pasta sauce may say 80% tomatoes, peanut butter 90% peanuts, raspberry yoghurt 10% raspberries etc. Other brands may have more or less tomatoes, peanuts or raspberries, so knowing the percentage is useful when comparing products.

    Sometimes what’s known as compound ingredients are used in foods. They’re ingredients that are themselves made up of two or more ingredients. For example, in some food items (e.g. Tim Tams 🤤), milk chocolate is used. So all of the ingredients in milk chocolate – sugar, milk solids, cocoa butter, cocoa mass, vegetable oil, flavour – must be listed in the ingredient list, along with the other ingredients. However, if a compound ingredient makes up less than 5% of the final food, it doesn’t need to be listed unless it’s an additive or allergen.

    Nutrition information panels

    These panels provide the nutrient details, as well as serving sizes and number of servings per package. Some labels also display % daily intake. This helps you choose foods that are lower in fat, sugar and salt.

    The nutrients listed are:

    • energy (kilojoules or calories)
    • protein
    • fat
    • saturated fat
    • carbohydrate
    • sugars – includes added and natural sugars (e.g. fructose in fruit)
    • sodium (salt).

    Some nutrition panels may include other nutrients such as fibre, potassium, calcium or iron. For example, a manufacturer may add calcium to the panel if they state on their yoghurt packaging that it’s a good source of calcium.

    Nutrients are displayed in a standard format showing the average amount per serve and per 100g (or 100mL if liquid).

    This means you can look at the 100g column on two different brands of cheeses and compare the nutrients, helping you make the healthiest choice.

    This diagram from Eatforhealth.gov.au provides a simple visualisation of what to look for in a nutrition panel.

    As far as serving size, this is the average serving according to the manufacturer. For example, a packet of crispbread lists the servings per packet as approximately 18, and the serving size as 7g (1 piece). If you eat more or less than the suggested serving size, you’ll need to factor in the difference in the energy, fat, sugar etc that you’re consuming.

    Health star ratings

    You may have seen these on the packages of some foods. They bring together all of the info from the nutrition panel, and give the food a rating out of 5, with 5 being the healthiest. These are a guide to help you very quickly compare similar products.

    Nutrition claims

    Remember the milk ad from many years ago, when a man asks for milk at a corner store? The lady behind the counter rattles off the following: ‘Low fat, no fat, full cream, high calcium, high protein, soy, light, skim, omega-3, high calcium with vitamin d and folate or extra dollop?’ They’re just some of the nutrition claims that we see on the packaging of many food products. Like reduced fat, baked not fried, light/lite, salt reduced, all-natural, no added sugar etc. They can make it hard to understand which is the best, healthiest product for you.

    Nutrition Australia (QLD) has a great article that can help you understand some of the more commonly used claims on packaging. Check out Reading food labels like a pro.

    Understanding food labels can be a little tricky at first, but with a bit of practice (and a magnifying glass 😄) you’ll soon be able to decipher what it all means and make healthy food choices. And it’s important to remember that you don’t eat separate pieces of food in isolation. They’re all part of your daily/weekly meal plan. That means there’s room for the sometimes foods we all enjoy, as long as you consume them in moderation, and you’re aware of what’s in them.

    Finally – remember there’s always help available. If you want to know more about choosing healthy food or need advice on diet in general, talk with your doctor and/or a dietitian.

    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.

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    resilience.jpg
    Lisa Bywaters
    10/Feb/2022
    Health InformationMSK articles

    Building resilience

    It’s hard to believe that we’ll soon be into our 3rd year of this pandemic 😷. We’ve made sourdough bread, gotten ‘used’ to masks, embraced jigsaws and telehealth, changed the way we work, go to school and socialise. We’ve missed out on many important events – big and small – as our world changed so dramatically.

    It’s been really hard, and it’s taken a toll on our physical, mental and emotional health.

    One aspect of ourselves that has suffered is our resilience. Resilience is our ability to cope and adapt to changes and challenges that the world throws at us. As this pandemic continues, we’re constantly tired, anxious, and stressed, with no end in sight. And this is really testing our resilience. Add to this a chronic, painful musculoskeletal condition, and everything seems amplified 😫.

    For example, this morning, I was driving to the chemist to buy more masks. Someone cut me off in traffic. In the past, I would’ve muttered to myself and continued on my way. But today, I flashed my lights, tooted my horn and yelled. I yelled! Madness 😣. And at that moment, I realised that the only person negatively impacted by the situation was me. The other driver was long gone, but I could feel my heart pumping and the adrenaline coursing through my veins. It’s clear that my resilience is at an all-time low at the moment. I’ve known this for some time but haven’t done anything about it. But it’s now time.

    So if you’re like me and know that your resilience isn’t what it used to be, and that you’re not handling stress and challenges as well as you once did, what can you do about it? How can you rebuild your resilience in a world that’s still so topsy-turvy, and you have no idea what’s around the corner?

    Accept that you’ll have to face change, stress and challenges. Our lives are messy. And nothing is ever smooth sailing. However, by accepting that change is always happening – both good and bad – you can mentally prepare yourself for it. You can learn from how you’ve reacted in the past and how situations have affected you. You can use this information to prepare for future events and challenges. But the first step is to accept that things will happen. Change is constant. You can choose to deal with it in a positive, proactive way, or you can choose to let it negatively affect you. Acceptance isn’t always easy and will take time and reflection, but it is possible. And if you need help, it’s available. Read our article on support for mental and emotional wellbeing for more info about the types of professionals who can help you.

    Make time for your people and your relationships. It’s tempting when you’re feeling low, in pain or like you just can’t take any more drama, to disconnect from others. However, when you’re on your own, it’s easy for your mind to get stuck on a merry-go-round of negative thoughts. They go round and round as you think about different ways you could have handled past events or as you worry about the unknown future. Staying in touch with the people who care for you can distract you from this rumination and help you focus on what’s actually happening in the world around you. They can also be a supportive ear and listen as you explain what’s affecting you and how you’re dealing (or not) with these things. They can also be a valuable source of advice if you choose to ask for it.

    Write it down. Putting pen to paper and writing down the things that are causing you stress, or to feel anxious or powerless, is a useful strategy to help you see the nuances of the problem. Take the time to think about all sides of the issue and how it affects you. You can then process it more clearly, allowing you to do some critical thinking and problem-solving. Read this article, ‘5 ways journaling can build your resilience’ for more info about journaling.

    Keep up your self-care. Again, it’s easy to let things slide when we’re not feeling on top of things. You may stop exercising, go to bed later or sleep in more often, eat comfort foods that give you a quick rush but don’t give you the nutrition you need, or rely on alcohol and other drugs to pick you up. But these behaviours will negatively affect your physical and mental health if you don’t get on top of them. So it’s important that you make a conscious commitment to continue your self-care, especially because your resilience is low. Because self-care practices such as sticking to a daily routine, eating a healthy diet, exercising regularly, getting good quality sleep and getting out into nature, will make you feel healthier and more able to cope with life’s challenges. They’ll also help you deal with pain and other symptoms of your musculoskeletal condition.

    Focus on what you can control, no matter how small. You can’t control what’s happening with the pandemic, apart from following the health advice you receive from the government and your healthcare team. This lack of control can sometimes make you feel powerless. But you can control things closer to you, like how often you access social media or how much ‘doomscrolling’ you’re doing. You can choose to give your mental health a break from negative news and socials. You’re giving yourself power – over your actions and the effect they have on you – which will help build your resilience.

    Think about how you can positively deal with challenges you’re currently dealing with. For example, if you’re working from home and feel isolated from your colleagues and the world in general, how can you manage this? Or, if you’re feeling financial stress because you’re not getting as much work as you once did, what options are available to help you? By problem-solving and coming up with a range of potential solutions, you can start to feel more in control. And if it all seems to overwhelming, you can always break big challenges down into smaller actions. If we look at the financial stress example, the first step might be to read our information on financial support. The next step might be to list who you need to contact to get help – e.g. your bank, utility companies etc. The third step might be to contact them, and so on. The point is, by breaking it down, and moving through a series of steps, you’re dealing with whatever issue or obstacle is causing you stress. You’re taking control of the situation.

    Think of the things that make you happy or grateful. Every day, before getting out of bed or before you go to sleep, think of three things that make you feel happy or grateful. It can be anything you like – the sound of your child laughing, the sight of dogs playing in the park, the scent of freshly mown lawn, the warmth of your partner’s hand as you go for an evening stroll etc. Taking time to think of these things will make you feel more optimistic because there’s so much good around us. We just have to take the time to be aware of it.

    Learn from the past. What things have helped you through a hard time in the past? Can you use that strategy/behaviour/resource now? It’s important to remember that you’ve gotten through tough times before, and you will again. It can just be a little hard to see that when you’re still going through it. But as they say, this too shall pass.

    Get help. Sometimes you can try really hard, but you just can’t seem to get on top of things by yourself. That’s ok. We’re living through very difficult times, and we all need help from time to time. Talk to trusted family or friends about how you’re feeling. They can help you work through many of the above strategies if you’re struggling. Or it may be time to speak with a mental health professional to get some support that’s specifically tailored to you and your own specific circumstances.

    We’ve all been rocked by these extraordinary times, and many of us are finding it difficult to find our footing again. We feel out of control and powerless by so much of what’s going on around us. However, by building our resilience, we’re more able to cope with these challenges and feelings and bounce back more quickly. It takes time and commitment to build your resilience, but it can be done. One step at a time.

    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.

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    thumbs.jpg
    Lisa Bywaters
    09/Feb/2022
    Health InformationMSK articles

    Osteoarthritis and your thumbs

    You don’t really notice your thumbs until something makes you take notice. You whack one with a hammer, jam it in a door, or you get arthritis.

    You then realise how often you use your thumbs every day 😖.

    Your thumbs are more flexible than the rest of your digits. They can rotate, flex and touch the tips of your fingers. This allows you to perform all sorts of simple and complex movements.

    So when something happens that impacts your thumb’s ability to move smoothly and painlessly, it gets your attention very quickly.

    Arthritis

    Many types of arthritis can affect your thumbs; however, osteoarthritis (OA) is the most common. OA occurs when the cartilage that covers the ends of the bones in a joint becomes brittle and breaks down. Healthy cartilage acts like a slippery cushion that absorbs shock and helps your joints move easily. When it breaks down, bone rubs against bone, causing pain and restricted movement. Your body tries to repair this damage by creating extra bone, called bone spurs. They may also cause pain and limited joint movement.

    Other conditions such as rheumatoid arthritis, psoriatic arthritis, gout and lupus can also affect your thumbs.

    This article will focus specifically on OA and thumbs.

    Who gets OA in the thumbs?

    You’re more likely to develop OA in your thumbs if you:

    • are female
    • over the age of 40
    • have had trauma or damage to the joints in your thumb
    • are obese
    • do work or activities that put stress on the thumb joints.

    Symptoms

    The symptoms of OA in the thumbs are:

    • pain
    • stiffness or limited movement of your thumb
    • joint swelling (inflammation)
    • grinding, rubbing or crunching sensation (crepitus)
    • loss of thumb strength.

    Diagnosis

    If you’re experiencing pain in your thumb that’s affecting your ability to do everyday activities, it’s important that you discuss this with your doctor. Getting a diagnosis as soon as possible means that treatment can start quickly. Early treatment will give you the best possible outcomes.

    Your doctor will:

    • take your medical history – this will include finding out about your symptoms, how long you’ve had them, what makes them better or worse
    • examine your thumb – this will include feeling for warmth, listening and feeling for grinding or crunching (crepitus), and moving your thumb through it’s range of movement.

    Your doctor may also request x-rays of your thumb to get a better look inside the joint and check for bone spurs.

    Treatment

    There’s no cure for thumb OA, but it can be managed effectively using self-care, splints, medications, and in some cases, surgery.

    Self-care

    • Exercise – as with all musculoskeletal conditions, exercise is one of the most important things you can do to manage your pain and keep your joints moving. A study published in the BMJ Open from researchers at The University of Sydney found that hand exercises, when used with pain relief, splints and education, increased hand function and decreased pain in people with thumb OA. In Appendix 2 of the article, you can access the exercises used in this study.  You can also see a hand therapist, a physiotherapist or an occupational therapist for exercises specifically tailored to you.
    • Heat and cold – cold packs/gels can help reduce inflammation, and heat packs/gels can loosen stiff muscles, both providing temporary pain relief.
    • Aids and equipment – such as jar openers, book holders, tap turners, button hook and zipper aids and easy-grip utensils can make tasks easier and more efficient by reducing the stress on your thumbs and eliminating tight grasps. You may need to speak with an occupational therapist about what equipment is best for you.
    • Avoid repetitive or repetitive activities that strain the thumb – e.g. hand sewing.

    Hand therapy
    A hand therapist is an occupational therapist or physiotherapist who has undergone advanced training to become experts in assessing, diagnosing, and treating upper limb problems (shoulder to hand). They can provide advice on joint protection and energy conservation (e.g. splints) as well as recommendations for adaptive devices/equipment to improve thumb and hand function. You can find a hand therapist via the Australian Hand Therapy Association website or talk with your doctor.

    Splints
    A splint can support your thumb, reduce your pain, protect your thumb while you do your everyday activities, and rest the joint. A hand therapist can give you advice on splints.

    Medications
    Your doctor may suggest medications such as analgesics (pain killers) and/or non-steroidal anti-inflammatory medications (NSAIDs) for temporary pain relief. Topical creams and gels are preferred over oral NSAIDs because less medication is absorbed into the bloodstream. Your doctor or pharmacist can advise you on the best medication to use for your specific health needs.

    Your doctor may recommend a cortisone injection into the joint if other strategies such as medications, the use of a splint, and self-care activities haven’t reduced your pain. These injections can reduce pain and inflammation for several weeks to months. However, you can only have a limited number of injections into the same joint in the space of a year.

    Surgery

    If conservative treatments haven’t helped and arthritis in your thumb is causing significant pain and distress and impacting your quality of life, surgery may be an option. A referral to a specialist hand surgeon is usually required. https://muscha.org/surgery/

    The most common types of surgery for thumb OA are:

    • Joint fusion (arthrodesis) – involves fusing two or more bones together. This essentially turns them into one bone and relieves pain because the joint no longer moves. However, you do lose flexibility in the thumb.
    • Osteotomy – involves cutting, shaping and repositioning bone to help correct joint alignment.
    • Trapeziectomy – involves removing one of the bones in your thumb joint (trapezium) to relieve pain.
    • Joint replacement (arthroplasty) – all or part of the affected joint is removed and replaced with an artificial implant.

    Osteoarthritis in the thumb can be a painful and distressing condition. But the good news is that there are many things you and your healthcare team can do to manage your pain and keep you doing the things you love to do. The important thing is that you seek treatment early and follow your treatment plan.

    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

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    summer.jpg
    Lisa Bywaters
    19/Jan/2022
    Health InformationMSK articles

    Tips for surviving the summer

    by Anne Lloyde, MSK Help Line Manager

    We’re well and truly into summer, so we need to think about ways to stay safe, keep cool but still have fun in the warmer weather.

    Taking care of your skin in the sun – it’s a balancing act

    We all know the ‘slip, slop, slap, seek, slide‘ message and the importance of protecting ourselves from the summer sun. After all, the sun’s ultraviolet radiation (UV) is the primary cause of skin cancer, and Australia has one of the highest rates of skin cancer in the world. But sun exposure is essential for bone health. Sunlight is our best source of vitamin D, which helps us absorb calcium for strong bones.

    It’s important to expose your hands, face and arms to the sun every day. The amount of time you need to do this depends on where you live, the time of the year, and your skin’s complexion. Healthy Bones Australia has developed a chart to help you work this out.

    It’s also important to be aware of the dangers of sun damage and how you can expose your skin to the sun safely. SunSmart has a free app to help you determine the safe times to expose your skin to the sun. You can find out more about the app and download it here.

    Sun sensitivity can affect people with various musculoskeletal conditions, including lupus and dermatomyositis. For people with sun sensitivity, sun exposure can cause rashes and lesions, flares or aggravation of their condition.

    Medications can also cause the skin to be sensitive to sunlight, including some antibiotics, disease-modifying anti-rheumatic drugs (DMARDs) and some nonsteroidal anti-inflammatory drugs (NSAIDs). For more information about medications that can increase your risk in the sun, read this article from The Conversation.

    If you have issues with sun sensitivity and limit your time in the sun, you may be deficient in vitamin D, as the main source of vitamin D is sunlight. Talk with your doctor if you think this is an issue for you, as you may need vitamin D supplements.

    How to take care of your skin:

    • Check daily UV levels by visiting the Bureau of Meteorology or the weather page in newspapers and online.
    • Use the Vitamin D and bone health map to guide you about the amount of time it’s safe for you to expose your skin to the sun.
    • Clothing, hats, sunscreen and shade are the best ways to protect your skin from UV light. You should use sunscreen with a sun protection factor (SPF) of 30 or higher on skin that can’t be covered by clothing. Choose your clothing carefully as not all fabric provides the same sun protection. To block more of the sun’s rays, choose clothing that has a thick, dark material with a tight weave. The Cancer Council has some useful information to help you know what to look for in sun-protective clothing.
    • Keep a scarf or sun umbrella with you during the summer, just in case you’re out in the sun unexpectedly.
    • Wear a hat that shades your whole face, neck, ears and head. Broad-brimmed hats with a brim of at least 7.5 cm provide excellent protection.
    • Try to stay out of the sun between 10am and 2pm (or 11 am and 3 pm daylight saving time) when UV levels are at their highest. Avoid highly reflective surfaces such as sand or water.

    For more information on protecting your skin, visit the Cancer Council website. They have lots of very helpful resources.

    Staying active

    One of the best ways to manage your musculoskeletal condition is to exercise regularly. But in the warmer weather, you need to consider the weather conditions. Your regular exercise program may not be appropriate for an Australian summer and may need to be adjusted. If you’re unsure where to start, talk with a physiotherapist or an exercise physiologist for information and support.

    Some general tips for exercising safely in summer:

    • Don’t eat before you exercise. Your body uses energy when it’s digesting food, creating more heat. That’s the last thing you want when you exercise, so give yourself plenty of time between eating a meal and exercising.
    • Drink plenty of water – before, during and after exercise. You sweat more when it’s hot and when you’re exercising, so you need to replenish the fluids you lose.
    • Wear loose-fitting, sun-protective clothing that allows you to move freely and for sweat to evaporate quickly.
    • Change the time you exercise. Avoid the hottest part of the day, so exercise earlier or later in the day. Or, if that’s not an option, change the way you exercise on very hot days. Exercise indoors using apps, online videos or DVDs. Or visit your local pool or beach and exercise in the water.
    • Recognise that there’ll be days when it’s not safe to exercise outdoors. And if you don’t have adequate cooling indoors, that applies to indoor exercise as well. Australia is a land of extreme temps, so on those really hot days, give yourself a break 😎.

    Storing your medications in hot weather

    You need to take special care with your medications in hot weather, and they need to be stored correctly in cool, dry places away from direct sunlight.

    Avoid bathrooms, as they’re often humid. Avoid cupboards above the stove or oven as they can get hot.

    People on certain biologic medications may need to store medications below 8ºC, and you may need a cool bag to keep them at the correct temperature when bringing them home from the pharmacy and when traveling on holidays. Pharmaceutical companies will often provide special travel packs. Talk to your pharmacist for more information.

    Preparing meals in summer and for special occasions

    We tend to gather more regularly in the summer to enjoy good company, good food and good weather. However, this can cause stress, especially if it’s a big event or if you put pressure on yourself for everything to be ‘perfect’. And when the temps are high, as they often are in summer, this can add to your fatigue and discomfort.

    Here are some simple steps to help you create and enjoy meals in a way that saves you energy and frustration, leaving you with more time to enjoy your family and friends:

    • Separate your tasks into small steps so that you can plan ahead and prepare things over time rather than in a rush.
    • Consider ordering your food and groceries online and having them delivered. Check out the websites of your local traders for more information.
    • When buying groceries, consider the pre-cut or pre-packaged fruit and vegetables. This will save you time and effort when preparing meals.
    • A range of kitchen utensils is available, including knives and peelers with wide easy-grip handles that make things easier when you’re cooking. Check out our online shop to see some gadgets that can make life easier
    • Remember that vegetables are easier to chop after they’ve been cooked.
    • If you have difficulty carrying saucepans and draining the water when cooking pasta or veggies, use a metal colander or wire basket slightly smaller than the saucepan. Put the food into the colander and place it in the saucepan. Once the food’s cooked, simply lift the colander out of the saucepan. Or ask someone to do this for you.
    • Share the load and have people bring a plate. You don’t have to do everything. And it gives everyone a chance to bring their favourite new recipe 😊.
    • When you head to the park or the beach, be on the lookout for outdoor tables where you can comfortably sit to enjoy your picnic, rather than having to sit on the ground or carry portable chairs.

    Medical cooling concessions and rebates

    These concessions provide a discount on summer electricity costs for concession cardholders who have specific medical conditions that affect the body’s ability to regulate temperature.

    Visit your state/territory website to find out if you’re eligible for this concession:

    Tips for surviving the summer from our volunteers

    • Exercise in the morning when it’s cooler.
    • In very hot weather, go for your daily walk in air-conditioned shopping centres, rather than outside in the heat.
    • Don’t forget to protect your feet. Put sunscreen on any exposed skin and wear supportive shoes.
    • Drink plenty of fluids to keep well hydrated.
    • Maintain a healthy diet with lots of light salads.
    • Prepare and pre-cook meals in the morning when you have more energy and when it’s a bit cooler. You can then reheat it in the evening.
    • Have your air conditioner serviced so that it’s more efficient.
    • Take ice packs when shopping to keep perishable goods cold.
    • Think about doing your shopping online and having it delivered.

    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

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    career.jpg
    Lisa Bywaters
    19/Jan/2022
    Health InformationMSK articles

    Is it time to change jobs?

    Working with a musculoskeletal condition can be a real struggle. Some people find that no matter how many accommodations or adjustments they make in their job, they can no longer perform their work duties to the required level. Or the job has become too taxing on their body, causing constant pain, fatigue and stress.

    This can be a devastating blow, especially if it’s a job that you love. It can also be an extremely scary time as you contemplate a new future, with a different job.

    The good news is that there are resources and organisations to help you through this process.

    Job Outlook

    Job Outlook is a great website and a good place to start when contemplating your next career move. It has a range of very helpful tools including:

    • Skills match – this tool helps you find new jobs that use your existing skills. You simply add your previous jobs, including unpaid or volunteer work, and it’ll give you alternative jobs that use your skills.
    • Career quiz – this simple quiz gives you a range of work scenarios. You choose the ones that appeal to you the most. The quiz provides a range of career paths that may interest you based on your answers.
    • Explore careers – provides all the relevant information about different occupations including tasks associated with the job, salary, future growth, skills and knowledge required, and the work environment (including physical demands of the job).
    • Links to training courses, job vacancies and other useful resources.

    JobAccess

    JobAccess is the Australian Government’s one-stop shop for information and resources for people with disability, employers and service providers. The section for people with a disability has a wealth of resources, especially on the Available Support page including:

    Australian Job Search

    Australian Job Search is Australia’s largest free online jobs website. Lots of useful info and resources for job seekers.

    Job Jumpstart

    Job Jumpstart provides articles and tools to help you find jobs that suit your interests. Information is tailored to your stage of life:

    Department of Education, Skills and Employment

    The Australian Government, Department of Education, Skills and Employment, provides information and support to help you with training and learning new skills.

    • Career Transition Assistance – designed to help people over the age of 45 build their confidence and skills when it comes to finding a job, and becoming more competitive in their local labour market.
    • Help with the cost of training – find out if you’re eligible for free or subsidised training.
    • Skills and Training Incentive – for people aged 45-70 years of age, it provides up to $2,200 to jointly fund training to help you remain in the workforce longer.

    My Skills

    My Skills is the national directory of vocational education and training (VET) organisations and courses. It provides info on:

    Careers counsellors

    You can also get professional help making decisions about your career choice by talking to a careers counsellor. They provide information, advice and guidance to help you make realistic choices about work, including further training or upskilling. They can help you identify jobs that match your skills and interests, create a resume, provide info on where to look for jobs and more.

    Visit Career Development Association of Australia (CDAA) to find a private career counsellor who can help you work out your best career options. Note – these services aren’t free. The CDAA advises that ‘all members are in business, they charge a fee for the services they provide. You are encouraged to contact 2-3 members and discuss your needs to make an informed decision about who could help you best.’

    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.

    CONTINUE READING
    doctor-appt.jpg
    Lisa Bywaters
    09/Dec/2021
    Health InformationMSK articles

    DontWaitMate: Managing your health during the pandemic

    Did you know that 52% of Australians are putting off their healthcare due to concerns about COVID-19? (1)

    This alarming figure has prompted the Continuity of Care Collaboration (CCC), a network of more than 35 peak bodies, industry and healthcare organisations, to create the #DontWaitMate campaign.

    The campaign aims to reassure people that attending their GP, dentist, pharmacist, allied health professionals, and specialists is safe. That it’s safe to get blood tests, skin tests, scans and all other pathology tests.

    It’s essential that anyone with chronic or complex health conditions, the elderly, vulnerable communities and people who are immunocompromised have continuity of care so that they’re able to live as well as possible. And that any changes in their health are picked up as soon as possible.

    #DontWaitMate campaign also urges anyone who’s been putting off their tests or has noticed urgent and/or new symptoms to pick up the phone and make an appointment today.

    Your health is the priority.

    CCC explains that there are measures to help you feel safe to access health care needs remotely, e.g. through telehealth, e-prescribing of medicines and home delivery of medicines. If you need to go to a clinic or hospital, personal protective equipment, regular cleaning, and distancing measures are all in place.(2)

    It’s all about keeping you safe while managing your ongoing healthcare.

    So Don’t Wait Mate. If you’re like me and have a pathology form stuck on the side of your fridge or a poo test in your bathroom drawer, go and get it, pick up the phone, and make that call. Don’t let them expire like I did ?. It just adds to the time you’re waiting to ensure everything’s ok.

    Or, if you’ve noticed some changes in your health or body that concern you, make an appointment with your doctor to discuss them.

    Because your health is too important to neglect.

    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.

    Reference

    (1-2) Continuity of Care Collaboration
    https://continuityofcare.org/

    CONTINUE READING
    GP-plan.jpg
    Lisa Bywaters
    18/Nov/2021
    Health InformationMSK articles

    Chronic disease management

    Ever notice how much governments love acronyms?? Unfortunately, this article is full of them, but we’ll explain what they mean and try to clear up the murky area of chronic disease management (CDM) plans, formerly called Enhanced Primary Care (EPC) plans.

    Note: The primary sources for this article is the Australian Government, Department of Health’s chronic disease management resources. Unfortunately this information has not been updated since 2014. Please treat this as general information only, and discuss your specific needs with your GP.

    What are CDM plans?

    In a nutshell, these plans are a proactive way for you and your general practitioner (GP) to manage your chronic, complex or terminal medical condition/s. The Department of Health defines a chronic condition as ‘one that has been (or is likely to be) present for six months or longer’.

    Chronic musculoskeletal conditions fit under this definition.

    These plans are prepared by a GP to help eligible people manage their condition/s. The plans set goals to help people manage and hopefully improve their health and wellbeing.

    There are two types of CDM plans:

    • GP Management Plans (GPMP) and
    • Team Care Arrangements (TCAs).

    GP Management Plans (GPMP)

    A GPMP can help people with musculoskeletal conditions by providing an organised approach to their care. It’s a plan that you’ve worked out with your GP that:

    • identifies your health and care needs
    • sets out the services to be provided by your GP
    • lists any other health care and community services you may need
    • lists the actions you can take to help manage your condition.

    For example, if you have osteoarthritis in your knees that’s causing you lots of pain, and you’re no longer able to comfortably play tennis or go bushwalking, you and your doctor might decide that losing some weight will improve this situation. However, rather than just agreeing that weight loss is a good idea, a GPMP is an action plan that sets out your clear aims and objectives.

    Once this plan has been developed, you should receive a copy to take with you.

    Team Care Arrangements (TCAs)

    If you need help from other healthcare providers to achieve your goals, your GP may also suggest a TCA.

    TCA’s include 5 visits per calendar year to other health care providers. These 5 visits can be to one healthcare provider or spread between several providers.

    On the first of January you become eligible for 5 new visits. You’ll need to see your GP about this.

    You should also receive a copy of this plan.

    Eligibility

    This is one of the areas that’s a little complicated, so if you think you might be eligible, it’s best to speak with your GP directly. When you call to make an appointment, let the receptionist know that you’d like to discuss a chronic disease management plan. You’ll need a longer appointment for this.

    The Department of Health states that while there’s ‘no list of eligible conditions…these items are designed for patients who require a structured approach and to enable GPs to plan and coordinate the care of patients with complex conditions requiring ongoing care from a multidisciplinary care team. Your GP will determine whether a plan is appropriate for you’. (1)

    Costs

    Also a tricky area. If a healthcare provider (e.g. dietitian) accepts the Medicare benefit as full payment for the service, you’ll be bulk billed and there’ll be no out-of-pocket costs. However if they don’t, you’ll have to pay the difference between the fee charged and the Medicare rebate. This is often called the ‘gap’.

    When you’re making an appointment, be sure to ask what your out-of-pocket costs will be. If the cost isn’t something you can afford, discuss your options with your doctor.

    Reviewing your plan

    Your plan will need to be reviewed regularly. These reviews allow you to see how much progress you’ve made. If you’re meeting your goals – e.g. losing weight, increasing your fitness – that’s great. If you’re not getting there or having difficulties, a review will allow you to discuss this with your GP and work on solutions or adjust your goals.

    Help!

    It can seem overwhelming, but your GP and the practice nurse are there to support you on this journey.

    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

    Reference

    (1) Chronic Disease Management Patient Information, Australian Government, Department of Health, 2014.

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