How to Manage Chronic Pain
by Christine Lehmann, M.A., N.T.P.
This past January, I endured a lot of pain when I broke a major bone in my left wrist while ice-skating. This was an acute injury that required surgery—a titanium implant and pain medications. The inflammatory process kicked in
and started to heal the injured tissue. After a few months of physical therapy, the inflammation, swelling and pain decreased significantly and I could fully use my wrist again. As the healing process progressed, my pain resolved. Unfortunately, many people live with pain on a daily basis. Some experience pain that may involve an old injury or chronic conditions such as arthritis, fibromyalgia, cancer, type 2 diabetes or obesity. According to the Institute of Medicine of The National Academies, nearly one third of all American adults suffer from some type of chronic
pain where pain signals keep firing in the nervous system.
What Causes Chronic Pain?
Excess weight is a major contributor to painful conditions such as osteoarthritis, which is the most common joint disorder. The excess weight puts additional stress on weight-bearing joints such as your knees. When you walk across level ground, the pressure on your knees is the equivalent of 1.5 times your weight. “So, for every extra five pounds
of weight you carry, that is 7.5 pounds of pressure on your knees. When you go up and down stairs,the force on each knee is two to three times your body weight,” says Dr. Joe Tatta, doctor of physical therapy and a board-certified nutrition specialist. When movement is painful, people tend to become sedentary. This creates a vicious cycle because
a sedentary lifestyle leads to excess weight, which in turn, makes it even harder and more painful for people to move.
Obesity is also associated with low-grade chronic inflammation, which makes it harder to lose weight. Abdominal fat, in particular, contains proinflammatory cytokines—the chemicals released by immune cells—and hormones secreted by fat tissue, which can generate and perpetuate chronic inflammation. This state of constant inflammation can lead to insulin resistance, also called metabolic syndrome, which experts estimate affects one in four Americans.
What’s the Solution?
If you’re overweight or obese, losing weight will reduce joint pain. The American Arthritis Foundation estimates losing even 15 pounds may decrease knee pain by 50 percent and lower the risk of developing osteoarthritis in obese young people. Because the intensity and duration of pain is primarily influenced by diet, movement and thought patterns, Dr. Tatta’s Healing Pain program focuses on a healthy anti-inflammatory diet, gentle movement and strength training and brain training.
A Healthy Diet
The first step is to eat whole foods such as vegetables, fruit, whole grains, nuts and seeds found in nature and a variety of organic plant-based and animal-based fat and protein. This will go a long way toward eliminating refined and artificial sugars, hydrogenated fats, preservatives and high sodium. Whole foods only have naturally-occurring sugar,such as fructose in fruit. In contrast, refined processed sugar, which is full of empty calories, is often added to even healthy-sounding processed foods, such as flavored yogurt, fruit juices, teas, tomato sauces and all sorts of protein and energy
drinks. In addition, most Americans consume a lot of refined starchy carbohydrates, such as white rice, pasta and
bread, all of which convert to sugar. As blood sugar rises, more insulin is needed to lower it. This ongoing demand
for insulin eventually leads to insulin resistance and type 2 diabetes, which is associated with chronic inflammation
In addition to eliminating sugar, Tatta recommends eliminating gluten and dairy, which contain proteins that
can also trigger inflammation and pain. Milk contains the protein casein and gluten contains the protein gliadin found
in barley, wheat and rye. “Your immune system, especially in those suffering from celiac disease or gluten intolerance, can confuse the casein molecule for gliadin. Essentially, your body creates antibodies against gluten and can confuse
those same antibodies with proteins found in other foods,” writes Dr. Tatta in “Heal Your Pain Now.” Moreover, dairy from cows treated with antibiotics and growth hormones can decrease immunity and autoimmunity and increase neurologic damage and neuromusculoskeletal diseases, such as Parkinson’s disease.
Most Americans are not getting enough fiber found in whole foods, especially fruits, vegetables and gluten-free grains such as quinoa and amaranth. Fiber offers the benefit of keeping you fuller longer and your body regular. It also removes excess estrogen from the body, which decreases inflammation, according to Tatta. “Movement is the best way to open up the natural drug cavity in the brain and naturally release opioids and endorphins,” says Tatta. “These chemicals help people become less sensitive to pain.”
Dr. Tatta recommends that people in chronic pain start with basic gentle movement, which makes them stronger, creates more flexiblity and helps with daily function. Examples include restorative yoga, Pilates, walking and Tai Chi. “There may be some soreness initially but it’s a relatively painfree and comfortable way to move your body,” said Tatta. Once people become healthier and more familiar with their bodies, weight lifting with eight to 12 repetitions twice a week is also an option. He also suggests doing repetitions of pushing, pulling, squatting and lunging and provides illustrations in his book. “All of us lose muscle mass as we age, especially if we’re not weight lifting,” added Tatta. But, when you have a chronic disease, it’s even more important to build muscle mass to become more functional as well as avoid weak bones, which can lead to fractures.”
The Brain and Pain
By changing your thought patterns, you can begin to change your brain’s perception of pain. Research shows that negative thoughts, emotions such as fear, anxiety and avoidance, memories, sensations and much more can magnify your pain experience. For example, if you injure your back while lifting something and you’re in a negative state of mind, your brain can actually perceive that pain as worse than it is. So, what’s the good news? According to Tatta, you can actually train your brain to shut off pain. He uses mindfulness as a way to make people aware of their negative thoughts and find ways to reframe them. Examples of negative thoughts are, “My pain will always be here.” “It will be the death of me,” and “It’s torturing me.” Negative thoughts tend to create more negative thoughts and worsen in intensity and duration. Jon Kabat-Zinn’s groundbreaking work with mindfulness training in chronic pain patients in the 1980s led to clinical studies looking at whether activating and reinforcing certain areas of the brain would decrease pain. A five-year study found that chronic pain patients who completed an eight week mindfulness-based stress reduction program significantly improved their pain symptoms and overall quality of life, even up to four years later. “This can be life changing,” writes Tatta in “Heal Your Pain Now.” The study discovered that, by activating and reinforcing some areas of the brain used in pain processing, meditation has the overall effect of helping to reduce pain intensity in patients. Dr. Tatta works with people to reframe their “catastrophizing thoughts” and reset their outlook with a more positive intention. The goal of reframing is to bring their focus away from the pain and toward what they can control and influence. Examples of reframing negative thoughts are: “Although I have pain today, I was able to go to work. Although my wrist is killing me, I went to my first yoga class today in three months. Although my knee still hurts,I lost five pounds and worked with my nutritionist.”
This article was published in the July issue of FRA Today Magazine.