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.
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.”
The disuse syndrome is caused by physical inactivity and is fostered by our sedentary society.
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.
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:
“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.”
This post was Originally Published: 08/26/2015
MORE ON TREATING PAIN FROM
THE CLEVELAND CLINIC
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:
- 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.
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.
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.
- 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.
- 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.
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.
- Stress management and mindfulness
Relieving stress and focusing on the present help to take your mind off pain.
- 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.
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.
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