Did you know that one in four Americans suffer from pain per the National Center for Health Statistics? Pain is the primary reason for seeking health care services. In 2010, the annual cost of pain was greater than the annual cost of heart disease, cancer and diabetes COMBINED. This pain is often caused by chronic inflammatory conditions like arthritis.
Common treatments for painful and inflammatory conditions includes Non-steroidal Anti-Inflammatory (NSAID) medications like Advil or Motrin or Celebrex. The mechanism of action to decrease pain is in the NSAIDs ability to block the COX-1 or COX-2 pathway which is why it reduces inflammation and pain. A common side effect of NSAIDs is gastrointestinal disruption especially with chronic use. More recently there was a study published demonstrating an increased risk of cardiac arrest with the use of NSAIDs.
Pain is a subjective experience determined by a localized response and a behavioral response. The localized response is driven by the pain receptors (mechanical, heat and chemical receptors) and nerve endings in the tissue of the injury or damaged area. This information is transmitted to the spinal cord via afferent nociceptors. At the spinal cord the message is relayed through a well-defined pathway to the higher centers in the brain. It is at the higher centers that the behavioral response is stimulated to begin behaviors that are directed at relieving or terminating the experience of pain.
The importance of Vitamin D cannot be ignored. Vitamin D is a natural conversion of blood cholesterol in the presence of UVB spectrum sunlight hitting the skin. Specifically related to intestinal permeability, Vitamin D3 has been shown to preserve epithelial barrier function in the presence of intestinal injury, be it Crohn’s disease or ethanol-induced or poor lifestyle choices. The free source of vitamin D3 is full sun exposure to a majority of your skin, without burning. Yet, during certain times of the year or even job requirements, it is not possible to get the needed skin exposure to produce adequate and therapeutic amounts. You can check your area for when the sun is above the 50 degrees altitude in order to provide UV B exposure for Vitamin D conversion. Spending five to ten minutes for fair skin during peak UV B exposure on a large portion of skin is the most effective and efficient. It’s important to gauge your skins response to avoid burning.
Fish oil or omega 3 fatty acids help recovery and pain reduction because of their ability to reduce inflammation, protect joints, provide a substrate that is neuroprotective (protects the nervous system) with improved dopamine neurons. These fatty acids are primarily found in cold water fish, eggs, cod liver oil and also flaxseed oil.
A recent systematic review and meta-analysis evaluated the effects of Omega-3 fatty acids on patients undergoing surgery for gastrointestinal malignancy. The authors concluded that omega 3 fatty acids were effective in improving the nutritional status and immune function in patients undergoing surgery. The omega -3 fatty acids not only enhanced immunity but attenuated inflammatory response. Another experimental study demonstrated that omega-3 fatty acids significantly decreased wound area by day 7 in diabetic wounds. Additionally, the wound strength was significantly increased by day 15. In an animal model for osteoarthritis cartilage degeneration, docosahexenoic acid (DHA) an Omega- 3 fatty acid, showed promise as a therapeutic agent in osteoarthritis prevention. In the field of dentistry, omega-3 fatty acid effect reduces bone resorption following gingivalis infection. The benefits of omega-3 fatty acids continue to be supported to improve cognitive function as well as reducing central nervous system oxidative stress.
Vitamin C, a natural constituent of many fruits, is a powerful anti-oxidant. It helps to prevent free-radical damage that contributes to aging and degenerative disorders. Vitamin C also prevents other antioxidant vitamins from being oxidized. Eating citrus is a good way to get Vitamin C, but it may not be enough when recovering from injury or surgery to reduce pain and risk.
Specifically, for chronic pain states like Chronic Regional Pain Syndrome (CRPS), Vitamin C used preoperatively at 2 g, reduces the morphine consumption in the post-operative stage. Fifty days of use at 1g/d post-operatively may reduce the CRPS risk development. A meta-analysis supports use of Vitamin C for reducing CRPS risk despite not finding conclusive dosage. Another study concluded that the administration of Vitamin C in preventing CRPS after distal radius fracture is low cost and has few complications. Another systematic review also supports the use of Vitamin C for foot and ankle surgery at 500mg for 45-50 days. There are some conflicting reports on effectiveness of 500mg Vitamin C in reducing pain, and it is worth noting as it may be dose dependent.
Is it possible that bacteria could aid in healing from injury or surgery?
Yes. In fact it is important to promote the variety of bacteria in your gut to promote immune health, reduce pain and reduce risk of infection.
As described in an earlier post about the leaky gut syndrome, supplemental recommendations that may reduce pain and improve healing are geared to promoting gut health. Specifically, the microbiome diversity is strongly linked to gut and mental health. This gut-brain connection is at the core of much of the research around supplemental probiotics. A literature review evaluated the research around use of probiotic use and migraine headache. The findings of improving gut microbiota and reducing inflammation may have positive effects on strengthening the gut and improving brain function. This is important to surgery/injury in that gut health supports brain health which thereby will have a positive benefit in the role of the brain in the pain experience.
What do papaya and pineapple have in common besides being tropical fruit?
They contain potent vegetarian proteases. A protease is an proteolytic enzyme that helps break down protein.
How does this relate to healing from orthopedic injury or surgery? A lot actually.
Proteolytic enzymes aids in breaking down animal proteins when ingested, but also mediates tissue repair and break down of cellular debris associated with inflammation metabolism.
Pain : (noun)
1. Physical discomfort caused by illness or injury
2. Careful effort, great care or trouble
I am on the top of Copper Mountain ski resort above the tree line at 12,000 ft.
It's 1 o C with a wind-chill factor of -6 o C.
I take my gloves off to capture a panoramic view with my phone. In moments, my hand begins to hurt from the cold. The pain is severe.
What would you do in that situation?
Osteoarthritis (OA) is the most common diagnosis that can affect any joint, but most often in the knees, hips, spine, small joint of the hand. Hallmark symptoms of osteoarthritis pain and stiffness of the joint. It is considered a degenerative disorder that results from the breakdown of the cartilage that provides the smooth surface of the joint for motion and acts as a cushion. This disease affects about 27 million Americans. Causes and risk factors for developing osteoarthritis are genetics, obesity, and overuse. 1
The pathophysiology link between obesity and osteoarthritis is related to both the direct excess of mechanical loads on the cartilage, but also the adipose tissue releasing leptin. In both scenarios, there ends up being an increase in inflammation, which helps to drive the tissue breakdown. 2 To describe this further, I often discuss with patients the “coin analogy.”
Metabolic Syndrome (Met S) affects nearly 47 million Americans. 1 The prevalence of arthritis is 52.5 million US adults between 2010-2012. This is estimated to rise to 78 million for Americans aged 18 years or older by 2040 per the Centers for Disease Control and Prevention. 2 These numbers are staggering in so much as it would seem lucky for you not to get either Met S or some form of arthritis. The question becomes whether or not having Met S may increase your risk of developing arthritis and how to avoid both problems.
Have you gone Gluten-free/Paleo and are frustrated that you still have pain?
In my integrative physical therapy and holistic health coaching practice I often get the clients who have failed other treatments to alleviate their painful symptoms. Yet, sometimes I also get those who have already gone “Gluten-free” and still have pain. Although, I will be the first to press the nutrition issue, it isn’t always the answer. Here are some common mistakes people make in going “Gluten-Free” which may be limiting your recovery of your painful condition.
It could be one of these or many of these occurring at the same time limiting recovery.
It is a common experience that a problem difficult at night is resolved in
the morning after the committee of sleep has worked on it.
Rest and Recovery
I remember in college when my husband and I were dating, after basketball practice and dinner at the dining commons, we would ride our bikes to the library to study. He was a premed double major in history and human physiology, and I was majoring in bioengineering. We would often start strong in our studying, and then we’d literally take a nap—at the table. At the time, I thought it was weird. Now it makes more sense. As we were challenging our brains with different problems, not to mention after a hard practice and high-glycemic food, we would just need some recovery time. After a nap lasting less than thirty minutes usually, we would feel rejuvenated, restored, and ready for more studying until closing time. As I mentioned before, we have been boring for a long time.
(This was a previous guest blog I wrote for my friend Dr. Kristin Prentiss Ott, MD on www.kristinprentissott.com October 2015)
My past work experience has included years working in the hospital including the surgical wards. Now, I specialize in outpatient orthopedic physical therapy. I see mostly patients who want to avoid surgery. I am a proponent of keeping the body intact whenever possible. However, there are times when accidents happen or it is necessary to have surgery in order to get back to living life.
Sometimes it happens.
You take good care of yourself and exercise regularly, but then you fall skiing and tear your ACL. Often, to keep up that same level of activity, the ACL will need to be surgically repaired.
Or you may have been a college athlete that played football and now have severe hip arthritis in your 60s that requires a total hip replacement.
Like I said, sometimes it happens. And if you are going to have surgery planned or not, here are a few tips to help you to optimize recovery, not faster, but optimally.
As a physical therapist, many of my patients have arthritic disease of the joints. During my traditional education I received minimal education related to the importance of vitamin D and calcium except that they are important for bone strength, and deficits are in part what lead to osteoporosis (thinning of the bones). However, I am interested in what role vitamin D and calcium play in arthritic conditions, and if there is a link to joint health and vitamin D and calcium.
Osteoarthritis (OA) is one of the more challenging diagnoses to successfully treat as a physical therapist. In trying to find a more effective way to educate and treat patients, I went to Pub Med to find complimentary approaches to OA.
Guest Blog from Grant Glass, PT, CIMT, OCS, CAFS, GPS
Did you know that your gut microbiome can also impact inflammatory arthritis disorders?
Rheumatoid Arthritis, an inflammatory arthritis disorder, is a debilitating autoimmune disease where the body’s immune system attacks its own tissue, typically the small joints of the hands and feet. Traditional treatments include medications, physical therapy and surgery to control symptoms and prevent joint damage. Recent research is indicating that probiotic intervention holds promise to decrease disease activity score and inflammatory cytokines (TNF alpha, IL-6, IL-10).1
Dr Carolyn Dolan DPT, Cert MDT, MSHN
Where physical therapy, nutrition and lifestyle meet, because how you live your life determines whether or not you soar. Inspiring action with information so you can reduce pain, optimize healing and improve function naturally during recovery from injury, surgery or painful condition. This is a website for the open-minded; obstinate need not apply.