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Chronic Pain-Completing The Gaps in Care

Prior to the pandemic of 2020 chronic pain was an important topic that was frequently discussed.  It has certainly taken a backseat to much more urgent public health issues. I’ve decided to create several pieces of content around chronic pain because I am certain that we will be finding this to be an even more important topic after the pandemic.

Chronic pain is defined as pain that “persist for 3 to 6 months” and “persist beyond the typical healing period” 1.

  It is important to distinguish chronic pain from acute pain because there are changes that happen in the neurological system that worsen the effects of chronic pain.

Medications, referral to specialist and physical therapy will likely play a role in the treatment plan.  These treatments can offer relief, but likely it will take a combination of treatments.  No matter how the chronic pain is approached, I am a firm believer that discussing healing modalities beyond prescriptions is important in healing the chronic pain.

Beyond the prescribed treatments, to heal chronic pain, other areas need to be addressed, including stress, sleep and diet.

Sleep

Assuring sleep quality by making sure the environment for sleep is peaceful and cool is important.  Reducing stimulation such as televisions, phones and tablets at least 2 hours before bedtime can allow the body to start producing melatonin naturally.  Making sure to have a practice that help with relaxation such as meditation can help with sleep. Most adults require at least 8 hours of sleep nightly. Keeping in mind, chronic pain drains the energy, so allowing for plenty of sleep every night is important.

If you are taking prescription medications for pain, ask your doctors which are best taken at night. Many medications that seem to be sedating can interrupt sleep and worsen insomnia. A surprising fact I often share with my patients is that while opioids are sedating, they actually lead to disrupted, non-restorative sleep. In one example, young healthy adults who received morphine intravenously suffered from increased non-REM sleep (sleep that does not lead to good rest), decreased REM sleep (deep sleep)2 .

Tips for Better Sleep

  • Avoid use of computers, tablets or cell phones 2 hours before bed
  • Avoid Caffeine after 2 pm during the day
  • Use soothing music or nature sounds rather than the TV for background noise

Diet

One of the most overlooked modifiable factors in dealing with chronic pain is diet.  Chronic pain increases the production of stress hormones such as cortisol.  This leads to craving sweet foods.   Ironically, consumption of inflammatory fats and sugary foods worsens pain. Every time we eat excessive glucose, our metabolic system goes into overdrive metabolizing these sugars. This leads to worsening levels of inflammation. This can also be a difficult topic with my patience, as they are undergoing psychological, emotional, and physical stress. But it is always worthwhile to make sure their diet is not creating more issues.  I have frequently encouraged my patients to keep a food journal and make a note of joint pain. I asked him to track the days if their joint pain is better and when it’s worse. Almost universally patients notice that arthritis pain worsens when they consume sugary foods.

sad albino on chair near bunch of fresh flowers

Stress

Stress management should be considered in dealing with chronic pain. Those suffering from chronic pain always have stress. This may be from the diagnosis itself, or from the fallout of dealing with multiple clinicians. Stress should be dealt with as soon as feasible in the course of treating chronic pain. This can mean working with a counselor or therapist. This can also involve starting a meditation practice to help relieve stress.

In the coming weeks, I am creating other content related to chronic pain. My podcast the Art of Healing will feature chronic pain, including the Chakras and Chronic pain.

  1. Pain. (2016). In Goldman-Cecile Medicine.
    1. Shaw, I. R., Lavigne, G., Mayer, P., & Choinière, M. (2005). Acute intravenous administration of morphine perturbs sleep architecture in healthy pain-free young adults: a preliminary study. Sleep28(6), 677–682. https://doi.org/10.1093/sleep/28.6.677

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