Mapping Out Your Next Trip

Many dream of traveling to discover new places. As Mark Twain said, traveling gives us the chance to “…explore, dream and discover.”

Yet, for those who live with chronic pain, traveling can be a difficult and painful experience — and an endeavor they may choose to avoid at all costs. A two-hour road trip can turn into two hours of agony. Sitting on a plane for six hours can render someone with arthritis in the knee nearly immobile if he or she is not able to move around.

For Leona, a jewelry-maker and part-time art teacher in Chicago, traveling would be a dream come true. “Oh, I would so love to see Paris, all of Europe, and all the art and museums. I would love to visit my siblings all across the U.S. and Mexico.”

Unfortunately, Leona lives with degenerative disc disease and osteoarthritis that causes severe, daily pain. Just traveling 90 minutes by car to visit family over Christmas aggravated her already inflamed joints and spine. She brought ice packs and a heating pad on her trip. “Even with these accommodations, it took me three days to recover from my trip. Travel right now, sadly, is out of the question.”

For Kate Mitchell, traveling is something she really enjoys. A graduate student with psoriatic arthritis who lives in Boston, Kate always weighs the pros and cons before deciding to pack her bags. Riding in a car for more than two hours and flying are difficult, but she visits her family in Maine. Her favorite destination is London — she’s been twice and hopes to return. When choosing to travel, Kate takes into consideration both the physical and monetary impact. “I don’t want to spend hundreds of dollars to travel somewhere if I’m going to feel horribly for most of the time.”

 

Preparing to Travel

Despite living with psoriatic arthritis, Kate Mitchell has traveled twice to London.
Despite living with psoriatic arthritis, Kate Mitchell has traveled twice to London.

Traveling may be an annual event for some, but for others, it is not even an option. Some people living with chronic pain already must travel long distances for work or to see their rheumatologists or pain specialists. More than half of pediatric arthritis patients must travel 100 miles or more to see a pediatric rheumatologist due to the shrinking pool of specialists.

How do you manage chronic pain when you’re away from home? There are several ways to make traveling less painful and more enjoyable, experts say. To start, make sure your trip matches your current health status. If you’re having difficulty walking, find a trip with fewer steps and more transportation provided.

Preparing for your trip goes a long way, said rheumatologist Arthur Mandelin II, M.D., Ph.D., assistant professor of medicine at Northwestern University Feinberg School of Medicine. “Patients very commonly come to their office visits and describe a recent vacation in which they overdid it just a little,” he said. “But despite paying the price of a few days of increased symptoms, they usually say the overall experience was worth it.”

Kate, who takes about 30 pills a day to manage her chronic pain, said she always brings her medications with her and makes sure to wear comfortable shoes.

Appropriate footwear is always recommended, agreed Erica Fritz, DPT, a physical therapist and board-certified orthopedic specialist with the Hospital for Special Surgery in New York. Rubber soled walking shoes are recommended to avoid slips and falls. “It’s especially important to wear shoes with support and good shock absorption with lower extremity arthritic conditions,” she said. “Insoles may be appropriate for certain patients with anatomical misalignments from flat feet, bow legs, or knocked knee.”

In her practice, Fritz — who sees a large number of patients with osteoarthritis and rheumatoid arthritis — reminds them that being immobilized for prolonged periods of time when traveling will increase their pain and stiffness. “I tell my patients that regardless of their means of transportation — bus, plane, train, or car — they should stand up every hour to stretch. Every 30 minutes I ask that they do something seated to move their affected joint.”

Fritz recommends several exercises for her patients who are traveling. She is quick to point out that not all exercises are appropriate for everyone, and a doctor should be consulted beforehand. Her favorite exercises when traveling include walking, sit to stands, marching in place, ankle pumps, heel and toe raises, stretching your neck from side to side, reaching both arms overhead toward the ceiling, and trying to elongate your spine.

Exercises to Do While Traveling

“The number of exercises that may help patients with arthritis, including osteoarthritis and rheumatoid arthritis, is endless. Research has shown that strength and flexibility training, manual therapy, aquatic therapy, and balance training can reduce pain and improve function in these patient populations,” she said.

On road trips, make pit stops every hour or so, said Mandelin. “Even a five-minute stroll through a gas station convenience store every hundred miles or so can make a difference.  Resist the temptation to just stay in the car until the journey is over.”

 

What to Pack?

Whether you’re planning an overnight trip or an extended vacation, there are several crucial considerations when packing your bags. With increased airport security and stricter rules for carry-on luggage, it’s more important than ever for people with chronic pain to be prepared for their next trip and have the right medications and supplies with them at all times.

To get through airport checkpoints without any hassles, ask your doctor for a note explaining your condition. Give yourself enough time to get through security, because you may be stopped and have to answer additional questions.

If you are flying, pack your medications and supplies in your carry-on luggage rather than a checked bag, said Mandelin. “Keep your medication in the original containers, with the pharmacy’s labels still attached. This way you can prove your medication is yours and that you are authorized to take it; this is especially important with high-potency pain medications that are controlled substances.”

Bring more medications and supplies than you normally need in case there are any unexpected delays or cancellations. Dealing with pharmacies and medical clinics to obtain additional supplies — particularly if you are overseas — can be frustrating and time-consuming.

If you’re taking injectable medications such as Humira or Enbrel, remember they require refrigeration. “Many injectable medications can tolerate so-called ‘excursions’ out of the refrigerator for a few hours while you travel, but you may want to check with your pharmacist regarding your particular drug,” said Mandelin. “If taking your injectable one day early or one day late would shift your schedule enough that you wouldn’t need a dose at all while you’re away, that’s probably okay, but check with your doctor.”

 

Anticipate Challenges

No one wants to think the worst when planning a trip, but travel often is riddled with challenges and complications. Anticipating as much as possible ahead of time will make the trip less stressful. Here are some tips to help you prepare for any and all medical issues.

  • Ask your doctor for a list of pain specialists located where you will be visiting.
  • Bring a recent prescription with you in case you run out of supplies or lose them. It’s definitely easier to get replacement supplies with a proper prescription.
  • Consider purchasing travel health insurance in case a more serious medical emergency should occur. Insurance not only will cover lost medications, but also will pay to transport you to a hospital of your choice and any qualified accompanying medical expenses you may incur. Most provide 24-hour hotlines for questions or assistance. Travel health insurance typically costs between 4% and 8% of the total trip cost and is calculated based on age, pre-existing conditions and length of travel.
  • Particularly for air travel, avoid peak travel times and the accompanying long lines.
  • Book nonstop air travel to minimize long walks through airport terminals.
  • Choose an aisle seat to make it easier to stretch and stand.
  • Remember that wheelchairs are available; call the airport in advance to request one.

Kate said she uses wheelchairs to get around airports. “Take advantage of things to help make your trip easier on yourself,” she advised. “And don’t forget to plan rest time into your schedule.”

Paul Wynn, a writer based in Garrison, N.Y., has covered health-care trends for the past 20 years.

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