Lifestyle changes for chronic pain

What is Chronic pain?

Chronic pain is a kind of pain that lasts for more than 3 months or, sometimes 6 months. But, according to the International Association for Study of Pain, the symptoms tell us whether the pain is chronic or not. Therefore the chronic pain has several characters like burning sensations, itching, cramping, etc. Also, it is associated with depression, lack of sleep, less or excessive eating, and also lack of exercise. All these in turn increases pain and several vicious cycles develop. In this article, we shall discuss all these factors in detail.

Chronic pain and stress:

Chronic pain and stress usually share a significant physiological and conceptual overlap. Both physiological and conceptual phenomena challenge the body’s homeostasis and demand or compel decision-making to assist individuals in adapting to their environment. But, chronic pain and stress share a common behavioral system of failure to put down or eliminate the negative memories. The persistence of chronic pain and stress is abnormal and could lead to vulnerable well-being (Abdallah et al.,2006).

How is Chronic pain related to anxiety and depression?

Anxiety and Depression Association of America opines that pain can be a good indicator and sometimes an important symptom of depression and anxiety disorders or GAD (generalized anxiety disorders). Beyond everyday pain and aches, some individuals will also experience chronic diagnostic pain such as fibromyalgia and arthritis. A co-occurring disease with chronic pain can make operating much more difficult for individuals with depression and anxiety disorders (ADAA organization, 2021).

According to this association, many chronic pain diseases are common in individuals with depression and anxiety disorders. Arthritis describes more than 90 medical conditions that affect the joints, muscles, or overall musculoskeletal system. Symptoms of arthritis include inflammation, stiffness, pain, and damage to the cartilage of the joints and other surrounding structures (ADAA organization,2021).

According to the research made by the American association, mood disorders like depression and anxiety are common among individuals who have arthritis, especially in younger adults. Chronic pain disorders, along with depression and anxiety disorders, are more challenging to treat. Also, individuals with chronic pain disorder along with depression and anxiety may be more sensitive to the side effects of medications. They may also be more vulnerable to pain than individuals who suffer from pain without depression and anxiety (ADAA organization,2021).

The vicious cycle of chronic pain and stress

It has been experienced that stress can contribute to chronic pain and that chronic pain can contribute to stress. The pressure of a long-term disability or disease can put a lot of financial and emotional pressure on an individual. For example, feeling misunderstood, feeling excluded from daily living activities, and the stress of being unable to work can negatively affect the way an individual realizes their character or part within the family and society (Stern et al.,2005).

Chronic pain is a debilitating and incapacitating condition that affects a person’s functions and mobility and influences the finance, work experience, and personal relationships of an individual. Feelings of being isolated can affect the levels of stress. Evidence shows that stress and chronic pain release the same chemicals and lead to some abnormal behavior and physiological changes (Stern et al.,2021).

How to break the vicious cycle of chronic pain and stress?

It is crucial to know that the pain you are suffering from is not your fault, and it is essential to understand that these reactions are entirely natural. Understanding the cause of pain and treating it will help to break the pain and stress cycle. Breaking the pain and stress cycle is the formation of adaptive behavior from maladaptive behavior. Some tips help you break the stress and pain cycle on your own (Marie et al.,2019).

Tips to break the vicious cycle of chronic pain and stress:

Self-education about the pain. Understand the cause of pain, the sciences behind the pain, and change the behavior can break the pain and stress cycle.
Exercise. The most important thing to break the cycle is exercise. Gentle exercise like swimming, walking, and physical therapy help you to move your body and protect yourself from immobility.
Replace avoiding situations with actions. Avoiding situations just because of their effects on your pain is worsens your pain rather than better. Once you understand the cause and science of pain, you can start to face the situation rather than avoiding it (Marie et al.,2019).

Chronic pain and sleep:

Chronic pain has considerable effects on sleep, and on the other hand, a sufficient amount of restless sleep can increase susceptibility to pain. Sleep disturbances due to chronic pain can cause behaviors, emotional and physical complications. For instance, it has been noted in the rheumatologic literature that there is a connection between chronic pain, sleep disturbance, and depression (Moawad et al., 2020).

Can there be increased pain due to lack of sleep?

Sleep deprivation has a significant impact on a person’s response to pain as the stages of sleep are compromised, pain during the daytime increases. Scientific studies indicate that sleep disturbance impairs pain inhibition pathways that generally help to regulate pain. According to the research, chronic pain is caused by a lack of sleep, or sleep disturbance may enhance the perception of pain that is already arising due to underlying factors (Moawad et al., 2020).

It is common for individuals with chronic pain to undergo problems falling and keeping naps due to their pain. In turn, it boosts their experience of symptoms, tension, and pain throughout the day. As a result, individuals feel more distressed, irritable, emotional, and they feel like they have less tolerance because of their pain. Individuals often report feelings of frustration and potentially shouting out at their loved ones (Katz et al.,2019).

The vicious cycle of chronic pain and sleep disturbance

Association between chronic pain and sleep disturbance is widely understood among patients with insomnia. Sleep disturbance can provoke physical disorders, such as pain, and pain, in turn, can cause difficulty in sleeping. Almost 45 percent of individuals with chronic pain also have difficulty sleeping. There are some reasons for the vicious cycle of chronic pain and lack of sleep.

Anxiety, stress, and negative emotions that accompany chronic pain can cause difficulty in sleeping.
Chronic pain changes the method of the brain to work usually.
Inconsistent patterns of sleep can cause disturbance in sleep or poor sleep.
People become less active due to pain and leads to poor sleep.
Pain can make it hard to find a relaxing sleeping position (Katz et al.,2019).

Tips for breaking the cycle of pain and sleep disturbances:

Avoid daytime sleeping if you need some rest due to pain or fatigue, nap between 2-4 pm and not more than 1 hour.
Take proper medications according to the doctor’s advice to reduce pain, and it results in to increase in the quality of sleep.
Engage in daily living activities or exercise throughout the day.
Avoid the use of caffeine, nicotine, and alcohol because all these substances cause sleep disturbances and hence exaggerates pain (Katz et al.,2019).

Chronic pain and exercise:

Accordion to the AAPM (American Academy of Pain Medicine), chronic pain affects more than 99 million U.S. individuals and costs $550 to $640 billion every year in direct medical treatment costs. Exercises are commonly used to treat chronic pain. Depending on current health status, exercise helps to reduce inflammation, overalls level of pain, increases mobility, and no medication is required (Freutel et al.,2017).

Role of exercises to reduce chronic pain:

There are differenet types of exercices. Out of these, strengthening, stretching, relax and cardio exercises are common exercises to reduce the pain. Following are the brief descriptions of these exercises.

Strengthening exercises:

Strengthening exercises help to stabilize the joint and prevent future injuries. Adequate core strength is essential for individuals suffering from chronic pain. It helps maintain balance and posture and minimize the risk of damages that can result in more pain. Working with the back, hips, and abdomen muscles can help improve core stability and strength (Freutel et al.,2017).

Stretching exercises:

If chronic pain is present in the neck and low back, stretching exercises help relieve stiffness and tension. Following equipment free stretching exercises are used in this case:

Bring the knees towards the chest and wrap arms around the knees giving a gentle hug to yourself.
Cross one leg over the other to stretch the muscles of the hips.

Relaxation exercises:

Visualizations and deep breathing are included in the relaxation exercises. During these exercises
Lie in a comfortable position on the floor or bed.
Place hands on abdominal and relax feet and shoulders.
Take a deep breath after closing your eyes.
Inhale through the nose and exhale through the mouth.
Repeat throughout the day or every evening as needed (Freutel et al.,2017).

Cardiovascular exercises:

Cardio exercises have some mental and physical benefits and help individuals with chronic pain. Walkie and swimming are included in cardiovascular activities and require little or no equipment.

Walking. Walking can help to increase endurance, strength, and heart health. The patient can use a cane or walker, depending on the state of health.

Water aerobics and swimming. Swimming and water aerobics are excellent alternatives to walking for individuals with mobility problems. This type of cardiovascular exercise help to keep moving without putting extra pressure on muscles and joints (Freutel et al.,2017).

A vicious cycle for chronic pain and lack of exercise:

When a person experiences chronic pain, he restores or relaxes to reduce the pain as a natural response. This response limits the activities and starts a vicious cycle. Too much relaxation or a sedentary lifestyle can be detrimental and result in wasting (atrophy) of muscles which can cause some further health problems like structural problems, less joint stability, and poor posture. Individually avoid performing daily living activities because they fear pain or injury from movement. Muscle strength could be reduced by preventing daily living activities. This cycle increases the levels of distress and disability (Huston et al.,2020).

How does exercise helps in chronic pain?

Physical activities help to manage the existing pain and also prevent from developing chronic pain. People experiencing chronic pain can enjoy a lot of benefits from exercise and physical activities. Exercise breaks the vicious cycle of chronic pain and lack of exercise.

The benefits of exercises in pain are due to following reasons:

Reducing inflammation

Chemicals are released from muscles that help prevent pain signals from reaching the brain, and tissue healing is promoted by increasing the anti-inflammatory cytokines of the immune system (Golightly et al.,2015).

2. Reducing anxieties and depression and improving mood

Exercise and physical activities help to reduce stress and depression and improve the patient’s perspective that breaks the vicious cycle.

3. Reducing pain sensitivity

Some studies have shown that exercises are more effective in reducing chronic pain than training methods without exercise. Exercises change the way the brain responds to pain by regulating the pain signals and enhancing the release of analgesics.

4. Reducing fatigue

Exercises have been shown to decrease fatigue, a common symptom of chronic pain disorders (Golightly et al.,2015).

Chronic pain and obesity:

Recent studies have shown that approximately 50 percent of the UK population is expected to be obese by 2025. It is estimated that chronic pain increases by the prevalence of obesity. There is no single cause of their relationship, but the link between chronic pain and obesity is multifactorial. A better understanding of their association is required to control the increasing numbers of patients (McVinnie,2007).

Effects of obesity on joint pain, osteoporosis, and diabetes:

During obesity, mechanical stress is increased, which increases the risk of joint and musculoskeletal pain. This article shows a positive relationship between increased mechanical stress and increased joint pain, particularly hip, knee, ankle, and low back pain. Overloading on the hip, knee, and ankle joints can cause degradation and damage to these joints leading to osteoporosis (McVinnie,2007).

Obesity interferes with the metabolism of bones through inflammatory, hormonal and mechanical factors. These factors are closely related to the dietary patterns, body composition, and weight of these patients. The net harmful effect of these factors on bone mass and the risk of fracture of different components during obesity is not well known (endoen,2016).

Tips and exercises to reduce obesity:

Studies have shown that exercise prevents obesity in various ways:

Push-ups, weight lifting, and other muscle strengthening exercises increase muscle mass by increasing the energy that the body burns throughout the day and make it easier to control weight.
Exercise reduces fat around the joints and all over the body and minimizes the chances of developing abdominals fat (Haskell et al.,2007).
Exercise increases the total energy expended of individuals, which can help them to lose weight and stay in energy balance.

Try to avoid trans fats as they are the building compounds of obesity. Noodles, burgers, pasta, cookies, junk food, instant food, and fast food, these trans fats are spread all across the world. Try to intake sugar less than 7 per cent of your total calories. Protein with every meal help to reduce obesity, and try to eat red, brown, and black rice instead of white rice (Haskell et al.,2007).

Chronic pain and diet:

Healthy diet:

A healthy diet helps protect against non-communicable diseases, including cancer, stroke, heart disease and diabetes, and malnutrition in all its forms. Increased production of changing lifestyles, rapid urbanization, and processed food, has led to a shift in dietary patterns.

A healthy diet is very important to build healthy bones and also for maintaining throughout life. Calcium plays a vital role to create a healthy bone, and vitamin D help to absorb calcium in the body. Poor bone health can cause osteoporosis and rickets and increase the risk of fracture from a fall (NHS,2021).

Approximately 700mg of calcium is required a day. A good and balanced diet will provide the needed amount of calcium. A significant amount of calcium is present in the following resources:

Anything made with fortified flour like bread.
Nuts.
Fortified milk.
Soya beans.
Green leafy vegetables, such as okra, cabbage, and broccoli but not spinach, contain oxalate and calcium, which reduces calcium absorption.
Dairy foods such as cheese and milk (NHS,2021).

We need 400 international units or ten micrograms of vitamin D a day. A small amount of a. Vitamin D helps to absorb calcium in the body, increasing bone strength in turn. Sources of vitamin D include:

Breakfast cereals, fat spread and some other fortitude foods.
Egg yolk.
Mackerel, sardines, and oily fish such as salmon.
Vitamin D is advised along with calcium in the case of osteoporosis, in which bone strength decreases (NHS,2021).

Diet for obesity:

Obesity is a condition in which body fat is increased, which increases the risk of other health problems. Obese individuals should take specific diets and avoid others. Diet for obese individuals include:

1. Whole grains contain bran, germ and endosperm. All the nutrients are present in whole grains, which play a vital role in obesity. Whole grains include maize, ragi and bajra.

2. Just like whole grains, chana dal and rajma are also better than washed dals.

3. Use salmon and chicken instead of red meat.

4. Always use seasonal vegetables because they provide both unsolicited and soluble fibers in addition to antioxidants, minerals and vitamins (Sengupta,2018).

A diet that reduces pain:

Ginger. This root is probably best known for its properties like stomach-soothing and anti-nausea. But this spicy root can also fight pain, including menstrual pain and aching joints from arthritis. Ginger worked just like anti-inflammatory drugs to relieve pain.

Blueberries. Blueberries contain a lot of phytonutrients that fight pain and reduce inflammation. Other berries like oranges and strawberries contain polyphenols and antioxidants and have the same soothing effect (Ratini,2020).

Pumpkin seeds. Pepitas contain a lot of magnesium which play a vital role to relieve migraines. Magnesium also reduces or prevent osteoporosis. For more magnesium, add lentils, beans, leafy vegetables, cashews, and almonds to your diet.

Salmon. Loaded with fatty acids and anti-inflammatory to relieve joint tenderness and considered heart-healthy.

Turmeric. Individuals with osteoporosis and rheumatoid arthritis who took supplements of curcumin can walk better without the side effects of the drugs (Ratini,2020).

References:

Adaa.org. 2021. Chronic Pain | Anxiety and Depression Association of America, ADAA. [online] Available at: https://adaa.org/understanding-anxiety/related-illnesses/other-related-conditions/chronic-pain [Accessed 22 July 2021].

Marie, A., 2021. The stress and chronic pain cycle. [online] Pathways. Available at: https://www.pathways.health/the-stress-chronic-pain-cycle-and-how-to-break-it/ [Accessed 22 July 2021].

Heidi Moawad, M., 2021. Sleep Disturbances as a Sequelae of Chronic Pain. [online] Psychiatric Times. Available at: https://www.psychiatrictimes.com/view/sleep-disturbances-sequalae-chronic-pain [Accessed 22 July 2021].

Katz, L., 2021. Pain and Insomnia – breaking a vicious cycle – Hamilton Health Sciences. [online] Hamilton Health Sciences. Available at: https://www.hamiltonhealthsciences.ca/share/pain-insomnia/ [Accessed 22 July 2021].

Fuel, N., 2021. Exercises to Reduce Chronic Pain. [online] Healthline. Available at: https://www.healthline.com/health/exercises-to-reduce-chronic-pain [Accessed 22 July 2021].

Huston, M., 2021. Pain Catastrophizing and Exercise Avoidance: A Vicious Circle. [online] Psychology Today. Available at: https://www.google.com/amp/s/www.psychologytoday.com/us/blog/some-assembly-required/202008/pain-catastrophizing-and-exercise-avoidance-vicious-circle%3famp [Accessed 22 July 2021].

University, U., 2021. Exercise and Chronic Pain. [online] Extension.usu.edu. Available at: https://extension.usu.edu/heart/research/exercise-and-chronic-pain [Accessed 22 July 2021].

WL, H., 2021. Physical Activity. [online] Obesity Prevention Source. Available at: https://www.hsph.harvard.edu/obesity-prevention-source/obesity-causes/physical-activity-and-obesity/ [Accessed 23 July 2021].

Nhs.UK. 2021. Food for healthy bones. [online] Available at: https://www.nhs.uk/live-well/healthy-body/food-for-strong-bones/ [Accessed 23 July 2021].

Food, O., 2021. Obesity Diet: What To Eat And Avoid To Manage Obesity. [online] NDTV Food. Available at: https://www.google.com/amp/s/food.ndtv.com/food-drinks/obesity-diet-what-to-eat-and-avoid-to-manage-obesity-1815463%3famp=1&akamai-rum=off [Accessed 23 July 2021].

Ratini, M., 2021. 10 Foods That Fight Pain. [online] WebMD. Available at: https://www.webmd.com/pain-management/ss/slideshow-foods-fight-pain [Accessed 23 July 2021].