A Holistic Approach to Chronic Pain Management
The expression of chronic pain in the body does not occur in isolation.
We can take a painkiller to temporarily relieve the experience of pain, but as pain exists in relationship with other processes in the body, a holistic approach is required to positively impact pain in the long-term.
Stress, quality of sleep, digestive health, as well as dietary and lifestyle factors, play core roles in pain expression.
This article describes just some of what research has revealed about the bidirectional relationship between these factors and chronic pain.
1. Stress
Stress itself is not a problem. We are biologically designed to deal with stress. Chronic stress, however, disrupts our body’s equilibrium in a way that begins to also impact upon inflammation and our sensitivity to pain.
Cortisol is released in response to psychologically or physical stress. It is a beneficial hormone serving an essential purpose. It mobilises us with glucose for energy and modulates inflammation (Hannibal & Bishop, 2014).
While cortisol release is adaptive in the short-time, long-term release results in increased inflammation in the body.
This increased inflammation increases the sensitivity of pain receptors, which also increases pain sensitivity (Hannibal & Bishop, 2014).
What’s more, is that chronic pain naturally causes us to be concerned, which causes us stress, which in turn impacts upon our pain creating a cycle.
We may also avoid activities or things we previously enjoyed if they cause us to experience pain, which can worsen our pain overtime.
Seeking support from a professional and implementing small changes will lessen the stress you feel about the pain itself. You will be moving forward, supported and with the knowledge that improvement is possible. The professional can also educate you about the pain, making it less scary and more manageable. The body’s resilience to stress can be bolstered through diet and lifestyle interventions.
2. Sleep
Research clearly demonstrates a bidirectional relationship between sleep and pain, and studies continue to explore the interesting effects of poor sleep quality on pain perception.
A poor night’s sleep has been found to increase pain sensitivity the next day in patients with rheumatoid arthritis (Irwin et al, 2012).
Melatonin, the neurotransmitter involved in controlling our body clock and promoting sleep, has also been found to play a role in pain perception (Palmer et al, 2019), suggesting that adequate levels of melatonin production are important for the management of pain.
Poor sleep is, for various reasons, associated with increased inflammation (Dzierzewski et al, 2020).
Not only can poor sleep effect our sensitivity to pain, pain can also naturally effect our ability to sleep well.
Medications for pain can also carry side effects that interfere with sleep. According to the Sleep Foundation, chronic pain can also result in anxiety, stress, or depression, which can causes sleep disturbances in their own right.
Poor sleep and stress deplete our body of certain essential nutrients. Magnesium, for example, is required by the body for energy production, quality sleep, muscle relaxation and supports our stress response.
Quality sleep can be supported through stress management, movement, herbs, lifestyle changes, strategic supplementation/nutrition, and healthy sleep practices.
3. Digestive Health
Research continues to explore the relationship between the gut microbiome and chronic pain.
The microbiome produces various signalling molecules (such as by-products of digestion, metabolites and neurotransmitters) that influence upon the expression of many types of chronic pain including inflammatory, headache, neuropathic pain and visceral pain (Guo et al, 2019).
Put differently, the microbiome can modulate changes in the gut-brain connection, that impact upon pain sensation.
More recent studies are exploring the gut-musculoskeletal connection, and it’s possible role in the development of fibromyalgia (Erdrich et al, 2020). New research also suggests that imbalances in the gut microbiome may impact on the development of migraines through the influence of microbiome-modulated inflammatory mediators, neuropeptides, serotonin, stress hormones and nutritional substances.
Improving gut health is a broad topic and the right approach differs person to person. In general, a diverse, wholefoods diet is recommended, along with avoidance of excessive consumption of refined sugars or carbohydrates, the temporary removal of foods causing irritation to the gut and the inclusion of probiotic and prebiotic rich foods.
A more personalised and therefore, effective, approach is more easily achievable with the support of a professional who can guide you.
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The presentation of chronic pain in the human body is complex and requires a holistic approach for long-term improvement. Discussed here are only some of the relationships between chronic pain and other physiological processes.
The good news here is that taking a holistic approach offers us multiple entry-ways into beginning to address our pain at a foundational level, paving the way for long-term improvement of chronic pain disorders and overall quality of life.
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Written by E Cooke
References:
Arzani M, Jahromi S.R, Ghorbani Z, et al, 2020. ‘Gut-brain Axis and migraine headache: a comprehensive review’. Journal of Headache Pain 21
https://doi.org/10.1186/s10194-020-1078-9
Dzierzewski J, Donovan E, Kay D, Sannes T, Bradbrook K, 2020. ‘Sleep Inconsistency and Markers of Inflammation’, Frontiers in Neurology, Vol 11
Erdich S, Hawrelak J, Myers S, Harnett J, 2020. ‘Determining the association between fibromyalgia, the gut microbiome and its biomarkers: A systematic review’, BMC Musculoskeletal Disorders
Guo R, Chen L, Xing C, Liu T, 2019. ‘Pain regulation by gut microbiota: molecular mechanisms and therapeutic potential’, vol 123, Issue 5, British Journal of Anaesthesia
Hannibal KE, Bishop MD, 2014. ‘Chronic stress, cortisol dysfunction, and pain: a psychoneuroendocrine rationale for stress management in pain rehabilitation’, Physical Therapy, Volume 94, Issue 12, p1816–1825
Irwin M, Olmstead R, Carrillo C, Sadeghi N, Fitzgerald J, Ranganath V, Nicassio P, 2012. ‘Sleep loss exacerbates fatigue, depression, and pain in rheumatoid arthritis.’
Palmer A, Souza A, Dos Santos S, Cavalheiro J, Schuh F, Zucatto A, Biazus J, Torres I, Fregni F, Caumo W, 2019. ‘The Effects of Melatonin on the Descending Pain Inhibitory System and Neural Plasticity Markers in Breast Cancer Patients Receiving Chemotherapy: Randomized, Double-Blinded, Placebo-Controlled Trial’, Frontiers in Pharmacology, sleep disorders
Sleep Foundation, 2022, ‘pain and sleep: common sleep disturbances & tips’
https://www.sleepfoundation.org/physical-health/pain-and-sleep