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 predispose you to pain on an ongoing basis. The procedure you had will reduce your pain for a while but it has not fixed the underlying pain.

Although the procedure you had is just a "band-aid" solution, this is not necessarily bad.  A temporary reduction in pain, gives you some time to focus on what matters for your bone and joint health.

What are the things that matter?  It is the actions 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 contributes 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 less. 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 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 necessary for optimal health and is 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 reduce the incidence of metabolic syndrome significantly.  What is metabolic syndrome?  Metabolic syndrome is classically defined as 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 your joints. You don’t need to find the right “diet” plan; you only need to work toward consuming less sugar and highly processed foods. Eat less, refined carbohydrates and consuming more whole foods (fruits & vegetables).  Work to consume fewer pro-inflammatory foods. 

4.  Excess weight.  Being too heavy contributes to extra mechanical load on the body. It also contributes to the chronic inflammation 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. Sleep deprivation then contributes to more pain.  The importance of protecting our sleep cannot be overstated. Simple and proven techniques to improve the quality of sleep are readily 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 have two suggestions:

 

1. Start a rehabilitation program with a physical therapist. Now that your pain is reduced, you have an increased ability to make physical changes that will help you in the long run. In Red Deer/Lacombe area, we would suggest: Lacombe Physiotherapy Clinic, Blackfalds Physiotherapy Clinic, Action Physiotherapy(Red Deer), Pursuit Physiotherapy (Red Deer), Vantage Physiotherapy (Ponoka)

AND...

2. Join a pain class to learn what causes chronic pain and take steps to manage your pain on your own.

As we have said, it is well established that lifestyle modifications are critical in managing chronic pain. It is also true that the more you get involved in your care, the better long term outcomes you will achieve. 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. We 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