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Anti-Inflammatory Foods and Pain

What we consume has the power to either help us heal or to cause us harm. Though this goes far beyond food (ideas, relationships, breath patterns etc.), it is clear that the Standard American Diet increases inflammation and oxidative stress, ultimately increasing the likelihood that we will be in pain. In working to “pain-proof” our bodies, it is essential to consume foods that reduce inflammation and reduce pain directly.

Many of my patients end up on a systematic anti-inflammatory elimination diet. Learning what works for our bodies and what does not is essential, and often only discovered through targeted trial and error. However, cutting out a bunch of foods is rarely a sustainable approach. Instead, we also focus on what to ADD into the diet.

Everything we eat sends a message to the cells of our body. In addition to the specific nutrients present in healing foods, they can change how our DNA is expressed (this is called “epigenetic”). Some of the best anti-inflammatory food-based molecules that have been proven effective for chronic pain include short chain fatty acids (butyrate being the most commonly available through food), polyunsaturated fatty acids (Omega 3s, high in cold water fish), polyphenols (found in many colorful plant-based foods), and polyamines (high in legumes).

Some food substances have also shown to be directly “anti-nociceptive”, meaning they reduce sensitivity to pain. Two of the best studied are curcuminoids (polyphenols found in turmeric) and zerumbone (a sesquiterpenoid found in ginger). Both have been shown to reduce pain in multiple conditions and should be considered as a component of a comprehensive plan for pain-proofing the body.

Source: PMID: 31301604

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07/19/19

Self-Management for Pain

Only you are essential to your healing. While getting care from your healthcare providers is often important, being an active participant is ALWAYS essential. Research shows that when people have higher levels of “self-efficacy”, they’re more likely to recover from their pain condition. What is self-efficacy? I define it as the belief in our ability to take control of our own lives. When it comes to our health, this means feeling that we’ve got the tools we need to move in the direction of sustainable healing.

One of the largest studies to date on the value of self-management has been a review of smaller trials on chronic low back pain. The researchers found that when it comes to chronic back pain, a self-management approach improves pain intensity and disability, especially in the first year.

What do the best self-management programs teach?
- Effective pain-focused problem solving
- Decision making to address common challenges around pain
- Local resources that may be available
- A stronger patient-provider relationship, valuing the patient’s experience
- Goal-setting and action planning, often in the form of SMART goals
- Self-tailoring of programs to be individualized to your own needs

Source - PMID: 27554077

Dr. Robert Kachko

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07/18/19

The Value of Self-Expression

An important aspect of any healing journey is being an active participant in that journey. This is especially the case when dealing with pain, and expressive writing can be an important tool in activating that part of ourselves.

A team of pain researchers developed an approach called emotional awareness and expression therapy (EAET) to see if it helped people with Fibromyalgia to feel better after 6 months. Importantly, they compared it to fibromyalgia (FM) education and cognitive behavioral therapy (CBT), which is considered the gold standard in mental-emotional treatment. The group receiving EAET went through a series of exercises in which they were helped to identify and express previously avoided emotions and feelings. That group experienced more pain reduction than the FM education group and similar improvements with the CBT group, except more people in the EAET group had at least 50% pain reduction than in the CBT group (22.5% vs 8.3%).

While this sort of active therapy isn’t an option for everyone, regular journaling certainly is. When it comes to expressive writing or journaling, it turns out that what you write often matters less than the fact that you’re writing at all. Many of my patients have learned that writing something down and “leaving it there” allows their body (and their subconscious mind) to process it more effectively. This approach can be helpful for reducing stress, improving mood, and getting more restful sleep. Of course, for some people “digging in” to their emotions may bring up a lot of “stuff”, and so this should be discussed with your healthcare team.

Have you ever tried journaling? What’s your experience been like?

Source: PMID: 28796118

Dr. Robert Kachko

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07/17/19

Pain: Sending The Right Signals

Our bodies and brains are complex, and each of us is impacted by pain in our own unique way. However, we ALL experience pain at two (actually, more, but let’s say two for purposes of clarity here :-)) distinct levels: sensory and affective. Our sensory perception of pain includes things like where the pain is, what it’s quality is (burning, stabbing etc.), and how severe is it (on a typical 0-10 scale for example). That last part, though, is also impacted by the 2nd level, the affective experience of pain.

This part of our pain perception, often processed by our limbic system, takes many cues from our environment and our emotional selves. This part of our brain, for example, is more primed for pain if we experience a lot of stress, depression, or fear in our lives. In effect, this is the part of our pain response that controls how much we suffer beyond just knowing that it exists.

Interestingly, this part of the brain can also be harnessed in a positive way: once we understand what the signals are that activate these areas, we can turn them “on” or “off”. What are some of the most important areas that impact our “affective” pain response?

(If these sound like a vocab lesson you’d rather avoid, don’t worry about the name of the brain area - instead, focus on the language that the area speaks):

1. Anterior Cingulate Cortex - this part controls our suffering from pain and the need to “do something” when we feel it. It’s also the part that is disengaged when we give away our healing capacity to our doctors. What helps? Calm acceptance of the sensation as a signal from the body that need not go away 100% to have quality of life.
2. Anterior Insula - this is like our internal thermostat, guiding us to understand if damage is occurring. What helps? Remembering that we’re “whole” and safe in spite of our pain, and that it isn’t a guarantee that damage is occurring.
3. Prefrontal Cortex - this part gives meaning to our pain and integrates it into our self-concept: “who will I be in the future with this pain?” What helps? Reframing the experience to understand that the experience of pain now does not reliably predict future pain.

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07/12/19

Pain: Our Brain Plays Tricks

When it comes to our experience of pain, as with all things, context matters! If you’ve been following along with previous posts, you know by now that the MEANING we ascribe to the pain we are feeling is often more powerful in determining how we feel than the cause or stimulus of pain itself. Put another way, two people can experience the same level of pain, but have very different amounts of personal suffering as a result. Similarly, the same person can feel very different amounts of pain from the same cause in a different context.

This was proven, rather brilliantly I may add, by a group of researchers who used light to modulate context. Our brains are primed to perceive some things as more dangerous than others. One such stimulus is heat, and based on our evolutionary priming we expect heat to be more dangerous than cold. Since we view the color red as more likely to be hot, and the color blue as more likely to be cold, this team decided to figure out if these colors impacted the amount of pain people felt.

Amazingly, when the same exact stimulus (a cold probe measuring -20 degrees celsius in temperature) was applied to people’s hands, they experienced a higher level of perceived pain when the probe was illuminated with a red vs blue light. This is not so different from the context of receiving medical care. All too often people are told that they “can’t be fixed”, or worse: that someone else is responsible for “fixing” their broken body. This sort of disempowering language only makes things worse.

Have you had any health-related experiences that “colored” how you felt about yourself and your body?

Source: PMID: 17449180

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07/10/19

Why Mindfulness Matters for Pain

Mindfulness meditation is all the rage these days. Proposed as a cure-all for everything from anxiety to pain, it’s rare to find someone who HASN’T heard that it is important to be mindful. The thing is, though, that there is no single fix for chronic pain. Techniques such as Mindfulness Based Stress Reduction, Mindfulness Based Cognitive Therapy, loving-kindness/compassion meditation have an important role to play as a component of comprehensive integrative pain care. An important aspect of mindfulness training comes from learning to come back into our physical bodies that are often neglected with long-term pain.

This makes sense, of course. When our bodies ache, our minds make every effort to distract us from that unpleasant experience. Instead, our brains are primed to make our mind wander (this is actually our default, driven by a part of the brain called the Default Mode Network). The challenge with this? It turns out that a wandering mind, pre-occupied by the stories we’ve told ourselves about our past (often in the form of regrets) and worried about the future is one that is predisposed to depression and pain. If this is our default, though, what are we to do?!

Well, one of the core benefits of mindfulness and other types of meditation is an increase in something called “meta-awareness”. Simply put, this is the state of “thinking about thinking”. It’s like sitting in a movie theatre and watching the movie (our moment-to-moment lives) WHILE also realizing that we’re in the theatre watching it all unfold. It turns out that the more we do so, the less this mind-wandering reduces our mood. The other factor involved in both chronic pain and low mood is a state of “hyper-vigilance”, where we are on constant alert of the world around us for fear of being harmed in some way. This state is characterized by living mostly in our thoughts, often ignoring our physical bodies.

Meditation increases meta-awareness and reduces hyper-vigilance, and both things can help reduce long-term pain by literally changing the structure of our brains.


Source: PMID: 28390029. Make sure to follow along for the remainder of July’s Holistic Pain Care Series

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07/08/19

Depression and Chronic Pain

Depression (and anxiety, among a host of other psychosocial factors) contribute to chronic pain. In fact, in one study in the journal PAIN, 60.8% of people dealing with long-term pain met criteria for depression (PMID: 26963849). Why might this be?

Emotional distress contributes more strongly than pain intensity to key outcomes like physical disability, work disability, and healthcare costs. For example, higher levels of perceived depression before surgery predict likelihood of successfully returning to work after surgery more than any other factor (including the the intensity of pain and disability before surgery). People in the upper half of scores for the experience of depression were 1/3 less likely to return to work and in general took nearly twice as long to return if they did.

Why might this be the case? Well, there are many theories out there, but the strongest one is this: depression is an otherwise appropriate response to living within an environment that doesn’t align with our deepest needs. When we’re feeling depressed, we become more “vigilant” (hyper-vigilant, to be exact) to an environment that feels more threatening, more dangerous. This increase in vigilance also increases things like inflammation, oxidative stress, muscle tension, and activity of our sympathetic (“fight-or-flight”) nervous system. All of these factors contribute to a higher experience of pain.


Comprehensive care for chronic pain helps us to process these feelings more effectively, alongside all of the “physical stuff”. You’re not alone, and it is OK to ask for help.

Source: PMID: 25527877.

Stay tuned for the rest of July’s Holistic Pain Care Series.

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07/05/19

Omega 3s and Osteoarthritis (OA)

Thanks to it’s high supply of Polyunsaturated Fatty Acids, fish oil is one of the best anti-inflammatory substances we have. Given that almost all chronic pain (and all chronic disease for that matter) has at its root some degree of inflammation, it’s no surprise that higher intake of Omega 3 fats may be helpful.

Osteoarthritis (OA) is the most common chronic pain condition. Historically, it was considered to be a non-inflammatory breakdown of healthy bone. We now understand that this characterization is not accurate, and that reducing inflammation is an important component of comprehensive care. Many anti-inflammatory medications (like NSAIDs, Cox-3 inhibitors, and corticosteroids) come with unwanted side-effects. Omega 3s work by reducing inflammation at its source, helping the body make compounds that “put out the fire”.

Multiple studies show that people with OA who take Omega 3s from fish have reductions in long-term symptoms. According to a study published in the Journal of Clinical Rheumatology (source below), Omega-3 Fatty acids seem to be an effective (and safe) strategy for those dealing with OA (as well as other rheumatic disease like rheumatoid arthritis and lupus).


PMID: 28816722

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07/03/19

Sleep and Chronic Pain

Sleep: the ultimate reset switch. We’ve got tons of research about just how important sleep is to our long-term health and well-being. It turns out that between 67% and 88% of people who deal with long-term pain also have trouble sleeping well. Poor sleep, in this way, is both a cause and effect of pain.

Without the right levels of REM Sleep and Deep/Slow-wave sleep, our bodies are simply unable to regenerate effectively. Sleep deprivation impacts many areas of the brain that have a role in pain, including: opioid processing, neurotransmitter production (like serotonin), immune function, melatonin production, the endocannabinoid systems, and the hypothalamus-pituitary-adrenal axis.

If there was a medication that could impact ALL of those systems at once, it’d probably be in the water supply. Instead, we have to sleep. So, what factors impact our quality and quantity of sleep the most?

1. Regularity: getting to bed and waking up at the same time every day is essential for deep sleep
2. Light exposure: the room has to be pitch black. Our cave-dwelling ancestors wouldn’t have had it any other way. Similarly, blue light from screens is terrible for our transition into sleep, preventing production of the all-important sleep hormone melatonin.
3. Temperature: in order to fall asleep, our core body temperature has to fall 2-3 degrees. Sleeping in a cool room is essential (65-67 degrees seems to be ideal). This is the same reason people like a hot cup of herbal tea or a hot shower before bed: it brings our core body temp up to facilitate it dropping
4. Coffee and Alcohol consumption: Depending on your genetics, it may take up to 24 hours to process the amount of caffeine in just one cup of coffee. Similarly, drinking alcohol (especially before bed) can impact REM sleep for up to 4 days!
5. Stress: Avoid stressful conversations or television (turn that news off!) before bed. More importantly, don’t do anything in bed (people who work on the laptop right up until they close their eyes, i’m looking at you) other than sleep and sex. Journaling may be one exception, if it lets you process the day - so long as you leave your feelings there and don’t take them with you to sleep.

What’s been most helpful for you to get effective sleep?

PMID: 31207606

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07/01/19

Holistic Pain Care Series

According to the CDC, 20 Million Americans deal with “high impact” chronic pain on a daily basis. This means it impacts their quality of life regularly - limiting the ability to work or sometimes even take care of themselves. To make matters worse, we’ve got an opioid epidemic in the United States that has put people with chronic pain into an even more difficult position: getting access to appropriately prescribed medication that for years has allowed them to sustain some quality of life.

Something has to change! Every National and International task force on chronic pain has clearly stated that a comprehensive, “biopsychosocial” approach to pain is the ONLY appropriate course of treatment. Sometimes, this may involve a prescription for opioids. But it ALWAYS involves:
1. Meeting people where they are
2. Helping them feel heard and understood
3. Comprehensively assessing the ROOT cause of their pain
4. Providing education on the nature of the pain to empower each person to help themselves

A holistic, integrative treatment plan for pain will usually involve education around nutrition, sleep, digestion, and appropriate movement/exercise. It will usually also involve helping the person to reframe their experience of pain, acupuncture, and manual therapy.

Together, we can change the lives of over 100 million Americans. Stay tuned for this month’s Holistic Pain Care Series, where we’ll get into the science of what works (and what doesn’t) for chronic pain.

Source: Center For Disease Control


Holistic Pain Care
Dr. Robert Kachko

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