homecare

Biochemical recommendations for people in prolonged pain

Deficiencies and insufficiencies of certain metabolites have been seen in many chronic pain conditions and can create a predisposition to the activation of trigger points and subsequent perpetuation of myofascial pain syndromes. Deficiencies are values that fall outside the normal range. Insufficiencies can be found in the low parts of range and can be equally problematic whenever demand is high.

The following table has been compiled according to the recommendations of Robert Gerwin MD, Pain and Rehabilitation Medicine, Bethesda, MD; Tim Taylor, MD and Anna Bittner, MD, of Pain Relief Home, Richmond, VA. Support studies are quoted in the text books ‘Myofascial Pain and Dysfunction’  by Travell & Simons, ‘Trigger Point Therapy for Low Back Pain’ by Sauer & Biancalana and ‘Myofascial Trigger Points’ by Dommerholt & Huijbregts.

Reference: Liebenson C. Rehabilitation of the Spine, 2nd Edition (2007), Chapter 30, page 730 ‘Nutritional Considerations for Inflammation and Pain’ by David R. Seaman DC

History

Before the light bulb was invented we used to average 9-10 hours sleep per day. We also worked harder, ate more naturally and had way less continual stimulation. We slept long and well.

Unhealthy habits

• Not really physically tired when going to bed
• Overeating or eating and drinking too close to bed-time
• Stimulated too close to bed-time by TV, computing, work projects
• Over-worry about things; deadlines, finances, family or friends health
• Out of synch with diurnal rhythms; especially with shift work
• Daytime napping for more than 45 minutes
• Medications that interfere with deep sleep

Bedroom environment components that interfere with sleep

• Room too warm or too cold
• Room too bright
• An easily visible, or loud alarm clock time
• A cordless phone in the bedroom (high electromagnetic forces)
• Room too cluttered with stuff
• Pets sleeping on the bed
• Mattress over 8-10 years old
• Pillows over 2 years old
• Covers too heavy or restrictive
• Spouse or partner that is restless, noisy, or generates too much heat

Medical conditions that interfere with sleep

• Respiratory disorders
• Cardiovascular disorders
• Gastrointestinal disorders
• Musculoskeletal pain and dysfunction
• Diabetes
• Renal disorders
• Prostate problems and small bladder causing urinary frequency
• Cancer
• Dementia
• Dental disorders
• Restless leg syndrome or Periodic Limb Movement Disorder (PLMD)
• Fibromyalgia (alpha wave intrusion)

Medications that can interfere with sleep

• Antihistamines: Benadryl (daytime drowsiness)
• Sympathomimetic Amines: bronchodilators and decongestants
• Antihypertensives and Beta blockers: Clonidine, Aldomet, Reserpine (daytime drowsiness)
• Steroids: Prednisone, dexamethasone
• Thyroid medications:
• Anti-epileptics and antipsychotics (daytime drowsiness)
• Parkinson medications: (daytime drowsiness)
• Stimulants for ADHD
• Anticholinesterase drugs for Alzheimer’s
• Antidepressants: Prozac, Fluoxetine
• Analgesics: opiates, Tramadol, Ultram
• Chemotherapeutics: (nausea and vomiting)
• Diuretics: (frequency at night)

Strategies for better sleep

• Consistency of sleep habits – develop a routine and stick to it
• Expose yourself to bright light on waking – tell your body it’s daytime
• Expose yourself to bright light late in the day – keep your body awake longer
• No napping after 3 pm (45 minutes maximum per day)
• Do a bit more physical activity during the day
• Develop a relaxing pre-bedtime routine
• Make the bedroom less noisy and less bright
• Remove the TV, radio, laptop and cordless phone from the bedroom
• Have a silent alarm clock without a bright display
• Keep the bedroom temperature in the low 60’s
• Reduce fluid consumption in the evening to avoid the need to urinate during the night
• Avoid caffeine and reduce alcohol intake
• Avoid late evening phone calls, computer games, emailing
• Use the guest room if necessary for uninterrupted sleep

Pre-bed Routines

• Have a warm (< 102° F) shower, 15 minute bath or spa bath just before bedtime (add Epsom salts)
• Play relaxing background or ambient music
• Meditate or read calming books to relax

In-bed routines

• Breathing technique for stress relief
• Position the tongue on the roof of the mouth just behind the upper teeth
• Breathe in through the nose to a count of seven
• Hold the breath for a count of eight
• Breathe out through the mouth to a count of 4
• Concentrate on diaphragmatic breathing, with the abdomen rising on the inhalation
• Use a contract / relax method to identify and reduce muscle tension in the body

Health in general

• At least 7 ½ - 8 hours of sleep
• Eat food that is varied, brightly colored, comprehensive and can be sustainably eaten
• High in Omega 3s, folic acid, vitamins D, B12
• Foods that contains D-Phenylalanine to prevent endorphin breakdown
• Chocolate, cocoa, meats, wheat, soy, cheeses
• Eat foods that contain Tryptophan to stimulate serotonin production (combine with Vit B6)
• Diary, meats, turkey, fish, whole grains, nuts, soy products, beans, rice
• Control your weight (don’t eat big portions of those listed above)
• Increase your daytime exercise
• Switches down the amygdala and produces endorphins
• Get more fun in to your life – laugh more, play around
• Don’t sweat the small stuff – and it’s all small stuff
• De-stress – allocate yourself quality ‘me’ time
• Develop a passion – have a project
• Spend time helping others
• Follow the three components to happiness
• Pleasure – comfort, safety, food, shelter
• Engagement – be personally involved with other people or causes
• Meaning – develop purposes in life