This is not medical advice. This should be considered educational, and does not substitute the guidance of a licensed physician. Always discuss changes in your prescription medications before making any decisions on your own.

Clinic care opens the door. Home care is what keeps it open.

At Home Care

1. Evil Bone Water

I can go on and on about the benefits of this spray. It is an ancient Chinese remedy, made in Florida by Saint Apothecary. We carry it in the clinic and we can barely keep it in stock. It can be used for pain relief, but on our, farm we use it for insect repellant and bite/sting relief, poison ivy, bruises, cuts, and burns. It speeds healing and reduces pain. Patients are always amazed, and come back to buy more bottles for friends.

2. Specific movement (not just “exercise”)

The goal isn’t to “work out.” It’s to signal safety + pump fluids through tissues.
Creative insight: micro-doses of motion throughout the day (2–5 minutes, 4–8x/day). For many chronic pain patients, this beats one big workout that triggers a flare.

Ideas that work well:

• gentle walking in short but frequent times throughout your day
• mobility flows for the affected area + adjacent joints (taichi, qigong)
• strength training scaled to tolerance (especially for joint stability)

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3. Stay active without boom/bust

Chronic pain loves extremes: overdo it → crash → fear movement → decondition → more pain.

‍Use a “minimum effective dose” approach: do the amount you can repeat tomorrow.

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3. Low-inflammatory foods (without perfectionism)

Focus on simple consistency:

• protein + colorful plants
• omega-3 rich foods (or discuss supplements with your clinician)
• fewer ultra-processed foods, added sugars, and alcohol

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Creative insight: inflammation is often cumulative, think of it like a bucket. Food is one of the easiest places to stop adding extra “drops.”

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3. Reduce stress (because stress is inflammatory)

This isn’t “just mindset.” Stress chemistry can tighten tissues, reduce digestion, worsen sleep, and increase pain sensitivity.
Practical tools:

• 5 minutes of slow breathing (especially longer exhales)
• sunlight in the morning + consistent bedtime
• boundaries around news/social media when flared

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A needed conversation: gabapentin and long-term risks

Gabapentin can be helpful for certain pain patterns (especially neuropathic pain) but it’s not a free ride, and “long-term by default” deserves scrutiny.

Here are concerns that have been increasingly discussed in the medical literature and by regulators:

Breathing risk in higher-risk situations

The FDA added warnings that serious breathing problems can occur with gabapentin/pregabalin, especially in people with respiratory risk factors, older adults, and when combined with opioids or other CNS depressants.

Increased risk when combined with opioids

A large population-based study found higher risk of opioid-related death among people prescribed opioids who were also taking gabapentin.

Cognitive effects are an active area of concern

Emerging observational research (not proof of causation) has reported associations between more frequent gabapentin prescribing and higher rates of dementia and mild cognitive impairment in chronic low back pain cohorts.

These findings are still being debated and need replication, but they’re important enough to warrant informed discussion and monitoring.

Dependence/withdrawal can happen

Some people develop physical dependence, and guidance commonly emphasizes tapering rather than abrupt stopping to reduce withdrawal symptoms. (This is a big one: patients sometimes think gabapentin is “easy to quit,” and that’s not always true.)

Misuse potential exists

Systematic reviews describe real-world experiences of misuse and dependence among some gabapentinoid users, particularly in higher-risk populations.

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How I frame it for patients: If you’re on gabapentin long-term, it’s worth asking your prescriber:

• What’s the goal and timeline?
• Is it still helping meaningfully?
• What are the risks for me (age, fall risk, other meds, breathing issues)?
• What’s the plan if we ever reduce it (slow taper, supports, monitoring)?

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