Miranda Olding is an MS nurse who specialises in pain. She recently wrote a chapter on pain management for talkhealth‘s myMS support programme which describes the different types of pain and treatment options available for people living with the condition.
What made you decide to specialise in pain in MS?
I have specialised in MS Nursing and pain is my area of special interest. I specialised in MS because it’s such an interesting and involving role within nursing. No two people are the same, and an MS Nurse’s role can span from education and health promotion, through navigating treatments and life events, to helping people to manage complex disability.
I developed a special interest in pain, because it’s such a tricky problem within MS, and can be caused by a variety of different factors, such as spasm and stiffness, musculoskeletal, or nerve pain. I became even more involved when we began a novel therapy using Action Potential Simulation machines ( or APS Therapy) at the MS Therapy Centre where I worked, which has been really successful. This led to me training and distributing APS Therapy in the UK, and also to develop my knowledge about other medical and non-drug options that can help people with pain caused by MS.
What exactly is APS Therapy and how does it work?
APS stands for Action Potential Simulation. Action Potentials are the body’s own ‘electrical signals’ that carry information along the cells. Action Potential Simulation machines send a copy of this biological signal through the cells of the body and this gets them to communicate with each other more effectively, helping to remove waste products and reduce inflammation. It also stimulates higher levels of ATP, the body’s energy-carrying molecule, which then stimulates the body’s own repair mechanisms. Certain neurotransmitters that are involved in pain relief and reduction of inflammation are also raised.
The result for many people, after a period of time, is pain relief. Some people also have a boost to their energy when using APS Therapy, so this can be useful for reducing fatigue in MS. It’s applied by attaching electrodes to the body and takes around 40 minutes per session. The results build up over weeks, so we generally recommend that people have a trial.
There are 12 MS Therapy Centres around the country who offer APS Therapy, some private practitioners, and people can also purchase machines for home use after having a trial.
You also have a background in holistic therapies. What is your opinion on using ‘alternative’ therapies are lifestyle factors for pain management?
I have been lucky enough to have been able to integrate some alternative therapies into my practice at different times. I’m just going back into the NHS, but in my last role, I used both HeartMath(c) biofeedback to teach stress resilience, and Bach Flower remedies, to support emotional health – as well as being very proactive about diet, exercise and sunlight!
I prefer to use the term ‘complementary’. What we mean to do is complement or enhance what is offered by western medicine, rather than provide an ‘alternative’. There is a lot of strength in integrating complementary therapies and lifestyle factors with medical treatment in our lives, and I think that most people intuitively know that taking a tablet alone is unlikely to help them find their best health.
There is more and more acknowledgment in medicine that lifestyle factors are equally as important to staying well, especially with a long term condition with MS. It’s now recommended that MS Nurses all talk to their patients about following a ‘brain-healthy lifestyle’, and that’s about diet and food, weight, smoking and drinking, and exercise; all of these things have been found in clinical research to have a profound impact on health with MS. Exercise, for example, has been likened to a disease-modifying treatment because of the strong role it plays in helping to reduce inflammation. And then, of course, there’s managing stress – which complementary therapies can be fantastic for.
What advice would you have for someone who is living with chronic pain and who has only been offered high-strength painkilling medication?
If you want to reduce your medication, first educate yourself about what else you can do to support yourself. This may be gaining a better understanding of what the pain is and means, and how you can best manage it. It may also be a different treatment, therapy, or an exercise program (depending on what sort of pain it is).
Take action on the new approach, and be consistent. Then, if and when you feel that it is helping and with your GP’s support, reduce your medication very gradually and see how you get on. Some high strength pain medications such as opioids (ranging from codeine/co-codamol, through tramadol and higher doses of morphine drugs), are now causing a lot of problems, as they cause dependences (needing a higher and higher dose in order to get the same relief), and addiction (when you feel like you can’t cope without the medication), so it is a good idea to make a strategic plan for reducing these.
Are people with MS at greater risk of complications from COVID-19, and what advice do you have from MS patients during this worrying time?
Having MS does not make someone more at risk of catching COVID-19, as MS does not weaken immunity. However, people who have had the disease-modifying drugs Stem Cell, Alemtuzumab, or Mavenclad (Cladribine) in the past three months may have a period of lowered immunity and should strictly shield themselves from infection as a result. If you’ve been shielding for the past few months, chat to your GP before heading back outside.
Fingolimod and Ocrevus can also lower immunity, but the risk of withdrawing treatment may be worse than the risk of taking it. Everybody on these drugs is advised to speak with their MS team. The other DMTs do not present a greater risk of getting COVID-19.
People who find it hard to cough or clear their lungs should also stay as safe as possible, as they may be more vulnerable if they catch the virus; as people with MS will know, having any type of infection often causes MS to play up for a time. There is very good information being regularly updated on the MS Trust website, and I would recommend staying in touch with this, as well as the latest government advice for everybody. Abide by the recommended actions, stay positive and get on with whatever makes you feel good and supports your health in general.
You can read more from Miranda on her MS Nurse with a holistic approach blog.