Working with Chronic Pain and Inflammatory Joints

21 Areas for Reflection.

Introduction

Painful kinds of arthritis/rheumatoid arthritis (often referred to as rheumatism) affect joints. Number of affected joints can increase. Conditions can also increase pain level such as wintry weather impact on joints, stress, smoking, carrying heavy things and unhelpful lifestyle/diet habits.

Around 2% of the UK population endure varying degree of rheumatoid arthritis.

From Carolinas Pain Center, USA.

Locations of Chronic Pain

Chronic pain can occur in any part of your body.

Typical types of chronic pain are:

• Arthritis or joint pain (especially in the hands, feet, wrists, ankles, and hips)

• Migraines or headaches

• Back pain

• Neck pain

• Pain in scar tissue

• Muscle pain all over the body (like with fibromyalgia)

• Neurogenic pain caused by damage to the nervous system

Experience of impact on the body includes:

• Inflammation of the joint and surrounding areas

• Limited mobility of the joints

• Muscle weakness and wasting

• Joint stiffness and pain

• Changes in health because of other factors unrelated to chr0nic pain.

• Sensitivity to environmental changes taking place, such as the onset of cold weather.

Medications try to control the progression and damages to health but cannot stop entirely. As always, the appropriate medication for the health issue matters. Patients need to listen to the body and its response to medication including the pharmaceutical industry and supplementary, plant based medicine.

The practices of wellbeing increase calmness and understanding while decreasing stress and anxiety. Otherwise, there is a risk that stress brings about impacting on physical health and prolongs pain.

People with forms of arthritis describe the impact on joints, spine and other parts of the body as:

• painful,

• chronic,

• rheumatic

• inflammatory

Chronic Inflammatory Response Syndrome

CIRS is an illness that occurs when a person gets exposed to toxins such as found in mold and certain insect bites. The syndrome can lead to the immune system attacking its tissues. This causes inflammation and other associated symptoms.

A skilful relationship to feelings, emotions and views on any kind of chronic pain reduces intensity and reactivity. Medical authorities define chronic pain as pain that continues for more than three months.

Symptoms of CIRS include:

• joint pain,

• morning stiffness

• body aches

• cramps,

• impaired memory,

• tiredness,

• watery eyes,

• rashes,

• tingling

• metallic taste in the mouth.

The medical profession describes CIRS as a syndrome, not a disease.

Autoimmune System

Autoimmune disease can indicate the body's natural defense system fails to recognise the difference between normal cells and foreign cells. As a result, the body mistakenly attacks normal cells.

People with such an autoimmune system can live full lives, though challenged daily with its impact.

Causes and supportive conditions include environmental/physical/biological/neurological/emotional and mental. There is no known single cause.

Microorganisms, including bacteria and viruses or drugs, may trigger changes in the immune system

Medical scientists report 80 types of autoimmune diseases, which impact upon a parts of the body.

Painful Joints. Inflammatory Joints.

21 areas for Reflection

1. Mindfulness. Meditation. Development of Senses

Join a group, physical world, virtual world or both, to develop mindfulness, meditation and upright posture. Develop practices of mindfulness of breath, body scan meditations, power of attention in painful regions and open awareness meditations to get a perspective on pain in specific locations. Cultivate the senses – seeing, hearing, smelling, tasting and touching. That means noticing forms and colours with the eyes, a range of sounds and silence, smelling different odours - pleasant/unpleasant, connecting with taste buds in the tongue to experience a range of taste sensations and experience touch – wind on the face, feet on the floor, hands contact with material world, sensations in the body. Explore such practices in daily life to reduce fear/anxiety around chronic pain. Remember, it is a daily practice. That means sometimes you will experience two steps forward and one step back.

2. Adaption to Pain

Learning/practising to pass through chronic, painful, inflammatory conditions. This includes dealing regularly with difficulties, gain and loss of body function, and the absence and presence of pain. A clear and calm relationship between the body, environment and lifestyle needs to develop daily.

There are beneficial and non-beneficial factors to the whole being adapting to a health condition. It takes time and space to find your way through the condition of health. The following findings can serve as inspirations.

3. Find insights into the body, the condition and factors which lead to change

Note when there are changes in pain levels and flexibility of limbs. Flaring up of inflammation comes in phases. Get to know the signs of the beginning, middle and ending of flare-ups. Observe and explore beneficial conditions and conditions with negative effects on the body. What is beneficial for one person can be challenging for the other. Become an expert on what supports the body and be aware of its vulnerabilities. Track effects (e.g. with the app Rheumabuddy: https://rheumabuddy.com/). Explore what is beneficial. Give your body time. Dare to develop confidence in knowing the body and the condition well.

4. Communication with doctors

It is important that a doctor (usually the family doctor or rheumatologist) can combine the different information. The quality of communication with doctors and between doctors is important. Collect information and findings. Be prepared for the consultation with the doctor, as it is might last under 10 mins. Aim for clarity. This might involve standing up for the health of both body and mind.

5. Water intake

Make sure your body stays hydrated. Proper hydration can help reduce pain and inflammation. Proper hydration supports the cartilage in joints being soft and pliable. You can protect your joints and muscles by keeping the cartilage soft, lubricated and pliable. Dehydration causes overall body aches and pains by pulling fluid out of your tissues.

6. Protect the joints in everyday activities

There are joint friendly and joint unfriendly ways of moving which put more pressure on joints. Pain can point to the body reaching its limits and an adjustment of a habit is necessary. You may need to change habitual language. For example, you change from chronic paind to intense changing sensations. The day consists of many small activities which add up.

Change the body posture regularly, stretch regularly and relax your body between posture changes. Sit, walk, stand tall as much as you are able.

Check: Are there small everyday activities which are done with less effort.

E.g: If brushing the hair causes pain in the elbow joint, could you use a brush with a longer handle? Get a jar opener with a handle to diminish pressure on the wrists, customize everyday objects so the handle is thicker and bend do not have to bend so much. Keep wrists and arms on a straight axis, e.g. when cutting vegetables. Distribute the weight between two arms.

7. Anti-inflammatory diet

The microorganisms in the gut interact with the immune system. A balanced, diverse plant-based diet with plenty of fruit and vegetables to support the functioning of the immune system and keep inflammation levels as low as possible.

Be sure to get enough vitamin B12 - the need is higher in rheumatic diseases. Inflammatory processes in the body mean the body needs a lot more nutrients. Make sure you provide the body with the necessary supplements, vitamins and minerals. The human body needs healthy fats as it can't produce them on its own. Avoid trans fats (found in e.g. in shortenings, margarine, cookies) and limit saturated fats (often solid at room temperature - butter, palm oil, coconut oil, cheese, red meats).

Replace them with essential polyunsaturated fats. The inflammation reducing ratio is 4:1 (omega-3s to omega-6s).

Eat more omega-3 fats (sources are e.g. flaxseeds and walnuts) to improve the ratio instead of cutting down on omega-6 fats (sources are vegetable oils like safflower oil, sunflower oil, sunflower seeds, walnuts, pumpkin seeds). Plant-based sources of omega-3-fatty acids are e.g. flaxseeds and walnuts.

Avoid fatty acids (of animal origin) as they can promote inflammation.

Make sure you include enough protein in your diet.

Alcohol and strong coffee can be a trigger for inflammation, flare-ups and a reactive mind.

8. Inflammation inhibiting and pain easing plants

Several ingredients in plants can down-regulate inflammation in the body (e.g. curcumin in turmeric) while others support inflammation (e.g. palmitate). Make sure you check with your doctor to prevent the interaction.

Plants with inhibitory effects on inflammation are:

Explore natural TNFs with strong inhibitory effects against pro-inflammation:

- Turmeric (contains curcumin)

- Green tea

- Grapes (contain Resveratrol)

- Thunder god vine

- Boswellia

- Devil's claw

- Dog rose

- Cat's claw

- Stinging nettle

- Ginger

Plants with pain easing power

- White Willow bark (if body tolerates salycid acid)

- Stinging nettle

- Boswellia

- Turmeric

- Ginger

- Bromelain

9. Posture and body statics

Focus on posture. Set reminders to erect your spine and release tension in the hips and knees regularly. Check out with an orthopaedic specialist if there is a slight imbalance of body static, especially of feet. An imbalance in contact between the feet on the ground affects the whole body. Set the foundations to avoid more pain adding up caused by imbalances.

10. Temperature

Depending on the symptoms and clinical picture, treating the body with warmth or can work to ease pain and relax the muscles. Does warmth or cold work better for you? Don't apply heat while inflammation or infection is active as it can accelerate the inflammation process. There are many options for treating the body with warmth at home.

You can treat your body with warmth several times a day for 10 to 15 minutes. Apply e.g. Hot water bottle (40-55C), grain pillow, heating patch, kidney warmer, red-light lamp. Consider taking warm baths regularly to support the relaxation of muscles and the relief of pain.

11. Exercise and Movement Therapy

Proper exercise to maintain strength, flexibility and function is crucial in the treatment of SpA. The right kind of exercise helps with joint motion, eases pain, improves posture and supports balanced muscle function. Including stretching and exercise for posture and strength. Move in the full range of motion, avoiding limiting the spectrum of movement. If one body part is weaker than the other, another one will compensate.

Dedicate time to hip strength and flexibility, so the spine doesn't have to compensate. Do include regular, moderate cardiovascular exercise - but take care it does not impact the spine and the joints too much. This does not mean you are limited to walking. The kind of cardiovascular exercise the body tolerates may vary from person to person a lot.

Stay in touch with activities you enjoy – hobbies, conversations, learning, a sense of purpose and learning/practising to co-exist with the health challenge

12. Avoid Stress

Avoid putting stress on your spine and back by twisting them too much. Listen carefully to the signals of the body instead of setting a stage of ability before the condition (or flare up) has started as an aim. Check with your physical therapist the beneficial range of twisting the spine.

For many people with chronic pain in the spine and joints, high impact exercise (especially running, climbing, beachball, tennis, squash) is not tolerable, while for others, e.g. running works while not in a period of flare, ups.

13. Joint Friendly Exercises

The best known joint friendly exercises are walking, cycling and swimming. Explore exercise which you really enjoy, which you feel inclined to and find combinations of exercise which are beneficial (e.g. Yoga, Qigong, Dancing,). Be aware of the pain relief and mood enhancing potential of hormones which are transmitted by joyful exercise.

Choose a time in the day when exercise is the most beneficial.

Do it consistently - but don't overdo it and know the limits of the body: Adjust the intensity of exercise to the state of the condition to avoid worsening it.

Physical therapy is often an important part of treatment. Make sure you find a physical therapist with expertise and experience with your condition. Find out which health insurance covers treatment and if there are ways to give you maximum support. Investigate with the physical therapist how to support the body to deal with the condition. Tailor an exercise routine to your specific needs. Inform your rheumatologist about the routine you've created.

14. Are your sleeping habits supportive?

A big part of humans' lives happens in bed. Check if you set up supportive conditions for the body to get the best sleep possible.

During sleep, the body relieves stress and repairs broken cells. Poor sleep causes stress and increases the sensation of pain.

15. Choose reclining posture

On the back) to make sure the spine and joints can recover and pressure on the body is reduced. With the bed, choose a supportive mattress, right size, thickness of pillow and right direction. Choose a blanket material and cover which is warm and light at the same time.

16. Enabling relaxation and rest

The perception of pain and the level of relaxation are interconnected. Take time for things that deeply relax the body and mind, e.g. deep breathing, massaging the feet, listening to soothing music, making yourself a nice hot drink.

17. Body friendly clothes

Choose clothes which are made of good fabrics that do not put pressure on the body and keep it warm (if warmth works well with you).

18. Wellbeing and care at the start of the day

Starting the day with stiff joints and pain is challenging. Is there something which nurtures and warms the heart? Something which provides a sense of care and connection? Could you set up a small habit like preparing a soothing hot drink, watering a plant, listening to an audiobook, music or reading something which touches the heart?

19. The Power of Friendship

Sharing and being understood by others who know from experience how it is to go through these painful and tough periods can be empowering. Check out support groups and events in your area which target people with the same condition or related conditions

20. Importance of Nurturing Joy

Choose wisely what you do in your free time. Living with a chronic health condition can leach out the energies of body and mind. Make sure you have enough time to rest. Never underestimate the importance of nourishment of heart and mind. Engage in joyful activities you deeply enjoy and bring you into a flow. Endorphins have pain relieving power. Build small islands on which are not under the spell of the condition.

21. Points to Remember

1. Go with precise questions when meeting with a doctor.

2. Ask for scientific evidence on any medication.

3. Remember the importance of regular eating three times a day.

4. Make use of porridge, muesli, toast, fruit, nuts, dates, tahini etc rather than put pressure on oneself to cook.

5. Prepare hot food to last two days.

6. Maximise time outdoors and rest a day between long walks.

7. Take mindful short walks in comfortable footwear.

8. List habits beneficial to develop.

9. Reflect regularly on the benefits of living alone.

10. Sit regularly in the buddha posture wherever you are.

11. Avoid caffeine if you know you have plenty of energy in the body and mind.

12. Remember there is life outside the locations of pain.

MAY ALL BEINGS ENGAGE IN SKILFUL PRACTICES

MAY ALL BEINGS LIVE WITH CALMNESS

MAY ALL BEINGS LIVE WITH WISDOM

Special thanks to a Dharma friend in Germany who did much research for the content of this post.