Vitamin D’s Role In Controlling Chronic Pain

vitamin d painWhen it comes to controlling chronic pain, we all know how important it is to get a restful night’s sleep, but that’s easier said than done when you’re in regular pain. However, new research suggests that adding something to the mix may help control pain and provide you with a better night’s sleep.

According to research published in the Journal of Endocrinology increasing the levels of Vitamin D in the body can help manage chronic pain conditions, including arthritis. The correlation between the sun vitamin and pain control is no secret, as previous research has suggested that the vitamin can help inhibit the body’s inflammatory response, which sometimes triggers pain sensations. Other research has shown that Vitamin D deficiency has been linked to sleep disorders, so correcting the problem may lead to a better night’s sleep, and in turn, less pain.

New Findings on Vitamin D

The newest findings regarding Vitamin D are that when used in conjunction with a good night’s sleep, it can actually make other treatment methods more effective. This means that patients who increase their levels of Vitamin D and who partake in physical therapy for their chronic pain condition may notice more pain relief than individuals who only partake in physical therapy.

“We can hypothesize that suitable vitamin D supplementation combined with sleep hygiene may optimize the therapeutic management of pain-related diseases, such as fibromyalgia,” said Dr. Monica Levy Andersen, who led the review.

They concluded that pain management specialists and primary care physicians should consider asking patients about their Vitamin D intake or begin monitoring it in order to see if increasing intake on a daily basis helps to mitigate symptoms from certain pain conditions. Now, it’s important to remember that simply taking a Vitamin D supplement isn’t going to take your pain from a level 8 to a level 2, but there’s a chance that when paired with other treatment options that it could help take your symptoms down a level or two. It’s certainly something worth exploring.

Food Choices For Pain and Weight Management

healthy diet food choicesEveryone is different, but improving your nutrition can drastically improve how well you feel. A good diet, exercise and adequate sleep all are parts of healthy living. Doing just one of the three things leads to mixed results. Living a balanced life can solve a lot of health problems, and is often very beneficial in treating pain. Unfortunately, doing the right things in life is not always easy. Most of these things take time and planning, and most are not fun.

Food and Pain

Different foods have different effects on the body. There are three basic food categories – proteins, carbohydrates, and fats. They all have different values to the body, and there are many ways to obtain these.

Proteins provide essential amino acids that are necessary for building various chemicals in the body including muscle, and can be a source of delayed onset energy.

Carbohydrates are used for energy, but also are in what we consider fiber.  It is important to remember that the quality of the food is often as important as the number of calories and how the body will use the food.

Fats are necessary also in small amounts for certain chemical processes in the body and can be stored for energy later.

Vegetables, fruits, whole grains, lean and vegetable type proteins, and healthy fats will provide quality energy during day while maintaining your health. Fast food provides limited short-term energy and often adds to the waistline due to the types of carbohydrates and fats.

Meal Planning and Pain Care

Starting your day with a good breakfast has been a nutritional rule for years. For most people, eating a breakfast with some complex carbohydrates like granola that is high in fiber and fruit, with a source of protein such as yogurt and nuts, provides energy throughout the morning, reducing fatigue and the desire to munch or eat things like donuts.  

Lunch provides the energy for the middle of the day. Some nutritionists say this should be the biggest meal of the day. Most of us do not have the time for this and is something that is eaten in a hurry. Maintaining a high fiber lunch with a protein source is a positive meal. A salad with a low fat piece of protein, like a chicken breast or tuna fish is an excellent meal to help control weight.

Many of us feel the need at times to snack. To help control this urge, drinking plenty of water is sometimes helpful. Nutritionally, one of the best snacks is nuts, especially almonds, walnuts, or other tree type nuts. These help reduce diabetic and cardiac risks, are high in protein, fairly low calories and will fill you up. The main thing to avoid  are sweets and high carbohydrates like potato chips or cookies. Popcorn that is not highly salted is also good due to high fiber content and low calorie amount.

Dinner is one of the hardest meals to do appropriately. It is important to learn balance and portion size. If you are trying to lose weight, eliminate simple carbohydrates like pasta and potatoes. Include salads, vegetables, and fruits to help to fill yourself up. Meat portion size should be about five ounces, and lean meats like chicken, fish and pork are the healthiest. Spaghetti squash can be used at times for a substitute for pasta in many dishes that have a meat sauce. Also, slow down your eating and drink plenty of fluids since both of these strategies help fill oneself up. Lastly, do not eat really late and then go directly to bed since this tends to allow the body to move the calories just eaten into fat for storage reasons. 

Dietary Health For Pain Sufferers

Eating a better diet often allows one to lose weight. Reducing the total calorie intake by reducing fatty foods and simple carbohydrates like bread, potatoes, and pasta, and also reducing sweets can go a long way to meeting a complex goal. The hardest thing is probably reducing the total amount of calories taken in during the day to maintain a balance with the activity level one is performing.

Most everyone will have an increasingly slower metabolism as we age, and to exercise enough to burn off all the calories we eat is often impossible. It takes a wise diet and exercise to lose weight. It is never easy, but the more one learns about eating healthy, the easier it becomes to lose weight. Discipline in diet is probably more important than any fad diet, and be sure to choose a diet that you can follow long-term.

An Update On The Daith Survey Study

daith surveyLast week, we announced that a colleague of ours was hoping to gather more information about the daith piercing and its role in migraine relief. We’re still hoping to collect more information, so if you have a daith piercing and you haven’t taken the quick five-minute survey yet, please do us a favor and find a few minutes to complete it.

So far more than 100 individuals have filled out the surveys, and the results have yielded some interesting findings. Although it’s still too early to really dig in and analyze the findings, the majority of individuals said the daith piercing helped to reduce their headache pain. The findings were also consistent for individuals with the worst types of headaches – migraines.

Daith Piercing Findings

So again, if you still haven’t taken the survey, you can click here and fill out the survey. Here are some more responses from the survey so far. The majority of people who underwent the daith piercing:

  • Were pleased they had the procedure.
  • Reported a consistent reduction in intensity and frequency of both mild and migraine headaches.
  • Reported a reduction in painkiller intake.
  • Reported an increased number of “better days.”

Additionally, some people experienced headache relief after the piercing was removed, which suggests that continued pressure on the vagus nerve may not be necessary for full relief.

So if you have a few minutes and want to help us gather more information on the subject, please consider clicking the above link to take the survey. If you’re still not sure about the daith piercing, feel free to check out some of our old blog posts on the topic, and if you have any questions or comments, leave them in the comments section below. Thanks again for helping us learn more about the daith piercing and pain pathways!

Dr. Cohn

The Uphill Battle Against Chronic Pain

Pain Pills insuranceOn Thursday May 4, 2017, a headline article in the Minneapolis StarTribune was on the effect of opioids on chronic pain. The article was written about a study at the Minneapolis VA hospital about not using opioids for patients with chronic pain. The study was done by Dr. Erin Krebs, an Internist who studied patients at the VA. The study involved two main groups of patients who all had back, hip or knee pain. One group received opioids and the other did not during a year of treatment, and both received extensive use of alternative pain management techniques.

The conclusion drawn by Dr. Krebs is that chronic pain patients do not need opioids since the non-opioid group did well with decreased pain intensity. Furthermore, Dr. Krebs, by her limited study, is implying opioids are ineffective to manage chronic pain and should not be used. This is a significant disservice to chronic pain patients and is an especially irritating claim being made by a physician who has practiced in pain management but only in an academic setting and is not even Board Certified in Pain Management.

Chronic Pain and Insurance Coverage

The first take home message for pain patients is that chronic pain is incredibly complex, opioids are only one medication management tool among many treatment options. This study is very limited, and the patient population does not truly reflect the complexity of many pain management practices with people who have multiple medical problems with multiple body locations of pain.

The patients in the study were given comprehensive and unlimited access to a number of treatments from physical therapy, psychological counseling, exercise, acupuncture, interventions and a variety of medications. In the “real” world, it often is extremely difficult to obtain insurance coverage on an ongoing basis for appropriate treatments including for anything that is not generic for medication, exercise programs, or psychological counseling (if a psychologist with interest in pain is even available).

Often the most appropriate management options for a patient are rejected by insurance companies, including a variety of interventional treatments, exercise programs, and non-narcotic medication. Proven interventions like spinal cord stimulation are rejected while the insurance companies have no problems with opioids. Patients who have failed all conventional treatments may benefit from a trial of options such as medical marijuana, and this is definitely excluded by insurance coverage.

The Complexity Of Chronic Pain

Chronic pain is not a single entity. It is a very complex outcome that is associated with multiple medical problems. Pain physicians and most doctors are not treating a single problem like osteoarthritis of the hips or knees – the main group of patients in this study by Dr. Krebs. Simple problems such as those in this study are often easily managed with a combination of conservative strategies and can oftentimes be treated quite well without opioids.

Now, most physicians are trying to avoid the use opioids for these issues when they can. Unfortunately, most physicians do not have enough training and experience in treating many of the problems that cause pain and up until recently, opioids were the easy solution to see a patient in a limited time and get them out of the office with a smile on their face. The solution to the opioid epidemic problem is much more complex then demonizing patients and a medication.

Most physicians are usually trying to do the right thing for their patients. Pain physicians are especially aware of the issues in treating these complex patients. First, coverage for alternative medical treatments for pain must be more easily approved, especially when recommended by a Board Certified specialist. Secondly, pain affects over 30 percent of the adult population and research into pain needs significant funding. Third, addiction to opioids is a separate issue beyond pain management, and needs to be treated in a different sphere, as only a small number of pain patients are addicted versus dependent on their medications. Lastly, there are multiple treatments for pain available, if alternative treatments were easily covered when recommended, less use of problematic drugs would surely occur.

If the media was more interested in telling the life of both legitimate pain patients and their treating pain physicians, a better understanding of how pain affects one’s life may occur. Too many people who have not been there are casting judgement on patients and physicians who are trying to treat a very complex problem. A third of the world population suffers from some sort of chronic pain, far exceeding the number who suffer any other medical problem, but there is hardly any money being spent on research and promoting safe management strategies. Moving forward will require less negative casting of the patients and physicians treating these problems and more investment into positive solutions.

Sleep and Caffeine May Play Key Role In Controlling Chronic Pain

sleep caffeineNew research out of Boston suggests that sleep and caffeine may play integral roles in controlling chronic pain flareups.

It’s probably not a huge surprise that sleep is beneficial for controlling chronic pain, as we’ve talked about the restorative benefits of sleep on our blog many times before, but the part about caffeine is interesting. Here’s what the researchers had to say.

Benefits of Sleep and Caffeine

For their study, researchers looked at the effects of sleep (or lack thereof) and caffeine on mice and their pain sensitivity. Researchers began by tracking normal sleep cycles and measuring brain activity, then they began to disrupt this healthy sleep cycle by giving mice toys and activities that entertained them and kept them awake (much like Netflix or our iPads do for humans).

“Mice love nesting, so when they started to get sleepy (as seen by their EEG/EMG pattern) we would give them nesting materials like a wipe or cotton ball,” says Dr. Alban Latremoliere, PhD and pain expert at Boston Children’s Hospital. “Rodents also like chewing, so we introduced a lot of activities based around chewing, for example, having to chew through something to get to a cotton ball.”

Researchers kept mice awake for up to 12 hours in one night or for six hours five nights in a row. They examined that fatigue, stress and pain sensitivity all increased during this time.

“We found that five consecutive days of moderate sleep deprivation can significantly exacerbate pain sensitivity over time in otherwise healthy mice,” says Dr. Chloe Alexandre, a sleep physiologist.

Caffeine’s Role

According to researchers, common painkillers did not help mice combat pain, and morphine was less effective in sleep-deprived mice, meaning chronic pain patients who are tired may have to up their morphine dose in order for it to be effective. However, researchers found that caffeine helped to block pain sensitivity.

This led researchers to conclude that a good night’s sleep combined with caffeine during the day (along with other good habits like regular exercise and a healthy diet) may be more effective for managing chronic pain than simply relaying on analgesic medications.

“Many patients with chronic pain suffer from poor sleep and daytime fatigue, and some pain medications themselves can contribute to these co-morbidities,” Dr. Kiran Maski, M.D. at Boston Children’s hospital who studies sleep disorders. “This study suggests a novel approach to pain management that would be relatively easy to implement in clinical care.”