Most Chronic Pain Caused By Inactivity

Relationship Between Chronic Pain and Inactivity: The Disuse Syndrome

If you suffer from chronic pain of almost any type, you are at risk for developing a physical “disuse” syndrome.

Back Muscles

Muscles will get smaller and weaker if you don’t use them, which can add to back pain.

See Exercise and Back Pain

What is disuse syndrome?

Basically, it describes the effects on the body and mind when a person is sedentary.

Disuse syndrome was first characterized around 1984 and, since that time, has received much attention in relation to back pain problems, other chronic pain disorders, and other illnesses. It has been generalized beyond chronic pain problems and some feel it is related to “the base of much human ill-being.”

See Depression and Chronic Back Pain

The disuse syndrome is caused by physical inactivity and is fostered by our sedentary society.

Back Muscles

Muscle wasting and chronic pain can be mitigated by exercise.

See How Exercise Helps the Back

Effects of disuse syndrome

This disuse of our bodies leads to a deterioration of many body functions. This is basically an extension of the old adage “Use it or lose it.”

There are several physical consequences from disuse. These occur in many body systems, most notably those of the muscles and skeleton, cardiovascular, blood components, the gastrointestinal system, the endocrine systems, and the nervous system. For instance, consider the following:

  • In the musculoskeletal system, disuse of muscles can rapidly lead to atrophy and muscle wasting. If you have ever had an arm or a leg in a cast, you will be familiar with the fact that the diameter of the affected limb may be noticeably smaller after being immobilized for some time.
  • Cardiovascular effects also occur due to disuse including a decrease in oxygen uptake, a rise in systolic blood pressure, and an overall blood plasma volume decrease of 10 to 15 percent with extended bed rest.
  • Physical inactivity also leads to nervous system changes, including slower mental processing, problems with memory and concentration, depression, and anxiety.

A key factor in chronic pain

Many other detrimental physiological changes also occur. Disuse has been summarized as follows:

“Inactivity plays a pervasive role in our lack of wellness. Disuse is physically, mentally, and spiritually debilitating.”

Many experts believe that the disuse syndrome is a key variable in the perpetuation of many chronic pain problems.

The disuse syndrome can result in a myriad of significant medical problems and increase the likelihood of a chronic pain syndrome developing or becoming worse.

Unfortunately, common attitudes and treatments in the medical community often lead to more passive treatment without paying attention to physical activity and exercise (of any type).

The disuse syndrome can also lead to a variety of emotional changes that are associated with an increased perception of pain.

See Diagnosis of Depression and Chronic Back Pain: Depression Questionnaire

So, what to do? Get more mobile. 

So, if you are suffering from disuse syndrome, you may be wondering what you can do about it. It can be overwhelming for some people in chronic pain to consider how to get moving. See Chronic Pain Coping Techniques – Pain Management

About Dr. Deardorff:

https://www.spine-health.com/author/william-deardorff-phd

“Research has demonstrated that disrupted sleep will, in turn, exacerbate chronic back pain.3 A lack of restorative sleep also hampers the body’s immune response and can affect cognitive function. Thus, a vicious cycle develops in which the back pain disrupts one’s sleep, and difficulty sleeping makes the pain worse, which in turn makes sleeping more difficult, etc.”

Learn more:

This post was Originally Published: 08/26/2015
_____________________________________________________

MORE ON TREATING PAIN FROM

THE CLEVELAND CLINIC

ccf22

Low Back Pain Killing You? Try 8 Remedies (Before Taking Pills)

Our spine expert reviews new treatment guidelines

physical therapist working with patient

You may have heard that doctors are getting away from prescribing opioids for chronic low back pain. New guidelines from the American College of Physicians (ACP) advise doctors to start with options that don’t involve any type of medication.

 

This breaks from the World Health Organization tiered medication scale favored in the past. The scale previously focused on drugs that included opioids.

“We interpret the new guidelines as saying, ‘Try a number of non-pharmacological options before starting the use of long-term medication for low back pain.’ That’s a positive step,” says spine specialist E. Kano Mayer, MD.

While the ACP reviewed lots of studies to formulate its guidelines, he notes that it failed to look at how long each intervention was effective or at outcomes other than pain reduction.

“Cleveland Clinic spine specialists favor the active, rather than the passive, therapies recommended,” says Dr. Mayer. “We prefer that you do things actively to control pain and improve function, rather than waiting for things to be done to you.”

What to try first for your back pain

Cleveland Clinic spine experts support the following ACP recommendations, he says:

  1. Physical therapy
    “Cleveland Clinic very much advocates active physical therapy,” says Dr. Mayer. An exercise prescription can help to ease back stiffness and strengthen muscles that support the spine.
  2. Acupuncture
    This ancient Chinese technique involves inserting hair-thin needles at key points to ease pain. “Acupuncture is better at relieving the radiating leg pain that can accompany low back pain. We often recommend acupuncture because relieving pain allows you to exercise and be active,” says Dr. Mayer.
  3. Exercise
    Individual, group or supervised exercise can make you sore at first. “But it can help improve your core strength, spine flexibility, endurance and balance,” he notes.
  4. Yoga and tai chi
    Practicing these meditative forms of exercise from ancient India and China “has shown good benefit for those with low back pain, improving their function, endurance and symptoms,” says Dr. Mayer.
  5. Cognitive behavioral therapy (CBT)
    “Research shows this popular form of talk therapy improves coping, lessens social isolation and decreases the social impact of pain on your life,” he says. Combining psychological therapy with physical therapy and social work support is also beneficial.
  6. Biofeedback
    Placing electrodes at certain points allows you to control and release tension in your back muscles. “This improves function, positional tolerance and muscle pain,” says Dr. Mayer.
  7. Stress management and mindfulness
    Relieving stress and focusing on the present help to take your mind off pain.
  8. Progressive relaxation
    Gradually releasing tension in each part of the body can be helpful in easing pain, especially before bed.

Remedies less likely to help

Cleveland Clinic spine specialists generally do not support the use of passive treatments for low back pain.

“Chronic use of low-level laser therapy, ultrasound, transcutaneous electrical nerve stimulation (TENS) and spinal manipulation may only help in the short term,” Dr. Mayer points out. “We don’t want you to waste your money on treatments unlikely to provide more than a day of benefit.”

When you may need medicine

If non-drug interventions don’t help, the ACP recommends first trying non-steroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen, naproxen, indomethacin or meloxicam. While NSAIDs provide some pain relief, they may put you at risk for GI bleeding or kidney damage.

As second-line drugs, the ACP recommends duloxetine (an antidepressant) or tramadol (a novel opioid, but still subject to abuse).

Due to their serious side effects and addictive nature, opioid medications (morphine, oxymorphone, hydromorphone, tapentadol) should be used only as a last resort when patients fail all other therapies, the ACP advises. The rule of thumb: Use the lowest possible dose of opioid for the least amount of time.

If you’ve been suffering with long-term low back pain, it’s worth exploring these non-drug treatment options before resorting to pills. You’re likely to find your quality of life improving.

Related Articles

senior woman with back pain

13 Ways to Fix Your Age-Related Back Pain

Man at computer suffering neck pain

What’s Causing That Pain in Your Neck (and What Can You Do About It)?

My Back Went Out 3 Weeks Ago. What Should I Do?

My Back Went Out 3 Weeks Ago — What Should I Do?

nerves in the shoulder and spine illustration

Need Pain Relief? Consider Radiofrequency Ablation

Physical Therapy

When (and How) Physical Therapy Can Provide Relief for Your Low Back Pain

Radiating leg pain

Radiating Pain in Your Leg? Best to See Your Doctor

Related Stories:

How Doctors Are Treating C-section Pain — Without Opioids

A Q&A examining the reasons behind this change and what it means for new mom + their babies

As the opioid epidemic rages on, some doctors are facing the problem head-on by looking in the mirror — reducing the amount of opioids and opioid prescriptions given out after surgeries, including cesarean sections.

Anesthesiologist Eric Chiang, MD, is on the frontlines, helping spearhead a change in pain meds prescribed after C-section at Cleveland Clinic. He explains the reasons behind this trend — and what it means for both mom and baby.

Q: Why are doctors reducing opioid prescriptions to treat pain after a C-section?

A: In the U.S., for the last two decades and continuing to today, we’ve focused on opioids as the main pain medicine. And not just for after C-sections — for after any surgery.

But this single-minded approach has led to excessive prescribing, which fuels the opioid crisis: Overprescribing means people are frequently left with extra pills. The meds are often diverted and sold on the street. A lot of people are exposed to these narcotics, which eventually lead them to heroin and other drugs.

Overprescribing has become a habit for doctors. There was pressure to prescribe them. There was pressure from the government on treating pain. And there’s been a demand for these medications from patients. Culturally, American patients think opioids are a stronger pain medicine. It all snowballed.

Although opioid use is on the rise around the world, the U.S. remains an extreme outlier. In other countries, Tylenol® and Motrin® are the first-line drugs. You hear statistics about how the U.S. has 5% of the world’s population and uses 80% of the world’s opioids. It’s totally true.

Q: What opioids have doctors traditionally prescribed during C-section recovery?

A: One of the main pain meds we used to give after C-section is Percocet®. It was very common to prescribe Percocet after any kind of surgery. Percocet is a combination drug. It’s an opioid (oxycodone) plus 325 milligrams of Tylenol. Vicodin® is similar — it’s an opioid (hydrocodone) plus Tylenol.

One problem is that if you prescribe Percocet to your patients, it becomes their go-to pain medicine. If they have 2 out of 10 pain, they’re going to take Percocet. If they have 10 out of 10 pain, they’re going to take Percocet.

We have had tremendous success by separating these drugs instead of giving a combination pill. This approach provides options: The patient can maximize non-narcotic medications (4,000 mg acetaminophen plus Motrin) and only take opioids if she really needs it — if she has “breakthrough” pain.

What happens if you prescribe a combination pill? Patients will have to make complex calculations and keep track of dosages. “How much Tylenol is in that Percocet? How much is in this pill that I’m going to take now? How much am I getting over 24 hours? I can’t go over 4,000 milligrams.” In our experience, patients end up taking Percocet for all pain, increasing their exposure to opioids unnecessarily.

Q: What pain meds do the doctors in your program prescribe after C-sections? What have been the results?

A: One of the objectives of our project at Cleveland Clinic was to try to address over-prescription. We made Tylenol and Motrin our primary pain meds after C-section. There are very few side effects, and they’re not opioids.

We have patients take Tylenol and Motrin around-the-clock, alternating them every three hours. Patients can use oxycodone in addition to the Tylenol and Motrin if they really need it. We let the patients decide.

When we did this, patients decided they didn’t want or need opioids:

  • Opioid use on our postpartum floors went down by 70% almost overnight.
  • Now, almost half of our C-section patients never get any intravenous (IV) or oral narcotics.

Previously, even if a patient did not use opioids during their hospital stay, we gave them an opioid prescription when we discharged them. We are trying to change this practice — patients who don’t need opioids in the hospital are no longer sent home with a prescription for them.

For patients who do need opioids in the hospital, we now sending them home with five oxycodone pills. For comparison, in 2016, C-section patients were going home with around 32 pills. We also give people prescriptions for three days of Tylenol and Motrin, emphasizing that these are their primary pain medicines for C-section recovery.

Q: How does reducing opioid prescription after C-section help both mother and baby?

A: Women need effective pain relief after childbirth because they need to take care of an infant. They need to learn how to breastfeed. Poorly controlled pain is also associated with postpartum depression.

Our patients are doing much better and are better able to care for their babies. They have fewer problems with issues associated with opioids. Patients are:

  • More awake.
  • Less nauseous.
  • Walking around more.
  • Recovering faster.
  • Passing their bowel movements sooner.

Patients have more control as well. They’re not left feeling like their only option is a narcotic pain med after C-section. They can decide what they want to take and if they’re going to take an opioid.

It’s also better if the baby is not exposed to opioids through breast milk. While all of the oral medicines we use are generally considered safe for breastfeeding, we prefer for the baby to get Motrin or Tylenol than oxycodone. Opioids can be a risk because they can cause respiratory depression — a decrease in the drive to breathe, both with the mother and the baby.

For more information please visit:

How Doctors Are Treating C-section Pain — Without Opioids

 

blog contact: maria.dorfner@yahoo.com

Cynthia’s Story: Helping Women Who Live with Chronic Pain

cynthiatoussaintinwheelchair

Cynthia Toussiant is a former ballerina and actress (FAME) who has suffered with chronic pain disorder for more than thirty years.

legpain1

The strong, graceful ballerina’s life changed when a minor ballet injury triggered chronic pain.

cynthiaathearing

The chronic pain left the strong and graceful ballerina mute and in a wheelchair for years.

brainhealth9

She visited countless physicians and was continually told it was all in her head.

pain8

Her husband, John Garrett, who has been with her for 34 years helped her get to the bottom of it.

cynthia10

Turns out, Cynthia had Complex Regional Pain Syndrome (CRPS) for 32 years. She later developed Fibromyalgia and Chronic Fatigue Syndrome.

cynthia13

I talk to Cynthia and John about it: https://www.hightail.com/download/UlRUTGs2bEpLVldjZDhUQw

WHAT IS COMPLEX REGIONAL PAIN SYNDROME?

According to the Mayo Clinic, Complex Regional Pain Syndrome is an uncommon form of chronic pain that usually affects an arm or a leg. Complex regional pain syndrome typically develops after an injury, surgery, stroke or heart attack, but the pain is out of proportion to the severity of the initial injury.

WHAT CAUSES IT?

The cause of complex regional pain syndrome isn’t clearly understood. Treatment for complex regional pain syndrome is most effective when started early. In such cases, improvement and even remission are possible.

WHAT ARE THE SYMPTOMS?

Signs and symptoms of complex regional pain syndrome include:
•Continuous burning or throbbing pain, usually in your arm, leg, hand or foot
•Sensitivity to touch or cold
•Swelling of the painful area
•Changes in skin temperature — at times your skin may be sweaty; at other times it may be cold
•Changes in skin color, which can range from white and mottled to red or blue
•Changes in skin texture, which may become tender, thin or shiny in the affected area
•Changes in hair and nail growth
•Joint stiffness, swelling and damage
•Muscle spasms, weakness and loss (atrophy)
•Decreased ability to move the affected body part

Symptoms may change over time and vary from person to person. Most commonly, pain, swelling, redness, noticeable changes in temperature and hypersensitivity (particularly to cold and touch) occur first.

Over time, the affected limb can become cold and pale and undergo skin and nail changes as well as muscle spasms and tightening. Once these changes occur, the condition is often irreversible.

Complex regional pain syndrome occasionally may spread from its source to elsewhere in your body, such as the opposite limb. The pain may be worsened by emotional stress.

In some people, signs and symptoms of complex regional pain syndrome go away on their own. In others, signs and symptoms may persist for months to years. Treatment is likely to be most effective when started early in the course of the illness.

WHEN SHOULD SOMEONE SEE A DOCTOR?

If you experience constant, severe pain that affects a limb and makes touching or moving that limb seem intolerable, see your doctor to determine the cause. It’s important to treat complex regional pain syndrome early.

FOR MORE INFORMATION VISIT THE MAYO CLINC AT: http://www.mayoclinic.org/diseases-conditions/complex-regional-pain-syndrome/basics/definition/con-20022844


backpain3

Once Cynthia and John learned more about it, they rechanneled their efforts to help other women.

HELPING OTHER WOMEN

cynthia11

Since 1997, she has been a leading advocate for women in pain. Cynthia gave testimony at two California Senate hearings. The first was dedicated to CRPS awareness. The second explored the chronic under treatment of and gender bias toward women in pain. Both of these efforts were the first of their kind in the nation.

Cynthia founded For Grace to raise awareness about CRPS and all women in pain.

In 2006, Toussaint ran for the California State Assembly to bring attention to her CRPS Education Bill that Governor Schwarzenegger vetoed after she got it to his desk in its first year. Her current Step Therapy bill will reform an unethical prescription practice used by the health insurance industry to save money in a way that increases the suffering of California pain patients.

Cynthia-Toussaint-200x200

Toussaint was the first CRPS sufferer to be featured in the New York Times, Los Angeles Times and on the Public Broadcasting System and National Public Radio. She is a consultant for The Discovery Channel, ABC News, FOX News, the National Pain Report and PainPathways, the official magazine of the World Institute of Pain. Also, she is a guide and guest contributor for Maria Shriver’s Architects of Change website. Her many speaking engagements include the National Institutes of Health and Capitol Hill.

cynthia

She is the author of Battle for Grace: A Memoir of Pain, Redemption and Impossible Love. Also, Toussaint is experiencing her first-ever partial CRPS remission largely due to the narrative therapy of writing this book.

Toussaint continues to be a leading advocate for health care reform in California. She was instrumental in changing public opinion which sparked sweeping HMO reform legislation that was signed by Governor Gray Davis in 1999. Her focus has now shifted to creating a single-payer, universal health care plan in California that would provide a model for the rest of the country.

Cynthia’s husband, John serves as Director at For Grace and was instrumental in launching the organization in April 2002 along with his partner Cynthia Toussaint, who has suffered with CRPS (and later other over-lapping auto-immune conditions) for 32 years. Garrett has been partner and caregiver to Toussaint for 34 years. He has done extensive research about the gender disparity toward women in pain, compiling a comprehensive library on that issue along with specific chronic pain conditions.

heart4

Garrett has assisted Toussaint in all aspects of media relations and advocacy regarding CRPS awareness and the pain gender divide. His work focuses on speech presentation, grant writing, research, media outreach and the development of branding strategies. Garrett has also advised California’s Department of Managed Health Care and other state agencies regarding pain management practices in the HMO industry.

cynthia12

Commenting on her long-term partnership with Garrett, Toussaint says, “My story as a woman in pain is also a love story because John’s support has been total and unwavering. Without his loving presence in my life, I wouldn’t be here.”

Garrett made numerous writing contributions in Toussaint’s memoir, Battle for Grace: A Memoir of Pain, Redemption and Impossible Love. He candidly shares the virtues and challenges of the caregiving experience.

CLICK HERE TO LISTEN TO FULL INTERVIEW with CYNTHIA & JOHN:

https://www.hightail.com/download/UlRUTGs2bEpLVldjZDhUQw

PHOTO MONTAGE OF CYNTHIA & JOHN:
https://www.hightail.com/download/UlRUeEVhbEpubVhSc01UQw

Elizabeth Taylor Quote on Living with Pain

Women with Chronic Pain, please visit:
WWW.FORGRACE.ORG

           

%d bloggers like this: