So, Your Pain Has Been Reduced, Now What?

When an intervention such as the injection or nerve ablation (RFA) procedure you received at this clinic is successful in reducing your pain, it is tempting to believe that you are “fixed.”  However, a reduction in pain does not imply a resolution of the issues that are predisposing you to pain on an ongoing basis. The procedure you had will reduce your pain for a while but has not fixed underlying pain perpetuating factors.

This is not necessarily a bad thing.  A temporary reduction in pain, gives you some time to focus on what matters in terms of your overall bone and joint health

What are the things that matter?  The things that matter are the actions that you can take to address the pain perpetuating factors that you have control over. The following are evidence-based lifestyle interventions that you can focus on improving while you are in less pain:

1.  Smoking Cessation: If you smoke, the evidence is clear that it is contributing to your pain.  We know that people who smoke are more likely to have chronic pain than those who do not.  There is also an association between the amount that a person smokes and their pain intensity.  Not only is the pain intensity higher, but they have more sites that are causing them pain.  Unfortunately, chronic pain often causes a person to smoke more rather than to quit as it is commonly used as a coping mechanism. One factor that may contribute to the pain is that smoking reduces the amount of blood flow to the joints and spine and reduces their capacity to heal areas of injury or degeneration.

2.  Exercise:  Physical activity has positive effects on the way we perceive our chronic pain.  It also helps us to improve our physical function, which is often eroded after years of suffering from chronic pain.  Using physical activity to affect our chronic pain is not easy.  It requires diligent compliance with a well-designed exercise program.  Activities like low impact aerobic conditioning, strength training, and stretching, have all been found to be effective. Some examples of physical activities that are typically well tolerated and beneficial include tai chi, yoga and aquacise.

3.  Nutrition:  Optimizing our nutritional intake is not only necessary for optimal health but may also be essential for optimizing our pain control.  Navigating the maze of nutritional advice can be challenging, and we can get mired down in the conflicting details. Thankfully, there are evidence-based recommendations that can get us started on the road to better eating habits.  Firstly, the evidence that metabolic syndrome can be a cause of osteoarthritis is established in the literature5.  Secondly, we know that the lifestyle measures that we define here are known to reduce the incidence of metabolic syndrome significantly.  What is metabolic syndrome?  Metabolic syndrome is classically defined as the presence of a group of risk factors including high cholesterol, high blood pressure, high blood sugar and abdominal obesity.  More recent studies link metabolic syndrome to higher levels of inflammation (and therefore pain) in our joints. You don’t need to find the right “diet” plan; you only need to work toward consuming less sugar, refined carbohydrates and consuming more whole foods (fruits & vegetables).  Work to consume fewer pro-inflammatory foods. If you want to follow a diet to make it easier, the Mediterranean diet is one of the better-studied diets.

4.  Excess weight.  Being too heavy not only contributes to extra mechanical load on the body but also contributes to the chronic inflammation that was mentioned earlier and is one of the risk factors in metabolic syndrome.

5. Sleep disorders.  Sleep is known to be an issue in chronic pain.  The relationship is defined as “bi-directional,” meaning that pain makes it hard to sleep, and a lack of sleep contributes to more pain.  The importance of protecting our sleep cannot be overstated. Simple and proven techniques to improve the quality of sleep are available.

6. Stress.  Stress is another aggravator of pain that can be described as having a bi-directional relationship with chronic pain.  Mindfulness-based stress reduction and cognitive behavioural therapy are known to help reduce the effects of chronic stress.

How do I get support in implementing these ideas?

We know from the research and through our experience in treating chronic pain that lifestyle modifications and patient involvement in their care are critical to achieving long-term pain control.  However, we also recognize that understanding and implementing these principles can be difficult.  If you feel a little overwhelmed by reading the above, we invite you to participate in our multidisciplinary chronic pain program, which will help you to understand and implement these principles in your life.  This program is a 10-week program that can be done in person or virtually.  We have a very high satisfaction rating with the program and are confident you will not only enjoy the program but will benefit from the knowledge you gain from attending.

1. Bo, S., Ciccone, G., Baldi, C. et al. Effectiveness of a Lifestyle Intervention on Metabolic Syndrome. A Randomized Controlled Trial. J GEN INTERN MED 22, 1695–1703 (2007). https://doi.org/10.1007/s11606-007-0399-6

2. Grundy, S. M. (2020). Metabolic syndrome (pp. 71-107). Springer International Publishing.

3. Garralda-Del-Villar, Maria, et al. “Healthy lifestyle and incidence of metabolic syndrome in the SUN cohort.” Nutrients 11.1 (2019): 65.

4. Mills, Sarah EE, Karen P. Nicolson, and Blair H. Smith. “Chronic pain: a review of its epidemiology and associated factors in population-based studies.” British journal of anaesthesia 123.2 (2019): e273-e283.

5. Zhuo Q, Yang W, Chen J, Wang Y. Metabolic syndrome meets osteoarthritis. Nat Rev Rheumatol. 2012;8(12):729-737. doi:10.1038/nrrheum.2012.135

Central Alberta Pain & Rehabilitation Institute, CAPRI

#1, 6220 HWY 2A, Lacombe, AB, T2L 2G5

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