Chronic pain and depression are so closely linked that a viscous cycle can easily set in if one does not honestly address and treat any underlying depression. Studies show that patients with chronic pain have lower levels of the hormones serotonin and norepinephrine compared to patients not in pain. Lower levels of these hormones are known to lead to depression and anxiety. Combine these physiological lower levels of hormones with the frustration patient’s feel regarding their lower quality of life and limitations from their pain and you have a set up for patients to fall into a feeling of hopelessness.
The first step toward finding your ‘cure’ and treating pain is to work to attack depression directly. Depression is a medical condition that should be treated with a multimodality approach. We work with our patients on setting up successful coping skills and techniques to improve their outlook on pain and depression. For a good amount of patients, working with a clinical psychologist or psychiatrist will also be a valuable member of a patient’s pain fighting team. There are prescription medications that not only treat depression related issues but also have FDA indications for pain. Cymbalta is one example, it has FDA indications for Fibromyalgia, Diabetic peripheral neuropathy, chronic low back pain as well as anxiety and depression.
For patients that want to avoid traditional pharmacological medications, supplements like Magnesium have been used to treat stress and are an excellent smooth muscle relaxant. If you want to avoid pills all together, meditation and exercise are two successful strategies that every patient would benefit from. Both meditation and exercise boost endorphin levels, decrease stress hormone levels and give patients an improved outlook on life.
Finally, anyone with depression issues need to find someone to talk with, whether that be a support group, licensed professional, or a close friend. Releasing stress through the power of conversation is vital in helping patients gain both insight and learn tools to better cope with pain and depression.
This is an absolutely huge topic, I can’t state that enough! In fact, this article is only a primer to an entire book we are writing that will help to attack and treat Fibromyalgia. I will give a few of the highlights on our ‘cure’ for Fibromyalgia.
Before we can treat Fibromyalgia, let’s try to put to the side the past stigmas associated with Fibromyalgia. For many years a majority of physicians did not believe in Fibromyalgia and there are still a few physicians who refuse to recognize or treat Fibro. While rounding on patients in the hospital, I overhead a colleague label Fibromyalgia as the “depressed, overweight, middle age, housewife syndrome”. On the other spectrum, you had the theory that Fibromyalgia was a warning of things to come. This group looked at Fibromyalgia patients similar to the theory of the canary in the coal mine.
Luckily, the medical community is finally coming around to recognizing this chronic pain condition. Current Fibromyalgia research and philosophy is a mixed component of a central nervous system dysfunction with a chronic myofascial component. Below is a list of recommendations we make to all of our Fibromyalgia patients on there first visit.
- Fibromyalgia is a diagnosis of exclusion, make sure to have labs to rule our other connective tissues diseases first, like Rheumatoid Arthritis, before accepting the Fibro diagnosis.
- Every Fibro patients needs a sleep study to treat any underlying sleep disorders that will directly complicate pain.
- Treat any underlying depression.
- Check underlying vitamin deficiencies that can complicate pain, including Vitamin D, Vitamin B12, Vitamin B1
- Start a daily home exercise/stretching program, Fibro will worsens with inactivity.
- Eliminate all soda’s immediately, totally toxic and can increase inflammatory levels in the body complicating pain.
- Restrict the ‘nightshade plants’ from the diet to limit their inflammatory related issues
- Limit yeast foods, so many of my patients struggle with this one but it will dramatically improve your energy.
- Work with a local physician and consider one of the FDA approved medications for Fibromyalgia: Cymbalta, Lyrica or Savella.
- Consider a workup for gluten allergy.
So much more to cover in future blogs, but this will give you a good starting point and as always consult your local healthcare provider before starting any new health lifestyle modification.
A very successful and overlooked tool in the treatment and eventual ‘cure’ of your pain is laughter. Laughter holds many known benefits for the body from a both psychological and physiological perspective.
Laughter is known to lower blood pressure and reduce stress hormone levels. Laughter, the actual act of laughing, can also improve cardiac health. Laughter is known to improve immune function which is a vital factor in your recovery. Laughing also triggers the release of endorphins which are your body’s natural pain killers. Laughing also improves a patient’s general well being. Laughter improves circulation and smooth muscle relaxation, of vital importance to patient’s suffering from chronic muscular pain conditions and ailments.
Beyond these physical responses to laughter, we have found that patients who regularly incorporate laughter have an improved outlook to their pain. Patient’s who have the insight to laugh at their circumstances have improved quality of life and improved overall function. The old theory of the glass half full really does seem to apply to pain patients and helps to set realistic expectations.
So find a few moments every day to add some laughter back into your life.
To help ‘Cure’ your pain you must become more active and vigilant in your own recovery and yes this also applies to taking advantage of your rest. Rest come in many forms from improving your sleep, which we have already discussed in an earlier blog, naps, meditation, stretching, and an approach to activity known as a active rest.
So much of our life seems to be some automated loop, whether that is our routine of running off to work in the morning or running our kids to school and various activities. People adapt to their hectic loop of a life by running from one activity to the next, pumping caffeine into their bodies at the local java hut to keep moving.
There is an argument that hitting the pause button and trying to find a better balance to our hectic lives and finding opportunities to rest is an excellent way to heal our body and our soul. A conscious approach to adding active rest based activities is a a natural approach to living within your bodies circadian rhythm. Most research show that humans are designed to take an afternoon nap. Although a nap is not possible for most, finding 10 minutes to meditate or take a nature stroll seems to do wonders. For patients able to exercise, we recommend alternating between a heavy exercise day with a lighter exercise day to not over stress our body. For patients with more disabilities to activity, we recommend trying to stagger doctor appointments or busy days so as to not overwhelm yourself psychologically or physically.
We are not promoting a couch potato lifestyle rather, we are simply recognizing that making a conscious decision to rest on the couch and read a book or relax the mind periodically is a healthy choice.
To make progress in finding a “Cure” for your pain, every patient needs to evaluate the food they put into their body. Your food is the fuel your body uses to heal and to repair itself. There are countless studies that show direct correlation to increased inflammatory levels and increased pain with different food groups.
Here is a list of foods we recommend to avoid or consider a 6 week elimination trial.
#1 Avoid all sodas! Interesting enough, diet soft drinks, due to the sweetener Aspartame, seem to have even worse detrimental side effects for pain patients. We have seen dramatic results from patients eliminating all soft drinks and replacing with water. Eliminating soft drinks improves energy, decreases inflammatory levels that trigger or exacerbate Migraine headaches, joint pain and Fibromyalgia.
#2 Limit or eliminate “Night shade” plants. Most patients assume that increasing vegetables would be a good lifestyle choice, however increasing studies are revealing that pain patients do worse with exposure to nightshade plants. Nightshade plants include a list of vegetables including tomatoes, peppers, white potatoes, eggplant and more! These nightshade plants increase inflammatory levels in the body and increase pain.
#3 Limit Carbohydrates! Carbs, specifically yeast related products worsen pain and specifically Fibromyalgia patients.
#4 Avoid Fast food, not even going to explain this further.
#5 Do your best to shop the outer ring of the grocery store. The outer ring of the grocery store will have more of the food that should be put into our body. The inner aisles contain all the processed foods. Obviously it’s impossible to avoid all of the inner aisles, but if you start on the outer ring you will improve your nutritional value.
#6 Consider being evaluated for Gluten.
This list will give you a good starting point to cleaning up your food intake and improving the food that fuels your body.