Category Archives: sleep

Can LED light bulbs, computer screens and TV make your pain worse?

The answer is probably yes.

The mechanism(s) go like this:

Exposure to full spectrum light in the evening > reduces quantity and quality of restorative sleep which in turn > increases chronic inflammation and contributes to depression both of which make pain worse.

Exposure to full spectrum light in the evening also > reduces nitric oxide production > which increases blood pressure and risk of cardiovascular disease and metabolic disorders.

In animal studies interruption of circadian rhythm with artificial light exposure when the animal would typically be sleeping decreases memory capacity.

And fat tissue has specific receptors for light which alters fat storage. Increased visceral fat produces more inflammatory cytokines and chemokines which sensitize pain fibers and increase inflammation throughout the body.

Exposure to artificial light in the evening even worsens the grades of children in school.

Adequate restorative sleep is so important that I prescribe all patients with chronic pain 2 pages of  sleep hygiene recommendations.

To optimize your circadian rhythm get some early morning light exposure (without sunglasses) before 12 noon and at sundown reduce your ambient light exposure to mimic the natural light outdoors. Sleep in absolute darkness and wear blue light blocking glasses in the evening.

You can learn more about this topic by listening to a 12 minute TEDtalk by Dan Pardi who does research in the Circadian LAB at Stanford.

Hat tip to Tommy Wood for bringing this TEDtalk to my attention.

Sleep well.

Doctor Bob.

My Autoimmune Disease: remission with the AIP (and one medication)

In September of 2018 I awakened with swollen, red and painful hands. I could not make a fist. I could not grip a steering wheel without extreme pain. I left dropped items on the floor because it was too painful to pick them up. All of my joints were painful and stiff. My legs were swollen. My wife had to help dress me so I could go to work. The simplest hand techniques to perform nerve blocks were painful. Just putting on sterile gloves caused severe pain. This happened just a few days after a week of camping. I felt weak all over and had trouble sleeping, unable to find a comfortable position.

(My camping vacation included digressions from my typical paleo/ancestral diet. I drank wine, ate some gluten containing foods and some dairy. I ate some wheat and sugar containing deserts.)

As a physician I ordered a variety of blood tests for tick born illness (such as Lyme’s Disease), rheumatoid arthritis, and other disorders that could cause my symptoms. All tests were negative except for an inflammatory marker (hsCRP) which was very high.

I queried physician friends about something I may have overlooked. No suggestions were forthcoming above and beyond what I had already done.

I prescribed myself a non-steroidal anti-inflammatory drug  NSAID. That provided modest relief but I was still suffering severe symptoms.

After 6 stubborn weeks I consulted a rheumatologist and he diagnosed me as having  “sero-negative” rheumatoid arthritis. Given the choice of several pharmaceutical interventions I chose the least toxic and started a drug called hydroxychloroquine. I was told it would take about 3 months to produce results, and in the meantime should continue the NSAID.

I immediately started to follow the Autoimmune Protocol AIP

Within one week of the AIP the redness in the joints of my hands was gone.

Within 2 weeks the pain in my joints was significantly reduced.

Within 3 weeks the swelling in my hands/fingers was completely gone and I stopped the NSAID. I no longer had pain in my hands and fingers while doing every day tasks.

Within 4 weeks I was able to resume my daily yoga and Pilates routine.

Within six weeks I felt in complete remission.

My rheumatologist agreed that I appeared to be in remission at follow up visit (no signs of inflammation, synovitis, etc., on examination with resolution of presenting symptoms) but he was and remains skeptical about the auto-immune protocol.

My clinical response was clearly way ahead of the expected time sequence for hydroxychloroquine. I concluded that the AIP was a major factor in my recovery.

All X-rays and MRI scans of my joints (which have suffered from osteoarthritis) were negative for the typical findings associated with rheumatoid arthritis.

The autoimmune protocol is a combination of lifestyle modifications involving diet, sleep, exercise, and stress reduction. It goes beyond the paleo diet. The paleo (ancestral) diet  eliminates processed/refined foods,  grains, legumes, dairy, added sugar, and refined vegetable oils. It stresses the consumption of a variety of organic vegetables and organic fruit, grass-fed meats, organ meats, free range poultry and eggs, wild seafood. The auto-immune protocol adds further restrictions: no nuts, eggs, nightshades, seeds, spices from seeds, and absolutely no alcohol.

There are many reasons for the added restrictions under the AIP. The added dietary restrictions are important for what they avoid but also important for the resulting increase in other beneficial foods that are allowed. The foods are omitted because they can cause or contribute to: gut irritation, dysbiosis, act as carrier molecules across the gut barrier, increase gut permeability, and/or cause inflammation. In theory, by eliminating those foods (hopefully on a temporary basis) and substituting nutrient dense less potentially harmful foods, we reduce some of the contributing factors to autoimmunity and inflammation.

For a detailed discussion of the AIP I suggest you visit Sarah Ballantyne’s  website and read her book: The Paleo Approach, Reverse Autoimmune disease and Heal Your Body.

Avoiding potentially harmful foods and beverages while increasing healthy nutrient dense foods represents the major focus of many individuals following the AIP. But equally important are the other lifestyle components. These include obtaining adequate  restorative sleep, reducing/managing stress (Stress Reduction and Health), getting reasonable amounts of playful exercise (this should be fun and occur in a green space as much as possible), sunshine, eliminating exposure to  environmental toxins, drinking filtered water, and frequent contact with supportive family and friends. Without addressing all of these areas one is not likely to succeed in achieving remission from an auto-immune disease.

In addition to Sarah’s Ballantyne’s book and website, if you have an auto-immune disease I recommend Dr. Terry Wahl’s website and book. Dr. Wahl’s, a medical school faculty physician, teacher and researcher,  was wheelchair bound with Multiple Sclerosis and facing death having failed all available medical treatments as well as some experimental drug protocols. She read about functional medicine, paleo nutrition and evolutionary biology in order to create her own treatment plan. One year latter she was in remission and riding her bike 20 miles. She subsequently raised money to do clinical research using her version of the AIP and has published a successful clinical trial.

There have been few controlled clinical trials of the AIP for auto-immune disease, largely because it does not involve drug research (no profits to be made) and because the NIH does not like to fund studies that alter multiple parameters at one time. Unfortunately, NIH funding has followed a drug and surgery model of medical treatment and does not look favorably on lifestyle interventions (one exception being the Mediterranean diet). I hope that bias changes in the future. In the meantime, physicians and scientists like Terry Wahls MD and Dale Bredesen MD, PhD (neurologist/researcher/author, The End of Alzheimer’s) remain pioneers in functional medicine and lifestyle interventions, being left to start their own foundations and raise money to fund medical research.

Both of these physicians have conducted clinical trials of lifestyle interventions (see below) that have produced revolutionary results, largely ignored by major medical societies and medical organizations. Progress occurs slowly, today’s iconoclasts are often tomorrows Nobel laureates.

Sometimes, despite significant clinical improvement with the AIP, some medication remains necessary with an auto-immune disease. If the auto-immune disease has been present for a long time, permanent damage may be present. That does not represent failure. If one can reduce drug doses, eliminate one or more drugs from a complicated medical regimen, and improve symptoms beyond what drugs alone achieve, I would call that success. Anecdotal reports from many patients (including my own) with auto-immune disease, suggest that it is not a cure-all, and those that show significant clinical improvement demonstrate various time responses ranging from weeks to several months in order to see results. But there are no down-sides to the AIP, no bad side-effects, no dangerous drugs, and only potential for clinical improvement. That seems like a no-brainer to me.

After eight weeks of strict dietary adherence, having achieved remission and appearing to be stable, I slowly added back small amounts of eggs, nuts and some nightshades (one at a time, observing for negative responses). I have been successful with that approach. I have not suffered any symptoms of rheumatoid arthritis since my initial remission. I remain on a paleo/ancestral diet and remain very cautions with regards to sleep habits, exercise, stress reduction, and social support. I try to laugh frequently and continue to engage in meaningful work. All of these components are essential to the AIP and to healthy living in general.

The following are links to published studies on the auto-immune protocol as well as links to a similar lifestyle intervention for Alzheimer’s disease. Another link is an editorial on inflammatory bowel disease and diet. The Autoimmune Protocol has been studied for Inflammatory Bowel Disease. In a peer reviewed published clinical trial it improved symptoms and inflammation seen on endoscopy, even producing remission in some patients. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5647120/) It has also been studied for Hashimoto’s Thyroiditis and found to be effective .(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6592837/)

Efficacy of the Autoimmune Protocol for Hashimoto’s Thyroiditis

Efficacy of the Autoimmune Protocol for Inflammatory Bowel Disease

Randomized control trial evaluation of a modified Paleolithic dietary intervention in the treatment of relapsing-remitting multiple sclerosis: a pilot study.

Multimodal intervention improves fatigue and quality of life in subjects with progressive multiple sclerosis: a pilot study.

Diet and Inflammatory Bowel Disease

A Multimodal, Nonpharmacologic Intervention Improves Mood and Cognitive Function in People with Multiple Sclerosis.

Reversal of cognitive decline in Alzheimer’s disease.

Inhalational Alzheimer’s disease: an unrecognized – and treatable – epidemic.

A colleague and scientist (Pedro Bastos), after reading my post, sent the following links to related articles (two by Loren Cordain, and a Master’s Thesis by one of his graduate students). For those interested in understanding the theories of molecular mimicry as triggers and mechanisms in autoimmune disease, Cordain’s work is outstanding.

Cereal grains, double-edged sword, Loren Cordain, 1999, Evolutionary Aspects of Nutrition and Health.

Rheumatoid Arthritis, molecular mimicry, dietary lectins, Loren Cordain, 2000, British Journal of Nutrition

Master’s Thesis, auto-immune disease and Paleo Diet, Trevor Connor

Eat clean, sleep well, exercise out-doors, get sunshine, love and laugh.

Bob Hansen MD

Sleep! You can’t live without it.

Circadian rhythm refers to the cycling of hormones according to the time of day. Every hormone cycles with daylight and darkness, each in it’s own way. Our brain has a master clock, called the circadian clock, controlled by specialized cells deep in the brain. There is a direct connection from our retina (in the back of the eyes) to the circadian clock in the brain. Blue light (part of the normal outdoor spectrum of light) stimulates very specific receptor cells in the retina which in turn communicates directly with the circadian clock telling the brain whether it is day or night. To synchronize our hormones and achieve restorative sleep, we must get outdoor light exposure to our eyes (without sunglasses, early in the day) and limit light exposure in the evening.

Artificial light, especially from cell phones and other devices that emit intense blue light, shift work, late night social activity, poor eating habits, sedentary lifestyle and at the opposite extreme, late evening workouts,  can all disrupt our circadian rhythm preventing adequate restorative sleep. A rare genetic illness called fatal insomnia that strikes adults at middle age prevents sleep and results in death within a few months, highlighting the importance of sleep. Sleep deprivation can kill a human quicker than starvation! Adequate amounts of deep non-REM sleep are required for tissue regeneration, healing, DNA repair and immune function. REM sleep with dreaming provides great benefit by organizing our memory, discharging the emotional content of traumatic events, and facilitating creative brain activity. One night of short-sleep produces a state of inattention and slow reflexes as dangerous as driving under the influence of alcohol intoxication. Chronic  short sleep and disrupted circadian rhythm results in increased risk of depression, cancer, hypertension, diabetes, dementia, obesity, metabolic syndrome, insulin resistance, heart attack and stroke, to name a few. Sleep interruption immediately halts weight loss during a calorie restricted diet (likely the result of hormonal disruption). So getting an adequate amount of restorative sleep every night is essential to good health. Here a few tips to help achieve a good night’s sleep each and every night.

  1. GET OUTDOOR LIGHT EXPOSURE ON YOUR EYES WITHOUT SUNGLASSES EVERY DAY, EARLY IN THE DAY. This helps set your biologic/circadian clock. Even on a cloudy day, outdoor light is much stronger and natural than indoor light. It is essential for setting your biologic/circadian clock. If you cannot get outside, stand or sit in front of a large window for 20-30 minutes in the morning, looking outside. Take a lunch break outside without sunglasses. Wear a shade hat instead of sunglasses. Your brain needs to experience natural outdoor light during the day.
  2. Avoid bright light in the evening, especially the light from TV, computer screens, cell phones, which all emit intense blue light and trick your brain into thinking it is daytime. Wear blue light blocking glasses/goggles for 2-3 hours before bed. (Amber tinted glasses which block blue light can be purchased on-line and can be worn over reading glasses) There is also software available that will decrease the blue light intensity of computer screens and cell phones in the evening.
  3. Practice time restricted eating. Limit all eating to an eight hour period, thus providing for an over-night fast of 16 hours. If that does not seem possible try to limit eating to a 10-hour period which provides a 14-hour overnight fast. This improves sleep, circadian rhythm, blood pressure, blood sugar and reduces stress hormones. NO SNACKS BETWEEN MEALS. NO FOOD FOR 2 HOURS BEFORE BED. For every hour decrease in eating time period from 12 hours to 8 hours you get health benefit.
  4. Eat an anti-inflammatory diet.
  5. If you snore, are overweight/obese, fall asleep during the day, or do not feel refreshed in the morning ask your doctor to order a sleep study. Obstructive Sleep Apnea makes restorative sleep impossible and increases risk of heart attack, stroke and most chronic diseases.
  6. Avoid alcohol altogether and avoid caffeine after late morning.  Alcohol in the evening may help you fall asleep but it results in a withdrawal from alcohol during the night. This disrupts normal sleep patterns.
  7. Sleep in a cold, dark, quiet room. Use black-out curtains, no night lights, no phone charger lights, no lights of any kind should be on in the room. Any amount of light in the room impairs the production of melatonin which facilitates sleep onset.
  8. Have a winddown time every evening. Develop habits of non-stressful activities, soft music, dim light, casual conversation, enjoyable reading. Do not spend evening time dealing with finances, conflict, or emotional activity.
  9. Try a magnesium supplement before bedtime. Magnesium glycinate, magnesium citrate, magnesium gluconate, are absorbed much better than cheaper supplements such as magnesium oxide. Magnesium L-Threonate is expensive, but it crosses the blood brain barrier into the brain with the greatest brain penetration of all magnesium supplements.
  10. Manage stress with yoga, meditation, regular exercise (but no intense exercise in the evening.) Perform most of your exercise outdoors in a green space. This provides much more health benefit than the equivalent exercise indoors.
  11. Regular contact with supportive family and friends is essential to health and reduces stress. The greatest predictor of health vs disease is the amount of social connectedness an individual experiences.
  12. Establish regular wake-up times and go-to-bed times. Regular sleep habits are essential. If you must rely on alarm clocks you do not have good sleep habits.

A few words about alcohol, caffeine and sleeping pills.

A drink or two in the evening may help you relax but it disrupts your sleep by causing a mild episode of alcohol withdrawal as your liver metabolizes the alcohol and your blood levels drop. Even this slight degree of alcohol withdrawal will impair a good night’s sleep.

Caffeine impairs sleep by blocking adenosine receptors in the brain. Adenosine is the neurotransmitter that increases gradually during the day creating a sate referred to as sleep pressure. Some people metabolize caffeine quickly, others slowly. The slower you metabolize caffeine the longer it takes to clear it from your adenosine receptors. Without adequate sleep pressure (adenosine receptors filled with adenosine in the brain) you cannot fall asleep. Many sleep experts recommend complete abstinence from caffeine and suggest that if you need caffeine to get started in the morning you are regularly sleep deprived.

Sleeping pills of all kinds interfere with normal sleep architecture. While they facilitate falling asleep, they impair your ability to achieve deep restorative stages of sleep and can produce many undesirable side effects including addiction, withdrawal symptoms, sleep walking, sleep driving, worsening of asthma and COPD, constipation, diarrhea, daytime drowsiness, burning and tingling sensations, unusual dreams, weakness, heartburn, etc…. Most importantly they all interfere with cycling through the various stages of sleep in a normal, restorative pattern!

If you want to explore these concepts in depth here are two excellent books that discuss sleep and circadian rhythm.

Why We Sleep, by Matthew Walker Ph.D.

The Circadian Code, by Satchin Panda Ph.D.

Eat clean, sleep well, spend time exercising out of doors, love one another.

Bob Hansen MD

Weight loss, discussion by Tommy Wood MD, PhD

My friend and colleague, Dr. Tommy Wood, recently posted a terrific discussion on weight loss and the many factors to consider. You can read it here. Should Calorie Counting Be the Main Focus for Somebody Trying to Lose Weight (Body Fat)? | Nourish Balance Thrive

Tommy is the smartest physician I know. He researches a topic extensively and carefully separates bad science from good science.

If Tommy renders an opinion, you can take it to the bank.

Read the NBT post by Tommy at the link above and you will not be disappointed. Then sign up to receive short weekly e-mails with sound advice on health and nutrition.

I have discussed the importance of circadian rhythm, restorative sleep, hormonal effects of food choices, and the effects of stress. Tommy covers all of these and much more with links to scientific papers if you are interested in delving deeply into the issues. But if you just want sound advice on weight loss,  read the post and organize your life around improving your habits as he recommends.

Live clean, eat real food, spend time with friends and family, hug someone every day, engage in meaningful work, get sunshine early in the day, exercise in a green space and live in the moment.

Doctor Bob.

Cartoon humor: A Prescription for Health!

 

prescription-for-exercise-cropped

Hat tip to Tommy Wood MD, PhD for introducing me to this great cartoon.

So what would happen if your doctor prescribed this? Would you be shocked? Would you follow the advice? Sadly few doctors make such recommendations as explicitly as this cartoon and fewer patients follow the advice.

How important are the elements in this advice?

They are essential. We too often focus on dietary concerns at the expense of ignoring other important low hanging fruit. Early morning  outdoor exercise with exposure to natural light in a green space, even on a cloudy or rainy day, is essential for health. Why? There are many reasons. Click the link above to read fitness expert Darryl Edward’s discussion with references. In fact outdoor exercise in a greenspace is more beneficial than the same exercise indoors. The reasons are many, including but not limited to Vitamin D production.

Early daytime exposure to natural outdoor light helps to maintain our Circadian rhythm and align the biologic clock in all of our cells and organs with the central biological Circadian clock in our brain. Most folks do not know that we have a biologic clock deep within our brain and that all the organs and cells of our body also have clocks. They all need to be synchronized with each other and with the sun for optimal health. When they are not synchronized bad things happen. Night shift workers and other folks with disturbed sleep have higher rates of cancer , depressionhypertension, heart attack and stroke.

Maintaining our circadian rhythm is vital to achieving adequate high quality restorative sleep. In turn, obtaining adequate restorative sleep contributes to lower cardiovascular disease risk in addition to four traditional lifestyle risk factors.

Exposure to artificial light at night disrupts our circadian rhythm and impairs the onset of sleep.

In medical school I learned that our retina has two cell types, rods and cones. But advances in science have revealed a  third cell type called retinal ganglionic cells. 

These cells are  particularly sensitive to blue light and directly connected to our central biological clock . Exposure to artificial light, especially from TV screens, computers, cell phones and other electronic devices after sunset disrupts our sleep cycle and delays the onset of sleep. That is why wearing blue light filtering glasses in the evening helps many folks to improve their sleep quality and duration.

Sleep deprivation for even one night causes elevation in interleukin 6 levels the following day. Interleukin 6 suppresses immune function and excessive levels cause bone and tissue damage (especially cardiovascular). Sleep deprivation  increases  Stress hormones (cortisol, adrenalin), decreases prolactin and Growth hormone , and decreases the nightly production of ATP .

Melatonin , often called the sleep hormone, is produced most abundantly during restorative sleep and essential for tissue healing, immune function, cancer prevention, and defense against tissue oxidation. These are just a few of the roles melatonin and sleep cycles play in determining our health..

So exercise outdoors in a green space daily to help synchronize your biologic clock with the sun, dim the lights in the evening and if you must watch TV or work on electronic devices before bed wear Blue Light filter glasses .

Of course eating an abundance of colorful fresh organic vegetables and fruits, and practicing some stress reduction techniques every day are equally important and essential to health and functional status.

Finally, not mentioned in the cartoon above is another healthy lifestyle choice, intermittent fasting (IF). IF will be discussed in the next post.

Until then, sleep well, exercise regularly out doors in a green space environment, eat clean, learn and practice some regular stress reduction techniques and read the next post about IF.

Bob Hansen MD

Nutrition Journals and the influence of the food industry

Ever wonder why the public is so confused about nutrition recommendations? Just follow the money and you will understand that most of the professional societies that publish nutrition articles are funded by big food companies that are trying to sell more sugar, refined carbs and junk food. I recently read an excellent post about this topic here:

The Vilest Villain: American Society of Nutrition

This theme is repeated by medical journals that are “The Official Journal of the Society of >>>>>>” Just fill in the blanks for just about any medical society. Funding comes from big pharmaceutical companies the same way that funding in the nutrition Journals comes from large (junk) “food” manufacturers.

Don’t get me wrong, there are plenty of very valuable, life-saving drugs out there.

But most chronic human disease in developed societies is generated by various combinations of poor nutrition, lack of exercise, disruption of circadian rhythm, inadequate restorative sleep, stress and lack of social support systems.

The obesity and diabetes epidemics continue to worsen yet the failed dietary advise of major health organizations is slow to respond to the data. Excess refined carbs (especially in the form of “food” made with flour) and added sugar (especially in the form of HFCS) are the major driving forces for obesity, diabetes and cardiovascular disease. Red meat is not the culprit, provided the meat is properly sourced (hormone and antibiotic free, grass fed) and cooked in a manner that does not create carcinogens and inflammatory mediators (cook with slow, low, moist heat, high temperature grilling and smoking cause problems, but that topic  is for another post).

Americans consume an average 130 pounds per year of added sugar and 140 pounds per year of refined flour. Those are averages so there are many people who consume more. The added sugar is not the white stuff people put in their coffee. It comes in all sorts of forms but is found in energy drinks, soda, lattes and mochas, salad dressing,  ketchup, canned soups, canned vegetables, white AND whole grain breads, pasta (even “whole grain”), crackers, breakfast cereal,  just about any packaged food that has more than one ingredient on the label. These foods represent 70% of the American diet. The problems created by this situation are enormous and will bankrupt our “healthcare system”. This is a cultural and economic problem.

The solutions are simple but largely ignored in our society. We are creatures of habit and convenience.

Eat whole foods, nothing from a package that has more than one ingredient. Eat meat, seafood, poultry, fresh organic vegetables (6-9 servings per day), fresh organic fruits, and nuts. Meat should be hormone and antibiotic free (free range, grass fed). Seafood should be wild. Poultry should be free range and the eggs should come from free range chickens, ducks, geese.

Do not worry about eating fat as long as it comes from healthy animals and sources such as coconut oil, extra-virgin olive oil, avocado oil and clarified butter (ghee).

Do not use any “vegetable” oils (corn, soy, and other oils from grains or seeds) The vegetable oils are highly refined and inflammatory. They contain easily oxidized omega 6 fats that feed the production of inflammatory mediators in your body and create oxidized LDL leading to atherosclerosis.

Exercise daily, preferably outside in a green space. Twice per week spend 20-30 minutes  doing resistance training (lift weights, work against the resistance of bands, use your own body weight doing pushups, pull-ups etc)

Reduce stress with mediation, yoga, tai chi, dancing, engaging in fun sports and social activities. Walk on the beach, by a lake, river or stream, in the woods, listen to music.

Get some sunshine regularly especially during the morning to get your circadian rhythm in order and to produce adequate amounts of vitamin D.

Spend time with family, friends and colleagues who are supportive and fun to be around.

Sleep in the dark.

Get at least 7 hours of sleep per night. Avoid TV, computer screens and other electronic devices for at least 2 hours before bedtime.

Unplug from the internet, email, etc on a regular basis.

We evolved as hunter-gatherers.

Peace

Bob Hansen MD

 

 

Chronic Pain: How does it occur and what can be done about it?

I have discussed the effects of nutrition, stress-reduction, sleep, and circadian rhythm on pain in previous posts . I have not yet discussed the theory of how chronic pain develops and persists. This post discusses some of the mechanisms involved in chronic pain as well as therapeutic approaches that have proven to be effective in addressing the root causes of chronic pain and suffering.

THE CENTRAL NERVOUS SYSTEM (BRAIN AND SPINAL CORD) CAN INDEPENDENTLY CAUSE PAIN AND OTHER PHYSICAL SYMPTOMS THROUGH THE DEVELOPMENT OF LEARNED NERVE PATHWAYS. THESE PATHWAYS INCLUDE CIRCUITS WITHIN THE BRAIN AND CIRCUITS CONNECTING THE SPINAL CORD TO VARIOUS PARTS OF THE BRAIN. THEY CAN PRODUCE PAIN EVEN IN THE ABSENCE OF ONGOING TISSUE DAMAGE.

THESE LEARNED NERVE PATHWAYS CAN DEVELOP AS A RESULT OF SEVERAL WEEKS OR MONTHS OF CONTINUOUS PAIN CAUSED BY AN INJURY OR DEGENERATIVE-INFLAMMATORY DISEASE. IF WE EXPERIENCE RELENTLESS PAINFUL IMPULSES COURSING THROUGH THE BODY THESE BOMBARD THE SPINAL CORD AND BRAIN WITH PAINFUL MESSAGES AND OUR BRAIN AND SPINAL CORD EXPERIENCE A CHANGE SIMILAR TO THE CHANGES THAT CAN OCCUR WITH PTSD CAUSED BY ONE OR MORE TRAUMATIC EVENTS.

THESE LEARNED NERVOUS SYSTEM PATHWAYS REPRESENT “NEUROPLASTICITY” MEANING CHANGES IN THE NERVOUS SYSTEM BROUGHT ABOUT BY EVENTS SUCH AS TRAUMA AND STRESS. THEY REPRESENT A “MEMORY” OF THE PAIN, TRAUMA AND STRESS IMPRINTED ON THE NERVOUS SYSTEM. THIS “MEMORY” INCLUDES NEWLY (AND OFTEN PERMANENTLY) FORMED CIRCUITS THAT OFTEN CONNECT VARIOUS PARTS OF THE BRAIN ASSOCIATED WITH PAIN, ANXIETY, DEPRESSION AND ANGER TO PARTS OF THE BRAIN AND SPINAL CORD THAT MEDIATE SENSATIONS OF LIGHT TOUCH AND PRESSURE. THESE CONNECTIONS PRODUCE “ALLODYNIA” WHICH IS A PAINFUL RESPONSE TO A STIMULUS WHICH IS USUALLY NOT PAINFUL. WE CAN ALSO EXPERIENCE “HYPERALGESIA” WHICH IS AN EXAGGERATED PAIN EXPERIENCE, OUT OF PROPORTION TO THE PAINFUL STIMULUS.

THE NERVOUS SYSTEM HAS A BUILT IN “MUFFLER” DESIGNED TO DAMPEN DOWN PAIN MESSAGES BUT IN CHRONIC PAIN THIS MUFFLER BECOMES AN AMPLIFIER THAT NOT ONLY AMPLIFIES THE TRANSMISSION OF PAIN BUT ALSO CONNECTS THIS AMPLIFIED PAIN SYSTEM TO PARTS OF THE BRAIN ASSOCIATED WITH ANXIETY, ANGER, AND DEPRESSION.

ONCE THESE CIRCUITS OR PATHWAYS ARE IN PLACE (“LEARNED”) THEY CAN NOT BE ELIMINATED (“UNLEARNED”). EFFECTIVE PAIN REDUCTION REQUIRES ACTIVATING ON A REGULAR BASIS ALTERNATIVE PATHWAYS THAT ALREADY EXIST SUCH AS THOSE ASSOCIATED WITH PLAY, MUSIC, DANCE, HUMOR, LAUGHING. ACTIVATING OTHER PATHWAYS CAN ALLOW THE PAIN PATHWAYS TO BE “TURNED OFF” OR MUFFLED. AS CHILDREN WE LEARN TO PLAY AND THOSE LEARNED PATHWAYS STAY WITH US FOR LIFE. WITH PRACTICE WE CAN REGULARLY ACTIVATE THOSE BRAIN PATHWAYS AND MAKE THEM AND OTHER PATHWAYS THE PREDOMINANT PATHWAYS OF OUR BRAIN ACTIVITY.

BUT BEFORE WE CAN UTILIZE THE PLEASANT ALREADY-LEARNED PATHWAYS IN THE BRAIN TO CIRCUMVENT THE PAINFUL-ANXIOUS PATHWAYS WE MUST FIRST DEAL WITH OUR ANGER. DEALING WITH OUR NATURAL AND JUSTIFIABLE ANGER REQUIRES FORGIVENESS. UNTIL THE ANGER IS RELEASED AND FORGIVENESS ACHIEVED WE CANNOT MAKE USE OF THE THERAPIES AND STRATEGIES AVAILABLE TO DECREASE AND MANAGE OUR PAIN. ANGER BLOCKS THE PATH TO HEALING AND PAIN REDUCTION.

The brain processes an emotional insult in exactly the same way that the brain processes a physical insult. Stressful life events and our emotional reactions to them may cause pain that is severe. This is why chronic pain becomes worse when we experience a stressful event. Vicious cycles develop as multiple circuits connecting pain pathways to areas of the brain associated with anxiety and depression become activated and stay activated.

COGNITIVE BEHAVIORAL THERAPY: Over the course of months and years, our reaction to chronic pain often includes repetitive negative thoughts. Cognitive behavioral therapy helps us learn techniques to avoid repetitive negative thoughts.

Mindfulness Based Stress Reduction is another technique that can help mitigate the suffering associated with pain. Mindful Meditation practiced 30 minutes per day produces measurable changes in brain activity that can be seen on Functional MRI scans of the brain within 90 days. These changes demonstrate decreased brain activity in areas associated with pain, depression, anxiety and anger. Scientific studies have also demonstrated that MBSR produces improved immune function, reduces blood pressure, reduces heart rate, improves sleep and provides other beneficial physiologic changes associated with healing and wellness. Yoga and meditation are essential components of an MBSR program.

SLEEP: Pain cannot be managed or successfully treated unless an individual gets 8-9 hours of restorative sleep per night. Sleep hygiene recommendations are an essential part of the path to wellness. Daily exposure to sunlight outdoors and restoring normal circadian rhythm are essential for pain management. Going to bed at the same time every evening and sticking to a regular schedule is the most important part of improving sleep. Daytime exposure to sunlight and dimming the lights in the evening are also required. Regular exercise (daily walking) is essential. Wearing blue-light blocking glasses for 2-3 hours before bedtime can facilitate sleep. When blue light wavelengths (light bulbs, computer screens, TV screens) hit the retina of the eye a message is immediately relayed to the “internal clock” of the brain that tells the brain there is still daylight. This inhibits the production of melatonin (the “sleep hormone”). Avoiding bright light (especially from TV or computer screens) for 2-3 hours before bedtime is important. If you must watch TV or work on the computer in the evening that blue light blocking glasses or goggles are a must. There are free software programs that will eliminate the blue light from your computer screen as an alternative to blue light blockers.

NUTRITION: Pain involves inflammatory pathways. An anti-inflammatory diet is essential for treating pain and providing the nutritional components necessary for healing tissue and establishing better brain chemistry. Paleo Diet removes potential sources of inflammation from the diet. If a patient suffers from an auto-immune disorder the more restrictive Autoimmune Protocol version of the Paleo-diet can help put the disease into remission and decrease the inflammation associated with the auto-immune process.

OBESITY AND OVERWEIGHT: Extra fat around the belly and internal organs causes chronic inflammation throughout the body. The fat cells around internal organs and the immune cells that reside alongside the fat cells both produce a steady stream of chemicals that circulate throughout the body stimulating inflammation everywhere. These circulating chemicals are called cytokines and chemokines. Certain cytokines and chemokines cause fatigue, brain fog, and sensitize the nerves, increasing pain. They also interfere with sleep. Weight loss is an essential component to pain reduction for overweight and obese patients. The best nutritional approach to weight loss includes a Paleo Diet with carbohydrate restriction (low carbohydrate, high-healthy-fat whole food diet). Adding medically supervised intermittent fasting (such as an 18- 24 hour fast every 1-2 weeks, consuming only water for 18-24 hours) can also be effective especially combined with a carbohydrate restricted Paleo Diet and lifestyle.

Exercise and Physical Conditioning: Chronic pain causes sedentary behavior which results in physical de-conditioning. This process involves loss of muscle, decreased bone density, shortening of ligaments and tendons and shrinkage of the tissues that envelope muscle. This leads to more pain when physical activity is increased and a vicious cycle is created. This cycle must be broken with a graduated daily exercise and physical conditioning program. If you follow a medically prescribed exercise program you will not damage your body even though it may be painful during the first several days. Exercise also helps to convert the “amplifier” back to a “muffler” in the nervous system.

Below are some links to articles related to this discussion.

Eat clean, live clean.

Bob Hansen MD

Applying modern pain neuroscience in clinical practice: criteria for the classification of central sensitization pain.

Central sensitization and altered central pain processing in chronic low back pain: fact or myth?

How to explain central sensitization to patients with ‘unexplained’ chronic musculoskeletal pain: practice guidelines.

Addressing sleep problems and cognitive dysfunctions in comprehensive rehabilitation for chronic musculoskeletal pain.

Exercise therapy for chronic musculoskeletal pain: Innovation by altering pain memories.

Efficacy of a modern neuroscience approach versus usual care evidence-based physiotherapy on pain, disability and brain characteristics in chronic spinal pain patients: protocol of a randomized clinical trial.

The effect of relaxation therapy on autonomic functioning, symptoms and daily functioning, in patients with chronic fatigue syndrome or fibromyalgia: a systematic review.

Pro-nociceptive and anti-nociceptive effects of a conditioned pain modulation protocol in participants with chronic low back pain and healthy control subjects.

Vagal modulation and symptomatology following a 6-month aerobic exercise program for women with fibromyalgia.

Brain-derived neurotrophic factor as a driving force behind neuroplasticity in neuropathic and central sensitization pain: a new therapeutic target?

The role of central sensitization in shoulder pain: A systematic literature review.

Chronic whiplash-associated disorders: to exercise or not?

Exercise, not to exercise, or how to exercise in patients with chronic pain? Applying science to practice.

Evidence for central sensitization in patients with osteoarthritis pain: a systematic literature review.

Malfunctioning of the autonomic nervous system in patients with chronic fatigue syndrome: a systematic literature review.

Endogenous pain modulation in response to exercise in patients with rheumatoid arthritis, patients with chronic fatigue syndrome and comorbid fibromyalgia, and healthy controls: a double-blind randomized controlled trial.

You may need a nerve to treat pain: the neurobiological rationale for vagal nerve activation in pain management.

Avoidance behavior towards physical activity in chronic fatigue syndrome and fibromyalgia: the fear for post-exertional malaise.

The role of mitochondrial dysfunctions due to oxidative and nitrosative stress in the chronic pain or chronic fatigue syndromes and fibromyalgia patients: peripheral and central mechanisms as therapeutic targets?

Thinking beyond muscles and joints: therapists’ and patients’ attitudes and beliefs regarding chronic musculoskeletal pain are key to applying effective treatment.

Evidence for central sensitization in chronic whiplash: a systematic literature review.

Pain in patients with chronic fatigue syndrome: time for specific pain treatment?

Kinesiophobia, catastrophizing and anticipated symptoms before stair climbing in chronic fatigue syndrome: an experimental study.

Central sensitization in patients with rheumatoid arthritis: a systematic literature review.